Non Corporate Practice of Medicine

I received a call today from a client. She received medical treatments in a medical spa in Southern California.  The provider was an RN who owns the medical spa. I have previously advised the client that the medical spa is not operating legally since it is owned by a non physician.  There was a complication and predictably, there is no physician on site or otherwise available.

Forty-five out of fifty states prohibit non physicians from owning or operating medical facilities. This includes medical spas or medical practices that engage exclusively in cosmetic, medical procedures.  There are limited exclusions to this (such as HMO's).  I do not understand why so many facilities ignore this well-standing premise of law.  In particular, nurses seem to feel that they can own a medical facility and provide treatments since they are fee for service or cosmetic in nature.  Many estheticians seem to believe this as well.

The short version of the story is that only physicians can own and operate a medical facility in the forty five out of fifty states (the notable exception is Florida).  Nurses must be employed by such a facility or otherwise contracted with them.  A medical director or supervisor is not enough to enable a nurse to own or operate a medical spa.

There are legal means in which a nurse and physician may own a medical spa together.  A medical spa is considered to be a medical facility and it must be governed accordingly.

Advice for Establishing a Medical Spa

It seems that a day does not pass before I am asked "Can I do this" or Can I do that" in my medical spa.  Everyone is seeing the answer to various medical/legal/business issues in a medical spa facility.  As you can imagine, it is often not easy to answer a question because it depends upon other variables and issues.  In 2005, I began to quantify the issues surrounding a true "medical spa".  A medical spa, to me, means that either medical services are performed in a spa setting, or a facility is a combination of medical services ans salon or spa services.

In 2005, I counted 126 variables that could determine the viability of a medical spa business plan.  There are more today. I developed a regression analysis as a toll to provide insight into the legal supportability of business plans. I still use this same analysis today.  No one can provide a simplistic answer in this heavily regulated industry.  There are countless "experts" who magically purported to have all of the answers.  It seems that every day, I am "fixing" a solution that such experts provided for a client.

I also caution medical spa owners and managers to beware of equipment suppliers that provide consulting services as part of the sale.  They have a vested interest in the outcome. This seldom leads to objective and thorough guidance.  For years, I heard of a letter from a legal department regarding the use of aesthetic lasers.  I have yet to find "the guy" that wrote "the letter". LOL  I have often stated that a laser company would sell a laser to my dog Stoli if he could pony up the money!!

Seek counsel from someone that has no financial gain if you move forward....you will be happy that you did!!

Paddy Deighan