The term ‘fly-in-fly-out’ surgeons or 'seagull surgeons' has been coined to refer to practitioners who carry out work on a short term basis but are not permanently resident in the UK. Due to the increasing popularity in cosmetic surgery procedures, many British cosmetic clinics have taken to using foreign surgeons on a fly-in-fly-out (FIFO) basis in order to meet the ever growing customer demand. Although there are currently no official figures available, the Sunday Times online recently reported that an estimated 66% or more of cosmetic surgery procedures are now potentially being carried out by FIFO surgeons at British clinics (20 January 2013).
The Potential Risks of FIFO Surgery
Currently, all surgeons practicing in Britain have to be registered with the General Medical Council (GMC). However, unlike British surgeons, foreign surgeons are not legally required to have UK medical indemnity insurance in order to carry out procedures in Britain. Consequently, many foreign FIFO surgeons who provide surgery at British cosmetic clinics are not insured in the UK, making it exceptionally difficult for patients who experience complications from their surgery to later claim compensation.
Penningtons Solicitors, a commercial and private client law firm based in London and the Home Counties, report having dealt with a number of cases arising from private cosmetic surgery performed by foreign FIFO surgeons and describe experiencing regular difficulty and a lack of cooperation in establishing who the medical indemnity insurer is. They state that, even once the medical indemnity insurer is established, foreign insurers are often slow to respond and lack experience of the clinical negligence protocol that operates in the UK, which prevents matters from proceeding as efficiently as they should. Penningtons maintain that all of these issues can make investigating FIFO surgery claims more difficult and time consuming, which then results in additional costs for the claimant through no fault of their own.
FIFO surgeons operating in the UK may be here today and gone tomorrow, thus making them difficult to locate and presenting a significant potential problem to those patients who experience complications or require additional post surgery support. The Sunday Times online reported a case of one woman who spent two years trying to track down the surgeon responsible for her breast reduction procedure, which resulted in her contracting a flesh eating infection. Although the surgery had been performed at a British clinic, the FIFO surgeon had subsequently returned to his home country of Italy and so was difficult to trace.
Making Surgery Safer for the Patient
Amidst increasing reports from patients who have experienced problems trying to track down and secure compensation from FIFO surgeons, the British Association of Aesthetic Plastic Surgeons (BAAPS) has responded by submitting a proposal to Government. The BAAPS proposal focuses on establishing proper informed consent, proper insurance cover, and proper standards, for the benefit of all patients. According to consultant plastic surgeon and BAAPS President Rajiv Grover, implementation of this proposal will provide a cost neutral and "straightforward way of dealing with the lack of clarity that exists regarding which surgeons, from where, are doing what and how much in this country".
A Three-Fold Proposal
1. Informed Consent
The BAAPS proposal calls on government to make it an essential requirement that all cosmetic surgery consultations be held with the surgeon who will ultimately be performing the operation. They claim that this will instantly reduce the large number of FIFO practitioners who are dependent upon UK based sales advisors and intermediaries to sign up and recruit their patients for them.
2. Insurance Cover
The BAAPS proposal calls on the government to make it a legal requirement for all surgeons operating in the UK to have UK based medical indemnity insurance or a policy that offers equivalent cover to that provided by a British insurer. The medical indemnity insurance policy must specifically and unambiguously state that the surgeon is covered for any work performed as well as for any costs should a legal case arise in the UK.
3. Ensure Standards
From December 2012, it became a requirement for all doctors to be appraised and re-validated by the General Medical Council (GMC) on an annual basis, regardless of how long ago or where their initial training and qualifications were attained. This will allow the GMC to ensure that the professional standards and skills of its members continue to be met and maintained in the future. However, currently, if a doctor or surgeon is recognised as a specialist in their own country, they are automatically eligible for listing in the UK’s Specialist Register. The BAAPS proposal recommends that all doctors and surgeons coming from abroad be made to undergo a re-validation process before being able to receive GMC registration and the concomitant ability to work in the UK.
By seeking to cut out the intermediaries, secure proper cover, and ensure standards, the BAAPS proposal offers a potential solution to the risks of FIFO surgery. If implemented by the government, this would enable patients to undergo private cosmetic surgery with a greater certainty that their surgeon is properly trained, traceable, and has UK medical indemnity insurance.
At present, the risks associated with FIFO surgeons remains an issue of concern and patients are thus advised to maintain caution and to ask for the relevant proofs regarding their potential surgeon’s training medical indemnity insurance and foreign contact details in order to avoid potential problems with traceability and securing compensation should this become necessary in the future.