Review of cosmetic surgery outlines 16 areas to improve patient safety

01 Sep 2022

Under the terms of reference, the review’s focus was on the existing system of health practitioner regulation and what is possible under the current law (known as the National Law). 

Independent reviewer, Mr Andrew Brown, said: ‘The review noted that the cosmetic surgery industry challenges the traditional surgical specialist model, with the industry largely sitting outside existing health systems and frameworks that offer safeguards to the public.’  

‘While the problems are relatively easy to identify and define, the solutions are much more complex. The unique nature of the cosmetic surgery sector poses regulatory challenges not normally experienced in other areas of medical practice and calls for more unique solutions,’ Mr Brown said.

The review found that there are no universal minimum standards for education and training in relation to cosmetic surgery and thus it is possible for any medical practitioner to perform invasive cosmetic surgical procedures irrespective of whether they have received appropriate training or have amassed sufficient supervised experience to reach an acceptable level of competency.  

‘In this environment consumers are largely left on their own when it comes to selecting a practitioner to perform cosmetic surgery, having to sift through a plethora of advertising and marketing material and try to make sense of numerous qualifications, in an attempt to identify a qualified and competent practitioner. This is not good enough,’ Mr Brown said. 

The review has made 16 recommendations for action that Ahpra and the Medical Board can take to improve patient safety, within their sphere of influence and under the current legislative framework. 

Recommendations include the use of an ‘endorsement’ process under the National Law to establish expectations about minimum qualifications for medical practitioners wishing to perform cosmetic surgery. An ‘endorsement’ recognises that a person has an extended scope of practice in a particular area because they have obtained a specific qualification that has been approved by the Medical Board. The education program(s) leading to the qualification must also be accredited by the Australian Medical Council. An endorsement in cosmetic surgery will allow consumers to easily identify whether a doctor is appropriately qualified. 

Other recommendations include:

• improving the way in which Ahpra and the Medical Board manage cosmetic surgery notifications (including through developing training and guidance material for staff specific to cosmetic surgery notifications to ensure they are consistently and appropriately managed and the risk assessment methodology is rigorously applied)
•  undertaking a targeted education campaign directed at health practitioners to address the significant under reporting of safety issues in the sector
• strengthening the advertising guidelines and taking stronger enforcement action against practitioners who breach the regulations including on social media 
• enhancing guidelines to set clearer practice expectations for medical practitioners who perform cosmetic surgery (including in such areas as preoperative screening, informed consent and post-operative care).

You can read the full key findings here. 

Mr Brown thanked the expert panel and all those who contributed to the review.

Background

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 undertook a public consultation stage which included releasing a consultation paper seeking written submissions from stakeholders, as well as an online survey aimed at consumers of cosmetic surgery. Public consultation ran for six weeks from 4 March to 14 April 2022, and resulted in 249 written submissions and 595 survey responses. Further targeted consultation was undertaken through the establishment of a Technical Advisory Group (which included for example representatives of specialist plastic surgeons, specialist general surgeons, specialist dermatologists, specialist anaesthetists, specialist general practitioners and cosmetic surgeons) and a Consumer Reference and Advisory Group (which included consumer representatives and experts in relevant fields), as well as consumer focus groups, and meetings with many individual stakeholders. 

Further information

• Full report
• Submissions
• Background to review

Contact us

csreview@ahpra.gov.au 

* Please note: The review and consultation were titled Independent review of the regulation of health practitioners in cosmetic surgery. However, the report is named Independent review of the regulation of medical practitioners who perform cosmetic surgery to better reflect the scope of the review and its recommendations.