Dermatologists and cosmetic surgeons who direct medical spas — whether these medical practices are extensions of their practices or not — assume responsibility for all procedures performed. And while it can be a financially rewarding career move, getting involved is not always simple, nor is it easy. In fact, many physician and nonphysician medspa owners may be operating these facilities illegally and not know it.
Alex Thiersch, J.D., sees and hears about cases involving medspas all the time. Thiersch, founder and director of the American Med Spa Association (AmSpa) and partner at Thiersch and Associates, a Chicago-based law firm specializing in medical spa regulation, says medspas loosely encompass any aesthetic practice that offers services like Botox, fillers, laser hair removal, tattoo removal and more.
Dermatologists and cosmetic surgeons who get involved in medspas usually don’t intend to do anything wrong. The business model might make perfect sense on the outside, but be a legal mess in reality. Take this scenario, which Thiersch says happens quite often in Illinois (the outcome could vary in other states): A nurse who is experienced at injecting Botox and fillers decides to open a medspa to offer those services. She enters into a contract with a medical director, a dermatologist, who doesn’t have Botox experience, and pays that medical director a percentage of the medspa’s revenue.
“I would say over half the medspas in Illinois are set up kind of like this,” Thiersch says. “Once they are open for business and start treating people, they’ve broken all sorts of laws.”
Among those broken laws: The nurse is engaging in the unauthorized practice of medicine. She owns the medspa, which is illegal in the state. And, while the spa offers Botox, the medical director didn’t have Botox experience.
“The state will come in and say, even though we admit it’s difficult to determine what these laws are and many people don’t know them, you’ve just broken three laws. We’re going to fine you $10,000 for each offense, and we’re going to censure your license, not only for the nurse but for the doctor who has no idea this is going on,” Thiersch says.
Landon Pryor, M.D., a plastic surgeon in Rockford, Ill., directs a medspa within his practice. Dr. Pryor joined forces with an existing medspa, called True Laser, which offered predominately hair removal services. True Laser had been operating illegally, unbeknownst to the nonphysician owner and physician medical director. Dr. Pryor stepped in and helped to restructure the business. Now, the medspa is a separate corporate legal entity, but Dr. Pryor technically owns it due to the way the Illinois law is set up.
“In Illinois, a medical practice has to be 100 percent physician-owned,” Dr. Pryor says.
While laws vary from state to state, Dr. Pryor says even many attorneys are not familiar with medspa regulations.
“I think a lot of physicians that get involved with these things think it’s a nice way to generate ancillary revenue, but there are definitely a lot of potential legal and licensure-related issues that they can run into if they’re just doing it arbitrarily and not thinking about the actual logistics…. As a medical director, they’re putting their licenses on the line for basically anything that’s going on in that medspa,” Dr. Pryor says.
If it sounds too good…