GPs share plastic surgeons concerns over lower standards for cosmetic surgery

Consultation over proposed accreditation standards to rein in ‘cosmetic cowboys’ will end Wednesday, with some saying the changes recommended by AHPRA and the AMC don’t go far enough.

Associate Professor Nicola Dean, president of the Australian Society of Plastic Surgeons, said the proposed model will allow doctors with far less training than is required for other types of surgery to continue to perform cosmetic surgery, putting patients at risk.

“The AMC specialists’ surgical accreditation is essentially the badge of safety and quality in a surgical training programme…Setting different standards for cosmetic surgery programmes is dangerous and inappropriate,” Associate Professor Dean said.

She cited progress in some areas, such as tighter restrictions on advertising—and notably, a decree at the Health Ministers Meeting in December to change the law so that only those who complete accredited, specialist surgical training can call themselves a surgeon.

However, the reforms won’t stop those who aren’t fully qualified surgeons from practicing cosmetic surgery; they just won’t be able to use the title.

“AHPRA basically operates by restricting what doctors can call themselves, rather than what they do—and that probably worked okay when your way of advertising your medical practice was having a little brass plaque,” Associate Professor Dean said, but that has changed with the rise of social media.

“You can’t look at what people are calling themselves very easily when it’s TikTok and Instagram…It’s not a good way of controlling people.”

She is calling on AHPRA to restrict the scope of practice of those without specialised surgical training.

“We’re not trying to restrict cosmetic surgery just to be the patch of plastic and reconstructive surgery. We’re just saying that from a safety perspective, you need to have gone through a full specialist surgical training programme,” she said.

It’s not just plastic surgeons who are concerned

In a Healthed survey last year, 78% of GPs said doctors who are not qualified surgeons should not be allowed to perform cosmetic surgical procedures, such as liposuction and breast implantation.

Only 7% of the surveyed GPs thought that doctors who are not fully qualified surgeons should be allowed to perform cosmetic surgical procedures, while 15% were undecided about whether this group should be allowed to perform cosmetic surgery.

GPs pick up the pieces
Between 10% and 30% of GPs who responded to Healthed surveys last year said they’ve seen a negative outcome following a cosmetic surgical procedure that had been done by doctor who was not a formally recognised surgical specialist (across multiple Healthed surveys).

A Healthed survey in August showed that 16% of GPs had seen at least one patient in this unfortunate position in the past 12 months.
Yet less than 1% of GPs said they reported these negative outcomes.

Under existing regulations, anyone with a basic medical degree can perform cosmetic surgery (including invasive procedures such as liposuction, facelifts, butt lifts, tummy tucks and breast implants) without undergoing the eight to 12 years of additional training that is required to become a registered surgeon.

An investigation by the SMH, The Age, 60 Minutes and Four Corners uncovered disturbing practices by some cosmetic surgeons, with hundreds of patients coming forward with stories of sepsis, liver damage, disfiguration and near-death experiences.

Australia’s $1.4 billion cosmetic surgery industry performs around 500,000 procedures every year.

On 1 September, AHPRA made 16 recommendations concerning cosmetic surgery, including creating a $4.5-million enforcement unit inside AHPRA, a confidential hotline (1300 261 041), a complaints committee, and banning patient testimonials.

Four doctors, including two GPs, were named in the independent review.

And yet on Tuesday, the SMH reported that AHPRA and the Medical Board of Australia had blamed greed for pushback on its proposed reforms: “There is a lot of money at stake in cosmetic surgery reform, and we’re finding in our consultation that most stakeholders support reform, but only if they don’t have to change what they do.”

However Associate Professor Dean said the issues with cosmetic surgery are not a matter of one-off errors, but rather the “systematic setting up of businesses to exploit and neglect patients.”

“It’s a different magnitude of sin and they (AHPRA) don’t seem to get that,” she said.

Many GPs appear to support Professor Dean’s concerns about AHPRA. In a survey this week, only 55% of GPs agreed that AHPRA is effective at protecting the public from doctors who are unfit to practice.

The AMC is seeking feedback on the proposed assessment and accreditation standards by 4pm on Wednesday 15 February.

Credits

Survey conception and design– Dr Ramesh Manocha

Survey analysis and visualisation; Reporting– Yasmin Clarke

Editing– Lynnette Hoffman