Wall Stree Journal Article on Medical Spa Franchises: Medspa boom is a bust for some

Via Wall Stree Journal. Read the entire article here.

Read the Medical Spa MD series: Inside a medical spa franchise.

Medspa Boom Has Become a Bust for Some

By RHONDA L. RUNDLE
November 21, 2006

...Medspa ownership turnover generally reflects business stumbles rather than safety issues. Ms. Leavy says many of the troubled spas are affiliated with franchise chains with flawed business models, such as those requiring too much of a franchisee's revenue to go for marketing. (She estimates that about 10% of medspas are franchises, although other industry experts put the percentage at 30% or higher.)

Several Sona franchisees, though not Mr. Nebot, are in private arbitration over problems that include misrepresenting a complicated business as a turnkey operation and failing to provide needed support. Sona officials declined to comment.

Several franchisees of Radiance MedSpa Franchise Group PLLC, a franchiser in Scottsdale, Ariz., say the company's financial projections overestimated revenue and underestimated initial start-up costs, including working capital.

The president of Radiance, Charles L. Engelmann, recently said: "There are currently 32 open stores and we will have 47 or 49 open by the end of the year. None of the stores have closed." He also acknowledged that some franchisees are attempting to get their money back.

One common pitfall for medspa operators is the failure to properly account for prepaid services, such as discounted packages of laser or light-based facial treatments. At Mr. Nebot's shop, for instance, clients would routinely pay $1,000 in advance for a package of laser hair-removal treatments to be delivered over a year or more. The shop's rooms were then filled with nurses treating customers who had paid months earlier. Finding new customers with fresh cash was a constant struggle.

Mr. Nebot says he felt like a cartoon character, "running faster all the time but falling further behind." He used radio advertising to draw more clients, moved to a larger space and extended his operating hours. To avoid alienating customers, he gave away free treatments to those who complained that their hair kept growing back after they finished the five-treatment regimen they purchased.

In the wake of the recent legal changes in Florida, some medical-spa owners there must shell out an extra $60,000 a year or so to a dermatologist or plastic surgeon to oversee operations.

"I can't be my own medical director any more, which is an added expense I can't afford," says one Florida physician who is not a dermatologist. He says he is "facing personal bankruptcy and trying my best to get out while there is something left for my family" after miscalculating what it would take to market, advertise and build his business. Indeed, many medspa owners are doctors who hope to make easy cash at a time when income is shrinking from their traditional medical practices.

Some franchisers have run afoul of state regulators by violating laws against the corporate practice of medicine. In February 2005, California denied a franchise application from HealthWest Inc., a Los Angeles firm that had more than a score of Inaara MedSpas around the country. California ruled that HealthWest had "falsely represented" to owners that they could legally own a medspa without a medical background. HealthWest has gone out of business, but some Inaara shops broke away from the founders and still are operating as independent, stand-alone shops. (Note: The former owners of HeathWest are now 'licensing' medspas under the name Solana.)

Another bust was Skin Nuvo International LLC, which filed for bankruptcy and sold its 37 stores to a private equity firm that in turn sold them to Pure MedSpa, a Toronto company.

Sleek MedSpa, a closely held chain in Boca Raton, Fla., recently acquired SkinKlinic's Fifth Avenue flagship in Manhattan, but SkinKlinic's two other stores, one in Las Vegas and the other in Greenwich, Conn., have closed. SkinKlinic's founder, Kathy Dwyer, is a former senior executive of cosmetics giant Revlon Inc. Attempts to reach her for comment were unsuccessful...

Fake Botox Lands Doctor in Prison

Anything for a buck...

SALMON, Idaho (Reuters) - A federal court sentenced a doctor in Boise, Idaho, Monday to six months in prison for injecting 200 people with fake Botox to smooth their wrinkles, officials said.

