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Ontario FPs can still
perform liposuction under new rules, but cannot
use the title "cosmetic surgeon"
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Ontario's medical community was
shocked last September when Krista Stryland, a young
real estate agent, died after receiving liposuction
at the clinic of a North York FP who advertised herself
as a cosmetic surgeon.
Ms Stryland's death shocked the
province's regulatory body into action. After months
of deliberation, the College of Physicians and Surgeons
of Ontario (CPSO) responded to calls from physicians
and the public alike for tougher regulations on who
is and isn't allowed to call themselves a surgeon. The
new regulations, released early last month, seek to
bar anyone not designated as a Fellow of the Royal College
of Surgeons of Canada (FRCSC) from advertising themselves
as such.
THE
LOWDOWN
Besides restricting the use of the title "surgeon" and
the word "surgery" by doctors without FRCSC credentials,
any material that advertises, promotes or describes
the medical services provided by a physician who isn't
recognized as a specialist cannot carry similar phrases
or descriptions like "cosmetic surgery." To do so is
now considered professional misconduct. Punishments
will be decided on a case-by-case basis, says Jill Hefley,
the associate director of policy and communications
for the CPSO.
Not everyone is satisfied with
the changes, however.
Dr Thomas Bell, a plastic surgeon
and past president of the Canadian Society for Aesthetic
Plastic Surgery, told CTV's Canada AM that the
reform doesn't go far enough. "The problem with it is
it falls short in the fact that it still allows the
non-surgeons to do surgery," he said.
He was referring to a stipulation
in the new guidelines that says if a GP or FP has taken
courses to expand their scope of practice and gone through
the College's application process — meaning they've
found a physician in a similar field to supervise and
evaluate their progress — they can continue practising
cosmetic surgery procedures so long as they don't advertise
it.
Ms Hefley responded to Dr Bell:
"You have to start with a process and set the standard,
saying this is the policy and our expectation. Only
then you can take it to the next step."
Dr Andrew Padmos, CEO of the Royal
College of Physicians and Surgeons, supported the steps
to standardize and reduce any confusion about who should
be called a surgeon. "The Ontario College took appropriate
and timely action to focus on individuals who aren't
trained as surgeons." Dr Padmos encouraged other Colleges
to do the same. In fact, Nova Scotia's College of Physicians
and Surgeons has already pledged to do so within the
next year.
RISKY
BUSINESS
All surgery is risky. Patients can develop complications
ranging from pneumonia to stroke, heart attack and blood
clots in the legs or lungs. Fluid or blood can collect
beneath the wound and have to be drained or removed
and excessive bleeding could require a transfusion.
The FP who performed Ms Stryland's
liposuction had trained in a number of courses on how
to perform specific procedures. Surgeons, however, must
train for at least five years and pass a number of examinations
before being licensed to do operations.
"When we go through our
surgical training, we're learning the basic techniques
of surgery and the principles of surgery," Dr Bell told
CTV. "You can learn a specific technique but it's a
matter of understanding - avoiding problems, how to
deal with problems."
With the CPSO's recent decision,
the total number of provinces that have any guidelines
limiting non-surgeons doing cosmetic surgery is now
four. Ontario's regulations are still not as stringent
as those in BC, Alberta and Quebec where doctors are
prohibited from performing invasive procedures unless
they are a registered plastic surgeon.
The CPSO isn't done making changes,
however. This month, the CPSO is considering more regulations
to ensure out-of-hospital facilities are safe for the
public by creating an inspection system to begin evaluating
the quality of all facilities that do procedures delivered
under certain kinds of anesthetic.
The CPSO also decided last month
that from now on physicians are going to have to start
being forthright with information that some might consider
personal. On their annual licence renewal forms, they
will be required to list malpractice findings and settlements,
criminal offences and drug and alcohol abuse problems.
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