When a group of physicians urged the Thailand Medical Council late last year to approve short-term certificate training in facial plastic surgery, the move angered certified plastic surgeons. The surgeons, who had undergone specialised training for up to seven years, asked the council to temporarily set aside the plan.
"We are often criticised for opposing the plan because it will take away our jobs," said Kamol Wattanakrai, president-elect of the Society of Aesthetic Plastic Surgeons of Thailand. "But that's not our concern. What we care about is the rise in [medical] complications."
But in the latest move to support the cosmetic surgery tourism boom, the council is on the verge of approving the first batch of short-term courses in a variety of medical specialities, including cosmetic surgery.
At the same time, physicians who are not qualified as plastic surgeons are rushing to produce even more of their kind, even if it means setting up their own training school.
OFFICIALLY CERTIFIED
Although the law allows aesthetic, or cosmetic, procedures to be conducted by doctors in all fields, a medical council regulation allows sexual reassignment surgery to be conducted only by plastic surgeons. The move followed scores of complaints to the council seven years ago about general practitioners conducting the surgery.
CATCHING UP: Dr Thanavatt, the Academy of Cosmetic Surgery and Medicine president. photo: SUPPLIED
The medical industry was dealt another huge blow in 2014 when the Public Health Ministry drafted a regulation allowing only physicians certified by the medical council to practise aesthetic medical services. That meant that only board certified plastic surgeons and facial plastic surgeons would qualify, leaving out hundreds of general practitioners.
"At the time, we received many complaints regarding the standards of aesthetic medical services. But we were stuck in limbo, since there was no certified training in this field," said Dr Akom Praditsuwan of the Sanatorium and Art of Healing Bureau, which regulates the industry. "We are now in the process of amending the regulation again."
Pol Lt Gen Attapan Pornmontarut, a former Academy of Cosmetic Surgery and Medicine president, said the move alarmed general practitioners, who were concerned the ministry will move forward with the regulation. The Academy of Cosmetic Surgery and Medicine established more than three decades ago supports GPs working in the field of cosmetic surgery who are not fully certified.
In November last year, a group of 834 physicians led by the academy's founder Sanh Salyasiri submitted a letter to medical council secretary-general Sampandh Komrit, urging it to offer certificate training in aesthetic surgical procedures.
The physicians, most general medical doctors, urged the council to consider this as an "urgent matter", due to the large number of complications arising from substandard surgery, according to the letter seen by Spectrum. However, experts interpreted the argument for improving standards as an "excuse" to qualify more doctors as cosmetic surgeons to meet the commercial demands of a booming industry.
"Since there is no systematic training of aesthetic surgery in Thailand, a large number of doctors choose to take part in substandard courses both domestically and overseas," said the letter.
The benefits would be twofold: not only will the number of aesthetic surgeons increase to support the rising demand, but the quality of the services will also increase, benefiting patients.
The decision to submit the letter went ahead without approval from Pol Lt Gen Attapan, then the academy president, who resigned in January after heading the association for 13 years.
"I told them to take this one step at a time because it would affect the practice system of specialists," said Pol Lt Gen Attapan, a board certified facial plastic surgeon -- a title not held by other academy members. "If general physicians were to attend these courses, they should aim to construct a solid understanding in surgery to prevent the risk of complications. But some patients don't know that it takes different levels of training for physicians to gain that ability."
The plan is now closer to reality, with medical council president Somsak Lolekha telling the Bangkok Post Sunday last week that the council has approved the plan in principle, but that the courses would cover a wide variety of subjects and not only aesthetic surgery. A final decision will be made by the end of the year.
'IT'S NOT COMPLICATED'
Alongside the official move to produce a new batch of aesthetic practitioners, the private sector, led by the Academy of Cosmetic Surgery and Medicine, is moving fast to set up their own teaching institution.
THE SPECIALIST: Dr Attapan, former Academy of Cosmetic Surgery and Medicine president.
"We will produce as many doctors as fast as possible in order to prevent foreigners from penetrating our market," said academy president Thanavatt Chotima.
The association uses "aesthetic practice" as an umbrella term which covers a variety of disciplines, including cosmetic surgery, medicine, gynaecology, anaesthetics and even feng shui. The procedures that would be taught include sex changes, Botox and filler injections, liposuction, tummy tucks and breast augmentation.
"It isn't only limited to surgery. This is something new to Thailand that isn't taught in medical school," said Dr Thanavatt, also president of the Thai Clinic Physicians Association. "This field wouldn't have sprung up if there was no demand for aesthetic services. Our competitive society means that those who are good looking have more opportunities than others."
The Academy of Cosmetic Surgery and Medicine is in the process of selecting members with over 10 years of experience in the field to become "teaching fellows" in their "academy". The instructors will provide both long-distance and hands-on training in their clinics in respective provinces -- a move Dr Thanavatt hopes will address the shortage of doctors in rural areas by creating part-time jobs.
"Any doctor can be an aesthetic practitioner. I don't think it should be limited to only a specific group," he said, adding there are more than 1,000 aesthetic practitioners in Thailand, over half of whom are GPs. "The government wastes a lot of time in creating specialists that can take up to six years…when in fact [certain procedures such as] nose augmentation can be taught in a short period of time."
Dr Thanavatt said the institute should be up and running by early next year, pending approval from the Education Ministry. Graduates will receive certificates provided by the Academy of Cosmetic Surgery and Medicine, although the association is also hoping the medical council will approve the curriculum. A certificate of speciality in facial cosmetic surgery will be provided to applicants who complete courses in six subjects.
Dr Thanavatt played down concerns over quality, saying graduates will require hands-on experience in "hundreds" of cases.
"Doctors are ethical and no one would perform surgery after going through only one session of training," he said. "Around 80% of aesthetic surgery is non-complicated. It's a medical art." n