It’s been dubbed the spa of the future, although the medical spa can be as old as “taking the waters.” In accordance with Hannelore Leavy, founder and executive director of The Day Spa Association, European spas have invariably been medical, centered around mineral springs and waters. “Treatment was but still is prescribed and monitored by a physician,” said Leavy within an interview from her office in West New York, N.J. Spas established with this country’s early history were also employed for medicinal cure, but a transition occurred about mid-twentieth century, essentially phasing out medicine and emphasizing beauty treatment. American spas are coming full circle, going back to their roots of integrative wellness.
Water therapy extends back many many thousands of years, having been made use of by highly-developed, ancient civilizations for treating disease and through primitive shamans for purification of body and spirit. Through tradition and legend, continued use of some locations of mineral springs brought concerning the establishment of healing centers. The spas of Roman times included elaborate bathhouses where an array of treatments linked to healing were offered. Roman expansion and invasion left its mark and spas flourished for hundreds of years on European and Commonwealth soil. Two such locations, Bath in England and Spa in Belgium, are appropriately named and one of the more historically famous.
Europeans immigrating to America within this nation’s early settlement brought together the “old country” concept of the spa. Already commonly used by Native Americans, medicinal treatment at natural springs became a well established “cure all” available from coast to coast, ultimately causing the building of exclusive spa resorts. In an age where medicine was still based on what we should today term alternative therapies, integrative care was the standard. But as health care became more medicalized, as well as a booming industrial society became more beauty-conscious, both separated paths. Medicine moved into the hospital and clinic and spas became pampering salons for your wealthy, a trend that remained strong for many years.
What is different and exactly why are medical spas popping up now? The perfect solution has many facets. Among them, the increasing demand by today’s consumer for alternative therapies and dexnpky83 treatment; an emphasis on preventive wellness care; as well as a medical system that’s been overwhelmed with insurance dictates, paperwork and restrictions on service.
Dr. Michelle Palmer, an esthetics educator and naturopath having a doctorate in alternative therapies, setup her first medical spa 10 years ago. From her headquarters in Phoenix, Ariz., Palmer offered her carry out the present trend. “I’ve always had a passion for handling anyone by and large. Bodywork, naturopathic and esthetics; that if you ask me is the future. There’s a tremendous market with naturopaths.” There’s a good course now offered for nurse practitioners and bodyworkers to become naturopath practitioners. “I do believe Sept. 11 changed plenty of directions. The better aggressive remedies are down. Today people is over-educated, although the advantage is the fact that patients want total care and lighter treatments.”
Just two simple words, but, all over the board and during the entire industry, there is absolutely no consensus as to exactly what spa los angeles is and ought to be. That’s not surprising considering the fact that the relationship between medicine and spas is comparatively new inside our modern experience.
For the most part, Americans have come to anticipate a routine of sorts in health care: being ushered in and out as fast as possible via a stark (sometimes emotionally, as well as physically) environment, being poked and prodded after which dismissed using a prescription, order for lab tests or even a “come again, same time the coming year.” We may feel assured our health and wellness is intact, but repeating the ability can easily wait another year, many thanks. On the other hand, our relationship with spas has become one among romance — pampering and personal attention, soothing touch and a sense of rejuvenation upon leaving the premises. Combining the two, in a sense, has changed into a conundrum. Wellness centers, doctors’ offices with spa services, spas with medical exams, anti-aging treatments and spiritual guidance — those qualify as being a medical spa? And who will determine that definition?
Based on Marian Urban, a frontrunner from the medical spa movement and managing editor of Medical Spas magazine, the term “medical” is the key. Speaking from her office in Santa Fe, N.M., she said, “The medical spa is the European concept. It’s nothing new; that’s the way they maintain their health. Regardless how you add it, a medical spa should have a doctor on board, and it should be a whole-time position.” Even just in a licensed facility, when there is no medical doctor on staff, there may be a liability issue. “It’s how for the future,” she said, “but it needs to be investigated thoroughly. You may be facing liability in a lawsuit. A medical spa is not only a face.”
