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« Patient Gagging & Your Plastic Surgeon? | Main | Fractional Laser Resurfacing Chat »
Wednesday
Mar112009

Laser treatment? Skin clinic? Who's in charge here?

It’s happened in Florida and now in Massachusetts. State legislators and physicians are trying to establish some guidelines and laws to protect the public from sustaining injury by unlicensed or untrained service providers.

We’ve read the of the lipodissolve horrors where people are offering lipodissolve, laser treatments and botox in their garage for heaven’s sake! It’s hard to believe it has come to this, but cosmetic medicine has turned into a “cash cow” for anyone!

I’m getting so sick of the turf wars amongst doctors of which specialty should be doing what... I mean seriously... can’t you all get along? Instead of fluffing your feathers to establish dominance over cosmetic medicine you should ban together to eliminate the bottom feeders who are performing services in their garages to protect the practice that IS cosmetic medicine! These are the people who are ruining your reputations! The unskilled, the unlicensed, money grubbers (and yes, I am also including lawyers here!)!

Let us also not forget that nurses and aestheticians are fighting over positions as well. There’s no certifying board for aesthetic nurses, or medical aestheticians. Here’s a funny story... when I started our medical spa with my husband years ago, I contacted both the heads of the nursing board and the cosmetology board. Since I hold both licenses I asked if I was allowed to perform a facial. I was told it’s a gray area. The nursing board said I could, in fact, perform a facial under the direct orders of a physician if the facial were deemed medically necessary. What physician do you know who will write an order for a facial? What physician wants to manage facials, and waxing, and massage, and the products which are dispensed? The cosmetology board said I could not perform a facial because the practice isn’t licensed or inspected by the board.

Huh?

With the economy the way it is, it’s no wonder everyone is jumping on the “medical spa” bandwagon! I mean, it’s like an ATM machine with no fees and no penalties. The perspective boards are all looking at each other and wondering who’s responsibility it is to be monitoring them.

The time is now upon us where legislation will take precedence, once again, on how we perform medicine and who may perform it. The powers that be will decide for us exactly if IPL is a medical device, or not. If the removal of a sunspot or tattoo can be removed by a physician, PA or nurse. Who may do cosmetic procedures, what training they must have and what certifications must be obtained prior to plucking an eyebrow (I digress, but you get my point).

Although we agree that certain treatments be performed or directly supervised by a physician, the fact is, there are many other services that aren’t deemed medical in nature. Should a physician be controlling those as well?

No current board has jurisdiction over all professions within a medical spa or laser clinic so, most likely, a new board will emerge with regulations, standards and licensing fees to add to our current practice.

It will take a few years to establish a task force and develop legislation for most states. But when all is said and done, what will arise is higher fees for service for the client, more inspectors showing up on our doorstep, higher licensing fees and insurance rates, and less control, once again, on how we treat our patients.

Are you ready for another government agency to take control of YOUR profession?

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

Submit a guest post and be heard.

Reader Comments (28)

Paula,

I am not sure what your point is.

Are you saying that there should be more rules and regulations or less?

Who are you saying should make those rules? Doctors? Nurses? Legislators?

What is your suggestion or your proposed solution to the problems: turf battles, garage sales, etc

Could you clarify? I think this is an important topic worthy of serious discussion. Your post is not very clear to me.

Dear Interested Party,
Yes, there are a lot of points in my post, but the main point I was thinking about when I went on a tangent is that if most states are requiring medical spas to have a supervising physician as a medical director (not on site much), then the medical board should establish regulations on those physicians. Those physicians, and any physician involved in an medical spa setting, should be required to monitor nurses and aestheticians more closely, patient charts, laser settings, hiring of qualified technicians, training and certification of those technicians, etc. If medical spas will be required by the state boards of medicine to have a qualified physician take such a responsibility, fewer adverse events will arise.

So I guess I'm saying the state medical boards should take ownership of medical spas (I emphasize the term "medical") under the advisement of qualified and trained professionals. I'm also saying I think we should be proactive rather than reactive, by requesting our state medical boards get involved before a new governing body is created.

The Medical Aesthetic Practice Association (MAPA) might be a good organization to advocate for this type of action. Better supervision from qualitied physicians rather than inadequate oversight from unqualified physicians.

I think we also need to keep an eye on and take a position of certain activites by our Plastic Surgeon and Dermatology colleagues who want to exclude anyone who is a non-core provider. This includes physicians, nurses, PAs and aestheticians.

We need to pay close attention to what has happened in California and Florida.

Who should be able to do specific treatments and who should supervise.
What should that type of supervision entail.
What type of physician and what type of experience and qualifications should that supervising physician have.

What types of services should be done only by Plastic Surgeoins or Dermatologists

Are Plastic Surgeons (who hire and supervise physician extenders) and Dermatologist (who do cosmetic medicine part-time) more qualified than full-time, busy non-core physicians to supervise or do certain procedures?

What are the Plastic Surgeon and Dermatology Organizations doing in individual states to exclued other doctors and stifle competition.

