Health regulator lowering safety standards for cosmetic surgery, specialists say

Critics say proposed new standards designed to clean up the cosmetic surgery industry, that would effectively allow non-surgeons to do operations, is further evidence of the need for a royal commission into the national health watchdog.

In response to a 2022 review of Australia’s cosmetic surgery industry, the Australian Health Practitioner Regulation Agency (AHPRA) has put forward a new “endorsement” model that has come under immediate criticism from leading experts in the field.

Mark Ashton says AHPRA has misread public concern about surgical safety.Credit: ABC/Andy Ware

The review followed revelations in The Age and The Sydney Morning Herald of widespread harms to patients by doctors operating as cosmetic surgeons without traditional surgical training.

There are currently no specific standards for medical practitioners who want to perform cosmetic surgery, whereas specialist surgical training requires about 10 years of rigorous study and examinations administered by the Royal Australian College of Surgeons.

Professor Mark Ashton, former president of the Australian Society of Plastic Surgeons, said AHPRA’s proposal highlighted again that health system regulation was broken and not protecting the public.

“AHPRA is planning to endorse a whole variety of practitioners, many of whom have not done accredited surgical training and would not be able to pass the standards required for all other types of surgery that exist,” Ashton said.

“We need a royal commission. I have previously called for a royal commission into AHPRA and the way it handles medical complaints and protects the public, I am dismayed at a regulator which appears to have misread public concern about surgical safety.”

Associate Professor Nicola Dean, president of the Australian Society of Plastic Surgeons, said proposed new standards of accreditation for cosmetic surgery training meant far lower standards of education for those performing cosmetic surgery than for any other type of surgery.

“The only existing endorsement model is for acupuncture, and that’s for doctors to do an additional standalone course to become acupuncturists. Cosmetic surgery is not anywhere near acupuncture, it is real surgery and has real risks associated with surgery,” Dean said.

“The idea of having a standalone program in cosmetic surgery, where you don’t have to be a surgeon, is already deeply problematic. This doesn’t help improve patient safety, it jeopardises it further.”

Dean said revelations in this masthead on Sunday that a student nurse’s career was destroyed after reporting her alleged rape showed AHPRA’s mishandling of public safety issues was not a one-off.

“It seems to me, having seen the article this morning, that AHPRA’s misguided notion of a cosmetic surgery endorsement model is not an isolated instance of them misjudging public expectations, and perhaps it is time for a comprehensive review of the institution.”

The Medical Board of Australia and AHPRA said in a statement on Sunday: “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.

“As regulators, we have to prioritise patient safety and not let self-interest from different parts of the profession stand in the way of sensible reform.”

The two organisations said data, “limited as it is”, indicated that no single part of the profession had a monopoly on patient safety. “Complaints data show there are bad eggs – or good eggs doing bad things – across the cosmetic surgery industry,” they said.

“It’s easy to dress up vested interest as a concern for patient safety,” the organisations said, adding that the Australian Medical Council was undergoing a robust process to decide on standards of training required for cosmetic surgery endorsement.

Endorsement is one part of a package of reforms coming to cosmetic surgery sector that includes higher professional standards, tougher advertising requirements and new registration requirements.

The four-week consultation on the plan ends on February 15, but Dean said the new standards diluted training requirements so much that they should be dropped in the interest of patient welfare, and more significant punishments for systemic neglect and disregard for safety should be introduced.

Health Minister Mark Butler has taken action along with state health ministers to reign in cosmetic cowboys.Credit: Alex Ellinghausen

She said AHPRA and the medical board should restrict the scope of practice when it came to cosmetic surgery, but that it seemed unlikely the organisations’ current leaders would do this.

“Why is it that a young woman undergoing insertion of breast implants is less deserving of a high standard of training for her procedure than someone having a gallstone operation or surgery for knee problem?” Dean said.

“When a patient is cut open, regardless of the purpose, there is the same risk of bleeding and infection, or other potentially devastating complications that require specialist skills to manage, so surely the same standards should apply.”

Ashton said AHPRA’s acceptance and support for the endorsement plan “represents a dangerous departure from well-established, accepted standards of surgical training”.

“It will not only fail to protect the public but will lead to more confusion around who is properly trained and makes a bad problem worse,” he said.

Federal Health Minister Mark Butler last week ordered a rapid review of attempts to reform AHPRA after reports in this masthead of widespread dysfunction in how complaints are investigated and a preview of a Four Corners report due to air on Monday night.

That six-month investigation will reveal Australia’s system of health regulation is allowing doctors who have sexually assaulted their patients to continue practising, the ABC reported.

Dr Tim Edwards, president of the Australasian Society of Aesthetic Plastic Surgeons, said he was astonished that AHPRA would support an endorsement model given harm to patients done by non-specialist practitioners that had been revealed in the media.

“We find it unfathomable that you would want to create a second tier of inferior training and lesser standards. That doesn’t make sense to us,” Edwards said.

“Cosmetic surgery is equally invasive and dangerous as any other form of surgery. The only conclusion I can come to is that people, politicians and AHPRA regard it as frivolous. This is a misogynistic point of view because it’s largely women who under this surgery and it’s not being taken seriously.”

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