ASAPS Tells Us: The ‘Cosmetic Surgeon’ Title Is Downright Dangerous

ASAPS has responded to the ACCS calling for Plastic Surgeons to stop their ‘cartel’ behaviour.

The conversation surrounding the confusing and somewhat misleading titles used in the medical aesthetics industry continues. The ACCS recently announced their move to lobby the Australian Government to bring clarity and reform for all medical practitioners providing cosmetic surgery.  

In response, Dr Robert Sheen, President of ASAPS, has provided SPA+CLINIC with the following exclusive commentary:

“Today’s cosmetic surgery market is complex and confusing. Consumers are overwhelmed by a deluge of information and made-up titles. Many of these made-up titles are misleading and do not clearly state the recognised skills and training required by law. These potentially unsafe, unregulated, and even illegal practices may compromise patient safety and mask an inability of the practitioner to deliver high-level results. 

ASAPS is extremely concerned that Australian consumers continue to be misled by practitioners who self-label as ‘cosmetic surgeons’. Our members, who are registered as Specialist Plastic Surgeons, are seeing the adverse impacts of this misleading activity every day. 

At best, patients present to us to correct the unfavourable consequences of poorly performed surgery. At worst, patients experience devastating complications with life-threatening health implications.

The title ‘cosmetic surgeon’ indicates to patients and the public that these practitioners do have specialist training of some kind. How can consumers make informed decisions when practitioners use misleading titles? 

• Australians believe it is wrong that doctors without any surgical training are allowed to call themselves surgeons
• 81% of Australians agree that the title ‘cosmetic surgeon’ implies that the doctor is a registered specialist

There are countless examples of patients who have experienced harm as a result of being misled by an unregulated title. This is a huge cause for concern. This is not a turf war. This is a rallying cry from patients that is echoed by ASAPS: practitioners must tell the truth about their qualifications. We are not telling these unregulated practitioners to stop performing surgery. We are asking them to tell the truth. What reason could a practitioner have for not telling the truth to a patient?

We know that not holding specialist registration does not mean a medical practitioner is not able to perform any services within a particular speciality. There are countless dedicated practitioners in remote and rural areas who provide valuable surgical, anaesthetic, and obstetric services to their communities. They deserve praise and support for their significant contributions to patient welfare.

The issue is that practitioners who refer to themselves as ‘cosmetic surgeons’ are usually practicing in urban environments that are well served by qualified, registered specialists. Unfortunately, the made-up title of ‘cosmetic surgeon’ is understood by reasonable Australians to indicate that these practitioners have specialist qualifications to provide those services. In reality, they do not.

Not only is this in clear breach of section 118(1)(b) of the National Law, as we have highlighted in our recent submission to the Senate Inquiry into AHPRA, but it is a clear breach of ethics and a duty of care. Practitioners must not mislead patients with titles like aesthetic or cosmetic surgeon, as the disgraced former doctor Les Blackstock did. 

• 92% of Australians agree that a patient’s safety is put at risk when a doctor performs surgery without having completed surgical training
• 93% of Australians agree that it would be easy to separate ‘registered surgeons’ from ‘unregistered surgeons’ if all doctors used only their AHPRA title, or included FRACS at the end of their title.

ASAPS is addressing the widespread deception of patients who go on to experience harm, through the following:

• Calling on practitioners to not use misleading titles, and to tell the truth about their qualifications so that the patient can make an informed choice.
• Urging AHPRA to exercise its responsibility to ensure consumers are not misled and can make informed decisions that consider their safety and wellbeing, and patient outcomes.
• Educating the consumer to know the difference between a registered specialist plastic surgeon and someone using an unregulated title. Patients should be able to rely on the ethics of practitioners and expect that AHPRA would enforce Australian law and protect the public from harm before it occurs.

1. Section 118(1)(b) of the National Law states:

118(1) “A person who is not a specialist health practitioner must not knowingly or recklessly:

(b) take or use a title, name, initial, symbol, word, or description that, having regard to the circumstances in which it is taken or used, indicates or could be reasonably understood to indicate –

(i) the person is a specialist health practitioner; or 

(ii) the person is authorised or qualified to practice in a recognised speciality. 

Only practitioners who have completed an additional eight to 12 years of specialist surgical training, beyond their medical degree, can lawfully use the title Specialist Plastic Surgeon. Specialist training is provided by the Royal Australasian College of Surgeons (RACS), a college that is accredited by the Australian Medical Council. The AMC’s task is to ensure the highest educational standards. It is completion of this world class level of training that qualifies RACS for specialist registration.

Yet, the use of the title ‘cosmetic surgeon’ is often interpreted to indicate that the practitioner is a registered specialist. This is clearly not the case. Unfortunate patients only discover this once the harm has occurred.

The point is that when considered in the circumstances in which it is used, that is to inform patients of a practitioner’s medical qualifications and expertise, the title ‘cosmetic surgeon’ is highly deceptive. It does imply that the person is a specialist health practitioner and is qualified to practice in a recognised speciality.

AHPRA needs to exercise its responsibility to ensure consumers are not misled and can make informed decisions that consider their safety, wellbeing and outcomes.

1. The Explanatory Note of the National Law tabled in Parliament makes it clear that the purpose of section 113 and the titling provisions is:

“to protect members of the public by ensuring they are not misled. Specifically, the intent is that if a person uses a title that suggests the person is registered in a health profession under the National Law, a member of the public may be confident that the person is in fact registered under the law and therefore appropriately qualified and competent to practise the profession”.

By being denied complete knowledge of their practitioner, patients are making poorly informed choices. These poor choices frequently result in patient harm. Since the practitioner has privileged knowledge of their training, skills and registration status, the practitioner has a power imbalance that can facilitate the provision of misleading information to the patient. This constitutes a significant breach of trust in the doctor patient relationship. Unethical behaviour which can lead to catastrophic outcomes.”

We will continue to report on this matter as further development unfolds.

What do you think? Should the term ‘Cosmetic Surgeon’ be banned altogether? Let us know in the comments.

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