By Patrick O'Brien, JD, Legal Coordinator, American Med Spa Association (AmSpa)

Congratulations—you made the excellent decision to become an AmSpa Member. You now have access to mountains of information to help in opening and running a successful medical spa or aesthetic-focused practice. You may be thinking, "Okay, now what?" Well, a good place to start is with your state legal summary, as it condenses down many legal areas and concepts into bite-size bits. The summaries are structured in a question-and-answer format and grouped broadly into five main categories: ownership, providers, treatments, business and marketing. Here, we reach my first bit of advice: when you first get access to the summary, don't just look up single questions; read the whole section first. We try to give as much information as possible in the answer to each question, but many of the concepts build off and interact with others, so having a baseline understanding is important. With that, let's have a closer look into the five categories and what to look out for in each.

Ownership

The ownership section is the first one listed in the summary because it contains the most foundational issues and common misconceptions in the medical aesthetics industry. You will notice that in many of the articles here we say that "medical spas are medical practices," and wonder what that has to do with anything. Well, unlike regular spas or salons, being a medical practice influences who can own the practice, what business structure you can use, and how you pay people. In many states, being a medical practice means that only a physician can be the owner. Knowing the rules in your state is important, because if you get it wrong, you may be practicing medicine without a license or aiding and abetting the unlicensed practice of medicine. In addition, in most states, these can carry a wide variety of penalties, from fines or loss of license to jail time, in some circumstances.

Providers

Because medical spas are medical practices, you will need the right professionals to perform the treatments. Every state restricts who can perform medical procedures, and many providers must work under the supervision of a physician. This section covers the most common professional licenses found in medical spas and covers important supervision and oversight needs for each profession. This section is important to understanding the later sections on scope of practice and can help you plan the staffing needs of your medical spa.

Treatments

This is the section where we get the most questions from members. This is understandable, as this is the area that changes the most from state to state. While all states have physicians, nurse practitioners, physician assistants and nurses, each state has its own rules and scopes of practice governing who can perform certain procedures and under what conditions they can perform them. Many states require special training or certifications to perform laser treatments or have restrictions on who may perform cosmetic injections. You will want to review this section to get an idea of what staffing changes you'll need to make when adding a new treatment or to see that the appropriate level of supervision is met. As an example, your medical director may be able to delegate to medical assistants performing microneedling or body contouring but may only be able to use nurses and more qualified medical professionals for injections.

Business

As discussed above, medical spas are medical practices, and your clients are your patients. This section of the summary highlights some of the unique aspects of these medical businesses, including patient privacy, buying and selling medications, and business naming. I think most people understand the concept of patient privacy—that your medical records should be kept confidential. However, privacy includes some other things that are not so obvious, such as chatting with a patient on social media and posting before and after pictures. Many states also have special rules for naming medical practices, the need to register the name, and what words can or can't be used.

Marketing

Marketing is critical to the success and growth of any business, and especially a medical spa. Because medical spas are, for the most part, medical practices (see ownership section), they must navigate rules and restrictions that other retail businesses don't. This section provides answers about many of these "special" rules, such as physician professional conduct issues and kickbacks or referrals. While each state is a little different, in general, a physician's advertisements must not be false and must not deceive or mislead potential patients. And while that seems obvious, it extends to areas that are not as obvious. For example, if the ad claims that the physician is "the best injector in the city," it is likely false. I'm sure the physician is very, very good at injecting, but unless there was a competition or official ranking, there is no way to back up the claim of "best." Similarly, "kickbacks," much like "bribes," sound really bad, and you are sure you aren't doing anything like that. But, in many states, giving a patient a Starbucks gift card as a "thank you" for recommending you to their friend probably qualifies as a kickback because the rules are written so broadly. In addition to checking this section before beginning new marketing campaigns, you can also review your state medical board's rules on advertising and unprofessional conduct.

With all the legal summary answers, it is important to remember that they are meant to provide you with general information for most situations. It isn't possible to cover every single step and aspect of a topic. Each of the questions could likely have a book written on them. For example, a registered nurse may be able to perform a laser procedure with appropriate training, but the legal summary is not able to describe all the topics, training and clinical experience that would qualify it as "appropriate" by the board of nursing. These sorts of specifics will depend on your situation and require more research or contacting the regulatory board. In short, the legal summary should be the first place you look but it shouldn't be the last place. The legal summary is also only one of your member benefits; you may also have access to recorded and live webinars and your state treatment delegation table. All of these can give you a good foundation with the legalities of running a medical spa.

AmSpa Members receive a complimentary 20-minute introductory compliance assessment with a ByrdAdatto attorney. Click here to learn how to join AmSpa today!