The Medical Board Of Australia (MBA) and Australian Health Practitioner Regulation Agency (Ahpra) have announced “a suite of measures” – including the necessity for referrals from GPs, a ban on testimonials and removal of deceptive or misleading social media posts – to “better protect patients having cosmetic surgery”. the reforms take effect from 1 July 2023.
The MBA and Ahpra commissioned an ‘Independent review of the regulation of medical practitioners who perform cosmetic surgery’ following a series of media reports that revealed ‘serious patient safety concerns including hygiene breaches, poor patient care, unsatisfactory surgical outcomes, and aggressive and inappropriate advertising’.
The package of reforms delivers on many of the recommendations of the review. It includes three key components:
- UPDATED: Guidelines for registered medical practitioners who perform cosmetic surgery and procedures (extended details in accompanying Breakout Box ‘Performance Guidelines: Details’);
- NEW: Guidelines for registered medical practitioners who advertise cosmetic surgery (extended details in accompanying Breakout Box ‘Advertising Guidelines: Details’);
- NEW: Registration standard: Endorsement of registration of registered medical practitioners for the approved area of cosmetic surgery (extended details in Breakout Box ‘Registration/ Endorsement Standard: Details’);.
The reforms follow a public consultation in 2022 and act on the recommendations made by last year’s independent review – led by former Queensland Health Ombudsman Andrew Brown and an expert panel including Professor Anne Duggan (chief medical officer at the Australian Commission on Safety & Quality in Health Care), Alan Kirkland (CEO at CHOICE) and National Health Practitioner Ombudsman Richelle McCausland.
MBA chair Dr Anne Tonkin commented: ‘There is a lot of money at stake in cosmetic surgery reform. Our reform package prioritises patient safety over vested interest. It reflects what is legally possible and what will help keep patients safe.’
She emphasised: ‘Patients choosing cosmetic surgery deserve safe care. We’ve put together and delivered a reform package that raises standards and increases safety measures to stop patients being exploited and reduce the
risk of harm.’
Under the new rules:
- doctors offering cosmetic procedures will be specifically banned from using influencer testimonials or posting photoshopped images on social media;
- cosmetic surgery advertising must not be false, use testimonials, offer discounts without terms and conditions, or create unreasonable expectation of beneficial treatment or encourage indiscriminate use;
- patients seeking cosmetic surgery must obtain a referral to discuss their motivations with a GP who knows their medical history and can share this information with the doctor they are referred to;
- disciplinary powers range from an initial warning and restrictions on practice to suspension for the worst offenders.
In what The Sydney Morning Herald described as ‘a suite of reforms aimed at cracking down
on rogue operators’, cosmetic practitioners have been given until1 July 2023 to ‘delete any deceptive and misleading social media posts’ before the new practice guidelines are enforced by the MBA and Ahpra from 1 July.
MBA chair Dr Tonkin said the Board would act against any doctor who breached the standards and put patients at risk.
She declared: ‘It’s time to clean up the cosmetic surgery industry to make patients safe – so we’re putting the profession on notice.’
Professor Anand Deva, director of cosmetic and plastic surgery at the Faculty of Medicine and Health Sciences at Macquarie University applauded Ahpra for taking a ‘stand against dodgy cosmetic surgery advertising’.
He told The Sydney Morning Herald: ‘Some of the stuff that’s being posted on social media by some cosmetic surgeries is just indefensible.
‘Too many of these doctors are tagging influencers on their social media, saying “doesn’t so-and-so look great in a bikini because I’ve done such a good job”, with no acknowledgement of the business exchange between the influencer and the doctor.’
Ahpra has been proactively auditing cosmetic surgery advertising since September 2020 and found ‘high rates of non-compliance’ and Professor Deva noted: ‘These posts are preying on vulnerable women, in particular, and I’d really like to see these people held to account with real consequences.’
‘It’s time to clean up the cosmetic surgery industry to make patients safe – so we’re putting the profession on notice.’
Revised practitioner guidelines
The reforms apply to doctors practising in two areas:
- cosmetic surgery (involves cutting beneath the skin – including breast augmentation, facelifts and liposuction); and
- non-surgical cosmetic procedures (which may pierce the skin but don’t cut beneath it, such as injectables, thread lifts and laser treatments).
