MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
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Training and Orientation If you are considering adding estheticians and non-medical skincare services to your practice, the first step is to determine what role the esthetician will play. "People look at dermatologists as skincare professionals; they don't want to be referred to an esthetician to talk about skin care," says Lorrie Klein, MD, president of OC Dermatology in Laguna Niguel, California. "Plastic surgeons, on the other hand, often smartly have estheticians who act as the skincare specialists and are available to answer patients' questions and discuss products. It depends on your patients' expectations and the interests of the provider. Do you want to delegate skincare questions and concerns? Or do you want to provide these services yourself?" Though the services provided by estheticians in a medical aesthetic facility are similar to those provided in a spa, there are some key differences between the two settings. Dr. Werschler, who was one of the first dermatologists to employ estheticians in a dermatology practice, admits there were some initial challenges in integrating the two groups. "Estheticians are not medical 46 NOVEMBER/DECEMBER 2013 | MedEsthetics professionals. They don't use the same vernacular, so we weren't speaking the same language. And even though we have the same end goals, the courses of our treatments are very different," he says. "Estheticians needed to raise the bar on their training, and dermatologists needed to recognize the value of esthetic services." Esthetic training programs have responded by improving education. "They are now learning about infection control and sterile techniques, because this is where the jobs are," says Dr. Werschler. In order to uphold your existing level of care and help create a cohesive team of medical and non-medical providers, practice owners and managers need to be aware that many of the concepts that are basic to a medical provider may not be part of an esthetician's training. All new employees in Dr. Werschler's practice—including estheticians—undergo training on HIPAA compliance, infection control and sterile techniques. "To me a medical spa is a facility that follows the same standards as a medical practice," he says. "If you're going to use the word med or medical, it is a medical facility, and you follow all HIPAA laws and infectious disease standards." Dr. Klein runs her spa and medical practice as two separate entities. Although the spa staff does not have access to medical records, she still recommends training on HIPAA compliance and patient privacy. "If the esthetician is working within the medical practice, she must be HIPAA-trained," she says. "And this is done annually." Dr. Klein also recommends having new estheticians shadow the medical professional for a day to gain a better understanding of the terminology used by medical staff and the range of procedures offered. "The patients they are seeing have either undergone these procedures or they are curious about them, and they will ask questions," she says. Bruce Katz, MD, director of Juva Skin & Laser & MediSpa, New York, highlights the need for advanced on-site training. "Like with waxing, don't double-dip after the stick has been used on the patient, always wear gloves when touching patients," he says. "Depending on what devices they'll be using, they may need training on microdermabrasion, radiofrequency or lasers, depending on your state." His practice is also strict about documenting treatments, something many estheticians have not been trained to do. "They need to document the treatment performed, the device settings used—a lot of spa personnel don't write all of that down. You also need to make sure your estheticians are using the proper templates and getting proper consent. There's a lot more structure in a medical practice than in a typical spa," he says. Standardized treatments may also be new to estheticians who have previously worked either on their own or in a setting that allowed them more freedom to perform their own treatments. "We standardize protocols so the patient is always getting the same treatment, regardless of who performs it," says Dr. Katz. "And we use questionnaires to get feedback from patients—we give the patient a small gift for filling it out—and we do this on both the medical and medispa side to make sure protocols are being followed. Being consistent is important." –Inga Hansen © ISTOCKPHOTO.COM ESTHETICIANS AND THE MEDICAL PRACTICE