Turkish Society of Plastic, Reconstructive and Aesthetic Surgery Calls on Ministry of Health

At a press conference held on Friday, 10 January at Point Hotel Barbaros under the hosting of the Turkish Society of Plastic, Reconstructive and Aesthetic Surgery, views and recommendations were shared regarding the regulations made within the scope of the "Regulation on the Amendment of the Regulation on Private Healthcare Establishments Providing Outpatient Diagnosis and Treatment."

Prof. Dr. Şükrü Yazar, Chairman of the Board of Management of the Turkish Society of Plastic, Reconstructive and Aesthetic Surgery, began his remarks by providing information about the "Regulation on the Amendment of the Regulation on Private Healthcare Establishments Providing Outpatient Diagnosis and Treatment," which was published in the Official Gazette on 7 January 2025 with number 32775 and entered into force. He drew attention to the fact that the regulations made with the regulation in question carry serious risks in terms of professional and public health and have created serious concerns among plastic, reconstructive and aesthetic surgery specialists.

Prof. Dr. Şükrü Yazar pointed out that with the regulation, aesthetic procedures that previously were required to be performed only by plastic, reconstructive and aesthetic surgery specialists, dermatology specialists and physicians with Ministry-approved medical aesthetics certification (*) can now be performed "by other physicians within the scope of competencies acquired through educational curricula and certificates."

Prof. Dr. Şükrü Yazar emphasized that the removal of branch names such as plastic surgery, reconstructive surgery, aesthetic surgery and the phrase "Ministry-approved" from the regulation would lead to blurring of professional boundaries and endanger patient safety, stating: "We invite the Ministry of Health to consult with the relevant specialist societies in such changes, to make regulations that prioritize scientific and ethical values, and to implement effective inspection mechanisms."

Potential Risks and Concerns Were Raised
At the meeting attended by members of the Board of Management of the Turkish Society of Plastic, Reconstructive and Aesthetic Surgery, the risks that the regulation could create in terms of patient safety, public health, health tourism and medical education were listed as follows:

Public Health: Aesthetic procedures performed by incompetent hands directly endanger patient safety. Aesthetic procedures can be performed safely only when carried out by physicians who have received specialist training, are experienced and possess the necessary medical knowledge. When these procedures are applied by persons outside their field of specialization and with insufficient training, they can lead to complications ranging from infections to serious tissue damage, aesthetic deformities and even life-threatening situations. Moreover, correcting errors resulting from such applications generally requires much more complex surgical interventions, which negatively affects both the patient's health status and the burden on the healthcare system.

In a statement made on social media, the Ministry stated that with this regulation change, aesthetic procedures cannot be performed by all physicians and can only be performed by physicians who have these procedures in their curricula or have acquired competency through Ministry-approved certification programs.

However, this statement does not eliminate the ambiguities created by the regulation text. No concrete framework has been drawn regarding the standards by which curricula content will be determined and how certification programs' content and supervision processes will operate. Moreover, it is obvious that a few weeks of certification training cannot replace 5 years of specialist training.

Balance of Healthcare Services: The attractiveness of aesthetic procedures, particularly as a financially more advantageous field, will cause physicians to turn to this area. This situation carries a serious risk of disrupting the balance of the healthcare system. While the need for physicians for public service in many specialties is already at high levels, more physicians shifting to commercially attractive areas such as aesthetic procedures will result in other specialties being unable to meet patient needs.

Today, while difficulty is experienced in finding plastic surgery and dermatology specialists in state hospitals, tomorrow it may become impossible to find internal medicine, neurosurgery or obstetrics specialists. In the statement made on the Ministry of Health's social media account, it was claimed that in the aesthetic field, where a limited number of physicians provide services, allowing other physicians to perform procedures within the scope of their competencies aims to address supply-demand imbalance. It is unclear how it was concluded that unmet demand in healthcare is primarily for aesthetic procedures.