Under the reforms, patients seeking cosmetic surgery will need a referral from their GP.
This new measure ‘adds a layer of protection for patients, who will in future be able to discuss their motivation for cosmetic surgery with their GP, who has the best knowledge of their medical history and can share this with the doctor being referred to’.
The MBA does not expect GPs to have a ‘detailed knowledge of cosmetic procedures or to seek the patient’s informed consent for cosmetic procedures they are not personally providing’.
Other changes in the revised and strengthened Guidelines for registered medical practitioners who perform cosmetic surgery and procedures include:
- higher standards for cosmetic surgery premises, with accreditation against Australian Commission on Safety and Quality in Health Care (ACSQHC) standards, required for cosmetic surgery premises from 1 July 2023;
- improved patient assessment by practitioners before surgery, including more scrutiny for signs of body dysmorphic disorder.
New advertising guidelines
The new guidelines, specific to cosmetic surgery and with ‘a strong focus on online and social media advertising’, are in addition to the existing code of conduct and advertising guidelines and ‘address the unique features of cosmetic surgery’.
They provide greater clarity about what is not acceptable. Advertising must not:
- be false, misleading or deceptive;
- offer discounts without terms and conditions;
- use testimonials;
- create unreasonable expectation of beneficial treatment; or
- encourage indiscriminate use.
Additionally, from 1 July 2023:
- medical practitioners must include clear information about their registration type and their registration number;
- clear information about risks and recovery must be easily found;
- videos and images must be used responsibly and not for entertainment;
- videos and images must not be sexualised or include gratuitous nudity;
- the use of negative body language is banned; and
- cosmetic surgery advertising must be identified as adult content.
Ahpra CEO Martin Fletcher explained: ‘We’re reforming cosmetic surgery to raise standards, improve consent about surgery and raise the bar in advertising.
‘We’re making it very clear what is not acceptable behaviour by practitioners.’
Delia Rickard, former Australian Competition and Consumer Commission (ACCC) Deputy Chair and now Chair of the Cosmetic Surgery Oversight Group, said this was a significant step in cleaning up this sector. She commented: ‘These developments are important for
patients and mark a real turning point. The line has been drawn for practitioners about what is not acceptable.’
Maddison Johnstone and Michael Fraser from Operation Redress have been monitoring online advertising in the cosmetic sector for years.
Fraser noted: ‘It is important that the medical regulator took the concerns of brave whistle- blowers and patients seriously and investigated the deeply troubling practices exposed by the media.
‘The new MBA guidelines, combined with the use of software to proactively monitor advertising, are significant steps towards increasing patient safety, protecting the public and putting Australia on a path to being a leading country in regulating the cosmetic surgery sector.
‘Young people are particularly vulnerable to cosmetic procedure advertising, so these changes will contribute to protecting young people and children from exposure to advertising that is known to impact their self-esteem.’
Endorsement of registration
Health ministers have approved a new registration standard for cosmetic surgery endorsement ‘to help patients know who is trained and qualified to perform cosmetic surgery safely’. The endorsement will ‘make it clear on the public register if a doctor has met cosmetic surgery standards set by the Australian Medical Council (AMC) and the MBA’.
In its announcement, the MBA noted that it ‘can’t limit surgery to surgeons – that’s not how the law works.
‘Already, every day, hospitals across rural and regional Australia employ doctors who are not specialist surgeons to provide surgery to patients. Changing this would grind surgical services to regional and rural Australians to a halt.’
Creating an endorsement ‘is the strongest regulatory tool in our kit. We’re introducing it to make patients safer.’
MBA Chair Dr Tonkin explained: ‘An endorsement will tell patients who is trained and qualified. Without it, patients will be no better informed than they are now and the opportunity to clean up the cosmetic industry will be lost.
‘We absolutely acknowledge the expertise of specialist surgeons and endorse health ministers’ decision to protect the title “surgeon” to stop anyone without specialist registration in surgery, obstetrics and gynaecology or ophthalmology from calling themselves a surgeon.
‘Both will help patients understand who is qualified.’
