The rules for a Med Spa are hard to decipher in California. Written vaguely and interpreted uniquely by each entity. A laser hair removal clinic is relatively easy to start but the rules and regulation will make your head spin.
Step 1 – find a good location. Check. Step 2 – figure out the business entity. Check. Step 3 – figure out the pricing. Check. Step 4 – find the right laser for the job. Check. Step 5 – open the practice and hire an RN. Mmm, not quite.
Laser Hair Removal Clinic
You might be accustomed to hearing about Med Spa’s. This term can be confusing because you think of it as a Spa which offers some elective procedures, performed by an RN.
In California the shit you do in a Med Spa is no different from what you do in an Urgent Care or a GI office. You are held to the same medical rules and practice acts as any other medical practice.
The problem is that no Med Spa does it the way California wants you to run such a clinic. When you walk into a Med Spa you rarely will interact with a physician. You are often evaluated by an RN, maybe a PA, and on occasion an NP.
I’ve been looking to start laser hair removal clinic for a few years now. I’m finally in a place to do it and am just now having to deal with the California medical board rules regarding this.
As I mentioned, just because you are offering an aesthetic, elective service to patients with a laser doesn’t mean that you are held to different standards of practicing medicine. The Medical Practice Act – which I knew nothing about until it was thrown in my face by the Oregon medical board – is your bible regardless of which state you practice in.
You need to have an EMR. You need to follow strict HIPAA guidelines. You must adhere to anti-kickback rules. A physician must examine each patient and guide each treatment plan. You cannot have any advertising that may be medically misleading.
A physician must also be geographically close to the staff at the Med Spa. This is a weird rule when I am allowed to live in Texas and treat California patients through telemedicine.
The California medical board not only seems biased but also a bit confused. Undoubtedly, their intentions are good and they want to make sure that no laser mills run amok. But by making it hard for physicians like myself to decipher the laws and regulations, it makes me lose a lot of faith in them.
Contrast: Urgent Care Practice
I have friends who own their own medical practice in California with PA’s seeing all the patients.
These physicians usually own multiple offices and will send a few hours a week at each clinic site. The PA’s can perform suture repair, set fractures, and drain abscesses.
There is supervision but nothing like what the California medical board is requiring for a Med Spa. And California has no qualms about such Urgent Cares.
Vague California Med Spa Rules
So what’s so vague about the Med Spa rules?
Supervision & examining the patient.
If you are the sole practitioner at your Med Spa and examine each and every patient and perform each and every laser hair removal treatment then there is absolutely nothing to worry about. That’s exactly how California wants you to proceed.
The definition of supervision is open to interpretation by the courts. The loose definition is that you must be overseeing shit in your clinic.
Does that mean I have to be standing over the RN’s head? Does that mean I have to see every benign post-laser reaction? Do I have to perform a repeat exam for every subsequent laser treatment on the same patient?
There is nothing clear about this on the California medical board website.
Can your RN perform all the laser hair removal treatments? According to the California medical board website and legal experts, no, you must examine each patient before the RN performs any treatment.
What if you have protocols in place? We’ll get into that in a moment.
Supervision by a Physician
In an Urgent Care I can have my nurses swab the throats of certain patients or take their blood pressure and even insert a rectal thermometer up an infant’s butt before I ever see them.
In order for that to happen, I must have some protocols and guidelines in place. The RN can then follow those guidelines and document his/her work. She can check a rectal temp, readjust a foley catheter, perform an EKG, and even send a patient for x-rays before I evaluate them.
Nurses even initiate breathing treatments and given antipyretics to patients without a physician’s exam. These are considered interventions, no different from performing a laser hair removal procedure on someone.
The medical board appears conflicted when they state that a physician can have guidelines in place for RN’s but that they are responsible to examine each patient before anything is done to a patient.
What does examining a patient really mean? Do I have to touch them? Can I do it by telemedicine? An exam is a vague term which the medical board should know. It’s just vague enough that it can get me into trouble.
