Face Value

Industry Face-Off

Core physicians may have reason to worry. According to Primary Care and Medispas Expand Aesthetic Market, a report from California-based "aesthetic medicine" research firm Medical Insight, core physicians accounted for 60.1 percent of the total aesthetic procedure volume in 2006 in the United States, non-core physicians accounted for 33.3 percent of treatments, and medical spas accounted for 6.6 percent. "Through 2011, however, medispas and non-core physicians will demonstrate the strongest gains in procedure volume, with compound annual growth of 35.2 percent and 27.1 percent, respectively, while procedure volume for core physicians will expand by 9.9 percent per year," the report notes.

Not all core physicians, however, favor tighter rules on medical spas. Dr. Richard H. Tholen, president of the Minnesota Association of Laser Centers and Medi Spas, opposes the MMA resolution, as does his association. Tholen opened Carillon Clinic, one of the first medical spas in the Twin Cities, as part of Minneapolis Plastic Surgery in Golden Valley. Several years later, he and a partner opened another Carillon Clinic in Maple Grove. If the resolution were to become law, Tholen's medical spa in Golden Valley would be in compliance, but the one in Maple Grove might not.

"Our position is that proper training and supervision are central to the safe and effective treatment of patients with lasers and injectables, including Botox and Restylane. But to restrict trade by insisting a physician be on site supervising does nothing to improve safety—it simply raises cost and makes it more difficult for patients to schedule treatments," Tholen argues. "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?"

Tholen believes the resolution is a move to restrict trade, or reduce competition, coming primarily from dermatologists. "I'm not saying we should lower standards," Tholen says. "But through proper training and supervision, medical clinic or spa personnel can and have been delivering safe and effective treatments. You don't just shut a place down that does not follow your practice model by instituting anticompetitive, monopolistic legislation under the guise of patient safety."

Like Tholen's Maple Grove spa, Skin Speaks Spa MD, where Carney is on site 20 percent of the time, also might not be in compliance if proponents of tightening regulations prevail. At Skin Speaks, Botox and dermal fillers are injected by physicians and nurse practitioners as well as registered nurses and certified physician assistants, and laser treatments are performed "by that same group as well as certified medical aestheticians who have been given a certification by as high of an accreditation as we could find," Carney says.

That puts Skin Speaks in compliance with a Minnesota law that states a physician can "employ, supervise, or delegate functions to a qualified person who may or may not be required to obtain a license or registration to provide health services if that person is practicing within the scope of that person's license or registration or delegated authority."