---
title: Supervision of Non-Physicians Performing Cosmetic Procedures
description: Learn how failure to provide appropriate supervision to non-physicians for cosmetic procedures outside a traditional physician’s office can result in medical board discipline.
---

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# Supervision of Non-Physicians Performing Cosmetic Procedures

 June 22, 2017

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The number of medical spas (also referred to as medi-spas or medspas) has been increasing as the desire for cosmetic procedures increases.1 A medical spa combines the atmosphere and traditional offerings of a day spa (e.g., facials, massages, manicures) with the provision of medical treatments such as injectable facial fillers (e.g., Botox), laser procedures, and even liposuction.

(From a risk management and patient safety perspective, the NORCAL Group of companies do not support the performance of surgical procedures in medical spas.)

It is important to remember that a medical procedure does not become a spa service simply because it is performed in a spa setting instead of a physician’s office. For example, if a medical spa offers Botox injections, and the state medical board considers Botox injection a medical procedure, the procedure must be performed by a physician or an appropriate allied health provider under a physician’s supervision, and the care provided must be documented in a medical record. Cosmetic services that are considered medical procedures must involve an informed consent process, documentation of an adequate history and physical that supports the procedure, documentation of what was provided and when, and monitoring for side effects.

The laws vary from state to state, but in general physicians performing or supervising a medical procedure in a medical spa need to document that they received appropriate training for that procedure and provide appropriate levels of supervision to allied professionals who perform it. A physician should be knowledgeable and competent in the procedure being delegated in order to properly provide guidance, direction, evaluation and oversight. A physician without the requisite training in a procedure cannot provide adequate supervision.2

## Risk Management Recommendations

### More Information About the Risks Associated with Practice Drift

- [Closed Claim Case Study: Laser Tattoo Removal by a Family Practitioner Presents Practice Drift Risks](https://www.norcal-group.com/library/laser-tattoo-removal-by-a-family-practitioner-practice-drift-risks?hsLang=en-us)
- [Closed Claim Case Study: Lipodissolve Administration by a Pediatrician — Practice Drift Risks](https://www.norcal-group.com/library/lipodissolve-administration-by-a-pediatrician-practice-drift-risks?hsLang=en-us)
- [Closed Claim Case Study: Breast Implant Removal and Mastopexy by an OB/GYN — Practice Drift Risks](https://www.norcal-group.com/library/breast-implant-removal-and-mastopexy-by-an-ob-gyn-practice-drift-risks?hsLang=en-us)

- Know state laws and regulations for the supervision of non-physicians performing cosmetic procedures.
- Only supervise procedures for which you and the non-physician have been adequately trained and are both competent to perform.
- Provide patients with the option of being treated by a physician rather than a non-physician.
- Develop written or documented policies and protocols for non-physicians who perform cosmetic procedures. 
    - Precisely outline roles and responsibilities.
    - Specify the types of cosmetic procedures they are allowed to perform.
    - Specify patient selection considerations.
- Establish and abide by requirements for appropriate training.
- Document the process used to determine that a non-physician is competent to safely and effectively perform a cosmetic procedure.
- Ensure non-physicians are educated and trained in the possible risks and complications of cosmetic procedures.
- Ensure that non-physicians adequately document the patient treatment in the medical record.
- Develop written or documented policies and procedures for responding to emergencies related to cosmetic procedures.
- Perform an appropriate examination when prescription drugs and devices will be used.

Failure to provide appropriate supervision to non-physicians can result in medical board discipline for aiding and abetting the unlicensed practice of medicine or unprofessional conduct. It can also result in direct liability for failure to supervise and indirect liability for employing a person who provides negligent treatment to a medical spa patient.

Before expanding a practice to include cosmetic services, contact your medical professional liability insurance carrier to determine if there are specific underwriting guidelines and requirements that must be met before the performance of cosmetic services will be approved for coverage under your policy. NORCAL Group policyholders should contact Customer Service at 844.4NORCAL to discuss coverage and to make proper arrangements.

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## References

1. Boyle A. "[The Beauty of Cosmetic Treatments: Billion-Dollar Nonsurgical Market Fuels Growth of Physician-Directed Spas](http://medicaleconomics.modernmedicine.com/medical-economics/news/modernmedicine/modern-medicine-news/beauty-cosmetic-treatments?page=full)." May 11, 2012. *Modern Medicine*. (accessed 3/27/2017)

2. Medical Board of California. "[The Bottom Line – The Business of Medical Spas](http://www.mbc.ca.gov/publications/newsletters/newsletter_2009_04.pdf)." (PDF) Medical Board of California Newsletter April 2009. (accessed 3/27/2017)

 Filed under: [Practice Drift](https://www.norcal-group.com/library/topic/practice-drift), [Plastic & Cosmetic Surgery](https://www.norcal-group.com/library/topic/plastic-cosmetic-surgery), [Article](https://www.norcal-group.com/library/topic/article), [Practice Manager](https://www.norcal-group.com/library/topic/practice-manager), [Physician](https://www.norcal-group.com/library/topic/physician), [Cosmetic & Reconstructive Procedures](https://www.norcal-group.com/library/topic/cosmetic-reconstructive-procedures)

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