Ivyl Wells, 66, the former operator of a Boise skincare clinic, in July confessed he sought to boost his profits by purchasing counterfeit Botox at a discount and charging his patients full price for wrinkle-fighting treatments, according to court documents.

Sona Medspas: Inside a medial spa franchise.

Medical Spa MD Series: Inside a Sona Medspa Franchise

Q&A from former Sona Franchise owner Ron Berglund.

Ron posted a number of thoughtful comments regarding the problems with medspa franchises.

After exchanging emails, Ron's agreed to answer a number of questions about his experiences with Sona including the good, bad, and ugly. Why he chose Sona? What he was told? What really happended? What went wrong?

As far as I'm aware, Ron is the first medical spa franchisee who's been willing to come forward and tell his side of the story in a comprehensive way.

Wall Stree Journal Article on Medical Spa Franchises: Medspa boom is a bust for some

The following article on problems with medical spa franchises ran in the Wall Stree Journal. It's a telling article that points the finger at the current crop of medical spa franchises. I signed up and read it after Ron posted his comments on being an unhappy Sona owner.

Medspa Boom Has Become a Bust for Some

By RHONDA L. RUNDLE: November 21, 2006

Jeff Nebot thought he had struck gold. Two years after opening a laser hair-removal franchise in St. Louis, annual revenue hit $3 million. And over time, the lavish salon added other cosmetic services as Mr. Nebot joined the rush of entrepreneurs into the emerging business of medical spas. Medspas (also called medispas) offer such medical treatments as Botox injections and laser hair removal in a luxurious environment rather than a doctor's office. The field has been rapidly expanding in recent years as entrepreneurs and doctors alike have sought to profit from the dual quests of many affluent consumers: prettification and pampering. For an increasing number of those who entered the business, the boom is proving a bust.

"Several Sona franchisees, though not Mr. Nebot, are in private arbitration over problems that include misrepresenting a complicated business as a turnkey operation and failing to provide needed support. Sona officials declined to comment.

Several franchisees of Radiance MedSpa Franchise Group PLLC, a franchiser in Scottsdale, Ariz., say the company's financial projections overestimated revenue and underestimated initial start-up costs, including working capital.

The president of Radiance, Charles L. Engelmann, recently said: "There are currently 32 open stores and we will have 47 or 49 open by the end of the year. None of the stores have closed." He also acknowledged that some franchisees are attempting to get their money back.

"I can't be my own medical director any more, which is an added expense I can't afford," says one Florida physician who is not a dermatologist. He says he is "facing personal bankruptcy and trying my best to get out while there is something left for my family" after miscalculating what it would take to market, advertise and build his business. Indeed, many medspa owners are doctors who hope to make easy cash at a time when income is shrinking from their traditional medical practices.

You can read the entire article on the Wall Street Journal site here. It does require a subscription. 

Sona MedSpas: An unhappy franchise owner.

Ron Berglund, a Sona medspa owner, left this comment on one of the most widely read articles on this site: What's wrong with medical spa franchises? The article Ron refers to is referenced here: Medspa boom is a bust for some.

"You may want to check out the November 21 issue of the Wall Street Journal. There is a very informative article about mdeical spas (primarily the Sona MedSpa and Radiance franchises).

Having been a franchisee (St. Paul, MN) for almost three years and now facing personal bankruptcy and financial ruin, I can vouch for the accuracy of the article. I have personal knowledge that perhaps 33% (and maybe over 50%) of the Sona franchisees have either already failed or are struggling. The Sona business model-- and I am guessing most of the franchised medspa models-- are replete with flaws, problems and booby traps.

For starters, any business that tells you to spend 25% of gross revenues on marketing and advertising is giving you a recipe for financial disaster down the road. Relying almost entirely on inflated revenues from prepaid multi-treatment packages (allowing you to take in - and spend-- thousands of dollars today without making any provision for the steadily growing future service liabilities) are also a trap for the undercapitalized and unsophisticated. Finally, Sona encouraged us to commit the mortal sin of cosmetic practice-- they coached us to overpromise results to the point of commiting fraud with thousands of clients. When the Sona-required lasers failed enable us to deliver these impossible results we were literally murdered with demands for additional treatments.

