It’s been dubbed the spa for the future, but the medical spa is really as old as “taking the waters.” As outlined by Hannelore Leavy, founder and executive director during the day Spa Association, European spas have always been medical, centered around mineral springs and waters. “Treatment was and still is prescribed and monitored from a physician,” said Leavy in an interview from her office in West New York City, N.J. Spas established within this country’s early history were also used for medicinal cure, but a transition occurred about mid-twentieth century, essentially phasing out medicine and emphasizing beauty treatment. American spas are now coming full circle, returning to their roots of integrative wellness.
Water therapy goes back many thousands of years, having been used by highly-developed, ancient civilizations for the treatment of disease and by primitive shamans for purification of body and spirit. Through tradition and legend, continued consumption of some locations of mineral springs brought regarding the establishment of healing centers. The spas of Roman times included elaborate bathhouses where an array of treatments connected with healing were offered. Roman expansion and invasion left its mark and spas flourished for many years on European and Commonwealth soil. Two such locations, Bath in England and Spa in Belgium, are appropriately named and among the more historically famous.
Europeans immigrating to America during this nation’s early settlement brought together the “old country” reasoning behind the spa. Already widely used by Native Americans, medicinal treatment at natural springs became a proven “cure all” available from coast to coast, leading to your building of exclusive spa resorts. In a age where medicine was still according to everything we today term alternative therapies, integrative care was the standard. But as health care became more medicalized, and a booming industrial society became more beauty-conscious, the 2 separated paths. Medicine moved to the hospital and clinic and spas became pampering salons for the wealthy, a trend that remained strong for several years.
What changed and exactly why are medical spas appearing now? The best solution has several facets. Among them, the improving demand for services by today’s consumer for alternative therapies and dexnpky83 treatment; an emphasis on preventive wellness care; plus a medical system that’s been overwhelmed with insurance dictates, paperwork and restrictions on service.
Dr. Michelle Palmer, an esthetics educator and naturopath with a doctorate in alternative therapies, set up her first medical spa 20 years ago. From her headquarters in Phoenix, Ariz., Palmer offered her take on the present trend. “I’ve always had a passion for dealing with the individual in general. Bodywork, naturopathic and esthetics; that for me will be the future. There’s a huge market with naturopaths.” There’s even a course now on offer for nurse practitioners and bodyworkers in becoming naturopath practitioners. “I think Sept. 11 changed a lot of directions. The greater number of aggressive remedies are down. Today everyone is over-educated, however the advantage is patients want total care and lighter treatments.”
Just two simple words, nevertheless, all over the board and through the industry, there is no consensus as to just what med spa los angeles is and must be. That’s less than surprising considering the reality that the relationship between medicine and spas is relatively new in your modern experience.
For the most part, Americans have come to anticipate a routine of sorts in medical care: being ushered out and in immediately by way of a stark (sometimes emotionally, along with physically) environment, being poked and prodded after which dismissed with a prescription, order for lab tests or possibly a “come again, same time next year.” We may feel assured our overall health is intact, but repeating the experience can easily wait another year, thanks a lot. On the flip side, our relationship with spas has been among romance — pampering and private attention, soothing touch and a sense of rejuvenation upon leaving the premises. Combining both, 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 — which of them qualify as a medical spa? And that will determine that definition?
As outlined by Marian Urban, a leader inside the medical spa movement and managing editor of Medical Spas magazine, the saying “medical” is the key. Speaking from her office in Santa Fe, N.M., she said, “The medical spa may be the European concept. It’s nothing new; that’s the way they maintain their own health. Irrespective of how you set it, a medical spa needs to have a health care provider aboard, and it needs to be a whole-time position.” Even in an approved facility, if there is no physician on staff, there can be a liability issue. “It’s how for the future,” she said, “but it must be checked out cautiously. You could be facing liability within a lawsuit. A medical spa is not only a face.”
