Face Value

Who's in Charge?

"I am from a line of Italian women who sat around the kitchen table waxing their lips over a cup of coffee," says Sue Lossing, a certified medical electrologist.
 
Eighteen years ago, Lossing opened the first of her 13 Permanent Choice Laser Hair Removal & Cosmetic Centers, which specialize in hair removal. But while she doesn't use the term herself, Lossing's clinics could fall into the medical spa category because they use lasers.

Lossing has a physician on retainer who handles the medical supervision at her facilities. Dr. James Wire, a Chaska plastic surgeon, oversees the company's procedure protocols, answers any questions Lossing and her staff may have, and conducts training sessions. But he rarely makes an appearance at any of her locations. A majority of the metro area's medical spas and laser centers work within similar models.

Facilities like Lossing's aren't required to have a medical supervisor. In Minnesota, nonsurgical cosmetic procedures can be performed by registered nurses, certified physician's assistants, certified medical aestheticians, licensed aestheticians, certified electrologists, even noncertified laser technicians, as well as physicians and nurse practitioners.
 
In September 2005, the Minnesota Medical Association adopted a resolution, submitted by the Minnesota Dermatological Society, that states that the association will "work to create public awareness about the risks of scarring . . . associated with the use of treatments from lasers, intense pulse light sources, radio frequency devices, and related technologies."

The MMA also resolved to support legislative or regulatory efforts that would require every patient to get a physician's evaluation before receiving treatments that utilize these technologies. But so far, the trade organization has not put the regulation of medical spas on its priority list.

Proponents of tighter regulations cite patient safety as a factor in their position. One is Dr. Brian Zelickson, the long-time medical director of an Edina "skin and laser specialty center" formerly owned by Abbott Northwestern Hospital, who bought and renamed the facility Zel Skin & Laser Specialists. Zelickson, who also operates dermatology practices in Wayzata and Minneapolis, acknowledges that requiring 100 percent onsite supervision probably isn't practical. (A physician is on site full time at his specialty facility.)

"Also, legislation and compliance monitoring add a whole layer of unnecessary bureaucracy. Do you really need a doctor's evaluation to tell you whether you are a candidate for hair removal at your bikini line?"

"I think there is enough data collection that says these are pretty safe procedures, but you can have complications," Zelickson says. "It's not like getting your hair dyed." He argues that requiring that a supervising physician be on site at least 30 to 50 percent of the time would ensure a greater level of patient safety, training, and protocol than is typical at many medical spas, where supervising physicians usually stop by infrequently.

Those opposed to the MMA resolution say that some core physicians are trying to tighten the rules for a very simple reason: money. They are afraid of losing market share to non-core medical and non-medical facilities.