Regulations
And The Spa Industry
by Melinda Minton
 With the advent of medical spas and the ongoing popularity of spas in
general, the industry can’t keep up. Hence, systems for managing spas
and measuring a spa’s safety and performance also have been neglected. While each state has its own rules for safety, licensing and general business
procedures, many states don’t have the funding to enforce their set of rules.
For instance, even though the state
of New York has legislation indicating that only physicians can perform
laser-assisted services, laser hair removal is common in many spas that aren’t
affiliated in any way with a physician. In Pennsylvania, microdermabrasion is
another physician-only administered and prescribed service, yet it is commonly
sold as a spa service.
Current Policy
Unfortunately, consumers are being hurt on occasion during
medical-spa procedures. The most common mishaps occur when a skin-rejuvenation
treatment or a laser-hair-removal service is performed and the client is burned
by the laser.
Another unfortunate occurrence is inappropriate or non-exact
use of stronger chemical peels for acne therapy or skin rejuvenation. While that
is a service that is legally administered by estheticians in some states, it is
still a treatment that only should be administered by those with advanced
training in that procedure and product.
As the attorney general’s office in each state begins to
investigate complaints and enforce regulations concerning medical spas, more and
more spas are considering partnering with a physician in some way. However, that
is a tricky proposition.
There are federal laws in place that prevent physicians from
fee-splitting, making the methods of payment difficult. Also confusing is the type of relationship the physician must
have with the spa. Some states now require that medical spas be “physician
owned and run.” This leaves current spa owners in an odd position when
considering adding or keeping medical-spa treatments on their menus.
Models For Medical
One of the most popular models for offering medical treatments
is for the spa to employ a nurse who is trained in laser use and injectables to
work at the spa part time, administering services that estheticians cannot
perform.
A similar setting sometimes occurs when a nurse from a plastic
surgeon’s office leases a room several days a month, paying a flat fee to the
spa and taking in earnings for the plastic surgeon’s office. This type of
arrangement makes for a nice referral base between the surgeon’s practice and
the spa.
Physician-run spas are the flip side of the scenario, with the
question remaining: What does “physician run” actually mean? In the early years of laser clinics, “physician run” meant
that a physician was involved in some capacity. Many of those facilities left
important facts murky such as which parties would be responsible for a lawsuit;
was the physician usually on the premises, and did the physician see each
patient and prescribe care accordingly?
There are franchises in recent years that are promoting
medical spas with the promise that a physician will not be necessary, yet when
the regulations are examined in many states, that doesn’t seem possible.
Scope Of Practice
Several states are taking the position that a physician must
see patients in the facility and prescribe treatments that qualified technicians
or nurses can perform. The physician ultimately is responsible for all legal
requirements and for ensuring the health and safety of the patient.
While not defining the standard of training that technicians
or licensed professionals must have, the regulatory agencies make it clear that
the physician is putting his or her license and insurance on the line and should
act as his or her own regulatory body.
Physicians, who with little thought offered their name and
license to a spa, sometimes find themselves wrapped up in a lawsuit where they
are responsible for a service they didn’t prescribe or witness. In retrospect,
these physicians must wonder why they became involved.
Defining who is qualified to perform which procedures is
another tough topic. Just because a spa owner or director is a physician, the
quality of care is not necessarily guaranteed if the realm of services is beyond
the physician’s scope of practice.
For instance, an ophthalmologist who was primarily doing
plastic surgery in his eye practice without an anesthesiologist once hired me to
do a business plan for a medical spa. That type of arrangement obviously is
frightening.
As medical spas continue to crop up, defining a scope of
practice for each type of position along with treatment examples is crucial
toward protecting the consumer against injury, harm and fraud in the future.
Melinda Minton is a spa consultant and health and beauty
expert living in Fort Collins, Colo. A licensed massage therapist, esthetician
and cosmetologist with an MBA in marketing, she founded The Spa Association, a
world-class organization dedicated to enriching the professional beauty industry
through self-regulation, education and sound business practices. Recently
featured in Entrepreneur magazine, Minton serves as a resource for such
magazines as Better Homes and Gardens, Shape, First for Women and Alternative
Medicine.
A New Licensing Program
Spa Secure is a first-of-its-kind international licensing
system. Introduced in July 2004, Spa Secure was designed to be a
self-regulating system working in cooperation with state and federal
governmental agencies such as the Public Health Department and the Board of
Barbers and Cosmetologists.
Spa Secure works by performing a hands-on inspection of each
spa, looking for unsafe practices, sanitation procedures, health and safety
measures, and scope-of-practice issues. A test is administered to the management
and technical staff of the spa.
Ongoing quality is monitored through unannounced mystery
shopping of the facility to check for consistency in safety and operations
quality.
Spa Secure is a division of The Spa Association
(www.thespaassociation.com). To find out more, visit
www.spasecure.com.
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