Cosmetic medicine is about to have a facelift, with major changes looming for the lucrative industry – but will GPs be unfairly targeted?
Cosmetic medicine in Australia is set to receive a major facelift, following AHPRA’s announcement that it will review the multimillion-dollar industry.
The largely unregulated sector is currently under massive scrutiny following the recent Four Corners program Cosmetic Cowboys, which ‘uncovered allegations of disturbing practices’ at the cosmetic clinics of Dr Daniel Lanzer.
The fallout from the report has been swift.
Head cosmetic surgeon and dermatologist by training Dr Lanzer has announced he will stop practising medicine in Australia.
Meanwhile, senior associate Dr Daniel Aronov – who had the largest social media presence of any cosmetic doctor in the country before deleting his TikTok account – did not escape unscathed either; he has been banned by AHPRA from performing cosmetic surgery and also had a number of conditions imposed on his medical registration.
Dr Aronov is a GP by training and obtained Fellowship in 2017. However, it is interesting to note that in addition to being banned from cosmetic medicine and surgery, the restrictions imposed on his practice all relate to his ability to work as a GP.
He is no longer able to work in general practice unless supervised and must ‘consult and follow the directions of the supervisor about the management of each patient before care is delivered and must be directly observed by the supervisor who is physically present at the site of practice at all times’.
It is unclear if Dr Aronov had continued to work as a GP while working with Dr Lanzer, but the fact that the restrictions imposed also affect his trained specialty should come as a warning for GPs.
Unlike Dr Aronov, the remainder of Dr Lanzer’s associates – most of whom it appears are not sub-specialised in any field including general practice – have so far managed to avoid a public trial by media and AHPRA.
While there is no denying the actions of Dr Lanzer and Dr Aronov necessitate review and action, especially in light of one of Dr Aronov’s patients ending up in ICU with post-operative haemorrhage following liposuction, GP and cosmetic doctor Dr Imaan Joshi believes ‘GPs are again being dragged through the mud because of the actions of a handful of people’.
‘The main issue here is that a lot of un-Fellowed doctors are increasingly branching out into aesthetics,’ she told newsGP.
‘There is no denying Dr Aronov did the wrong thing, but why is the GP the default scapegoat? Why is there not a stronger focus on the un-Fellowed doctors?’
Dr Joshi fears the recent media coverage naming and shaming Dr Aronov could impact the public’s confidence in general practice.
‘There has been a gentle erosion of the GP’s reputation for some time,’ she said.
‘GPs have now dropped below nurses, paramedics and pharmacists as to how trustworthy we are in the public eye. Despite there being 40,000 of us, if a few of us go rogue, we all suffer.
‘We [GPs] seem to be the punching bag for media anytime something happens and in this case, it appears Dr Lanzer’s un-Fellowed associates have continued to operate even after he gave a binding agreement not to practice medicine in Australia.
‘Surely common sense and ethics would dictate that in the wake of such a devastating expose, all staff would press pause and reflect on what went wrong and how to avoid it in future.
‘Instead, they seem to have continued operating and within weeks the most prolific one lands himself in trouble and happens to be a Fellow of general practice.’
The RACGP previously raised concerns about the unregulated industry back in 2015 in a letter to the Medical Board of Australia.
In it the college states it would support action to ‘strengthen current guidance for medical practitioners providing cosmetic medical and surgical procedures through new practice-specific guidelines that clearly articulate the Board’s expectations of medical practitioners’.
The Medical Board subsequently released their guidelines in 2016.
The college also acknowledged in the letter that the training backgrounds of those performing cosmetic procedures differ and so suggested it would be beneficial if the industry could agree on a delineation of services according to the complexity of procedures.
AHPRA’s latest announcement should be of particular interest to GPs currently working in the sector given that many cosmetic procedures such as injectable Botox and collagen treatments are often performed by a beautician or nurse, even if it is under the supervision of a GP.
‘It’s about time [for change] and I hope AHPRA investigate non-surgical procedures too,’ Dr Joshi said. ‘Many are now training in nursing for example to get straight into injectables.
‘Junior doctors are also opting to do aesthetics on the side or bypassing training programs to do aesthetics on a mobile basis. The entire industry needs an overhaul.
‘I think there should be a minimum of five years training as a nurse or doctor to be able to operate independently in a regulated cosmetic sector.’
While there are still many unknowns ahead, it is clear that the industry needs reform.
However, this reform should not come at the expense of the GPs reputation, especially those working in the sector ethically and within current guidelines.
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