I predict a huge "shakeout" in 2007 as other medspa franchisees hit the courthouses with litigation and financial nightmares. The profitable delivery of esthetic medical services is a tricky and demanding challenge for anyone. I believe it takes a unique combination of business and marketing acumen together with great medical skill and emotional intelligence to navigate these tumultuous waters without drowning."

Ron Berglund 

The article Ron refers to is referenced here: Medspa boom is a bust for some.

From the same thread.

JustCurious asks: How does a medspa franchisee handle closing its doors? Aren't there agreements (in years) that must be signed with the franchisor and wouldn't there be penalties for closing shop? I've notice several medspa franchises closing or selling their business within 2 years of opening their doors and I'm wondering (a) what motivates them to close or sell so quickly and (b) what the penalties of closing/selling could be. Also, if a franchisee sells their medspa in this "billion dollar industry" so quickly, is that usually an indication of a failing business?

Dear Just Curious: Thanks for the response to my recent comment. You are asking two additional questions which are very important with regard to the subject at hand. First, you are asking how does a medspa legally close its doors. Closing shop would be no problem if all transactions were handled on a "pay as you go" basis. Unfortunately, most med spas sell primarily multi-treatment "packages". The Sona model encouraged us to do that almost exclusively. We typically sold five-treatment packages for laser hair removal, and often offered BOGO promotions wherein the client would purchase -- and pay cash up front for --five treatments at the "regular" price (full bikini @ $975 for example) and then would receive five FREE treatments for the underarms area. I had an excellent first year of operations since I was taking in thousands of dollars each month for treatments to be performed in the future. After signing up an average of 100 clients per month and pushing the future service obligation forward, you end up "painting yourself into a corner" and facing an insurmountable liability for performing treatments already paid for. Jeff Nebot had the same problem in St. Louis, except that his numbers were typically about triple my numbers. As this isn't enough of a problem, just imaging what happens when you try to sell or close the business!! You have several thousand clients who have prepaid and are legally entitled to the treatments they have already paid you for-- but you cannot afford to keep the Pnonzi scheme going! Believe me-- this makes any medspa almost impossible to sell because any prospective purchaser is scared to death to walk into this huge liability. That is the primary reason Jeff Nebot and I ended giving away our centers for free. Our buildout, furniture and equipment in St. Paul had cost us almost a million dollars and Jeff Nebot's investment was probably twice as much. I know first hand of several former Sona franchisees losing more than a million dollars on the whole mess-- in addition to a million headaches. There was a story posted on the Internet about the former Salt Lake City Sona franchisee closing her doors and failing to provide hundreds of clients with their pre-paid treatments. The article stated that Utah authorities chased the owners down in Texas and instituted some type of legal proceedings against them. I never heard how the matter was resolved, but I heard that the state was trying to impose some stiff penalties against the (Sona) owners.

Your second question asked how can it be that all these problems are occuring when this "med spa boom" is supposed to be happening all around us. The answer-- in my opinion-- is that the so-called med spa "boom" is to a large extent hype. I predict that the majority of the marginal operations will fall by the wayside during the next twelve month and the survivors will be the operatoins that are well funded and operated on sound business principles. Sona and many of the other franchised systems were attempting to offer a "get rich quick" scheme and also a model which-- for the most part-- utilized the physician as essentialy a mere figurehead. My personal belief is that the only truly successful med spa model requires three key components: 1. The physician is the key to the business-- similar to the dentist in the traditional dental office model; 2. The physician needs to be "on site" for a number of reasons-- business, professional and regulatory; and 3. The model requires superb marketing including a ton of cross-promotion and "guerrilla" marketing. Due to competition. typical profit margins and a number of other factors, med spas simply cnnot afford to allow advertising and marketing expenses to exceed over 10% of gross revenues. Whereas most physicians already have from 5000 to 15,000 patients in their data base who can serve as a "warm" client base for a med spa, all of the franchised med spa models start with zero and need to "buy" each client they recruit. Believe me--these outrageous advertising expenses eventually catch up with you! There is a reason the typical fast food franchises absolutely require that advertising expenses remain in the neighborhood of 7% of gross revenues. In order to survive in the low margin marketplace, there is no other way.

