New standard of practice for out-of-hospital cosmetic and aesthetic procedures for Manitoba docs

Physicians in Manitoba who perform vasectomies, male circumcisions or cosmetic and aesthetic procedures in their community-based clinics must adhere to a new standard of practice as of Jan. 31. The new standard of practice is the College of Physicians and Surgeons of Manitoba’s (CPSM) contribution to regulating Manitoba’s growing cosmetic and aesthetics industry. “We recognized in developing this standard that there was no regulation around the aesthetics business in Manitoba, and we wanted CPSM to be leaders in coming out and setting regulations for the most skilled, most knowledgeable providers who are working in this area,” said Dr. Ainslie Mihalchuk, assistant registrar. The College of Registered Nurses of Manitoba is planning to release their own standard of practice, she noted. The procedures covered under the new standard of practice include: Vasectomies Male circumcision (not including neonates) Laser and light-based therapy for the removal of skin lesions and pigmentation Injection of fillers for soft tissue augmentation Injection of Botox or neuromodulators Peripheral stem cell injection approved by Health Canada Platelet-rich plasma injection approved by Health Canada Procedures performed in hospitals or government-owned/operated healthcare facilities are excluded from the new standard of practice. Opthalmology procedures are also excluded. The strongest directives in the new standard of practice may be the obligations and responsibilities of medical directors of facilities offering these services, Dr. Mihalchuk said. This includes that a medical director must be in attendance in-person at a facility to make sure physicians can’t be attached to a clinic in name only. They also can’t buy products for people not associated with the clinic. “We no longer permit medical directors to purchase fillers or injectables for other regulated health professionals unless those health professionals are part of that medical director’s direct operation,” Dr. Mihalchuk said. While developing the standard of practice wasn't prompted by any case published by CPSM, “we wouldn’t develop a document like this unless we were apprised of or were concerned about a risk to the public,” Dr. Mihalchuk said. During the consultation process, the college heard from experts who had lived experience with problems or risks arising from these procedures. Read: Fake doctor caught in sting operation injecting guests at Botox-and-filler party gets sent back to jail The main motivation for the new standard came from the development of a new accredited facilities bylaw. It outlined which procedures had to be done in a facility accredited by the CPSM. Some procedures did not need to be carried out in an accredited facility, but still posed risks to patient safety. Neonatal male circumcision is excluded from the standard of practice after feedback from public consultation. “We received a lot of feedback, which was very helpful, to ensure that the restriction on circumcision was appropriate to where there was risk and there was no consequence to any religious practices as a result of this standard of practice,” Dr. Mihalchuk said. The standard of practice does not define the quantity or quality of training expected for the procedures covered, as each physician will have a different level of initial training and experience for each procedure, Dr. Mihalchuk explained. For example, a dermatologist may have different training and experience than a family physician for laser therapy for removal of skin lesions. “What we do make clear is that, as part of registration with the college, individuals must ensure that their knowledge, skill and judgement matches the work that they’re doing,” she said. Read: Nose out of joint: Doctor disciplined after patient's vascular event post cosmetic filler injection Dr. Mihalchuk said the Manitoba standard of practice is in keeping with other provinces’ medical regulators’ expectations. “It has been positive to start to build some regulation around this business, recognizing that there are a variety of people, regulated health professionals and non- regulated health professionals that have been engaging in some of these practices and that there is harm that is coming to the public as a result of that,” she said. Certain procedures not identified in the province’s Regulated Health Professions Act are not included. For example, facials, peels, microdermabrasion, micro-needling and laser hair removal. Read: QUIZ: Do you know the latest on Botox injections?

New standard of practice for out-of-hospital cosmetic and aesthetic procedures for Manitoba docs

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