Generally, the public has associated medical spas with plastic cosmetic surgery and also other beauty-related procedures, but Urban highlights that this medical spa these days focuses on total wellness in the individual. “You can find all kinds of physicians arriving in, a wide scope. It’s not just a place you will have a facelift. It is possible to spend every week and also a whole battery of tests run for a whole picture of health. For me, medical spas will probably be the hospital of the future, for those looking for alternatives.”
Leavy views the medical spa arena as two very different modalities. “You have the doctor’s office that adds on spa services, like homeopaths, internists, dentists or plastic surgeons. Doctors are finding that spa services are useful to their patients, for relaxation, to relieve anxiety, so that as medically beneficial, such as pre- and post-surgery. In skin diseases, it will also help with the process of healing of the patient. Also, they are realizing these matters will not be protected by health insurance and folks are able to pay a great deal because of it. They don’t need to worry about HMOs. This is an important factor for doctors, to escape paperwork and medical insurance. They may earn income that’s not regulated by health care insurance. Research shows that men and women will certainly alternative practices and spending additional money for alternative remedies than on regular doctors.
“However, there’s the spa aligning itself together with the medical. Sometimes they have to possess a medical director, if it’s what the state requires.” Leavy also emphasizes the need for staff to get educated in what to consider in referring a client for medical consultation. “A spa therapist will be able to differentiate between an age spot and a melanoma.” The spa therapist, as defined by Leavy, is someone trained for an esthetician (also as being a masseuse) that has basic understanding of spa treatments as well as an extensive expertise in the body and ailments, and contraindications of certain treatments.
Based on Palmer, the medical field may have the final say in defining the medical spa. “Anything they (facilities and staff) are going to do, medicine will be responsible. They’re gonna regulate it.” It could be a phenomenal team with doctors and estheticians, she said. A doctor is an M.D. or D.O. You can add an R.N., esthetician, massage therapist, nutritionist among others to create a complete medical spa team. The most important element of this, she noted, is having the appropriately-trained staff member for each treatment.
While consensus concerning definition, defined purpose and guidelines for that operation of medical spas still hangs in limbo, most industry experts appear to agree that one is forthcoming. Through conferences, symposiums and personal encounters, attempts are being designed to formally gather opinions and set up industry standards. In June 2002, the National Coalition of Esthetic Related Profession Associations (NCEA) hosted a wide open forum to share with you viewpoints and discuss future directions, devoting a full session to medical issues. The Medical Spa Conference, sponsored by The Spa Professionals Alliance and scheduled for November of the year, has as the headline “How can we discover an equilibrium between the spa profession and the medical profession?” Organizers wish to increase awareness and data in the field, said Urban from the conference. “The main objective would be to bring out education and have people talking one-to-one, instead of already have it become a large trade exhibition. We are creating folks who suffer from been working together with medical spas for several years, but haven’t planned to take advantage of the term medical because they’re afraid. It’s not much of a light word to work with.”
Is the doctor actually in the house? If not, there might be trouble in paradise. While some facilities have taken on full-fledged medical directors, others have contracted for any name and an occasional personal appearance. What responsibilities fall under the title of medical director within a spa and why is full-time presence so necessary?
Susanne Warfield is president and CEO of Paramedical Consultants, Inc. and publisher of PCI Journal. She also serves as executive director in the NCEA and also the Society of Dermatology SkinCare Specialists (SDSS). Being a leading expert about the business aspects, she addressed several issues that should be considered regarding medical facilities, medical directors and federal and state regulations.
Speaking in a interview from her Glen Rock, N.J., office, Warfield said, “I contacted the medical director’s association and they also do not have such definition to get a medical director within a medical spa. It’s a gray area. If the medical director is actually a doctor, is it the main one whose name is happening the leasing or purchasing contract of your medical device to be used inside a spa?”
Under federal regulation, any machine for sale goes through a classification procedure by the Food and Drug Administration (FDA). How the federal government classifies a product will determine if it is defined as “prescriptive,” meaning simply a prescriptive user can order its purchase. “Then it’s up to each state to ascertain that can use that device by prescription,” said Warfield. Generally in most states, your order for purchase has limitations to physicians. Federal laws not just include medical devices, noted Warfield, but additionally cosmetics. “Could they be drugs? And in some states, their state boards of cosmetology will be going after medical spas since they are not properly licensed using the state board of cosmetology.