Ron Berglund 

Top 10 reasons why loyalty programs don't work.

Medspas consultants will often promote loyalty programs as a way to reward your best clients and build their loyalty to the practice. But loyalty programs are often not all they're cracked up to be.

10 reasons whyloyalty programs won't work in your medical practice?

1. Loyalty programs are based on discounts, which ‘train’ existing patients to expect 'sales' and wait out your normal prices.
2. They attract your most loyal patients who would happily pay a premium.
3. They confuse patients and staff and create customer service problems.
4. they discourage new patients by making them feel punished or excluded.
5. they encourage competitors to retaliate with me-too programs.
6. they damage your perceived image by making you a 'discount' store.
7. they reduce profit margins from your best patients.
8. they reduce your ability to serve patients at the highest levels.

Ok, there were only eight. But the point is, patient loyalty can’t be programmed. As soon as patients begin to feel ‘stalked,’ they choose ‘fight’ or ‘flight.’ They either figure out how to game the system, or else they seek care elsewhere.

Chaos causes medical mistakes, not incompetence.

How to "survive" an ER visit.

(and as bonus: Complexity causes 50% of all returns.)

"The main culprit isn’t incompetence but chaos: The nation’s emergency rooms are overburdened and underfunded, treating ever more patients with ever fewer resources. "You don’t want to scare the public, because hundreds of thousands of patients get cared for very well in emergency rooms every day," says Gail Warden, president emeritus of Michigan’s Henry Ford Health System, who chaired a trio of studies of emergency care released in June by the National Academies’ Institute of Medicine. "But the system is stretched, and it could be at a breaking point in three to five years."

Federal law requires that ER doctors and nurses treat everyone who shows up, regardless of ability to pay, but there has never been enough federal money to cover those costs—and that money is dwindling."

And from Complexity causes 50% of product returns.

Half of all malfunctioning products returned to stores by consumers are in full working order, but customers can't figure out how to operate the devices. Product complaints and returns are often caused by poor design, but companies frequently dismiss them as "nuisance calls.

The average consumer in the United States will struggle for 20 minutes to get a device working, before giving up.

Most of the flaws found their origin in the first phase of the design process.

This last one might be viewed as the most important. During the design of a system program or product, most of the problems with interface or use that are going to crop up are built into the system. .

California Medical Board: Use Of Mid-Level Providers for Lasers, IPLs, Botox, & Other Treatments

The State Medical Board of California has addressed the Use Of Mid-Level Providers for Lasers, IPLs, Botox, & Other Treatments. (Links to PDF) It's a common question that is often brought up over in the discussion areas.

You should read this information carefully. Although it's specific to California, the information is substantially similar to many states.
Read also: Medical Spa Legal: How to...  l  Medspa Legal Discussion Area  l  Building a Medispa inside your practice  l  Medical Spa Franchises

From the Medical Board of California:

Due to an influx of calls to the board regarding who may perform what type of medical / cosmetic procedure and where, the following frequently asked questions and responses are provided for informational purposes and as a reminder. This is a reprint and update to an article published in the October 2002 Action Report.

Who may use Lasers or Intense Pulsed Light devices to remove hair, spider veins, and tatoos?

Physicians may use Lasers or Intense Pulsed Light devices. In addition, Physician Assistants and Registered Nurses (not Licensed Vocational Nurses) may perform these treatments under a physician's supervision. Unlicensed Medical Assistants, Licensed Vocational Nurses, Cosmetologists, Electrologists, or Estheticians may not legally perform these treatments under any circumstance, nor may Registered Nurses or Physician Assistants perform them independently, without supervision.

