‘Legitimises the activities of unscrupulous operators’: Cosmetic surgery safety fears

Doctors will be able to receive an official “endorsement in cosmetic surgery” from the Medical Board of Australia despite not undertaking the training that would make them proper surgeons, after the country’s health ministers agreed to create a special category in an attempt to regulate the controversial industry.

The move has alarmed the Royal Australasian College of Surgeons, the body in charge of surgical training and qualifications, as well as several other plastic surgery and nurses groups, who say it will give a green light for practitioners to conduct invasive surgery without the proper safeguards and put patients at risk.

State and federal health ministers last year flagged urgent action to improve the safety of the $1.4 billion cosmetic surgery industry and make it safer for the public. It followed a 2022 investigation by the Herald, The Age and 60 Minutes which revealed dozens of patients were left permanently disfigured and in pain, and hundreds of others were left scarred by improperly trained doctors.

They made changes in December that will ban doctors without suitable qualifications from calling themselves cosmetic “surgeons” as well as restrict their use of patient testimonials – decisions that were welcomed by the health sector.

But an additional measure approved at a health ministers’ meeting last month means people practising cosmetic surgery without a surgical qualification could apply to the medical board as having been officially “endorsed in cosmetic surgery” under a new mechanism.

The Royal Australasian College of Surgeons has accused Health Minister Mark Butler of ignoring its advice that there was no need for an additional cosmetic surgery endorsement because surgery qualifications were already available through existing rigorous training.

President Sally Langley said the endorsement model did not require the high standards of her college’s minimum five-year specialist training and there was no precedent for how it would be done.

“Cosmetic surgery is invasive surgery, it’s real surgery, and it should be done by medical practitioners who are trained surgeons, with the agency-accredited training college,” she said.

“We are disappointed that our submissions don’t seem to have been acknowledged and that we, the experts in field, have not been appropriately consulted about this. Patients deserve well-trained surgeons and they are misled by some of the practitioners out there.”

An open letter to health ministers from six health groups including the Australasian Society of Aesthetic Plastic Surgeons, Australian Society of Plastic Surgeons, Australian College of Nurse Practitioners, and Breast Surgeons of Australia and New Zealand, has also said the endorsement model requires “an urgent rethink”.

“It undermines Australia’s established surgical standards and legitimises the activities of unscrupulous operators who have knowingly performed invasive surgery on vulnerable patients without the required training,” they said. “It also creates unnecessary confusion for consumers.”

A spokeswoman for the federal health department said the medical board, which recommended the new endorsement model, had undertaken extensive industry consultation. So had the Australian Medical Council, which is the independent accreditation authority now finalising standards for the new training.

“[These standards] will be submitted to the board for approval in March 2023 for implementation from mid-2023,” she said.

“The training program leading to the qualification also must be accredited by an independent accreditation authority. Once established, it will be easy for consumers to identify whether a practitioner is qualified to perform cosmetic surgery as the endorsement will be listed on the [regulator’s] public register.”

But the president of the Australasian Society of Aesthetic Plastic Surgeons, Tim Edwards, said the council’s draft standards lacked detail, while the submissions of surgeons to the consultation had been ignored.

“It doesn’t explain who will do the training, who will mentor and supervise the trainees, how they will gain hands-on operative experience, how they will be examined and, most importantly, training doesn’t finish with a rubber stamp. It is ongoing for your lifetime. It makes no explanation for how ongoing professional development will be achieved,” he said.

“The most glaring error [is] it deviates from the pathway of every other specialist surgical qualification in this country. And why on earth would you do that?”


‘We shouldn’t be accommodating people who want to thumb
their nose at the system of surgical training that applies
to every other surgery, and every other discipline, in this nation.’

Tim Edwards, President of the Australasian Society of Aesthetic Plastic Surgeons


The spokeswoman for the health department said cosmetic surgery had become a market disruptor that sat outside existing health system frameworks and challenged the specialist registration model.

She said all health ministers were committed to ensuring Australians had access to doctors with the skill to provide safe and quality services.

“Over recent months we have seen a litany of appalling stories of poor practices in the cosmetic surgery industry with permanent damage done to untold numbers of Australians. Australians deserve to have confidence in the safety and quality of the cosmetic surgery industry and these changes will provide that,” she said.

However, Edwards said the changes would do the “exact opposite”.

“If you say only surgeons with a speciality qualification can call themselves surgeons, but then bring in a qualification so people without that can practice surgery, then you’ve undermined the standard you sought to enforce,” he said.

“We shouldn’t be accommodating people who want to thumb their nose at the system of surgical training that applies to every other surgery, and every other discipline, in this nation.

“They are complex surgeries that carry significant risk of injury and harm to patients, as we’ve seen in the media, and they require the same level of expertise and training as cardiology or neurology procedure.

“And the regulator – which is here to protect the standard of surgery in this country – is going against what the provider of surgical training is recommending. That’s a staggering thing when you think about it.”

Australian Medical Association president Steve Robson said the AMA had broadly welcomed the suite of reforms but said “the devil will be in the detail”.

“Endorsement will only properly protect patients effectively if the standards are set at a level that is at least equivalent to an Australian Medical Council-recognised surgical training program,” he said.

This article was, Published on The Sydney Morning Herald 20 March 2023.


For your cosmetic surgery