The MBA said the ‘same rigorous process that accredits the training programs of specialist medical colleges (like the Royal Australasian College of Surgeons) is setting the standards of training (accreditation standards) required for cosmetic surgery endorsement’.
The cosmetic surgery accreditation standards ‘are expected to be published shortly and will set the bar that determines which qualifications will be recognised for endorsement’.
Cosmetic surgery training providers ‘will apply for accreditation of their training program’. If their program meets the accreditation standards, their graduates will be eligible for endorsement.
Endorsement plan criticism
Peak surgeons’ bodies are ‘staunchly against’ the Endorsement of Registration reform ‘that would allow doctors practicing cosmetic surgery without a surgical qualification’ to apply to the medical board ‘as having been officially endorsed in cosmetic surgery’, reported The Sydney Morning Herald.
The Royal Australasian College of Surgeons, the Australian Society of Plastic Surgeons, and the Australasian Society of Aesthetic Plastic Surgeons, among others, ‘warned the endorsement model would give a green light for practitioners to conduct invasive surgery without the proper training and put patients at risk’.
Dr Timothy Edwards, president of the Australasian Society of Aesthetic Plastic Surgeons (ASAPS), told The West Australian that the medical regulator ‘is proposing a loophole that would allow cosmetic cowboys to claim they are “endorsed to perform cosmetic surgery” without the proper surgical training to back it up’.
He emphasised the ‘loophole means some doctors will soon be able to receive an official “endorsement in cosmetic surgery” from the MBA without undertaking the proper training required to become a registered surgeon’.
Dr Edwards warned the ‘new move will weaken the decision to protect the title “surgeon” and create unnecessary confusion for patients, who have only recently begun to understand the difference between a registered plastic surgeon and the unaccredited title of “cosmetic surgeon”.
‘The proposed new endorsement could give cosmetic cowboys undeserved legitimacy, potentially allowing them to continue performing dangerous invasive surgeries without the required Australian surgical training.
‘Experience alone isn’t enough to perform cosmetic surgery safely. Years of experience are not the same as specialist surgical training.
‘A patient undergoing cosmetic surgery by a doctor who does not have specialist surgical training is 19 times more likely to report a complication than with a registered specialist. In fact, almost two-thirds of cosmetic surgery complaints recorded by Ahpra were against non-surgically trained practitioners performing cosmetic surgery.’
Dr Edwards summed up: ‘Why should cosmetic surgery training be judged differently from any other surgical training?’
Performance Guidelines: Details
The ‘Performance Guidelines’ are in two sections, with separate guidance for:
- cosmetic surgery; and
- non-surgical cosmetic procedures.
Cosmetic Surgery
Recognising potential conflicts of interest
- Medical practitioners must recognise conflicts of interest can arise when providing cosmetic surgery and must ensure the care and wellbeing of their patient is their primary consideration.
Assessment of patient suitability
- All patients seeking cosmetic surgery must have a referral, preferably from their usual GP – if that is not possible, from another GP or other specialist medical practitioner. The referring practitioner must work independently of the practitioner who will perform the surgery and must not perform cosmetic surgery or non-surgical cosmetic procedures themselves.
- The practitioner who will perform the surgery must discuss and assess the patient’s reasons and motivation for requesting the surgery, including external reasons (for example, a perceived need to please others) and internal reasons (for example, strong feelings about appearance). The patient’s expectations of the surgery must be discussed to ensure they are realistic.
- The practitioner who will perform the surgery must assess the patient for underlying psychological conditions such as body dysmorphic disorder (BDD), which may make them an unsuitable candidate for the surgery. The practitioner doing the assessment must use a validated psychological screening tool to screen for BDD. The process and the outcome of the assessment and screening must be documented in the patient’s record.
- If screening indicates the patient has significant underlying psychological issues which may make them an unsuitable candidate for the cosmetic surgery, they must be referred for evaluation to a psychologist, psychiatrist or GP, who works independently of the practitioner who will perform the surgery.
- The practitioner who will perform the surgery must discuss other options with the patient, including surgery, procedures or treatment offered by other health practitioners and the option of not having the surgery.
- A practitioner must decline to perform the surgery if they believe it is not in the best interests of the patient.