Who may inject Botox?

Physicians may inject Botox, or they may direct Registered Nurses, Licensed Vocational Nurses, or Physicians Assistants to perform the injection under their supervision. No unlicensed persons, such as Medical Assistants, may inject Botox.

I've been approached by a nurse to be her 'sponsoring physician' for her laser and Botox practice; would that be legal?

No. There is no such thing as a 'sponsoring physician'. Nurses may not, under California law, employ or contract with a physician for supervision. A  nurse may not have a private practice with no actual supervision. While the laws governing nursing recognize "the existence of overlapping functions between physicians and registered nurses" and permit "additional sharing of functions within organized health care systems that provide for collaboration between physicians and registered nurses" (Business and Professions Code section 2725), nurses may only perform medical functions under "standardized procedures." The board does not believe this allows a nurse to have a private medical cosmetic practice without physician supervision.

I've been asked by a layperson to serve as a "Medical Director" for a "medi-spa" that provides laser and other cosmetic medical services; would that be legal?

No. No one who cannot legally practice medicine can offer or provide medical services (Business and Professions Code section 2052). A physician contracting with or acting as an employee of a lay-owned business would be aiding and abetting the unlicensed practice of medicine (Business and Professions Code sections 2264, 2286, and 2400). To offer or provide these services, the business must be a physician-owned medical practice or a professional medical corporation with a physician being the majority shareholder.

I see these ads for "Botox Parties" and think that it has to be illegal. Is it?

The law does not restrict where Botox treatments may be performed, as long as they are performed by a physician or by a registered nurse, licensed vocational nurse, or physicians assistant under a physician's supervision.

Who may perform microdermabrasion?

It depends. If it's a cosmetic treatment, that is to say it only affects the outermost layer of the skin or the stratum corneum, then a licensed cosmetician or esthetician may perform the treatment. If it's a medical treatment, that is to say it penetrates to deeper levels of the epidermis, then it must be performed by a physician, or by a registered nurse or physicians assistant under supervision. Treatments to remove scarring, blemishes, or wrinkles would be considered a medical treatment. Unlicensed personnel, including medical assistants, may not perform any type of microdermabrasion.

I would like to provide non-medical dermabrasion, and hire an esthetician to perform that and also cosmetic facial and skin treatments. What do I need to do?

It is legal for physicians to hire licensed cosmetologists or estheticians to perform cosmetology services, if they have obtained a facility permit from the Bureau of Barbering & Cosmetoloty. All licensed cosmetologists, including estheticians, must perform their services in a facility with a permit.

Why can't I use a medical assistant instead of a nurse?

Medical assistants are not licensed professionals. While doctors have become accustomed to their assistance in medical office practices, medical assistants are not required to have any degree, nor do they have to pass an examination or be licensed. For that reason, the law only allows them to perform technical supportive services as described in sections 2069-2071 of the Business and Professions Code, and Title 16, California Code of Regulations, sections 1366-1366.4.

What is the penalty if I get caught using or helping an unlicensed person to perform medical treatments?

The law provides a number of sanctions, ranging from license discipline to criminal prosecution, for aiding and abetting the unlicensed practice of medicine. Physicians could be charged with aiding and abetting unlicensed practice, and the employee could be charged with the unlicensed practice of medicine. 

I understand that all of these practices may be illegal, but I see advertisements all the time for these kinds of illegal practices. What should I do?

You may file a complaint with the Medical Board. To do so, please send the advertisement, the publication name and date, and your address and telephone number where you may be reached,  to our Central Complaint Unit at 1426 Howe Avenue, Suite 54, Sacramento, CA 95825. The board will contact the business, inform them of the law, and direct them to cease any illegal practice. If it is simply the advertisement that is misleading, they will be directed to change or clarify the ad.

