02.A non-regulated industry
Regulation of the industry
While most practitioners regularly describe themselves as either plastic surgeons or cosmetic surgeons, in some cases the difference can be up to eight years of additional training for plastic surgeons. Despite the popularity of cosmetic procedures and increasing competitiveness of the industry, in Australia there is no regulatory body. Instead, there is a range of medical colleges and associations all claiming to offer training and qualifications for doctors providing a range of cosmetic procedures.
Currently, any medical doctor or specialist can perform cosmetic procedures, as it is not recognised as a medical specialty by the Australian Medical Council. However plastic surgery is recognised as a specialty, and members of the Australian Society of Plastic Surgeons are highly trained, members also of the Royal College of Surgeons, and perform both reconstructive and cosmetic procedures. The non-regulation of this growing area of cosmetic medicine is compounded by profuse marketing, following the legalisation of advertising for medical practitioners in 1994.
In 1999, the NSW government commissioned an inquiry into the cosmetic surgery arena; 10 years later, most of the subsequent key recommendations have still not been implemented.
Who should I choose?
In this fiercely competitive industry, CHOICE discovered intense rivalry between the two main industry associations, the Australian Society of Plastic Surgeons (ASPS) and the Australasian College of Cosmetic Surgery (ACCS). Both vehemently put their case to us, but it is up to consumers to decide which is the best option for them. Plastic surgeons undertake a minimum of seven years of additional training once they have obtained their medical degree and most likely become members of the ASPS, which provides specific guidelines to which practitioners must adhere.
Plastic surgeons are also Fellows of the Royal Australasian College of Surgeons, which awards them the status of specialist. The ASPS claims many doctors without specialist training are doing complex cosmetic surgery procedures and advertising themselves as leaders in their field. ASPS President Dr Howard Webster says there is nothing illegal about a GP undertaking surgical work so long as they disclose that information to the patient, but stresses the benefits of specialist training. ”If you train in a certain area then you should probably work in that area. You would probably use an orthopaedic surgeon to do hip surgery on you instead of a GP.”
Cosmetic surgeons The Australasian College of Cosmetic Surgery (ACCS) was established in 1999, stating that its purpose is to fill a gap by providing training and representation for a range of doctors with varying qualifications who have an interest in cosmetic surgery. To qualify as a Fellow of the ACCS, members must be “at least five years postgraduate” and have worked for a minimum of three years in a surgical environment. The college then provides two years of specialist training, and members are audited annually. ACCS President Dr Daniel Fleming argues that “cosmetic surgery is already an area of specialised practice and the only area of medicine practised by a range of doctors from diverse specialty groups from GPs, dermatologists to ear nose and throat specialists, all of whom are united by the fact they conduct cosmetic medical practice”.
In late 2008 the ACCS announced it would be mandatory for its members to disclose how many times they had performed a particular procedure at the initial consultation, if fewer than 100 times. It is also awaiting a decision on an application it made in 2007 to the Australian Medical Council to have cosmetic surgery recognised as a medical specialty. In the meantime there have been a few small positive developments for consumers, with the Victorian government banning “before” and “after” photographs in advertising, while in Queensland the term “surgeon” can only be used by Fellows of the Royal Australasian College of Surgeons. While both major industry associations (ASPS and ACCS) have their own guidelines, as does the NSW Medical Board, these are not enforceable.
Update: Draft code for Australasian College of Cosmetic Surgery rejected by ACCC
Since our initial research, the Australian Competition and Consumer Commission (ACCC) has signalled it will deny authorisation for a code of practice and bylaws developed by the ACCS. In its draft determination the ACCC says it has concerns that a number of clauses in the College's code are not effective.
The ACCC says that it considers that the code in its current form is underdeveloped, and encourages the College to further develop the code with a view to addressing the concerns raised which include transparency for external appeals, a robust and well promoted complaints process and for members to provide sufficient information to patients regarding qualifications, credentials and experience.
The ACCS has 3 weeks to re-submit this application and has indicated that it is willing to work with the ACCC to further develop the code.