I was interviewed alongside two leading voices in plastic and cosmetic surgery on 2SER
I recently was interviewed by 2SER’s The Wire (‘New Endorsement Model for Cosmetic Surgeons in Australia‘) in a program covering the newly proposed regulation of cosmetic surgeons through an endorsement model. The recent acceptance by the Health Ministers of the proposed endorsement model follows the production of an independent report commissioned by AHPRA and the Medical Board of Australia last year, which recommended the same.
However, another reform was also proposed and accepted — as a separate matter — in a decision of the Health Ministers in Febrary (effectively the Ministerial Council for the purposes of the relevant Health Practitioner Regulation National Law (NSW) (‘National Law‘)). That was a proposed reform to make the title ‘surgeon’ a protected title.
Though details of the relevant Bill, titled the Health Practitioner Regulation National Law (Surgeons) Amendment Bill 2023, are not yet published, the effect of this reform would be, I presume, to add the title surgeon to the list of protected titles that currently appears in a Table (see below) under section 113 of the National Law.
At the moment, there are a number of titles protected under this section 113 Table for each of the 15 health professions. However, only ‘medical practitioner’ appears as a protected title within the category of medical practitioners. Presumably, the title ‘surgeon’ would be added here. (Interestingly, the term ‘dental surgeon’ is also not specified in this statutory table next to dentists; although certain restricted dental acts are specified under section 121.) The table appears in the National Law as below:
Given that the titles in the above table require a parliamentary amendment to change, they may be regarded as a ‘durable’ list of titles that strictly cannot be used without the relevant legal authorisation: namely, registration from AHPRA and the relevant health practitioner board.
Below this level of ‘strict’ or ‘durable’ regulation, however, there are a number of ‘specialist registrations’ that various health professionals may qualify to hold, including in medicine, dentistry, and even surgery. These specialist titles for surgery are also currently restricted — even though the general term ‘surgery’ is not. And you need to hold a ‘specialist registration’ to use them. And so, through this regulatory arrangement, a registered medical practioner with simply a general registration can currently call themselves a ‘surgeon’; however, that practitioner will need a specialist registration (with special training) to call themselves a ‘specialist orthopaedic surgeon’ or ‘specialist plastic surgeon.’
In terms of regulatory reform, however, it could be said that these specialist titles in surgery — just like all the specialist titles — are a bit less durable, or alternatively more agile, than those named in the primary Act. That’s because you do not need to change the primary law by amendment to change these. They can be changed when AHPRA recommends that a specialty should be recognised to the Health Ministers and the Health Ministers agrees.
And it would arguably be quite burdensome for Parliament to have to amend the National Law (namely, the table under section 113) every time the Health Ministers decided that a new specialist registration should be recognised and its use, as a title, restricted. Thus, the currently restricted specialist titles are not housed in the primary Act but are instead identified by the Medical Board of Australia here. The relevant part of this list for surgeons is reproduced below:
Importantly, however, the Health Ministers, or the Ministerial Council, is the body that approves what new specialist registrations are possible under the relevant sections of the National Law: namely, section 13(2) of the National Law. Once the specialist registration is approved, the Australian Medical Council (the practitioner training accreditor) and the Medical Board of Australia (the regulator of medical practitioners) then use guidelines (published in 2018) to ensure that anyone who seeks and holds such a specialist registration has undergone the relevant accredited course of training.
Notably, when the title ‘surgeon’ is protected, this appears to create protection for a more capacious or extensive rage of practitioners than ‘cosmetic surgeons.’ Indeed, the term ‘cosmetic surgeon’ will not be a specialist registration for a surgeon, and so it will not be protected. Rather, the more general term ‘surgeon’ appears to be proposed as the one that will be protected, and this may have strange ramifications for those who are practising cosmetic surgery. Presumably, there will be an exception that says ‘cosmetic surgeons are able to use the title ‘surgeon” when it is used in the full title ‘cosmetic surgeon.’
However, to make this make sense, the so-called ‘endorsement’ model will have to be created so that ‘endorsed’ cosmetic surgeons will be able to use the title in this way (as an exception) only. If any medical practitioner who performs cosmetic surgery is able to use the title surgeon as they describe themselves as a ‘cosmetic surgeon’ — even if they do not have an endorsement — then the title protection will be otiose.
This takes me to the first point I raise in this interview: namely, whether the ‘endorsement’ model will require registered medical practitioners who perform cosmetic surgery to be endorsed, or whether it will simply be a ‘nice to have’ — so that health consumers can feel better guided by the accreditation standard signalled by their chosen practitioner’s endorsement in the area of cosmetic surgery. I think this gets addressed in my analysis above. What I suspect will happen is that ‘endorsed’ cosmetic surgeons will have an entitlement to call themselves ‘surgeons’ without liability of penalty. The current example of this is the case of acupuncturists, which also have an endorsement model.
Under section 114 of the National Law, there is a carve out for acupuncturists that permits them to use the title without any liability:
As can be seen in the provision above, the acupuncturist can only call themselves an acupuncturist if they have an endorsement under section 97 of the National Law, as follows:
I suspect we will see similar provisions inserted into the National Law for cosmetic surgeons, although it could be that cosmetic surgeons are covered by the catch-all provision for certain areas of practice under section 98 (‘Endorsement for approved area of practice’) and regulations take care of clarifying that a cosmetic surgeon is an approved area of practice. However, in my view, the legislature should mirror the acupuncturist provisions to make the reform abundantly clear and durable.
The other point I make at the end of the interview related to the resolution of the so-called turf war that has been long running between ‘untrained’ cosmetic surgeons and those who have significant training — the plastic surgeons and others who are fellows of the Royal Australasian College of Surgeons.
Obviously, I am relatively neutral in this debate, not being from either camp. However, I was sandwiched, as it were, between the leading voices from each camp in this interview, which made it an interesting result, given that I had no idea that these other interviewees would be taking part. Luckily, I did not take sides inadvertently, and, perhaps as some kid of reward, was gifted a few minutes’ exclusive commentary at the end of the report.
Please let me know if you have any feedback on my take below or on Twitter.