AHPRA promises sheriffs for cosmetic Wild West

The regulator has accepted findings of an independent review, vowing to lift standards and inform the public. But plastic surgeons are not satisfied.

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The long-awaited independent review into Australia’s largely unregulated cosmetic surgery industry has finally been released, with the regulator accepting all recommendations in full.

AHPRA will establish a Cosmetic Surgery Enforcement Unit – cosmetic sheriffs to the cosmetic cowboys, if you will – to work with the Medical Board to set official standards, crack down on misleading testimonials and deal specifically with cosmetic surgery complaints.

What’s changing

The cosmetic sheriffs themselves will have an oversight group that will report its progress to the public.

Under the recommendations, practitioners who perform cosmetic surgeries will also have to have a specific cosmetic surgery endorsement on their registration.

AHPRA would then have to produce a public education program to ensure consumers are aware of the new standard.

RACGP president Adjunct Professor Karen Price welcomed this, as did the AMA.

“We want to see that consumers can differentiate qualifications and standards and know exactly who and what they’re signing up to,” Professor Price told The Medical Republic.

The one true training pathway

The report notes that there are no universal minimum standards for the education, training and qualifications required to be a cosmetic surgeon.

Instead, specialist colleges have set up their own pathways for cosmetic surgery training.

The reviewers want these to be consolidated into one “endorsement” program for cosmetic surgery.

“The RACGP does have an accredited and standardised way for GPs to perform cosmetic surgery,” Professor Price pointed out.

There’s also the Australasian Society of Aesthetic Plastic Surgeons, which is made up exclusively of doctors who have received Australian Medical Council-accredited training in plastic and reconstructive surgery through the Royal Australasian College of Surgeons.

Cosmetic surgery, ASAPS president Dr Robert Sheen said, is an integral part of plastic and reconstructive procedures.

Dr Sheen argues that the independent reviewers should have seen this training pathway as the existing minimum standards for cosmetic surgery.

“If they’d gone to [RACS] and said, ‘Can you tell us, do you teach cosmetic surgery and what evidence do you have,’ all [the college] have would have had to do is show the reviewers the curriculum and the Australian Medical Council accreditation report,” Dr Sheen told TMR.

“All discussion around [there being no one cosmetic surgery pathway] would be over because that would be shown to be a false assertion.”

The endorsement model proposed by the independent review, he said, would have automatically grandfathered in clinicians like disgraced dermatologist Dr Daniel Lanzer.

For what it’s worth, the Australasian College of Cosmetic Surgery and Medicine, which does not have an AMC-accredited program, claims that the RACS program does not have a sufficient focus on aesthetic cosmetic training.

Sydney GP Dr Imaan Joshi, who practices cosmetic medicine with a focus on injectables, said that until the issues surrounding clinicians like Dr Lanzer had come to light, many doctors without RACS training had safely worked within their scope of practice.

Endorsement, she said, would be “a step in the right direction if it comes to pass”.

Dr Joshi is not affiliated with ACCSM.

Advertising

Of the 16 recommendations, four are dedicated to defining, monitoring and auditing misleading advertising in the sector.

This is particularly relevant, given that an amendment is currently in front of Queensland parliament which if passed will lift the current ban on using patient testimonials in advertising.

The Queensland parliament committee has been waiting for this report before the proposed legislation progresses any farther. Changes to the National Law legislated in Queensland will apply nationwide.

The report itself was critical of testimonials, but stopped short of making a formal recommendation not to lift the ban.

“Ideally, AHPRA should attempt to discourage the use of testimonials by practitioners in the cosmetic surgery sector until the recommendations in this report have been progressed (although it is noted there may be significant challenges in enforcing this and it may only likely be achieved voluntarily),” the reviewers said.

Dr Sheen said that allowing testimonials will only make a bad situation worse.

“The people who are the victims are the most vulnerable, disempowered people,” he said.

“They think they’re making good doctor choices, but they’re making terrible choices based on misinformation.

“If these testimonials are allowed, the disinformation will amplify.”

AMA president Professor Steve Robson also called for the Queensland legislation to be dropped in response to the report.

“Testimonials can be fake or taken out of context and there are limited protections in the Bill which will prove to be unenforceable and likely lead to increased harm, complications and worse health outcomes for many consumers,” he said.

The independent review defined cosmetic surgeries as procedures which involve cutting beneath the skin to revise or change otherwise normal and functional bodily features.

Procedures involving cosmetic injectables, laser skin therapy and reconstructive plastic surgery were not considered.