So You Want to Direct a Medical Spa?
Christopher L. Nuland, Esq.
FSPS General Counsel
With the passage of HB 699, which requires physician extenders working in satellite facilities offering "primarily aesthetic skin care services" to be supervised by a board certified dermatologist or plastic surgeon, many Society members are being approached to assume the medical directorships of medical spas. While such offers often appear lucrative on their face, physicians should carefully consider the relative risks and benefits of such relationships.
The benefits of such relationships are usually fairly apparent. Most such contracts offer a monthly salary and access to scores of potential patients who may be candidates for more advanced medical procedures. In addition, the plastic surgeon usually is allowed to bill the patient separately for direct clinical services and, in some cases, leverage the fees earned by supervised extenders.
However, these arrangements also carry responsibilities, few of which are explicitly set forth in the Agreement. For instance, a supervising physician, by law, must file a protocol for each supervised ARNP and register as the supervising physician for each physician assistant. By supervising these extenders, the physician also is deemed to be practicing medicine in those offices in which the extenders operate, and the plastic surgeon must ensure that he is covered for such services in each location or has posted a sign that the physician in uninsured.
Finally, medical directors usually assume responsibility for ensuring the regulatory compliance of the medical spas. The supervising physician must therefore ensure that the RNs are not performing laser hair removal, that all patients are seen by a physician prior to receiving injections, and that prescriptions are appropriately issued and implemented.
Even with the above responsibilities, the benefits of serving as a medical director may well outweigh the risks. However, Society members are urged to review such arrangements carefully and determine if they are truly able to provide the appropriate level of supervision.