Of course, physicians' orientation towards commercially profitable areas instead of basic health services will seriously weaken the quality and accessibility of public health services. If the balance of healthcare services cannot be maintained, health inequalities will increase throughout society and the sustainability of the healthcare system will be endangered.

Medical and Resident Education: Experienced physician educators working in education and research hospitals and university hospitals turning to aesthetic procedures due to the attractive conditions offered by aesthetic procedures will create problems difficult to reverse in terms of medical education and resident physician training. This situation will create significant gaps in educator positions and result in resident physicians being insufficiently prepared during their training period.

Medical education is not only knowledge transfer, but also based on mentorship and experience sharing. Physician educators leaving their fields will cause disruption in these critical processes and result in student and resident physicians not obtaining adequate preparation. In the long term, this will weaken the fundamental pillars of the healthcare system; it will restrict society's access to qualified health services. The domino effect of educational deficiencies causing serious wounds to the sustainability of the healthcare system is inevitable.

Supervision Deficiencies: Currently, even though aesthetic procedures should only be performed by plastic surgeons and dermatologists, unauthorized persons' underground practices cannot be controlled, and this leads to serious complications and consequences that threaten public health. In an environment where existing supervision mechanisms are insufficient, expanding the scope of authorized physicians will further complicate supervision processes and make control of such applications nearly impossible.

The way to prevent underground, unauthorized procedure applications is not to create a risky area by expanding authorities; rather it is to improve, tighten supervision processes and implement deterrent sanctions against such applications.

Loss of Prestige for Our Country: Turkey has become a global brand in the field of health tourism and is particularly recognized for its reliability internationally in the field of aesthetic surgery. However, loosening competency criteria in aesthetic procedures will seriously damage this reputation. Complications that will increase as a result of insufficiently trained persons performing these procedures will not only cause individual patient grievances, but will also shake international confidence in our country's healthcare sector.

Sustainable success in health tourism is only possible with the provision of high-quality, reliable and standards-compliant services. Such regulations carry the risk of weakening Turkey's image in the eyes of international patients. Maintaining our country's brand value and international reliability, it is of critical importance that applications in the field of health tourism are kept at high standards and are performed only by persons specialized in this area.

Call to the Ministry of Health
At the end of the meeting where the Turkish Society of Plastic, Reconstructive and Aesthetic Surgery's views and solution recommendations on the issue were conveyed, emphasis was placed on the urgent need to re-evaluate the regulation in question, which endangers patient safety, creates imbalances in the healthcare system and has the potential to harm our country in terms of health tourism.

The Turkish Society of Plastic, Reconstructive and Aesthetic Surgery noted that they are always open to cooperation with the Ministry of Health in the planning and updating of such regulations, stating that regulations made without consulting the views of physicians specialized in the field and professional organizations can negatively affect not only public health, but also professional standards and confidence in our country's healthcare system.

The goal is to work in cooperation with the Ministry of Health to protect public health and strengthen professional standards, and with more effective cooperation and shared objectives, all stakeholders aim to benefit from this process.

What is the Rationale for the Decision?
Chairman Prof. Dr. Şükrü Yazar invited the Ministry of Health to consult with relevant specialist societies in such changes, to make regulations that prioritize scientific and ethical values, and to implement effective supervision mechanisms, stating the following:

"We are having difficulty understanding the rationale for granting physicians outside their specialty authority to perform aesthetic procedures with this regulation change. Granting authority to physicians outside their specialty is generally a temporary measure taken in extraordinary situations, for example during a pandemic or war, to meet urgent needs.

What urgent need or insufficiency in interventional aesthetic procedures is currently being considered that such a regulation has been made? The rationale for this decision, which threatens the healthcare system, patient safety and professional standards, should be transparently explained. As the Turkish Society of Plastic, Reconstructive and Aesthetic Surgery, we wish to emphasize once again our determination in protecting public health, defending the boundaries of our profession and strengthening ethical values."