A booming, broken industry

I am a Registered Nurse with 30 years’ experience in cosmetic medicine, so it goes without saying that I have seen many changes in the aesthetics industry.

The aesthetics industry has boomed over the past few years in Australia, with demand from consumers at an all-time high after Covid lockdowns, and this mirrors all markets across the world. With any boom comes opportunity and entrepreneurs who will avail themselves of that opportunity – and the cosmetic medical and surgical industry is no different. However, it has meant that some of the checks and balances within the specialty have been lost in translation, as growth has been rapid and driven more by business than by medicine.

Training gaps and the myth of competence

Cosmetic medicine is a medical specialty whether recognised as such by Ahpra or not. It requires a high level of skill and knowledge to be done safely. It takes strong consultation skills to set realistic expectations, and clear communication to ensure appropriate patient selection.

When these elements align, the outcomes can be life-changing for the patient and deeply fulfilling for the practitioner. These skills fall into the scope of practice of doctors, nurses and dentists alike with extra training. Unfortunately, there is no recognised or standardised training, and the type and quality of training varies enormously – from just a few days to several years.

This, in my opinion, is one of the core problems within the industry: there is no agreed-upon level of training for those performing these procedures, nor a practice standard to help patients assess a practitioner’s level of expertise. Practitioners themselves have unconscious incompetence; some clinicians believe they are experts after just two years in practice, while others with 20 years of experience may not have kept up to date with advancements or new techniques – and therefore are not offering the best outcomes or product options to patients.

The fall of collaboration

The division in our industry of specialty ownership has gone on for 25 years, longer than most think the industry has existed. The problem really is how much money is associated with the business side of this industry. Until 2000, most practices were collaborations between doctors and nurses in one clinic working together with oversight over each other’s practice, and a sharing of opinions for best outcomes for the patient.

This collaboration mimicked that of hospital and primary health settings, and it was fairly difficult to achieve. Nurses like me who established their own clinic and employed doctors were frowned upon and often bullied, alongside the doctors who supported this, as it did not fit the conventional model of ‘doctor / nurse’ relationship. However, it remained collaborative and mimicked all other medical specialties in terms of collaboration, scripting, checks and balances.

All areas of specialty have at some stage tried to own the aesthetics industry – from plastic surgeons, dermatologists and nurses to dentists and paramedical aestheticians. My feeling is we all have our place. We all offer our unique approach to patient care in cosmetic medicine and surgery, and the patient needs us all along their ageing journey. The perfect world would be a clinic that houses one of every specialty all working together providing support and collaboration for each other as professionals for the best patient outcomes delivered safely and effectively.

Most probably think I am crazy expecting this in an industry where it seems there is now a constant fight to have control of the industry and the money. We all find ourselves in an industry that has lost its way, with many working on the fringe of guidelines and legislation – not intentionally but because interpretation is difficult and vague and unconscious incompetence in this area exists.

Collaboration between practitioners is minimal, patients are seen faster as there are many more to treat, and the pressure is on to make more money (if that is the goal). It has forced the industry into a place that is not the medical model it used to be, and many more mistakes are being made, outcomes are not always great, and patients are being harmed.

The rise of commercial medicine

The influx of money in this new multi-billion-dollar industry has, in my view, driven lobbying efforts motivated by a range of interests. While many medical practitioners are genuinely motivated by a desire to improve patient safety, I believe there are those who hide behind ‘patient safety’ to take financial control of their area of the industry. Hiding behind patient safety is easy; who would refute it as being of the utmost importance? Of course, patient safety must remain the highest priority – but what truly constitutes safer practice?

What safe practice looks like

The Cosmetic Nurses Association (CNA) was established in 2020 by a group of industry stakeholders passionate about representing nurses to government as healthcare professionals and not beauty therapists, as we were being regarded at that time. Since then, the CNA has worked tirelessly to help government bodies understand what high levels of skill is required to deliver the treatments and procedures we offer. Previously, nurses had very little or no voice.

As the current President, I am passionate about nurses having a place at the discussion table, and a place in the industry. Nurses provide the largest part of the cosmetic medical workforce, and we should therefore have representation so that our position is understood.

It is not my belief that your original qualification makes you safer, nor is there medical evidence to support this. No medical specialty includes cosmetic medicine and training in their base training. It matters how quickly you move from basic treatments to higher risk treatments. It matters how many patients you see and how regularly you practice, that you are a good communicator and understand informed consent.

Adhering to the Ahpra guidelines for your scope of practice, and being accountable for that scope, is a requirement for all practitioners, yet this can be forgotten in the haste to grow a business. We are still medical professionals, and we have requirements to fulfill our obligations within our scope to maintain emergency training, adverse event training and other basic requirements for our profession.

We are not all equally trained as we have significantly different training specialties, but we can bring equal joy to patients in the cosmetic medical space by delivering good, safe outcomes with collaboration across specialties.

Calling the industry to account

Legislators are beginning to interpret the law as they see fit, but without full engagement from all stakeholders. As a result, they have not fully understood the needs of patients seeking cosmetic medical services, leading to significant upheaval across the industry. Many practitioners now find themselves operating in legal grey areas. This not only impacts the ability of skilled professionals to practise and care for their patients, but also highlights the need to our industry to start setting a standard of practice that is safe for both patients and practitioners.

As an industry, we need to stand together—regardless of our qualifications—in pursuit of shared goals around education and practice standards. This isn’t about defending turf or questioning who has the right to be here. It’s about reflecting on how we practise and being willing to ask ourselves the hard questions: Does my clinic process represent a medical model? Do I have enough experience and training in all that I offer patients? Am I working fully within the law? Am I accountable for my practice? Are those I work with practising within their scope and accountable for what they bring to my practice?

We all need to play our part in lifting industry standards and helping each other in understanding and striving towards a standard that is exemplary of safe practice. Together, we can build an industry to be proud of – one that is inclusive of all specialties essential to achieving a positive patient journey.

To join the Cosmetic Nurses Association and support nurses, visit www.cosmeticnursesassociation.org.au. AMP