Patient consultation
- Number and type of consultation
- A patient seeking cosmetic surgery must have at least 2 pre-operative consultations.
- The patient’s first consultation must be with the practitioner who will perform the surgery or another registered health practitioner who works with the practitioner who will perform the surgery (not a patient advisor or an agent).
- At least 1 of the 2 consultations must be in-person with the practitioner who will perform the surgery.
- When consent can be given
- The patient must not be requested to sign consent forms at their first consultation.
- The patient cannot consent to cosmetic surgery until they have had an in-person consultation with the practitioner who will perform the surgery.
- The decision to have the surgery (provision of informed consent) must be made at a consultation with the practitioner who will perform the procedure (in person or by video).
- Cooling-off period
- There must be a cooling- off period of at least 7 days after the patient has had 2 consultations and given informed consent (signed consent forms), before the surgery can be booked or a deposit paid.
Additional responsibilities for patients under 18
- Practitioners must know and comply with relevant legislation of the jurisdiction in which they practise, in relation to restrictions on cosmetic surgery for patients under 18.
- The practitioner who will perform the surgery must assess and be satisfied the patient hasthe capacity to consent to the surgery.
- The practitioner should, to the extent practicable, have regard for the views of a parent or guardian of the patient under 18, including whether the parent or guardian supports the surgery being performed.
- Before any cosmetic surgery, all patients under 18 must be referred to, and be evaluated by, a psychologist, psychiatrist or GP, who works independently of the practitioner who will perform the surgery, to identify if there are any significant underlying psychological problems which may make them an unsuitable candidate for surgery.
- For patients under 18, there must be a cooling-off period of at least 3 months between the provision of informed consent and surgery being performed. The patient should be encouraged to discuss why they want to have the surgery with their GP during the cooling- off period.
Informed consent
- The practitioner who will perform the surgery must provide the patient with enough information to make an informed decision about whether to have the surgery. The practitioner must have a verbal consent discussion (in a language understood by the patient) as well as provide written information in plain language.
- Information provided must not glamorise surgery, minimise the complexity of the surgery, overstate results or imply patients can achieve outcomes that are not realistic. It must include information about the:
- cosmetic surgery: what the surgery involves (including the type of anaesthesia and pain management); where it will be performed; whether it is new or experimental; the range of possible outcomes, short and long-term; risks and possible complications, short and long-term; risks specific to the patient including the possible impact of any comorbidities the patient has; the possibility of the need for revision surgery or further treatment in the short-term (such as capsular contracture) or the long- term (such as replacement of implants after expiry date); recovery times and specific care requirements during the recovery period.
- practitioner performingthe surgery: practitioner’s registration type, for example, general registration or specialist registration (including recognised specialty and field of specialty practice if applicable); whether the practitioner has an endorsement for cosmetic surgery on their registration (when area of practice endorsement for cosmetic surgery is available); the practitioner’s qualifications, training and experience; which other practitioners will be involved in the surgery (if applicable).
- costs: total cost; costs of any implants or other devices; costs of other practitioners, for example, assistant surgeon and anaesthetist fees (costs if known, indicative cost or information on how to find out these costs); facility costs, for example, theatre fees, and hospital or day procedure centre (costs if known, indicative cost or information on how to find out these costs); details of deposits and payments required and payment dates; refund of deposits; payments for follow- up care, including any garments or devices to support recovery; possible costs for allied health or other care required post- operatively; possible further costs for revision surgery or additional treatment; advising the patient that cosmetic surgery is not covered by Medicare.
- For any cosmetic surgery that includes an implantable device, the patient must be given the Therapeutic Goods Administration (TGA) approved patient information leaflet (PIL) (before surgery) and patient implant card (PIC) (after surgery) for the device.
- Consent must be requested for any photographs or videos a practitioner proposes to take
- of a patient in a consultation or during the surgery. The patient must be given information about proposed use of any images of them, including: the purpose (for example, for medical record only, for advertising); how the images will be used (for example, stored in patient’s record, shown to prospective patients in consultations, published on website and posted on social media); where they will be stored and who will have access.
- Patient images must be stored on a secure device. Practitioners must not store patient images on a personal device.