“Another point to consider will be the Occupational Safety and Health Administration (OSHA),” said Warfield. Under OSHA are three aspects of medical regulation that will affect medical spas.
– The Bloodborne Pathogen Standard requires facilities to have in place an exposure control policy for blood or other potentially harmful body materials. “Are the estheticians wearing vinyl gloves to do facial and the body treatments that might place them vulnerable to exposure?” asked Warfield. “I think, these treatments place you in jeopardy.”
– The Health Risks Communication Standard is related to hazardous materials on the job. For example, glycolic acid remains to be considered a hazardous substance. The American National Standards Institute (ANSI), now adopted by OSHA, regulates using lasers. “If the facility has invest a laser, they will be checking out compliance with safety for that,” said Warfield.
– Medical spa owners also require to pay attention to the Clinical Laboratory Improvement Amendments (CLIA), which regulate the grade of all laboratory testing (except research) performed on humans in the usa. Some medical spas are doing hair analysis, staining procedures and live blood cell testing. As a hospital, CLIA regulations will probably be applicable. “You can’t just put out a shingle and begin to complete all of these things,” said Warfield.
Regardless of if the business is called a hospital or medical practice, compliance by using these regulations will probably be required. In each state, the board of medicine determines if certain equipment may be used by physicians only or under physician supervision. Within a survey of state medical boards conducted this year with the American Electrology Association, 13 states have restricted use of laser for hair removal to physicians only, with another seven allowing its use by others under direct physician supervision. “Additionally, there are delegation rules with regards to who a health care provider can delegate responsibility to and this varies one state to another,” said Warfield. “Even the board of cosmetology, how is that planning to affect scope of licensure of estheticians? By way of example, right now we get more than 20 states which do not recognize esthetician licenses in medical practice.
“When a medical spa is actually medical, there’s a whole new act to understand — the Health Insurance Portability and Accountability Act (HIPAA),” Warfield said. Established in 1996, this act requires all medical organizations that maintain or transmit electronic health information to comply with specific standards in maintaining and transmitting health facts about individual patients. Facilities will have to be in final compliance by April 2003.
“So is definitely the medical spa a medical practice or perhaps is it a spa?” asked Warfield. The state laws vary and will have an affect on exactly how the medical spa operates, not just as being a medical center and also as being a cosmetology facility. “Under some state laws, when it is considered cosmetology, then a state laws of cosmetology apply.” Highlighting the phrase “medical,” Warfield noted in case a physician is training of your medical spa, the individual will not be planning to identify herself as a client, but rather as a patient. “Regardless how much we should give them a call clients, they’re still patients. The individual perceives this as medical therapy.
“The last point of this can be accreditation,” said Warfield. “Some states have enacted rulings which need medical facilities employing a certain level of anesthesia to accredit their facility. By way of example, laser resurfacing requires nerve blocks.” A spa offering this specific service is necessary to be accredited. The same holds true for other medical procedures now being performed in offices and spas away from the field of hospitals and medical centers. Two instances of non-profit, private accrediting organizations are the Joint Commission on Accreditation of Healthcare Organization (JCAHO) and also the American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF).
Licensing is yet another component that requires investigation and varies from state to state. “Take a look at all the agencies you should look at,” said Urban, “and also have every one of the licenses in place” whether for business, physician or staff. “This is why it gets tricky. This can be new and everybody is wanting to determine how we insure these individuals,” she added, by using a warning that this malpractice faction is “quickly becoming educated” and is indeed a threat to the businesses.
No matter who is licensed for what, when an unbiased esthetic practitioner shares the identical waiting room together with the physician, the physician ultimately carries the obligation. “When someone is working beneath a doctor’s office, they become the doctor’s employee,” said Palmer. “Your physician takes liability. That’s challenging. Doctors have so much liability the esthetic industry doesn’t understand. But the bottom line is not am I licensed, but am I properly trained?”