NP or PA Operating a Laser
One option for the entrepreneurial physician in California is to hire an NP or PA to perform the laser treatments. This will help handle the examination portion and alleviate the supervision issues. But there is more to it.
A PA still requires supervision even though they can practice independently. The advantage is that they can perform the initial exam. They can then perform the laser and manage any potential complications.
A PA can also direct RN’s to perform the laser after they do the exam.
Can I, as a physician, be away from the clinic if I have a PA? Sure, in practice everyone does it. People go on vacations or run their clinic from another state. The problem is that it’s technically not okay with the California medical board.
An NP doesn’t need physician oversight as strictly as a PA. They can examine the patient, perform the laser treatment, and manage complications themselves.
Despite this, the California medical board still recommend that the physician be the one who sets in place treatment guidelines and management criteria.
CALIFORNIA Laser Hair Removal Clinics
Just to figure out the landscape for laser hair removal, my business partner and I decided to see how other laser hair removal clinics do it in California.
As expected, these Med Spa’s are having patients walk in, evaluated by RN’s, scheduled on the spot for laser treatments, and most will never see a doctor.
One of our friends who owns a laser hair removal clinic told us that there are a few patients who want to sit down to talk to a doctor first. These are far and few in-between. These patients are scheduled by telemedicine with the doctor where the questions are addressed.
Are these laser clinics operating under the guidelines of the medical board? No, not based on what I have read and researched on the California medical board website.
As far as medical malpractice lawyers are concerned, it’s not advisable to defer an exam on a patient before performing laser hair removal or any other laser treatment.
How You Get Busted
Laser hair removal is only as affordable as it is because physicians can be a more hands-off. Their properly trained RN’s can handle most of the cases.
Most patients want costs to remain low. They don’t care for a physician to be present and are comfortable with an RN who knows what the fuck they are doing.
Unfortunately, once a human being is disgruntled, all foresight goes out the door and complaints are filed. Or, I should say, everything is fine until the medical board gets wind of your practice. Suddenly, they want to go through everything with a fine-toothed comb.
Whatever they find isn’t an opportunity to educate you and the public. Instead, it’s the perfect opportunity for fines and punishments.
How does the medical board get your laser hair removal Med Spa on their radar?
One of the main ways Med Spa practices get busted are from competitors reporting the to the medical board. The average Med Spa brings in nearly $1M of gross income per year.
A pissed off competitor realizes that they are losing all of their business to a new Med Spa and will send in one of their undercover staff to pose as a patient. They learn the ins and outs and figure out what to report to the medical board of California.
That RN you fired for showing up late, for picking fights with patients, and stealing cash from your Med Spa – well, she might decide to report you to the medical board.
If you just did one thing wrong, the medical board of California will love to sink their teeth into you. They simply don’t like Med Spa’s.
Your lovely ex-husband who emptied out your bank account before he dumped you for the transsexual sex worker – well, he knows your dirty little secrets and might decide to report them to the medical board.
If you happen to have embezzled some cash from the IRS as well, they’ll report that as well.
Your patient gets a nasty burn on her forearm after laser hair removal. She won’t tell you that they have been tanning on a tanning bed for the past week and so your RN won’t be able to make the proper laser adjustments.
They take pictures of the burn and report the incidence to the medical board whose very first question will be if they were examined by a physician before having their procedure done.
Is a Med Spa a Viable Business?
Yes, it’s a viable business and customers want this service done. As long as the FDA rules the US med industry, laser treatments have to be performed by licensed professionals.
Medical lasers can only be operated by MD’s/DO’s/RN’s/NP’s/PA’s. No exceptions. Some DDS’s will be able to perform non-aesthetic laser treatments which I won’t get into.
To run this business viably it’s necessary to have adequate legal advice along the way. Having oversight by being present on-sight and performing the majority of the patient intakes is necessary.
Supervising the RN’s and PA’s is also important if you don’t want to deal with an intrusive medical board investigation.
You could try to hire an NP for your practice but they are in short supply and highly sought after.