- Patients must be given an opportunity to view images before consenting to their use
in advertising. Patients have the right to refuse use of their images and a patient cannot be required to agree to use of their images in advertising. Consent for the use of images in advertising must be separate from consent to the surgery. Patients must be allowed to withdraw their consent to use of their images and the practitioner must promptly stop using images (for example, not show them to prospective patients, delete them from advertising) if a patient withdraws consent. A patient’s consent for taking, use and storage of any images must be documented. - Informed consent must be obtained by the practitioner who will perform the surgery. This cannot be delegated to another person.
- Informed consent must be obtained at a consultation (in person or by video) at least 7 days before the day of the surgery and reconfirmed on the day of surgery and documented appropriately. A copy of the signed consent form must be given to the patient.
Patient management
- The practitioner who will perform the surgery is responsible for management of the patient, including ensuring the patient receives appropriate ongoing post-operative care.
- If the practitioner who performed the surgery is not personally available to provide post-operative care, they must have formal alternative arrangements in place, including a nominated delegate who is a suitably qualified practitioner. These arrangements must be made in advance, documented, and made known to the patient, other treating practitioners and the relevant facility or hospital.
- When a practitioner performs cosmetic surgery in a location that is not their primary place of practice (practitioners who visit or ‘fly in/fly out’ of a second, rural or interstate location), the practitioner who performed the surgery must be available at that location for at least 24 hours after the surgery. Ongoing post-operative care in these locations can be delegated after the first 24 hours.
- When a patient may need sedation, anaesthesia and/or analgesia for cosmetic surgery, the practitioner who will perform the surgery must comply with the Australian and New Zealand College of Anaesthetists’ (ANZCA) guidance on procedural sedation and ensure there are trained staff, facilities and equipment to deal with any emergencies, including resuscitation of the patient.
- There must be protocols in place for managing complications and emergencies that may arise during the surgery or in the immediate post-operative phase.
- It is preferable that the practitioner who will perform the surgery has admitting rights to an appropriate hospital in the event post-operative admission is required. If the practitioner does not have admitting rights, prior arrangements should be made with another practitioner who has admitting rights and who can take responsibility for ongoing patient care. In the event of complications requiring hospital admission, the practitioner who performed the surgery is responsible for coordinating care until the patient is under the management of the alternative practitioner or hospital.
- Collaborative care arrangements with the wider healthcare team, as indicated by a patient’s history and needs, should be considered pre-operatively, organised prior to discharge and made known to the patient.
- Written instructions must be given to the patient on discharge including:
- contact details for the: practitioner who performed the surgery; nominated delegate practitioner in case the practitioner who performed the surgery is not available;
- details of the surgery performed and anaesthesia used;
- the usual range of expected post-surgical symptoms;
- instructions for the patient if they experience unusual pain or symptoms (escalation points and who to contact and when);
- instructions for medication, dressings, activity restrictions and self-care; and
- dates and details of follow-up visits.
- Medical records must include the surgery performed, described in enough detail to enable another practitioner to take over post- operative care and/or operate on the patient in the future with an adequate understanding of what has been done.
Provision of patient care by other practitioners
- The practitioner who performs the surgery is responsible for ensuring any other person participating in the patient’s care has appropriate qualifications, training and experience, and is adequately supervised as required.
- When a practitioner is assisted by another registered health practitioner or assigns an aspect of the surgery or patient care to another registered health practitioner, the medical practitioner who performs the surgery retains overall responsibility for the patient. This does not apply when the practitioner has formally referred the patient to another registered health practitioner.
Complaints
- Patients who are dissatisfied have the right to make a complaint. The practitioner must provide all patients with information before surgery, about the range of complaints mechanisms available including:
- raising and resolving the complaint directly with the practitioner who provided the surgery;
- accessing the clinic or facility’s complaint process;
- making a complaint to the health complaints entity in the state or territory where the surgery was performed;
- making a complaint to Ahpra, the Health Care Complaints Commission or the Medical Council of NSW (in NSW) or the Office of the Health Ombudsman (in Queensland).
- Medical practitioners must ensure any non-disclosure agreement (NDA) they use makes clear that a patient, or a person on behalf of the patient, can still make a complaint to Ahpra, the Health Care Complaints Commission or the Medical Council of NSW (in NSW) or the Office of the Health Ombudsman (in Queensland).