This is a great forum to discuss all these issues. There are other threads on MedicalSpaMD which discuss actions in California and other states.

I'm certainly willing to discuss it - but only if the tone is civil. No bashing of specialties - otherwise you certainly won't get them to join your MAPA!

Regulating who does what means suggesting standardized rules and regulations. And somebody- usually a non-core person, it seems- gets their nose out of joint thinking that they deserve to be an exception to some suggested rule, because of their unique situation. Soon, the conspiracy theories and paranoia starts to roll....as they have time and again on other threads on this site.

We're not going to go through all that anti-derm and anti-plastic rhetoric again, are we?

03.10 | Unregistered CommenterTF

Non-cores are a little sensitve because of what has happened in Florida and California and now what has happened with RealSelf.com. TF, you are very wise and level headed. We respect you a great deal. Not all Plastics are like you. We respect you and like minded Plastic Surgeons and Dermatologists.

Let's keep this discussion civil and lets ignore the "rabble risers".

We need to keep the discussion focused on training, experience, clinical skill and qualifications.
We also need to leave out Plastic Surgery (only Plastic Surgeons should be doing that).

We can discuss Assisted Liposuction as a seperate topic and we can discuss other surgical procedures that other types of surgeons might feel qualified to perform in another blog thread.

For the purposes of this discussion lets keep it to: Lasers, Light Devices, Toxins, Fillers and Laser Assisted Liposuction.

If anyone gets off target, I will copy this entry and remind everyone to get back in focus.

Liposuction is a grey area - so let's just start with lasers, light-based devices, botox and fillers. This should be a little easier to reach a consensus.

Assuming one is not a core specialist, what do you think the minimum requirements (certification, training, experience, examination, supervision, etc.) are to perform these procedures?

Above all, patient safety is paramount.

If you want to do these procedures, you need to be able to handle your own complications. And accept full legal liability for anything you perform or supervise.

03.10 | Unregistered CommenterTF

For the purposes of discussion, I would suggest we define lasers, IPLs and light based devices, botox and fillers as medical devices and medical therapies.

Thus, they always require a licensed physician to perform or order the therapy.

They can not be performed by non-licensed personnel.

In some circumstances (yet to be defined), they may be delegated to appropriate licensed physician extenders (PA, NP, RN). Some low power light based devices may be suitable for use by aestheticians.

03.10 | Unregistered CommenterTF

I think we need to try to define oversite as well. There are many clinics that are "supervised" by a physician (including plastics, derm and non-core) and the physician only shows up once a year to fill out paper work.

Then once you have defined oversite what percentage of time does the physician need to be onsite? Again once a year is not enough.

Who can oversee? Do we want a core or non-core trained physician that has never used the laser should they be required to have certain amount of use, training and knowledge of the laser?

03.10 | Unregistered CommenterLH

LH and TF:

Over the last couple years I have compiled a collection of a variety of state regulations dealing with this exact subject matter. Some of the regs are quite detailed and others are quite obtuse. Would it be helpful to post a couple samples for interested parties to review and comment on??? Let me know if you think this would be helpful. There is no need to re-invent the wheel. We may want to simply polish it up a little.

Excuse my ignorance: I know what happened in Florida... but what happened in California since everybody is referring to "what happened in Florida and California"??

03.11 | Unregistered CommenterDrJack

Med spa guy - Great! Let's see what you have found.

03.11 | Unregistered CommenterTF

What happened in Florida?

03.11 | Unregistered CommenterFlorida?

Great article in this months MedEsthetics Magazine.

Medical Spa Regulations: The Massachutts Legislature convened a task force to draft standards and regulations for medical spas. Its findings may serve as a model for other states. March/April 2009. p. 14-16.

It seems to me that they are doing things correctly. There are two derms, a plastic surgeoin and an internist on the panel along with others. The framework makes sense to me.

www.medestheticsmagazine.com

03.11 | Unregistered CommenterJEE

oh yeah- also has a guy that is trying to get Laser training in his esthetics school since now they are not reconized for it. Also has the woman who runs the only school in MA that does offer laser training at ridiculous prices and makes false promises of guaranteed employment.
So far they've really done nothing but meet a few times in the last 2 1/2 years passing no legislation at all. Seems to me it's just another way to try and restrict laser treatments to a handful of practitioners who have the $ or school loans to pay these people to get trained.

BetterOffNow,

I read the article and it made it sound like something great was happening in Massachettes.
If this is NOT TRUE, we need to know what is wrong.
Massachuttes may be used as a MODEL for other states. This is extremely important.

BetterOffNow, if you know something, we need to know SPECIFICALLY what is going on. We need to know names and we need to know specifics about the "conflicts of interest".

Give us what you got!

Thanks.

