Medical Spa MD - Inside Sona Medspas Part 6: Physician Oversight
These posts are written by former Sona Medspa owner Ron Berglund to provide an inside view of the way medical spa franchises recruit, train, and support their owners as well as detailing some of the problems with medspa franchises.
Read Part 1: Why I bought a Sona Franchise l Part 2: Sona Promises l Part 3: The Franchise Pitch l Part 4: Legal Structure & Revenue Sharing l Part 5: Opening a laser clinic
Sona Medspas: Physician Oversight
About medical oversight at Sona?
What did Sona tell us? Sona gave us some rather generic information about the requirements for a medical director as they were aware of the pertinent statutes and regulations.
Sona's manuals included a generic "Medical Director's Manual" and "Nurse Manual" which covered some of the relevant concerns. Their franchise documents and verbal statements naturally put the burden on each individual franchisee to get legal counsel in their state to cover all the bases, etc. They provided us with a generic "standing orders and protocols" document for the nurse to provide to the treating nurses (or "laser technicians") which provided a good start for most.
I know that in California and a number of other states the standard Sona model did not work and these franchises had to have significantly more creative (and expensive) legal work done to structure the operation properly. In a number of other states the clinics had to be located literally "across the hall" from the medical director- or the clinic had to incur significantly higher expense to have a physician actually "on sight" to comply with that state's laws and medical board regulations. (Read: Can a non-physician employ a physician.)
In Minnesota we employed the standard off-site "medical director" model which required a licensed physicians to "oversee" clinic operations and protocols. (Read: Physician oversight in medical spas l Mid-level providers in medical spas)
Sona was strict about requiring our docs to review and either sign or initial each patient chart and each entry on every treatment log to double check that proper parameters were being used, etc. We also had a decent system set up requiring "adverse event" reports for every "incident" which was also sent to the corporate office each month. Fortunately, we had very few adverse events over the years--partly because the majority of our treating nurses were primarily interested in CYA and not having any of their patients experience "discomfort" or causing any minor burns or blisters. Due to the very conservative teaching and recommended parameters furnished by Sona our BIGGEST problem through the years was with EFFICACY.
The majority of our treated patients still had significant hair remaining after five treatments-- which caused most Sona operations to slowly crumble due to patient dissatisfaction and demands for additional free treatments, etc.
Did your system work for your medical directors?
The main problem encountered by both Minnesota clinics for the first few years of operation was
keeping a medical director in place.
We went through a succession of medical directors for a variety of reasons-- retirement, relocating, not being comfortable with the procedures or the risk involved (vs the small fee we were willing to pay the medical director which ranged from $1500 to $2000 per month per center).
The most outrageous situation was our young dermatologist who was forced to give up her "moonlighting" job due to an edict issued by her boss-- who coincidentally was the head of her department at a major university and also owned a competitive laser center in the same city!.
Medical Oversight Problems?
The centers in Minneapolis and St. Paul actually operated without incident for six and four years respectively without incident until a female police officer treated in St. Paul (Woodbury) experienced a minor burn typical of treating skin with a "base tan" with high parameters required for Alexandrite laser hair removal treatments beyond the third or fourth treatment when high parameters are required for efficacy.
Even though I told this woman that our nurse absolutely followed our established laser parameters, etc. she insisted that the nurse had done something wrong so she lodged a formal complaint with the Minnesota Nursing Board. The nursing board did a preliminary investigation and shipped the case to the Minnesota Attorney General's office where it is still under investigation. All this attention caused me to take a close look not just at the Minnesota statutes and regulations covering physicians but also the Nursing Board Act.
I was very surprised to see the level of detail required to legally employ nurses to operate lasers in Minnesota. I wrote a separate blog on this topic in another section of the web site
where I asked if anyone out there was aware of a college or university that could provide a 30 hour course on the use and operation of lasers required by the nursing board.
They also require a very detailed delegation /prescription document from the physician to the nurse similar to what a nurse would need to legally dispense prescribed medications.
What questions did the staff have about this?
In order to try to avoid getting my staff riled up and worried about these "legal" issues (and the fact that they may have been guilty of
"practicing medicine without a license"), where they were potentially at risk of losing their nursing licenses, etc., my usual practice was to say as litle about this as possible.
My nurses were always well trained (especially after we started doing our own in-house training) and always treated patients cautiously. As we became more experienced we began doing more and more test spots-- even though these were not encouraged by Sona for the 80% of our patients who were Caucasian.
After our business had collapsed financially in early 2006 we actually operated for several months without a medical director because my partner refused to dig deep enough to pay for one and we were primarily treating existing patients by this time.
During the late spring of 2006 my experienced nurses started to ask directly who the medical director was and they noticed that nobody was reviewing the charts on a weekly basis as had been done the previous three years. At this point I told them that my personal friend (a dermatologist who had been traveling regularly between Florida and Minnesota the past five years and had served as our director for several months previously) had agreed to act as our medical director for the time being. This was a stretch, of course. It is tough to do things right when you are stone cold broke!
Whart were your concerns with the medical aspect of the business?
I believe the survivors will be the physicians who are actually owning and operating the clinics. This makes sense marketing wise-- as docs can market extensively and much more economically to their existing patient population-- as well as legally. I would venture a guess that a prospect is five times more likely to respond to a direct mail piece or a newsletter that comes from her physician than a mailer from an unknown operation that-- for all she knows --could be operated by any flake out there (maybe even a telephone call center headquartered in Michigan!).
Ron Berglund