Training & experience
- Cosmetic surgery must only be provided by medical practitioners with the appropriate knowledge, training and experience to perform the surgery – and deal with all routine aspects of care and any likely complications.
- When area of practice endorsement for cosmetic surgery is available, an approved qualification eligible for endorsement for cosmetic surgery is appropriate training. In the interim, the Board expects that at a minimum, a practitioner providing cosmetic surgery will have undertaken appropriate surgical skills training, training in the specific cosmetic surgery being offered, and have completed supervised practice to ensure they are safe to perform the surgery.
- A practitioner who is changing their scope of practice to include cosmetic surgery is expected to undertake the necessary training before providing cosmetic surgery.
- All practitioners must participate regularly in continuing professional development (CPD) relevant to their scope of practice. All practitioners whose scope of practice includes cosmetic surgery, must undertake CPD that includes activities related to cosmetic surgery, including reviewing their performance and measuring their outcomes.
Qualifications & titles
- A practitioner must not make claims about their qualifications, experience or expertise that could mislead patients by implying the practitioner is more skilled or more experienced than is the case. To do so is a breach of the National Law.
- Practitioners must clearly inform their patient of their registration type; for example, general registration or specialist registration (including recognised specialty and field of specialty practice, if applicable).
- Practitioners must not use a protected title unless they hold the related registration type.
Advertising & marketing
- Advertising material, including practice and practitioner websites and social media, must comply with the Board’s Guidelines for advertising a regulated health service, the Board’s Guidelines for registered medical practitioners who advertise cosmetic surgery, the current Therapeutic Goods Advertising Code and the advertising requirements of section 133 of the National Law.
Facilities
- Practitioners must know and comply with relevant legislation, regulations and standards of the jurisdiction in which they are practising in relation to facilities, including facility licensing, where the surgery will be performed.
- All cosmetic surgery must be performed in a facility accredited by an Australian Commission on Safety and Quality in Health Care (ACSQHC) approved agency to ACSQHC standards as specified by the Board.
- Cosmetic surgery must be performed in a facility appropriate for the level of risk involved in the procedure and the risk profile of the patient. Facilities must be appropriately staffed and equipped to manage possible complications and emergencies.
Financial arrangements
- No money should be payable until after the cooling-off period (other than for initial consultations).
- The practitioner must not provide or offer to provide financial inducements (such as a commission) to agents for recruitment of patients.
- The practitioner must not provide or offer to provide free or discounted surgery to prospective patients, including social media influencers or users, for promotion of cosmetic surgery or services.
- The practitioner must not offer, promote or recommend financing schemes to patients, either directly or through a third party, such as loans or commercial payment plans, as part of the cosmetic surgery. This does not preclude a practitioner from informing patients of accepted payment methods such as credit cards (such as Visa, Mastercard), buy-now/pay-later products (such as Afterpay, Openpay, Zip Pay) or from offering the option to pay for cosmetic surgery in instalments in a non-commercial payment arrangement between the practitioner and patient.
- Practitioners must not encourage patients to take on debt (for example, personal loans, re-mortgage) or access superannuation, to access cosmetic surgery.
- Practitioners must not offer patients additional products or services that could act as an incentive to cosmetic surgery (such as free or discounted flights or accommodation).
- Practitioners must:
- ensure they do not have a financial conflict of interest that influences the advice they provide to their patients;
- disclose any financial interests that could be perceived as influencing the advice they provide to their patients.
Non-Surgical Cosmetic Procedures
The same general guidelines apply, as well as these additional elements.
Patient consultation type
- Practitioners must have a consultation with the patient, either in person or by video, each time they prescribe them schedule 4 (prescription only) cosmetic injectables. Additional responsibilities for patients under 18
- The practitioner must consider the appropriateness of the cosmetic procedure for the patient who is under 18. The Board considers botulinum toxin and dermal fillers should not be prescribed for patients under 18 for cosmetic purposes.
