Only doctors trained and formally recognized as surgeons can claim to practise cosmetic surgery in Ontario, the physicians' regulatory body has ruled.

The College of Physicians and Surgeons of Ontario yesterday reserved the title of surgeon for doctors whose qualifications it formally recognizes or are certified as surgeons by its national counterpart.

The regulation, however, does not forbid non-surgeons from continuing to perform procedures such as liposuction, nose reconstruction and breast enlargement.

"The regulation that was passed today is strictly about title, what they can call themselves," said college president Dr. Preston Zuliani. "Today's regulation was primarily to protect the public by providing clarity about what the qualifications are."

Currently, hundreds of family physicians in Ontario advertise themselves as cosmetic surgeons without any specialty designation or training – an issue that sparked demands for the college to crack down on the industry following the death of a Toronto real estate agent last fall during liposuction.

Zuliani added the college is continuing with a program it began last year to send teams of doctors to inspect the quality of cosmetic practices across the province.

While the wording of the ruling does not specifically mention cosmetic or plastic surgery, it was pointedly aimed at the field, which has been drawing dozens of general practitioners and other non-surgeons into its lucrative ranks over the past decade. "In the past, there have been difficulties where some physicians have embellished their credentials and called themselves cosmetic surgeons, for example, when indeed they weren't," Zuliani said. "This sort of behaviour now will be forbidden."

It will likely be this summer or early fall before the changes will become law, said Ontario health ministry spokesperson John Yoannou.

Zuliani does not yet know how doctors who breach the rules will be penalized.

The issue made headlines last September with the case of Krista Stryland, 32, who died following liposuction at a North York cosmetic clinic. Her physician, Dr. Behnaz Yazdanfar, was not recognized as a surgeon by the provincial doctors' body or the Royal College of Physicians and Surgeons of Canada.

Yet she, like any other doctor with some amount of training in cosmetic procedures, was able to claim to be a cosmetic surgeon or to practise such surgery.

In November, the college announced it was investigating 16 physicians performing high-risk cosmetic procedures in which there was evidence they were not properly trained. That investigation is still ongoing, the college said yesterday. It also demanded another 20 doctors answer a survey or their licences would be suspended.

Dr. Gordon Wilkes, president of the Canadian Society of Plastic Surgeons, welcomed the move, saying that only qualified surgeons should be performing surgery.

"There is quite a bit of confusion amongst the public about what a cosmetic surgeon is," Wilkes said from Edmonton. "Most people who use the terms are not plastic surgeons and many are not surgeons at all, but the public presumes that they are plastic surgeons because they view them as synonymous."

Wilkes said most plastic surgeons, who spend at least five years in post-medical school training, would view claims made by many general practitioners that they were properly trained in cosmetic procedures as laughable.

As well, he said, undertrained doctors have caused tremendous harm in doing cosmetic surgeries.

"Surgery isn't something you can learn on a weekend course," he said.

Canadian-trained doctors who are surgeons will have the letters FRCSC, which means they are a Fellow of the Royal College of Surgeons of Canada, Wilkes said.

"Ideally, I don't think anyone should be calling themselves a cosmetic surgeon, you should call yourself what you are," he said. "It should be clear to the public who they are dealing with."

Toronto cosmetic surgeon Dr. Bill Middleton, who has more than six years of surgical training and is recognized by the Royal College, said the move will clarify things for people seeking cosmetic procedures.

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"The way doctors have described themselves in the past has caused a lot of confusion for patients," said Middleton, who specialized in head and neck surgery before turning to a cosmetic practice.

A Star investigation last September documented years of dithering by the college about whether to crack down on unqualified cosmetic surgeons. College council briefing notes and discussion papers from as far back as the early 1990s showed years of lax standards and unenforced regulations, even as college officials quietly raised concerns about family doctors conducting cosmetic procedures without oversight or training.

Three weeks after the story, the college sent out mandatory surveys to 406 physicians requesting details about their cosmetic procedures to determine whether a "practice assessment" by the college was necessary.