Fly-in, fly-out doctors: what are the risks?

Heather Stephen

It may sound glamorous when a surgeon jets in from Monaco to do your breast op or face lift, but what happens when he goes home? Heather Stephen examines the issue of ‘fly-in, fly-out’ doctors.

‘Marco may fly in from Milan to do a breast op but what happens if the patient has complications and Marco is not around to sort it out?’

That was the question posed by Dr Paul Charlson, President of the British College of Aesthetic Medicine, when asked his honest opinion of ‘fly in, fly out’ cosmetic surgeons.

While you would assume that the doctor employed by the medi-spa or hospital your visiting is a full-time employee and resident in the UK you could be mistaken. These days it’s not uncommon for facilities offering a range of treatments employ practitioners who fly in for a few days a week, do their work and return home again.


The doctors are lured from overseas because of the prestige of working in the UK and the higher fees, and the clinics are attracted to using cosmetic and plastic surgeons from other countries because they cost less than their UK counterparts. But are they as qualified as a UK-based doctor and what redress do their patients have should anything go wrong?

Although there are no official figures in 2013 the Sunday Times online reported that two out of three cosmetic operations were being performed by fly in-fly out (FIFO) surgeons at UK private hospitals. And Dr Charlson thinks one in 10 private hospitals now employ doctors from overseas.

Tighter regulation

It’s a situation that has the The British Association of Aesthetic and Plastic Surgeons (BAAPS) hot under the collar. It’s hoping Brexit will give the government a chance to tighten regulations on fly-in, fly-out doctors. Last October it proposed that European surgeons should “no longer have the automatic right to work in the UK, so fly-in-fly-out surgeons … will no longer be as freely contracted by commercial chains who routinely use them for their lower cost.” It not so affectionately referred to them as ‘seagulls’ because they “make a lot of noise, then leave a big mess before flying away.”

At the moment the General Medical Council (GMC), which sets standards for the medical profession, does its best to protect the public by insisting that any doctor working in the UK, even if just flying in for the day, is registered with the GMC and has a license to practice here which involves holding appropriate professional qualifications from their own country.

To keep their licence doctors have to prove to the GMC their knowledge is up to date every five years – whether they are here 365 days of the year or just popping over for the weekend.


And the GMC says all doctors working in the UK must have adequate insurance to compensate any patient harmed by their treatment.

This sounds all well and good but critics say even if a doctor is registered and qualified it doesn’t guarantee they are proficient in a procedure or that the standard of training they received in their home country is as high as it is in the UK.

And when it comes to their insurance, even if a doctor has indemnity insurance from another country it can be difficult to track down the company and get redress should something go wrong.

Fly and flight

Dr Charlson says problems can also arise as visiting surgeons fail to realise they have responsibility for aftercare.

‘Doctors from other countries may not be fully aware that they have a duty of care to their patient so if anything goes wrong or if there are complications they are obliged to manage them,’ says Dr Charlson.

‘The GMC regulates all doctors licensed to practice in the UK, including overseas doctors. But if the overseas doctor leaves the UK and does not return there are no real sanctions.’

Dr Charlson says seeing a ‘fly in fly out’ surgeon can be acceptable if your clinic has good arrangements for follow up care, including the doctor seeing you the next time he is in the country as part of your treatment package.

But he warns: ‘This can provide sub optimal care as, in some cases, availability of that doctor may be very limited and it is crucial for all complications to be managed promptly and appropriately by a clinician at the clinic where the treatment took place.’

Devastating consequences and the NHS picks up the bill

According to Naveen Cavale, spokesperson for the British Association of Plastic, Reconstructive and Aesthetic Surgeons, most private hospitals are excellent at providing after care but he says there are hospitals who fail to ensure standards are high enough amongst visiting doctors and this can have devastating consequences.

‘Recently I saw a patient who had seen a fly-in, fly-out surgeon for a procedure in London,’ he says. ‘The patient had developed a serious infection and became very ill but when she saw the same doctor a week later he gave her inappropriate antibiotics and didn’t even advise she went to hospital.


‘Within 24 hours of seeing him she was in intensive care in her local NHS hospital and needed three operations. She has been left with big scars and her surgery cost the NHS around £40,000.’

To increase your chance of safe and effective surgery Mr Cavale recommends choosing a UK-based surgeon who has been trained in the UK and is also insured here.

And to make sure you get the very best treatment he adds: ‘I would also recommend people look for surgeons who also work in the NHS. It is very difficult to get a job in the NHS as a consultant and choosing someone with this kind of background will mean your surgeon is properly trained and all the checks and balances are in place.’

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