The final report from the Independent review of the regulation of medical practitioners who perform cosmetic surgery has now been released.
- Cosmetic surgery practitioners will be policed by a dedicated enforcement unit for the first time in Australia as part of an industry-wide crackdown by Ahpra, the national regulator.
- The $1 billion industry will undergo significant reform after an independent review highlighted misconduct.
- The Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia have agreed to implement the recommended changes to strengthen industry regulations and improve patient safety.
- The inquiry, led by former Queensland Health Ombudsman Andrew Brown, found unsafe practices, misleading advertising and substandard marketing across the cosmetic industry.
- When it comes to cosmetic surgery, universal minimum standards for education, training and qualifications are non-existent in Australia.
The report, which follows a six month examination of the regulation of the sector including through a public consultation, makes 16 recommendations to improve patient safety in the sector.
Ahpra and the Medical Board have accepted all 16 recommendations and vowed to establish a Cosmetic Surgery Enforcement Unit to take action alongside the medical board, which is backed by a $4.5 million investment for extra resources.
The review’s 16 recommendations to improve community safety includes introducing an “endorsement” process under national law to establish expectations about minimum qualifications for medical practitioners wishing to perform cosmetic surgery.
Other recommendations include improving the way Ahpra and the Medical Board manage cosmetic surgery notifications, and implementing a targeted education campaign to stop the under-reporting of safety issues.
Concerns around misleading advertising could also be addressed by strengthening the advertising guidelines and taking stronger enforcement action against practitioners who breach the regulations, including on social media.
Whether the term ‘surgeon’ alone should be a protected title (and therefore only be permitted to be used by specialist surgeons) is currently under consideration by the Ministerial Council and outside the scope of this review.
Ahpra and the Medical Board’s response to the review
The Medical Board and Ahpra have accepted all 16 recommendations to improve patient safety in the cosmetic surgery industry.
Backed by a $4.5 million investment for extra resources, Ahpra will establish a Cosmetic Surgery Enforcement Unit to work with the Medical Board to:
- Set clear standards: We want to make it easier for consumers to know who is trained and qualified to do cosmetic surgery safely. As the review recommends, we 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. If Ministers change the Law to protect the title ‘Surgeon’, then only doctors with AMC-accredited qualifications could be called Cosmetic Surgeons in future.
- Crackdown on advertising: Enforce a ban on testimonials that mislead and deceive consumers and trivialise risk, by cracking down on advertising and social media used to promote cosmetic surgery. We will update and enforce advertising restrictions and use new technologies to audit social media, backed by tougher regulatory action.
- Tackle under-reporting: Not one of the serious matters featured in recent media coverage was reported to Ahpra by a medical practitioner before it was broadcast, even though many doctors and nurses provided patients with much needed follow up care. Silence allows poor practice to go unchecked and this harms patients. No doctor wants that. We will encourage reporting of patient harm in the cosmetic industry so we can act more quickly to keep patients safe. We 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: We will target the misuse of non-disclosure agreements (NDAs) to gag consumers in the cosmetic industry. We will launch a campaign to remind consumers that honest disclosure to regulators is legal and their right when things go seriously wrong. We will also set up a confidential hotline 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. We will be stepping 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. We will require practitioners 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: We will change how cosmetic surgery complaints are handled in a bid to remove dangerous doctors more quickly. We will centralise experience and establish a national team of regulatory experts 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: We will work 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. We look forward to action from jurisdictions to address these issues.
Governance and oversight of this work will be sharpened by a Cosmetic Surgery Oversight Group. This Group will report publicly on progress and assure the community, governments and professional stakeholders that we are doing what we have committed to do, as quickly as possible.
Overview of the Independent review of the regulation of medical practitioners who perform cosmetic surgery
The independent review was commissioned by the Australian Health Practitioner Regulation Agency (Ahpra) and the Medical Board of Australia (the Medical Board) in November 2021, in the wake of media reports that raised various concerns about alleged conduct of some medical practitioners in the sector. Mr Andrew Brown (former Queensland Health Ombudsman) was appointed as the Independent Reviewer, alongside an Expert Panel comprising Conjoint Professor Anne Duggan (Chief Medical Officer, Australian Commission on Safety and Quality in Health Care), Mr Alan Kirkland (CEO, CHOICE) and Ms Richelle McCausland (National Health Practitioner Ombudsman). The review formally began in mid-January 2022 and submitted its report in August 2022. The review examined the regulatory approach of Ahpra and the Medical Board to medical practitioners who perform cosmetic surgery with a focus on consumer safety and made recommendations about actions that will better protect the public.
