These are merely guidelines and represent a legal opinion. It is advisable to consult with an attorney as well as your malpractice carrier to ensure you are compliant with all the regulations. Nothing in this blog is meant to constitute legal advise.
Given the rapid growth of the medical spa industry, there is tremendous variation from state to state about the requirements for a medical spa in terms of ownership as well as who can perform the procedures. In addition, different boards within the same state may have conflicting or differing guidelines. For example a board of nursing may allow a nurse to perform a procedure under the supervision of a physician however the board of medicine may not allow a physician to delegate certain procedures. If there is a poor outcome, then the supervising physician will be held to the more stringent guidelines of his/her own board even if the nurse performed the procedure.
In New Jersey, only a physician or physician group can own a medical spa. There may be certain work arounds to this such as a MSO or medical service organization which can only help with operations and administration and should have no bearing on the medical treatment.
The most important aspect is who can performed procedures in a medical spa. In New Jersey, In terms of laser based services, a physician can delegate certain procedures like laser hair removal, infrared devices ( this can include YAG and non ablative erbium devices) and IPL to a physician assistant or a nurse.
A physician cannot delegate the use of radiofrequency to anyone. This applies to all radiofrequency devices including RF microneedling.
In terms of ablative treatments, such as a CO2 laser or ablative erbium laser, only a physician should be performing these treatments.
The NJ BOME proposed regulations prohibit a physician from delegating the performance of fillers or neuromuscular blockers to anyone. Proposed regulation N.J.A.C. 13:35-6.14B. This certainly is not followed in New Jersey where may of these procedures are performed by physicians assistants and nurses (nurse practitioners)
The physician can only delegate the task to a PA or RN after the physician has personally examined the patient. Thereafter, the physician does not have to be physically on site during the procedure, but will have to be in communication via phone or email. Coolsculpting would be included in this category.
For a more complete list of answers to commonly asked questions, you can purchase documents for each state here.
Which procedures at medical spas constitute medical treatment?
Can an aesthetician perform laser procedures?
Who can own a medical spa?
What type of training is needed?
Who can perform the procedures?
Is a good faith examination needed?
If I’m not a doctor, can I employ a “medical director” to provide medical services for my medical spa?
If I’m not a doctor, can I share in the profits of a medical spa?
Can a nurse, physician assistant or nurse practitioner take a commission for administering laser treatments or injectables like Botox?
Can a physician assistant practice independently?
How many physician assistants can a physician supervise?
Can an advanced practice registered nurse practice independently?
Do I have to be a doctor to own medical spa equipment, like lasers, or real estate?
Do I need to charge sales tax on procedures like Botox?
Who can legally fire a laser under New Jersey law?
Does a physician need to be on site during laser and intense pulse light (IPL) devices?
Can a dentist inject Botox?
Is Informed Consent required?
Does a medical spa need to obtain a license to operate?
Must I follow OSHA regulations?
What type of records are medical spas required to keep of their patients?
How long do I have to keep the patient’s records?
Can a med spa text or email patients to convey confidential medical information?
Are Botox parties legal?
What type of insurance does a medical spa need?
What type of information must a medical spa post?