We are concerned about reports of patients suffering adverse outcomes when elective, cosmetic surgery is performed by medical practitioners who do not have specialist registration in a surgical discipline.
Australians rightly expect all surgical procedures to be performed to the highest possible standards. They expect those carrying out procedures to meet nationally established educational standards, undertake regular training and be registered in an appropriate specialty.
Yet there is a worrying trend occurring in Australia, which can mislead patients. A quick Google search of cosmetic surgery will return many results. Procedures will be advertised on shiny websites, and memberships of impressive sounding international organisations recited, but a significant proportion of those advertising cosmetic surgical procedures will not have Australian specialist registration in a specialty with a significant surgical scope.
Cosmetic procedures are performed to reshape structures of the body and to alter a person's appearance. Like any form of surgery, cosmetic procedures need to be performed by a practitioner who is trained in the procedure, including appropriate proper post-operative care. Risks include problems related to anaesthesia and surgery, excessive bleeding, infection, scarring and failure to heal.
To fully understand the problem, it is important to understand what a specialty is, how a medical practitioner obtains one, and which specialties include cosmetic surgery within their scope of practice.
In Australia medical specialties are approved by the Health Council (the combined state and territory health ministers). There are many medical specialties, for example 'surgery', 'psychiatry' or 'paediatrics and child health'. Several medical specialties have approved subspecialties or 'fields of specialty practice'.
Registration in an approved specialty is available to those who have achieved Fellowship level from one of the recognised medical specialty training colleges. In Australia, a recognised medical specialty training college is one that has been independently evaluated and accredited by the Australian Medical Council (AMC). Once registered as a specialist, practitioners need to comply with their respective college's program of continuing professional development (CPD) to maintain their specialist registration. This ensures that practitioners remain current in a career that may span several decades.
RACS is the sole provider of accredited training and education for nine 'surgical' fields of specialty practice.
The nine surgical training programs are five or six years at a minimum, on top of a primary medical degree. The education and training provide the physiological, ethical, psychological, pharmacological, surgical and medical expertise to safely diagnose, treat and manage surgical patients.
The practice of cosmetic surgery is within the scope of practice of several surgical disciplines. Cosmetic surgical procedures within the scope of RACS fields of specialty practice are performed by, but not limited to:
- Plastic and Reconstructive surgeons
- Otolaryngologists
- General surgeons
- Urologists
In Australia, the common theme linking the above practitioners is that they have all completed an AMC accredited fellowship and comply with ongoing CPD requirements. Compliance allows them to attain and then maintain specialist registration.
A relatively minor but potentially effective reform would be one which prevented medical practitioners not registered in a specialty with a significant surgical scope, and who have not been trained in an AMC accredited surgical training program from representing themselves as 'cosmetic surgeons' and advertising to the general public as such. We understand the Health Council is looking at this issue and RACS urges prompt action.
