The medical aesthetic industry is $5 billion in North America and is growing. For spas this represents an opportunity to expand their services to better meet the needs of their clients and to grow their revenue. However, it also means offering services that require medical professionals and assume greater risk. This risk can be balanced with a cautious approach and a dedication to ensuring quality of care.
In Ontario medical services are controlled by the Registered Health Professionals Act (RHPA). Providers of medical services are controlled by provincial colleges, such as the College of Physicians and Surgeons of Ontario (CPSO) for doctors. Registered Massage Therapists are controlled by the College of Massage Therapists of Ontario. This is in contrast to non-registered professionals such as aestheticians.
Equipment, supplies and facilities are not directly controlled by any college, but a practitioner is expected to maintain a reasonable standard of practice which indirectly mandates quality control over all parts of their practice. Surgical suites are the only facilities that are directly controlled by the CPSO via a relatively new program – the Out of Hospital Premises Inspection Program.
Controlled acts are specified in the RHPA, as acts, which may only be performed by authorized, regulated health professionals. Of the 14 controlled acts, physicians are authorized to perform 13 and may, in appropriate circumstances, delegate the performance of those acts to other individuals who may or may not be members of a regulated health profession.
The list of acts includes performing a procedure on tissue below the dermis and administering a substance by injection. This will include prescription medications such as Neuromodulator (Dysport, Botox) and injectable medical devices (Restylane, Juvederm).
The RHPA also regulates applying or ordering the application of energy. However, it does not contain any specifications on type or strength, so energy can be applied by non-registered professionals, such as aestheticians. Energy based treatments such as laser, ultrasound and radiofrequency must be approved by Health Canada, but manufacturers can sell to anyone.
However, while the RHPA doesn’t specify details about energy, it does specify that “No person, other than a member … within the scope of practice of his or her profession, shall treat … a person … in which it is reasonably foreseeable that serious bodily harm may result from the treatment ...”. Thus, non-registered providers can treat, but certainly bear significant liability when using energy.
Some benefits of having a physician on staff include using their expertise around indications for treatment, medical screening, treating or delegating treatment, management of complications, and risk mitigation.
All doctors in Canada are required to carry malpractice insurance from a single provider – the Canadian Medical Protective Association (CMPA). The facility needs separate liability for premises and staff often known as Errors and Omissions Insurance.
A doctor-patient relationship requires a history and physical exam and direct personal interaction before any medical treatment can be administered. Telecommunication is not allowed for cosmetic medicine. The doctor can delegate to a registered nurse or registered practical nurse only after establishing physician-patient relationship. The nurse must have “adequate” training and experience.
When dealing with doctors it is important to remember that there is no such thing as a “cosmetic” training program. The only specialty programs that offer cosmetic training are Ear, Nose, and Throat (ENT) and Plastic Surgery. Other doctors wanting to do cosmetic treatments need to complete a “Change of Scope of Practice” with the CPSO. This involves some additional training and mentored clinical experience.
If you hire a physician be sure to get a copy of their CPSO license to be sure it is current and to see their registered specialty (family doctor, plastic surgeon etc.). Go to the CPSO website and search for the physician. You will be able to see their background and see if they have any actions pending.
Ask the physician specifically if they have ever had their license revoked or limited in any jurisdiction, have voluntarily settled any action against them, and if there are currently any actions pending against them. Have them sign a form confirming their answers for your records. Also, get a copy of their current CMPA insurance coverage which is renewed annually. Your contract with the physician should include non-disclosure, non-solicitation, and non-compete clauses.
Physicians need to complete continuing medical education (CME) with the Royal College of Physicians and Surgeons or the College of Family Physicans of Canada. This has an annual requirement, and runs on a five year cycle. Failure to maintain this will result in loss of licensure, so be sure your physician is doing this.
Typical compensation for a Family Physician is $250-300 / hour providing cosmetic services and $400-500/hour for a surgeon. It is worthwhile to consider a commission structure to ensure that the doctor is motivated to grow business. Doctors may be willing to accept part of their compensation with services. The physician can indirectly benefit from referrals to their own practice, but the doctor cannot give “kickback” for referrals, as this is illegal.
Medical aesthetics represents an opportunity for spas to leverage their existing clients for greater revenue and at the same time offer powerful tools to address the clients’ needs. The risk of these services can be balanced with careful quality control and qualified medical staff.
Dr. Cory S. Goldberg is a dual-certified Plastic Surgeon with advanced training in Craniofacial Plastic Surgery. He specializes in reconstructive and cosmetic facial surgery including rhinoplasty and facelift procedures.
He has run his cosmetic surgery practice for 7 years and is acting Medical Director for Sanctuary Day Spas.
Spa Life E-Magazine Winter 2014 11
Dr. Cory S. Goldberg BSc MD MASc FRCS (C) FACS
190 Sherway Dr. Suite 401
Etobicoke, Ontario M9C 5N2