Prescribing & administering schedule 4 (prescription only) cosmetic injectables
- Practitioners must know and comply with the requirements of their state or territory drugs and poisons (or equivalent) legislation for schedule 4 (prescription only) cosmetic injectables. For example, requirements relating to permits, prescribing, records, supply, storage and transport.
Patient management
- If the ‘prescription only’ cosmetic injectable is administered by another registered health practitioner who is not an authorised prescriber, the prescribing practitioner remains responsible for the management of the patient, including ensuring the patient receives appropriate post-procedure care.
Registration/Endorsement Standard: Details
The MBA has published a series of Q&As relating to the upcoming introduction of the new ‘registration standard for cosmetic surgery endorsement’.
When can I apply for a cosmetic surgery endorsement on my registration?
The registration standard for endorsement comes into effect on 1 July 2023. There are no approved qualifications yet. Applications for endorsement will be available when the standard is in effect and there are approved qualifications.
Who is eligible to apply for a cosmetic surgery endorsement?
There are no approved qualifications yet. Practitioners who have an approved qualification (from a set date) will be able to apply for an endorsement on their registration.
Can I apply for a cosmetic surgery endorsement with a ‘substantially equivalent qualification’?
To be eligible for a cosmetic surgery endorsement, applicants must have an approved qualification or another qualification that is substantially equivalent to an approved qualification. When there are approved qualification(s) for cosmetic surgery endorsement, the Board will provide information about the process for having a qualification assessed to determine whether it is another qualification that, in the Board’s opinion, is substantially equivalent to, or based on similar competencies to, an approved qualification.
Who can use the title ‘surgeon’?
Health ministers are progressing proposed amendments to the National Law to restrict which medical practitioners can call themselves ‘surgeon’ to medical practitioners holding specialist registration in surgery, obstetrics and gynaecology, or ophthalmology. Until the amendments are made, there is no restriction on who can use the title ‘surgeon’.
Will a medical practitioner who has cosmetic surgery endorsement be able to call themselves a cosmetic surgeon?
Once health ministers make proposed amendments to the National Law to restrict which medical practitioners can call themselves ‘surgeon’, only medical practitioners holding specialist registration in surgery, obstetrics and gynaecology, or ophthalmology will be able to call themselves ‘surgeon’. That means anyone else without the relevant specialist registration will not be able to call themselves ‘surgeon’, regardless of endorsement.
GP Referral Mandatory For Cosmetic Surgery
The MBA has also published a series of Q&As relating to the new requirement for a GP referral for cosmetic surgery patients from 1 July 2023.
What is the purpose of a GP referral for patients seeking cosmetic surgery?
Similar to any other referral, it will provide important medical information to the referred practitioner such as patient history, existing comorbidities, and medications. The GP can assess a patient’s physical and mental health – and it is also an opportunity for a patient to discuss their motivation for cosmetic surgery with an independent practitioner. It is expected it will support continuity of care and patient safety. A referral from a GP is therefore not a recommendation of a surgery or a cosmetic practitioner.
Which cosmetic surgery and procedures require a GP referral?
Only cosmetic ‘surgery’ requires a GP referral: Examples include breast augmentation, abdominoplasty, rhinoplasty, blepharoplasty, surgical face lifts, cosmetic genital surgery, and liposuction and fat transfer. ‘Non- surgical’ cosmetic procedures, such as cosmetic injectables, laser and thread lifts, do not require a referral.
Does the referral have to be from the patient’s usual GP?
It is preferable the referral is from the patient’s usual GP, as this will ensure it includes the patient’s relevant medical history and will assist continuity of care. However, the patient may choose an alternative GP if they wish.
Does the referral need to be from a GP or can another medical specialist refer?
While it is preferred that the referral is from the patient’s usual GP, it can be from another GP or other medical specialist (as long as they don’t provide cosmetic surgery or procedures themselves).
In the Guidelines, what does ‘the referring GP must be independent of the practitioner providing the surgery’ mean?
The referring GP and the practitioner providing the surgery must not:
- practise in the same clinic location or for the same employer/ business;
- have any financial relationship;
- be a close relative.
In the Guidelines, what does ‘the GP or other referring practitioner must not perform cosmetic surgery or non-surgical cosmetic procedures themselves’ mean?