It is impossible to cover all of the relevant legal issues in a short article, and these questions and answers are not a substitute for professional legal advice. Physicians may want to consult with their attorneys of malpractice carriers about the use of their office personnel. In addition, the board has a number of written materials with more thorough information on this subject. There are legal opinions on the use of lasers and dermabrasion, materials outlining the legal limitations on use of medical assistants, as well as the actual statutes and regulations. To request any of these documents, please contact the Medical Board of California, 1426 Howe Ave., Suite 92, Sacramento, CA 95825, or call (916) 263-2389.

Gruntdoc visits the Dermatologist.

 GruntDoc on bedside manner.

However, Derm's lack of any appreciable bedside manner has me reevaluating one of my longest-held beliefs, that people don't really care if their doctor has a great bedside manner, but only really want a doctor who is very competent and does the job right.

And, painfully, I have to look hard at myself. I am, occasionally, a touch cranky. I try very very hard to not be cranky toward my patients, but I'm not in such denial to say I never act cranky with a patient.

Physician, heal thine own bedside manner. Me first.

What's wrong with 90% of medspa convention presentations?

Everyone's attended useless presentations. My guess is that 90% of all the speakers I've heard have fallen into one or more of the gaffs below.

Which is sad. Hundreds of attendees have paid and given up time to learn something only to be confronted with information that's just not useful. What's up with the speakers? It's really the show organizers fault. The Medical Spa Expo for example is put on by Reed Exhibitions, a business that organizes conventions and expos as a venture. They find a group in the market they're interested in and, voila, instant show. The politics that go into picking speakers are profound. The first presentors are a resouce to the company putting on the expo. They tend to bring in their friends and keep out the competiton.

Now events are often worth going to for the 10% of speakers that are worth listening to. There's often a useful tidbit here and there among the rest as well. But speakers would be better off resisting the most common traps. Here are some tips drawn from my own experience as a speaker and, more importantly, sitting in the audience.

#1. Speakers: No, you can't pitch your lovely company

If you're presentation is really a sales pitch (i.e., your company markets goods or services to the types of people who attend this show), your chances of making it worth sitting on a folding chair for an hour are extremely slim unless you:

• Have your clients speak with you and eliminate all the tricky little references to your company.
• Present new research thats usefull ot the audience and give it away.
  
• Present tactics, jobs, mistakes, etc., anything with numbers. The more, the better.
• Run a workshop at the conference.
• Pitch your physicians or other professionals who are completely and thoroughly unrelated to marketing and sales.

I've seen some absolute horror shows with this one. Please don't regale me with your franchise pitches and tell me how easy it is to make money if only I'd place myself in your caring hands.

#2. Consultants: No tired speeches about your glory days.

Show attendees sit in multiple presentations on the same topic. At medical spa expos it's the marketing baby. Show organizers know this (which is way they often swap postal lists with each other for promotions). They'll pad the schedule with medspa consultants who did lots of stuff in the past but don't own or run a clinic now. If the resume doesn't currently include something other than consulting, it should. This is a lucritive field. Consultants don't make the money or have the info, owners do.

#3. Experts: Avoid overviews

Great -- you've noticed there's a presentation about a topic that promises to pull back the curtin and let you into the good stuff. What you get is not an expert with hands-on experience but a novice with strong opinions about the topic. In either case, the expert and the psuedo-expert, the overview speaches are useless in the daily operations and growth of a business. That's what blogs are for.

#4. Don't ignore format

Most shows tend to focus primarily on one particular type of presentation such as group panels, intensive workshops, case studies, roundtables, etc. Stick with what you're supposed to be there for. Here's a link to Guy Kawasaki's 10/20/30 powerpoint rule. Required reading for anyone presenting anything anywhere.