03.11 | Unregistered CommenterJEE

Massachusetts (sorry about the spelling above)

03.11 | Unregistered CommenterJEE

Florida? and Dizi Izle,

I think what everyone is referring to about the Florida incident can be found on this site in the Medical Spa Business Forum, and is entitled "Legislation about to affect all FL med spa's and MDs".

look I don't know if I can come out and accuse anyone of a conflict of interest. But I just think it's sort of self serving for business owners who are running schools to train laser techs to sit on a board that will oversee the schools that will train the laser techs.
Although it's smart to join up with the very people who will eventually regulate you, isn't the whole point of this to be about patient care?
There is so much money to be made in laser, botox and other cosmetic procedures everyone is jumping on board and there is nothing but debate and analysis about who is more worthy to do treatment.
For every derm that thinks they're more worthy than a NP or PA who thinks they're more worthy than a medical -oops-"advanced" esthetican, there's a plasti that thinks only their skilled hands can handle a foto facial. puh leeze
And here we go: now the govt is going to try and get involved.
maybe I'm a little cynical but I just don't see this task force contributing much so far, and I'm scared that when they do, it will be draconian.
But maybe this is the best that there is? At least MA is trying rather than defaulting to the wishes of medical community to keep it with drs only?

BetterOffNow,
It looks like the process in Mass is reasonable. Let's give them some guidance via this blog. Tell us what you think about who should be doing what and what kind of training and experience they need. Let's be proactive and positive and influence the process the way we think would be best.

03.11 | Unregistered CommenterJEE

I agree JEE, as I initially stated in my post... we need to be proactive instead of reactive and we need to make progress without trying to rip each other to shreds! We're all medical professionals here and patient care is definitely our utmost concern. I'm wondering how we can proceed with our progress (if we actually make any) and get it to legislation? This is not my area of expertise.

For those interested, here is the link to the final report recommendations dated Jan 12, 2009 from the Mass MedSpaTask Force.

http://www.massmedboard.org/public/med_spa.shtm (select final report to see complete recommendations)
As you will see they put lasers and various procedures into 3 categories and listed which "professional" could perform each group.
I'm here to address the non-licensed or even licensed professionals that have been lasering since the beginning of laser time. Since there was no formal training in place years ago and no licensing board would or could took responsibilty, there were alot of individuals that were trained and learned thru various manufacturer programs or on-site training with their physicians. Shouldn't there be something in place for people that have had experience doing any or all of these treatments?? These individuals are working under a medical directors license. A physician is taking responsibility for that persons performance. Training and years of experience performing procedures should allow them to be grandfathered in. Just because someone is a MD doesn't prohibit problems. As a matter of fact, I've had 2 tattoo removal cases in the past 2 weeks with significant scarring which were from MD performed treatments. Doesn't look like being a "licensed professional" stopped that from happening. What do you guys think is fair on this subject? WhatNow

03.12 | Unregistered CommenterWhatNow

Quite a sensible report - there's much in it that is good. Somethings in level II I might change a little, but it's a very good start.

03.12 | Unregistered CommenterTF

Perhaps MAPA could form a Task Force to comment on the Mass Task Force.
We could provide our recommendations and then influence policy in Mass which may influence policy nationally.
MAPA is composed of all types of physicians (inlcuding core physicians), physician extenders, nurses, aestheticians etc.
If anyone is interested in reading the report, discussing and commenting, please send me an email at Jeff4459@aol.com.
If you are NOT a memeber of MAPA, you can join by sending a dollar bill along with your email address and contact information (go to MAPA (upper left tab) and drop down to "Join MAPA".

03.13 | Unregistered CommenterJEE

Count me in! My dollar is in the mail! It's definitely worth more than a dollar to me if we can make some progress before things get out of our hands.

Now... if we only had a front person to take this to the Capital of NJ and PA!

(Hint)

Before things get out of hands in what sense Paula D. Young RN?

03.13 | Unregistered CommenterMedhacker

Medhacker,
What I meant was before decisions are being made from a legislative point of view without input from currently practicing professionals. For example, there are many nurses, PAs and aestheticians who have been doing aesthetic procedures for years, with lots of skill and experience, most working under a physician. One of my fears is that if legislation is drafted which states you must attend certain curriculums or coursework and must have such-in-such certification, that experience and skill will not be grandfathered in.

For example, my friend from nursing school, who also has an aesthetician's license in NJ, helped open a very famous medical spa in NYC with a well know dermatologist and helped build the practice from the ground up. With NJ's new law revisions which state she cannot perform laser hair removal, it just hurt her solo practice in NJ as her skills and experience aren't even given consideration.

A consumers question. I live in CO. A esthetician used the Lam Probe for minor skin irregularities on my face. I was told there were virtually no risks involved. I asked specifically about scarring, was told it could not happen as it only affected the very outer limit of skin. Microdermabrasion was performed and then Lam Probe on all my minor irregularities. 2 1/2 months later I still have scars and larger areas of hyperpigmentation than I started out with. I also found out that the Lam Probe is FDA approved as a epilator only. I don't know what I am supposed to do now. The esthetician said it must be my fault due to the fact she has never heard of anyone reacting this way, so it can't be her or the machine. Any advice?

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