Doctor's Orders

The medical esthetic and medical spa industries are growing, and, as a result, there is far greater competition than there has been in the past. The battle to get new patients in the door and treat them quickly and efficiently has, unfortunately, led some medical esthetic practices, medical spas, and laser centers to cut corners. One of the most glaring omissions relates to the lack of proper physician consultation and supervision when seeing patients.

Some practices routinely offer laser treatments, microneedling, and fillers without the patient seeing a physician prior to treatment, if at all. Whether knowingly or not, failing to have a proper initial consult is a clear violation of the law and can lead to charges of the unauthorized practice of medicine, which may result in fines or even loss of license. To avoid the regulatory entanglements, you need to understand the role that a physician must play in routine medical esthetic treatments.


Initial Patient Consultation

It is fairly common for medical esthetic clients who come in for routine procedures, such as Botox injections and laser services, to only see a nurse or a laser technician before undergoing treatment. This is especially common at laser centers that accept walk-in patients. However, in most states, the law requires that a physician conduct a face-to-face consultation with each new patient who seeks to undergo a medical procedure. Make no mistake—the treatments that are commonly administered at medical spas are medical in nature. Therefore, they are subject to the rules and regulations that govern medical procedures in your state.

So, in most states, a physician must take a history, conduct a physical, and administer an examination for each new patient who seeks a medical treatment at a medical spa. This means that, prior to all laser treatments, injectable treatments, and even microneedling treatments, the patient must have a face-to-face consult with a physician. After the initial consult, the patient does not need to be seen before each subsequent treatment. However, a face-to-face consultation needs to happen at least once before a course of treatment takes place.

Most medical spas do not have physicians on staff full time, but they need to accommodate the scheduling needs of their patients. This is where nurse practitioners (NP) and physician assistants (PA) come in. A physician is typically allowed to delegate initial consults to an NP or a PA, provided such tasks are listed in the NP’s or PA’s agreement with their supervising or collaborating physician. Using an NP or PA allows medical spas to operate without needing a physician present at all times.

Some medical spas have attempted to circumvent these requirements by using video technology, such as FaceTime or Skype, to allow physicians to conduct these examinations remotely. Such exams may not satisfy the requirements of medical consultation laws, because simply viewing video of a patient does not allow the physician to sufficiently examine and diagnose each patient. Many state boards require a physician (or NP or PA) to be in the room with the patient at the time of the examination in order for it to meet legal standards.

Medical spas that do not comply with these laws are subject to severe penalties, as are the non-licensed individuals who perform these exams and the physicians who operate these establishments. And because of the medical spa industry’s growth, many states are aggressively pursuing these violations. Where an outside observer might see a grey area with regards to what constitutes a medical procedure, state regulatory agencies see only black and white. So if your medical spa is not using a physician, NP, or PA to conduct patient consultations, you should certainly correct this immediately.


Performing Treatments

After a successful consultation, the patient’s treatment can commence, and that treatment does not necessarily need to be conducted by a physician. Provided the procedure falls within their scopes of practice, other licensed or non-licensed professionals—such as laser technicians or nurses—may perform the actual treatments in lieu of a physician. However, most state laws require that the physician, NP, or PA be available during the treatment, should his or her assistance be needed. The spa should always be able to reach the physician, NP, or PA in the event of a complication, which means that he or she can be offsite while the treatment is being conducted.

Despite the fact that a physician, NP, or PA does not necessarily always need to be around, it is a good idea to make sure that some type of medical professional, such as a nurse, is onsite while medical procedures are being performed. Most medical spa treatments have very little risk of complications or negative outcomes. However, should one occur, a licensed medical professional can help. What’s more, his or her presence will help protect the business against charges of impropriety. State regulatory agencies are always on the lookout for situations in which a licensed professional is not present at a facility that is conducting medical procedures, because that can signify that the practice is conducting improper patient exams. And as mentioned earlier, this can lead to significant sanctions for both the medical spa and the individuals involved in said exams.

No amount of profit is worth losing your license. One of the most egregious violations in the minds of state regulators is the unauthorized practice of medicine. Administering medical spa treatments without proper physician consultation or supervision falls squarely into that category. And because of the harsh penalties meted out to violators, it’s crucial to bring your medical spa in line with the laws of the state in which it operates.—Alex R. Thiersch