California recently passed a law that will increase the penalties for medical spas who don’t follow the rules of having a doctor supervising the procedures. But will the more severe punishment really do much to protect consumers when any kind of doctor can operate a med spa?

Nurses vs. Doctors
White Coat Confusion
Protect Yourself


A new law passed earlier this month that increased the financial and prison penalties for illegally owning or operating a medical spa. An existing law states that 51 percent or more of a medical spa must be owned and operated by an actual doctor, with the remaining ownership possible for a licensed practitioner, such as a nurse.

As you probably know, more aesthetic procedures than ever can be done without the need for an operating room, surgery or down time.  However, it’s still important to be seen by a licensed practitioner or doctor that is familiar with your cosmetic procedure and willing to take responsibility for the outcomes.

At least in California, this is a step to increase the penalties for more shady med spas.  The previous penalties were only $200-$1200 fines, with 60-day to 180-day penalties.  The new law increased the fines from $1,000 – $50,000, and prison times to 6 months – 5 years.

Nurses vs. Doctors

However, this law still does not address some things that I find concerning.  In California, you can still be treated by only a licensed practitioner, such as a nurse, and never see a doctor at a medical spa. Obviously, some nurses are better than others, but there’s no real way for government agencies to grade and rate who is better at what cosmetic procedure at this time.

The same is true for doctors, especially if their area of training and specialty is not in plastic surgery or dermatology, which will be discussed below.

Also, there’s no real way of measuring how much a nurse or licensed practitioner discusses a patient’s particular case BEFORE some procedure occurs.  Every state is different in terms of these regulations, so your state may:

  • Require a doctor to be physically near the nurse during the procedure
  • Require the doctor to be “available” for the procedure, which may mean being on a cell phone within the state, or even in another country

White Coat Confusion

In California, as well as the rest of the United States, any MD can do whatever they want in their med spa.  Certain procedures that a doctor could never hope to get hospital privileges to do are routinely being done in a spa that’s outside the review of a hospital.

There is no law against a cardiologist doing laser hair removal or laser peels, for example. Historically, states have trusted physicians to practice in their area of training. But as medicare and insurance reimbursements continue to decrease, more doctors from all specialty areas are jumping into the cosmetic world in hopes of making a better living..

I have written about this here, with a diagnosis of “white coat confusion:”

And the New York Times has discussed this as well:

Protect Yourself

I’m truly NOT trying to generate fear and angst in you, nor am I railing against cosmetic doctors that are doing procedures outside the scope of their training.  However, as a potential patient and medical consumer, it’s your right to know 1) who owns a med spa, 2) what their medical specialty is and 3) who you will actually meet with at the med spa.

The simplest way to figure out your best choices is to simply call the med spas you’re considering and then asking them these questions over the phone.  You save time and gas money and ensure that your med spa meets your baseline criteria before you commit to a consultation.

“Caveat Emptor” is a Latin phrase for “buyer beware.”  Even in this day and age of more information at your fingertips in a lawful nation like the U.S, it’s still best if you take personal responsibility and do a little investigation before you commit to a med spa.

In my office, I personally do all of the consultations and perform the Botox, dermal filler injections, and Obagi Blue Peels.  I don’t have a nurse do it, because  I would rather make sure that everything is done to the highest standards possible.

(Plus, I can get to know you, and I can torture with my not very funny jokes.  It’s a win-win all around!)


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