A Medical Spa Is a Medical Spa, or Is It?
As more and more people clamor for glamour and an increasing number of physicians become disenchanted and frustrated with a troubled health care system that continues to erode their professional control, the climate for entrepreneurial development ripens.What''s in a name? If Juliet of wherefore-art-thou fame were alive today, she might well ask this question about medical spas (or medi-spas as they are also called). The answer would be: the jury is still out as to what constitutes a medical spa, exactly. It seems that the term medical spa can refer to any facility?be it in a mall, storefront, doctor''s office or the backroom of a beauty salon?that provides any number of aesthetic services from hair removal to massages and facials, even services once confined to the province of medicine like various laser therapies.
Medical spas are burgeoning, a phenomenon driven by consumer demand and the recognition that there''s money to be made in them thar wrinkles, sags, skin blemishes and hirsute areas. As more and more people clamor for glamour and an increasing number of physicians become disenchanted and frustrated with a troubled health care system that continues to erode their professional control, the climate for entrepreneurial development ripens. Witness medical professionals and lay entities alike jumping into the medical-spa fray, even cooperating, by forming partnerships, corporations and all sorts of other quasi-legal business arrangements to supply the increasing demand for services.
Today''s aesthetic medicine is not your mother''s brand, in fact, even the physicians who are performing some of the procedures like laser treatments and BOTOX injections have changed. Attend a laser seminar or cosmetic surgery meeting and you will observe not just the usual genre of dermatologists and laser surgeons, but gastroenterologists, family practitioners, even OB/GYNs interested in jumping on the medical spa bandwagon by broadening their practices to include aesthetic services.
Adding to the confusion of (1) new and ever-changing services (2) physicians from specialties other than cosmetic medicine participating in the delivery of aesthetic services and (3) the existence of a multitude of varying business arrangements is the fact that few states have any regulations in place to guide medical spa owners or consumers. Guidelines as to what procedures are or are not appropriate and who should or should not administer them are sparse and tenuous at best.
The urgency felt by state regulatory bodies and medical societies to formulate guidelines for medical spas, including standardizing procedures and defining practitioner qualifications, has been lethargic at best. However, the rash of medical spa boo-boos reported by the media of late has reenergized the guideline process. For those unfortunate few on the receiving end of deleterious results at the hands of incompetent spa personnel, a well meaning desire to create and enforce guidelines by state governments and medical organizations is a case of too little too late.
That said, in fairness to those bodies attempting to create guidelines for the purpose of oversight and regulation, it must be pointed out that the issue is complicated by the many different professionals who may be practicing their specialties under the same roof: cosmetologists, electrologists, aestheticians, nurses, and physicians. In states like Massachusetts for instance, each of these professions is licensed by its own board, and each board has its own standards. The trick in writing a defining set of regulations peculiar to the operation of medical spas requires incorporating each profession''s standards into the guidelines for each cosmetic procedure?not an easy task.
The American Society for Lasers in Surgery and the American Society for Dermatologic Surgery produced actual guidelines for medical spa personnel, but without regulatory oversight, these guidelines have little clout. The prevalence of regulatory differences between states further complicates matters. For example, in some states laser hair removal is classified under the practice of medicine (meaning the procedure must be performed by a licensed medical practitioner), while in other states, this same procedure can be performed by non-medical, but certified or licensed personnel with the stipulation that a physician be immediately available on site, not just a telephone call away. Some states require procedures to be performed under medical supervision, but the definition of "supervision" is so loosely defined that it can mean anything from having the physician physically present at the procedure to several rooms away or even just available by telephone.
So called "medical equipment" is also in regulation limbo. A medical grade laser hair removal device can be purchased by a spa owner (even when no physician is on staff to render the service) with the supposition that a physician will then be hired to perform the actual procedure. This begs the question: Does anyone know if the physician is actually present or even hired?
The bottom line in this confusing morass of rules and no-rules is this: There is no standardized regulation of medical spas across all states and all disciplines. Regulations that do exist differ from state to state, not all states have regulations and some states have no regulations in place at all.
There is little doubt that consumers of medical spa services remain in need of greater protection.
Likewise, owners of medical spas offering legitimate and safe services would benefit by having their industry regulated. For everyone involved in the dispensation of cosmetic procedures, enhanced regulation and oversight can''t come too soon. Until it does, the caveat for the consumer of medical spa services is to undertake your own due diligence to protect yourself from risk.
The American Society for Aesthetic Plastic Surgery (ASAPS) is concerned about the lack of consumer education with respect to the risks associated with procedures performed in medical spas by unlicensed personnel. The Society cautions consumers not to let anyone "inject anything into your body without the advice of a doctor." It also warns against undergoing any cosmetic procedure offered in a non-clinical setting such as a beauty salon and stresses that "only licensed practitioners should perform cosmetic procedures."
The ASAPS recommends checking to see if the facility is accredited, but this is easier said than done because not all facilities are accredited by the same organization necessitating an investigation into which accrediting organizations are truly credible?simply too difficult a task for most consumers.
A good deal of information can be found on the website of The American Board of Plastic Surgery, www.abplsurg.org, in the Q & A section including what it means to be board certified, how to check the credentials of a particular practitioner and how to know if your physician is certified to perform the type of cosmetic procedure you are seeking.
When you begin your investigation of a particular medical spa prior to using its services, ask first about physician supervision and what that really means. Find out the physician''s area of practice. Is he/she a dermatologist, a plastic surgeon or from some other discipline? Ask if the surgeon is board certified and if the answer is yes, be sure to ask for the name of the board that has granted him/her certification. It is not very reassuring to know that the supervising physician is certified by the American Board of Orthopedic Surgery when what you want is laser treatment on your face.
Next, if you know the cosmetic procedure you are seeking, ask about the person who will actually perform the service. Is this person required by law to be licensed and certified? If so, by what entity? How many years has this practitioner been performing this service?
Be sure to ask about malpractice insurance and professional liability insurance. Is the physician covered? Are the non-medical personnel covered as well as the business? If something goes wrong, who will pay the bill for any needed correction?
The American Society for Aesthetic Plastic Surgery (ASAPS) and The American Society of Plastic Surgeons (ASPS), in an effort to advance healthy outcomes and protect patient safety, have created a list of questions you should ask "before committing to any procedure or medical treatment in a spa or non-traditional facility." You can find the complete list at http://www.surgery.org/press/news-release.php?iid=462.
Frankly, the list is daunting?so many questions to ask and so much information to absorb?but without the appropriate answers you are putting yourself at risk. Only you can ask yourself, what price beauty?
The information in the article is not intended to substitute for the medical expertise and advice of your health care provider. We encourage you to discuss any decisions about treatment or care with an appropriate medical professional.