A medical practitioner who provides cosmetic surgery and/or non- surgical procedures (whether full-time pr part-time) cannot refer a patient for cosmetic surgery.
A GP who provides non-surgical cosmetic procedures part-time/ in-addition to their usual general practice cannot refer a patient for cosmetic surgery.
What if the GP has limited knowledge of the requested cosmetic surgery?
The purpose of the referral is to provide information to the practitioner about the patient’s history. A discussion with the patient about their motivation does not require detailed knowledge of specific surgeries. The practitioner performing the surgery is responsible for providing information about the surgery. The Board does not expect GPs to have detailed knowledge of every cosmetic surgery. It is not their role to provide information about the proposed procedure.
Does the referral have to nominate a specific cosmetic surgery?
The referral should indicate the nature of the patient’s request, but the decision about which surgery is provided (if any) will be made by the patient and the practitioner performing the surgery.
Does the referral need to be a named practitioner?
Yes.
What should a GP do if a patient requests a referral to a named practitioner?
The GP can provide information about the doctor’s registration type (accessed from the Ahpra public register) and can provide advice/ information about types of medical practitioners, surgeons and medical qualifications. The referring GP is not responsible if the patient doesn’t like the practitioner they are referred to or has a poor outcome.
How does a GP determine which practitioner to refer to?
The Board doesn’t expect GPs to know all the practitioners who provide cosmetic surgery and which surgeries they provide. Practitioners providing cosmetic surgery must have appropriate training. The public register provides information about practitioners’ registration type (and will include cosmetic surgery endorsement once available).
Can the GP appointment for a referral be by telehealth?
The referring practitioner must have a ‘real-time’ consultation with the patient (in-person or by video) before a referral is made. In-person is preferred.
A referral that is based on a questionnaire completed by a patient without a real-time consultation is not acceptable.
Can the GP visit be charged to Medicare?
The Board does not determine how consultations can be billed or if a rebate is payable. Medicare is not payable for cosmetic surgery or procedures. However, Medicare Australia has advised that for a GP consult where the purpose is to assess an individual patient’s physical and mental health, help them make a decision and provide a referral, benefits would most likely be payable, provided the requirements of a relevant item are met.
What should the referral letter include?
The same as any other referral – at a minimum, the reason for the referral and relevant patient history.
Who is responsible for obtaining ‘informed consent’ for the surgery?
As per any surgery, the practitioner providing the surgery. The referring GP is not responsible for obtaining informed consent.
Who is responsible for the ‘psychological screening’ of the patient?
The Board’s Guidelines for registered medical practitioners who perform cosmetic surgery and procedures set out the Board’s expectations of the practitioner providing the surgery to screen patients for body dysmorphic disorder (BDD) using a tool. They must document the process and the outcome.
However, it is expected that the referring GP discusses the requested procedure with the patient and if there are indications of BDD or another similar condition, they would manage the patient as they would any patient who presented with such a condition.
It is expected that if the GP determines the patient has BDD or any other condition which would make them an unsuitable candidate for cosmetic surgery, the GP should not provide them with a referral for cosmetic surgery.
Who is responsible if the patient is not satisfied with the surgery or if something goes wrong?
The Board considers, as per any surgery, the practitioner providing the surgery is responsible for the surgical care and management of their patient, not the referring GP.
What does the medical practitioner providing the cosmetic surgery do if a patient does not want to get a referral and/or attends their appointment without a referral?
The cosmetic practitioner should decline to proceed with the consultation, as this is a requirement of the Board’s Guidelines. It is advisable that cosmetic practitioners should inform patients of the requirement for GP referral when a patient makes an appointment.
Does the cosmetic practitioner need to report back to the referring GP?
Yes, same as any other referral. AMP
Advertising Guidelines: Details
The cosmetic surgery advertising guidelines apply to ‘cosmetic surgery’ – defined as ‘operations that involve cutting beneath the skin and which revise or change the appearance, colour, texture, structure, or position of normal bodily features with the dominant purpose of achieving what the patient perceives to be a more desirable appearance’.
Examples include breast augmentation, abdominoplasty, rhinoplasty, blepharoplasty, surgical face lifts, cosmetic genital surgery and liposuction and fat transfer.