Generally, people has associated medical spas with plastic cosmetic surgery and other beauty-related procedures, but Urban highlights that this medical spa today concentrates on total wellness of your individual. “You can find all sorts of physicians to arrive, a large scope. It’s not only a place you have a facelift. You are able to spend per week and also a whole battery of tests run for a complete picture of health. For me, medical spas will be the hospital for the future, for anyone looking for alternatives.”
Leavy views the medical spa arena as two totally different modalities. “There is the doctor’s office that adds on spa services, like homeopaths, internists, dentists or cosmetic surgeons. Doctors are discovering that spa services are helpful to their patients, for relaxation, to relieve anxiety, and as medically beneficial, for example pre- and post-surgery. In skin diseases, it will also help using the recovery process from the patient. They are also realizing these matters usually are not paid by medical health insurance and people are prepared to pay a good deal for this. They don’t need to bother about HMOs. This is an important factor for doctors, to escape paperwork and medical health insurance. They could earn income that’s not regulated by medical insurance. Research has revealed that men and women are likely to alternative practices and spending more money for alternative remedies than on regular doctors.
“On the flip side, 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 requirement for staff to become educated in things to search for in referring a client for medical consultation. “A spa therapist must be able to tell the difference between an age spot and a melanoma.” The spa therapist, as defined by Leavy, is someone trained as being an esthetician (also as a masseuse) having basic understanding of spa treatments as well as an extensive knowledge of the entire body and ailments, and contraindications of certain treatments.
Based on Palmer, the medical field could have the ultimate say in defining the medical spa. “Whatever they (facilities and staff) are doing, medicine is going to be responsible. They’re planning to regulate it.” It can be a phenomenal team with doctors and estheticians, she said. The physician is surely an M.D. or D.O. You could add an R.N., esthetician, masseuse, nutritionist yet others to produce a complete medical spa team. The main part of this, she noted, has the appropriately-trained staff member for each and every treatment.
While consensus concerning definition, defined purpose and guidelines to the operation of medical spas still hangs in limbo, most skilled professionals appear to agree that you is forthcoming. Through conferences, symposiums and private encounters, efforts are being made to formally gather opinions and set up industry standards. In June 2002, the National Coalition of Esthetic Related Profession Associations (NCEA) hosted an open forum to share viewpoints and discuss future directions, devoting a whole session to health problems. The Medical Spa Conference, sponsored from the Spa Professionals Alliance and scheduled for November on this year, has as its headline “How could we discover an equilibrium between the spa profession and the medical profession?” Organizers want to increase awareness and data from the field, said Urban in the conference. “The main objective would be to draw out education and get people talking one-to-one, rather than get it be considered a large trade exhibition. Our company is creating those who have been working with medical spas for many years, but haven’t wanted to make use of the term medical because they’re afraid. It’s not much of a light word to utilize.”
Is the doctor actually in the house? Or even, there may be trouble in paradise. While many facilities took on full-fledged medical directors, others have contracted for the name along with an occasional personal appearance. What responsibilities fit into the title of medical director within a spa and how come 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 from the NCEA and the Society of Dermatology SkinCare Specialists (SDSS). As being a leading expert around the business aspects, she addressed several issues that must be considered regarding medical facilities, medical directors and federal and state regulations.
Speaking inside an interview from her Glen Rock, N.J., office, Warfield said, “I contacted the medical director’s association and so they do not have such definition to get a medical director in the medical spa. It’s a gray area. In case the medical director is in fact a health care provider, will they be usually the one whose name is going on the leasing or purchasing contract of the medical device to be used in a spa?”
Under federal regulation, any device offered undergoes a classification procedure by the Food and Drug Administration (FDA). How the federal government classifies a device will determine whether or not it can be called “prescriptive,” meaning merely a prescriptive user can order its purchase. “Then it’s around each state to determine that can use that device by prescription,” said Warfield. Generally in most states, an order for purchase is restricted to physicians. Federal laws not just include medical devices, noted Warfield, but additionally cosmetics. “Are they drugs? And in some states, the state boards of cosmetology are going after medical spas as they are improperly licensed with all the state board of cosmetology.
