Regulation needed to ensure patient safety, M.D. credibilityRegulation needed to ensure patient safety, M.D. credibility

National report — The medical spa industry's rapid expansion has created an environment in which patrons don't always know what they're getting — and many providers don't know what they're getting into.

"A lot of doctors don't realize that as soon as you use the word spa, your facility and staff may now be under the jurisdiction of your state's board of cosmetology, licensing professions or whatever it's called in that state," says Susanne S. Warfield, president and CEO of PCI Publishing. She has authored and published many books, including Legal & Liability Issues of a Medical Spa and The Guide to Building a Medical Esthetic Practice, and is the executive director of the National Coalition of Estheticians, Manufacturers/Distributors & Associations (NCEA).

"That's what's causing the biggest problem right now," she says. "People are putting out shingles and calling themselves medical spas, but they have no concept of what a spa is, let alone what a medical spa is." The NCEA, the largest coalition serving the skincare industry, defines a medical spa, in part, as "a facility that operates under the full-time, on-site supervision of a licensed healthcare professional." A key element of the NCEA's definition is that practitioners working within a medical spa are governed by their appropriate licensing board, if licensure is required. 

However, Ms. Warfield says, "in some of these medical spas, they are just letting a medical assistant perform all sorts of invasive procedures, without any type of medical supervision."

Patient safety This situation creates "tremendous issues regarding patient safety, and the issue of appropriate care and oversight of that care," says Roy G. Geronemus, M.D., president of the American Society for Laser Medicine and Surgery (ASLMS). "A growing number of patients are being injured by inappropriate and ineffective care being provided by nonphysicians without medical supervision. There is an alarming number of people with long-term, if not permanent, problems as a consequence of treatments for benign or cosmetic conditions."

According to a survey taken by 342 American Society for Dermatologic Surgery (ASDS) members, nearly 41 percent of respondents reported an increase in patient complications resulting from the nonphysician practice of medicine (in spas and elsewhere) treated between 2001 and 2002. The percentage of physicians reporting complications from laser hair removal posted the biggest jump (approximately six percentage points).

Dr. Geronemus says, "It seems as though, in many ways, the bar has been lowered in terms of who is providing these procedures and services."

State regulations States' regulations vary widely in this regard. In New Jersey, only physicians can perform laser or light-source-based procedures. In Connecticut, a physician must be on site during these procedures, though he or she can delegate them.