By Alex R. Thiersch, CEO of the American Med Spa Association (AmSpa)

During its early years, the medical aesthetics industry was dominated by the physicians who are referred to as "core doctors"—plastic surgeons, facial plastic surgeons, oculoplastic surgeons, and dermatologists. This makes sense, since these physicians are well-suited to oversee and provide medical aesthetic services. However, in recent years, more and more non-core doctors have entered the marketplace. They are looking for ways to boost their compensation, define their brands and be their own bosses, and they are taking over the industry, much to core doctors' chagrin.

Today, approximately 60% of all medical directors at medical spas are non-core physicians, and it's likely that percentage will only increase in coming years. An incredible influx of non-core doctors is coming into the marketplace, and it is very likely that their ranks will expand as the popularity of medical spas increases and the public becomes more aware of these businesses.

Core doctors tend to presume that they are best-equipped to deal with the intricacies of the non-surgical medical aesthetic industry, because it is roughly adjacent to their fields of expertise. However, many often try to run their medical spas as parts of their surgical and dermatological practices without realizing that a medical spa requires a much different business model and perspective.

Non-core doctors, meanwhile, are aware that they don't know about the medical aesthetic industry and are willing to work to learn about it. They tend to place their primary focus on their medical aesthetic practices, and they become part of the industry by fully participating in it and committing to it. They perform the treatments, build their brands, undergo business training—in other words, they experience all the aspects of running a medical spa. Whether through education or trial and error, they try to learn how to run medical spas effectively. They know they need to have patients in order to survive, which is something many core doctors tend to overlook—if a medical spa associated with a surgical practice doesn't make money, it's not a major problem because the surgical practice is where the real money is. If a medical spa is a physician's primary focus, though, he or she must learn to adapt quickly, and that's why non-core doctors have experienced significant success in the medical aesthetic industry in recent years.

Of the top 10 medical spas that I know of in the country, none are run by core doctors—they're run by either non-core doctors or entrepreneurs, most of whom partner with non-core doctors as their medical directors.

In the face of this, core doctors have begun to express concern about the quality of the treatments provided by non-core doctors and, honestly, they have a point. After all, you probably wouldn't want to be one of the early patients at a medical spa that's run by a non-core doctor who is new to the industry. However, at the same time, why would you want to go to a core doctor's medical spa that's connected to a surgical practice, where your treatment is viewed as an afterthought?

Non-core doctors are affecting the industry in ways that few could have foreseen. When I speak to core doctors at conferences such as Vegas Cosmetic Surgery, I tell them that they'e fallen behind when it comes to medical spas, and that they need to start considering their medical spas as discrete businesses or else they're going to be pushed out of the industry. Some core doctors understand this, and when they implement this philosophy into their medical spas, they'll likely be surprised by how much more money they make.

However, as of now, the medical aesthetic industry belongs to the non-core doctors, and it's up to the core doctors to catch up and reclaim what was once theirs.

If you would like to learn more about the legal issues surrounding your medical spa, attend The Medical Spa Show this coming February in Las Vegas, NV.