'Cowboys' on notice: cosmetic surgery reform welcomed

The Australian Health Practitioner Regulation Agency (Ahpra) and the Medical Board of Australia have welcomed "the strong decisions from Australia's health ministers to make cosmetic surgery safer".

Health ministers have agreed to the following reforms at the most recent meeting: preventing medical practitioners who are not qualified describing themselves as cosmetic 'surgeons'; ensuring anyone conducting a cosmetic procedure has appropriate qualifications; limiting surgery to properly accredited facilities with minimum hygiene and safety standards; banning doctors using patient testimonials for cosmetic surgery including on social media; and better information for patients on the risks and their rights so they can make an informed decision about any treatment.

A statement by Federal Health and Aged Care Minister Mark Butler said the work to implement these reforms begins immediately, with the Medical Board of Australia set to act on: better credential cosmetic surgery providers by adding an 'Area of Practice' to medical registrations; a crackdown on the use of testimonials and social media; strengthening guidance and providing improved information for doctors in the sector; and establishing a hotline for complaints.

The Australian Commission on Safety and Quality in Health Care has been tasked with developing specific safety and quality standards for where and how cosmetic surgery can be performed. The Commission and the Medical Board have been asked to report back to Health Ministers within two months.

Butler said, "I welcome the decisive action agreed by health ministers to rein in the cosmetic cowboys.

"These cosmetic cowboys have been riding unchecked for years, and the previous government simply didn't act to clean up an industry that has come to resemble the Wild West.

"Australians deserve to have confidence in the safety and quality of the cosmetic surgery industry and these changes will provide that.

"I thank the brave women and men who have spoken about their experiences and shed light on this appalling behaviour. This has been crucial in finally bringing much needed action."

Medical Board Chair Dr Anne Tonkin said an area of practice endorsement for cosmetic surgery, along with title protection, would help consumers make informed decisions.

"Protecting the title surgeon will limit who can call themselves a surgeon and make it easier for consumers to know who is trained and qualified in surgery. It is an important step forward.

"Consumers choosing cosmetic surgery have a right to know who they can trust. When these changes are made, only qualified surgeons will be able to call themselves a surgeon. The endorsement for cosmetic surgery doctors will clearly define who has met high training standards, so that consumers can go to them for safe care," Tonkin said.

Ahpra CEO Martin Fletcher said, "We welcome the support from health ministers for the recommendations of the Independent Review and the actions we have recently announced."

Last week, the board and Ahpra announced a continuing ban on testimonials in cosmetic surgery because they are inherently misleading and deceptive, Fletcher said. We respect ministers' decision to maintain the ban more widely, he said.

"We're also pleased ministers have committed to joint work on facilities licensing and other gaps that pose risk to consumers, while wider industry reforms are underway," he said in a statement.

Ahpra said it will establish a Cosmetic Surgery Enforcement Unit, backed by a $4.5 million investment for extra resources, to work with the Medical Board to:

• Set clear standards: Ahpra wants to make it easier for consumers to know who is trained and qualified to do cosmetic surgery safely. As the review recommends, it will create an area of practice endorsement in cosmetic surgery. A doctor's registration on the public register will show if they have met clear standards in cosmetic surgery set by the Australian Medical Council and the Medical Board of Australia. This will be strengthened by ministers' decision to change the law to protect the title 'Surgeon'. It means soon only doctors with AMC-accredited qualifications will be legally allowed to call themselves a Cosmetic Surgeon.
• Crackdown on advertising: Enforce the ban on testimonials that mislead and deceive consumers and trivialise risk, by cracking down on advertising and social media used to promote cosmetic surgery. Ahpra will update and enforce advertising restrictions and use new technologies to audit social media, backed by tougher regulatory action.
• Tackle under-reporting: Silence allows poor practice to go unchecked and this harms patients. No doctor wants that. Reporting of patient harm in the cosmetic industry will be encouraged, so the agency can act more quickly to keep patients safe. Ahpra will write to every doctor in Australia so they know what to report and when, and why it's the right thing to do. Patients will be safer when doctors, nurses and other health practitioners understand their professional responsibility to report unsafe practice.
• Strengthen patients' voice: A campaign will be launched to remind consumers that honest disclosure to regulators is legal and their right when things go seriously wrong. A confidential hotline will be set up for cosmetic complaints, to make it safe for people who are currently too scared to report harm.
• Reinforce and strengthen existing guidelines: The Medical Board will strengthen its guidance for medical practitioners performing cosmetic procedures and surgery. Ahpra will step up scrutiny and enforcement of the requirements in the board's code of conduct and other guidance for medical practitioners who work in the cosmetic industry. Practitioners will be required to inform their cosmetic surgery patients of their registration type as part of the informed consent processes. This will ensure patients are aware if their doctor does not hold specialist registration.
• Changing the way we deal with complaints: The handling of cosmetic surgery complaints will be changed in a bid to remove dangerous doctors more quickly. The experience will be centralised and a national team of regulatory experts will be established to investigate complaints and make decisions about cosmetic complaints. National decision-making will be led by the Chair of the Medical Board, Dr Anne Tonkin, supported by an expert investigative team of Ahpra staff, backed by co-opted external regulatory expertise in forensic investigation and social media scrutiny.
• Working with others: The agency looks forward to working with state and territory health authorities to close current loopholes and address inconsistencies in areas such as facilities licensing and drugs and poisons rules, which are outside our authority and control. These problems are outside National Scheme or practitioner regulation powers and remit and are contributing to patient harm. The agency looks forward to action from jurisdictions to address these issues.

Image caption: iStockphoto.com/FG Trade