#5. Copywrite or sell your presentation

The last time I saw this I was at a Thermage presentation by Virginia Stevens M.D.. Doctor Stevens was presenting information for performing Thermage treatments on the body for a packed room of docs. Everyone sat speachless while Dr. Stevens literally flew through her presentation without pause, questions or clairity. The reason became apparent at the end when Dr. Stevens last slide showed the ordering information available for the presentation on her website for a mere $295. The Thermage sales people were horrified and apologized to everyone (out of hearing of Dr. Stevens).

If you're going to accept the invitation to present, then present, don't sell. You just piss people off.

#6. Let go of your ego

Yeah, you're the expert. But the audience is smart too. Prancing around as the man with the plan will get you used and discarded. I sat on a panel with one doctor (remaining nameless here) who bluntly told the audience that he had the ego of any three men. (He was completely believable too.) But that was the end. The audience totally tuned him out an he was forced to elbow his way in to answers. Everybody has an ego. We just don't want to hear about yours.

technorati tags: medspa, expo, medicalspa, consultants, training

Lipodisolve: Mesotherapy Horror Posts!

These posts about mesotherapy were taken from discussion threads on this site.

 
The individual comments have been removed from the discussion threads for obvious reasons but are reposted here:

Yono writes: I am a nail salon owner and learned it from a friend. It works great and you do not need a prescription ! Go online for the best prices and instruction. Mesotherapy is great for anyone and you don't have to go to France!

JJlin writes: Anyone can perform mesotherapy. I tell people its cheaper to inject yourself in the comfort of your own home. You can purchase sterile needles and mesotherapy injectables online, compounding pharmacies, just about anywhere. Instructions online as well.

Aestheticianspa writes: I perform manicures, mesotherapy, botox, and laser hair in my garage transformed into a spa like office. I think anyone can do it as long as you have a doctors lisc. Just send em the check every month. :)

And Cosmo: Its pretty safe and effective. You can pick up the solution at any compounding pharmacy or online and inject it yourself. I tried it many times on a friend. Real easy for anyone. Go for it.

JJlin again: I agree w/ Cosmo. Who cares if it works or not? Everyone should get into Mesotherapy. Its cheap, easy and good cash.

Where to begin. It seems hard for me to believe that this kind of activity is actually happening let alone there are those who are posting that injecting yourself or others in the comfort of your home or garage is a good idea. The stupidity is overwhelming.

If you are injecting anyone and are not a licensed medical provider you are practicing medicine without a license, a felony in every state. If you are injecting yourself you are just plain stupid and should be removed from the gene pool as fast as possible. It's no wonder that mesotherapy has a hit-and-miss reputation for being pseudo-garage-science.

Medical Spa Legal Issues: New Q&A Discussion Area

I added a new discussion area called medical spa legal Q&A

 

In order to address a host of questions that I receive by e-mail and are carried on in discussion threads in other areas about what is legal or illegal, how physicians can structure a business with a non-physician, who can perform treatments, what the scope of practice is, what constitutes direct medical oversight, how you find out what your state regulations are, etc.

I have noticed that there have been a number of postings by non-physicians that are blatantly wrong, and so we are offering the legal area in order to have a little continuity where our physicians can get information that is at least slightly moderated and not full of spam and nonsense. If you have a question about any of the legal aspects of running, owning, operating a medical spa, read the medspa business discussion or the physician to physician threads as well as some of the other postings about opening a medical spa, building a medical spa inside your practice, etc.

None of the comments or posts are offered as legal advice. Consult your attorney before you do anything stupid. 

The Disappearing Botox Reps.

The worst thing your medical spa can do is to overpromise and underdeliver.

Six months ago I had a visit from a Botox rep that described his position as a new "practice building rep". He handed out a few rhinestone studded 'Botox' t-shirts and promised to help build our Botox revenue. (We had showed up on some Allergan screen for increasing Botox revenue 400% in a year.) I was told that Allergan had empowered these new reps to do whatever they needed to do to help clinics with increasing sells.

So what happened.

Nada. Zippo. Zilch...