You have probably all now seen or heard about the story on A Current Affair that aired January 11, 2021. The story focused on adverse events resulting after procedures including cool sculpting and LASER. An incident was highlighted where horrific burns and long term consequences resulted from improper and inappropriate use of a Cryo chamber.
The story whilst shocking was not informed by consultation with professional bodies that can speak for those that were targeted by this story. Of concern there were claims made the medical profession seeks regulation to have “medical” procedures only in the hands of medical (AHPHRA regulated) practitioners.
Should these procedures be performed only by medical professionals?
The Issue is not whether medical or non medical professionals should be performing the treatment. Rather the question is do they have the depth of knowledge, level of critical thinking and relevant training and experience required to assess risks, prevent or manage any complications associated with these procedures. This includes energy devices, skin penetration procedures and medical grade cosmeceutical skin products.
There are “non medical” health professionals that have completed 3 or 4 year health science degrees as skin health professionals. Specifically they have specialisation in performing non surgical minimally invasive ‘medical?’ procedures on the skin.
This requires expert knowledge of the mechanism of various technologies and energy devices as well as tissue interactions to achieve desired outcomes and prevention of skin damage. It also requires proficiency during their study by completion of many clinical hours under supervision in performing techniques so that treatments are both safe and effective for the Australian public.
Medical professionals whilst definitely qualified to understand risks and to manage the complications are not, as part of their medical degree taught extensively about skin or performing non surgical procedure using these technologies. Both nurses and doctors should, and do, undertake appropriate post graduate training. These medical specialisations have their own challenges with recognition and regulation of what education and training allows them to use titles such as cosmetic physician, surgeon or nurse.
Is regulation required?
In Australia there is a who dares can attitude among a small number of both medical and non medical practitioners that damages the reputation of the vast majority of practitioners who are ethical, patient centred and apply evidence based practice.
The ASDC agree regulation is required. This is common ground between medical and non medical professions. It’s required to protect the public from unscrupulous providers of substandard short course education. It’s required to protect against companies that don’t concern themselves with who has the device or product they sell, or if they have the education and training required to use it safely. It’s also required for those very, very few non medical and medical individuals who practice outside their scope or dance along the margins because “nothing says they can’t”.
To say that the industry is not regulated at all is not accurate. There are professional bodies that align with dermal (skin) science and therapy performing aesthetic/cosmetic procedures. Members of these organisations are provided with guidance and expectations regarding scope of practice, continuing education, use of titles and information about practice based on current evidence and best practice.
Educational institutions that offer bachelor level qualifications have to demonstrate to accrediting bodies they have processes to ensure curriculum is robust, evidence based and complies with all industry, government, profession and institution based regulatory requirements.
The ASDC are an affiliate member of Allied Health Professions Australia (AHPA) in recognition of their status as an emerging health profession that is evidence based and meets the benchmark standard of representing university qualified allied health professionals.
The problem does not lie in medical or not medical. The real problem is a lack of regulation and recognition of the duration, depth, level and relevance of education required to operate in this specialisation and how this relates to scope of practice
The problem lies in a current lack of recognition and protection for emerging health professions that are trained to manage skin health and the most common skin conditions.
Beautician and Beauty Parlour title is it obsolete?
The problem also lies in the continued use of antiquated titles such beautician and beauty parlour. These terms are used to cover everything from beautification procedures to minimally invasive non surgical cosmetic procedures.
These terms are often used in a quite derogatory manner especially in instances such as the A Current Affair story but examples were also noted with industry classifications during COVID-19. The government currently lumps everyone from Cert III qualified beauty therapists to University qualified Dermal Clinicians under the same categorisation.
These terms “beautician and beauty parlour” have no relevance and should not be applied to those that perform non surgical cosmetic/medical procedures whether this be in dermal therapy, cosmetic clinics or other medical and healthcare settings. It’s time that categorisation and descriptions of the "beauty/cosmetic" industry are updated. The titles dermal clinician, dermal therapist must receive Industry endorsement, be accepted, respected and consistently used so that are only used by those endorsed to use them through recognised education and training.
The importance of non-medical (allied health) skin health professions
With the health problems facing Australia in the years to come and projected potential shortages in the medical workforce, allied health is going to play a larger role in preventative health reform and management of common conditions related to their scope.
Dermal Clinicians play an important role in the early detection of skin disease and disorder, assisting Australians to age well and healthily. Dermal clinicians can manage common skin conditions to prevent further deterioration and subsequently assist with improving mental health caused by the burden of skin disease and disorders. The government has a 10 year reform plan that integrates allied and medical health services.
The ASDC response to treatment warnings by Australian doctors.
The ASDC are lobbying government for greater recognition and respect for what Dermal Clinicians and Dermal Therapists can do and the education and expertise we hold.
We are lobbying for regulation that respects the education and expertise that is required to both manage and perform these procedures.
We are lobbying for this to be based not only on medical or not medical education, but who is most qualified in that area of specialisation. Just like in many other health areas where there is overlap in scope of practice.
You wouldn’t want a GP or nurse doing your X-ray, performing spinal manipulation or compounding your medications because they are medically trained. Medical professions definitely understand the risks and can manage complications associated with these, but all these ‘dangerous’ procedures are performed by trained experts in these specialisations.
We will be lobbying government to ascertain if government regulation is being revisited.
We will be working to develop consensus and understanding with other stakeholders in these discussions should this be the case.
We will continue on our path to being recognised as a self regulating allied health profession and ordinary member of AHPA by 2024.
What part can industry play in preventing these adverse events?
If you aren’t a member of the ASDC or other professional bodies become one. This is an important way to stay informed and to seek advice.
If you are considering taking on a new device or procedure or have a “medical grade” device or product, ask yourself the following questions. What is the worst that can go wrong? Are my employees/am I adequately trained to prevent this from happening? Can a wide range of people be treated safely and effectively by using clinical reasoning to adapt treatment when required? Do we know when not to perform the procedure and why? If something does go wrong are we educated and trained to manage this ourselves?
If the answer is no to any of those questions don’t perform the procedure, it’s not in your scope of practice. Refer to someone who can that has the qualification and expertise required.
If you are looking for a dermal Clinician or therapist contact the ASDC.
Post edited 15/1/2021 to amend title beautician and beauty parlour title obsolete.
The ASDC advocate that all skin health practitioners have a place in client management relevant to qualifications and scope of practice.
We advocate for cross referral among skin practitioners who perform services related to education and training. This heading was not intended to anyway demean those that use the title beautician. Rather to highlight re-classification (government) of the beauty and cosmetic sector is required so that the public understand titles currently used in relation to education and scope of practice.
On behalf of the ASDC General Committee