“Another denote consider may be the Occupational Safety and Health Administration (OSHA),” said Warfield. Under OSHA are three aspects of medical regulation that can affect medical spas.
– The Bloodborne Pathogen Standard requires facilities to have set up an exposure control policy for blood or some other possibly damaging body materials. “Are the estheticians wearing vinyl gloves to do facial and the entire body treatments that would place them in danger of exposure?” asked Warfield. “I think, these treatments put you in jeopardy.”
– The Risks Communication Standard has to do with hazardous materials in the workplace. For example, glycolic acid continues to be classified as a hazardous substance. The American National Standards Institute (ANSI), now adopted by OSHA, regulates the use of lasers. “When the facility has devote a laser, they will be checking out compliance with safety for that,” said Warfield.
– Medical spa owners also require to be familiar with the Clinical Laboratory Improvement Amendments (CLIA), which regulate the quality of all laboratory testing (except research) performed on humans in the states. Some medical spas are performing hair analysis, staining procedures and live blood cell testing. Being a medical facility, CLIA regulations is going to be applicable. “You can’t just put out a shingle and initiate to do most of these things,” said Warfield.
Whether or not the business is named a hospital or medical practice, compliance with one of these regulations is going to be required. In each state, the board of medicine will determine if certain equipment may be used by physicians only or under physician supervision. In a survey of state medical boards conducted this current year from 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. “There are delegation rules concerning who a doctor can delegate responsibility to and this varies state to state,” said Warfield. “Even the board of cosmetology, how is the fact that gonna affect scope of licensure of estheticians? For example, we currently get more than 20 states that do not recognize esthetician licenses in medical practice.
“In case a medical spa is in fact medical, there’s a whole new act to be familiar with — the medical Insurance Portability and Accountability Act (HIPAA),” Warfield said. Established in 1996, this act requires all healthcare organizations that maintain or transmit electronic health information to abide by specific standards to maintain and transmitting health facts about individual patients. Facilities will need to be in final compliance by April 2003.
“So is definitely the medical spa a medical practice or maybe it a spa?” asked Warfield. The state laws vary and may have an impact on how the medical spa operates, not merely being a medical center but additionally as being a cosmetology facility. “Under some state laws, if it is considered cosmetology, then a state laws of cosmetology apply.” Highlighting the phrase “medical,” Warfield noted in case a physician is hitting the gym of a medical spa, the consumer is just not likely to identify herself as being a client, but rather like a patient. “Irrespective of how much we should give them a call clients, they’re still patients. The customer perceives this as medical treatment.
“One final point of this is accreditation,” said Warfield. “Some states have enacted rulings that require medical facilities by using a certain measure of anesthesia to accredit their facility. For example, laser resurfacing requires nerve blocks.” A spa offering the service is necessary to be accredited. The same is true for other medical procedures now being performed in offices and spas outside the world of hospitals and medical centers. Two samples of non-profit, private accrediting organizations are definitely the Joint Commission on Accreditation of Healthcare Organization (JCAHO) as well as the American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF).
Licensing is yet another ingredient that requires investigation and varies from state to state. “Have a look at every one of the agencies you need to look at,” said Urban, “and possess all of the licenses into position” whether for business, physician or staff. “This is when it gets tricky. This is brand new and everybody is attempting to figure out the way you insure these folks,” she added, using a warning that this malpractice faction is “quickly becoming educated” and is indeed a threat to such businesses.
Regardless of who is licensed for which, when an impartial esthetic practitioner shares exactly the same waiting room with all the physician, the physician ultimately carries the responsibility. “When someone is working under a doctor’s office, they get to be the doctor’s employee,” said Palmer. “A doctor is taking liability. That’s a challenge. Doctors have so much liability how the esthetic industry doesn’t understand. But the end result is not am I licensed, but am I properly trained?”