Medical Spas nationwide, but specifically in Florida, have been opening up at a staggering pace. For many reasons, including new services, technological advances, and lax regulations, the opportunities for medical spa businesses are endless.

In 2010, there were about 1,600 medspas operating in the United States generating about $1.1 billion in revenue (about $700,000 per medspa on average). By 2018, these numbers increased to over 5,000 medspas generating about $7 billion-$8 billion in revenue (about $1.4 million per medspa on average). The number is expected to grow to over 10,000 medspas by 2023 with about $18 billion-$20.7 billion in revenue.

While medical spa owners have taken advantage of these opportunities, state authorities have yet to keep up. The medical spa industry is largely unregulated, whether that be due to the nature of the services provided, or the explosive growth in this alternative type of medical clinic. On top of that, there’s been a expansion in scope of practice and supervision requirements for certain providers, including nurse practitioners.

Nevertheless, the ever-changing landscape and increase in offerings means that medical spa owners and providers must stay current on available guidance and regulations, including any grey areas.

Regulatory Issues

In Florida, a non-physician can own and operate a medical clinic. When that clinic is a cash-only clinic, no additional license is necessary to operate the clinic. Rather, the clinic owner just needs to hire licensed healthcare providers to provide services. This includes physicians, nurse practitioners, physician assistants, Electrologists, and estheticians (cosmetologist/full specialists), generally.

The scope of practice for these individuals tends to be the greatest source of regulatory enforcement. More specifically, the licensed providers have to look towards their professional statutes, administrative codes, and governing boards for guidance on what they can do with their respective licenses. This also includes understanding the level of supervision required for each licensee. Many medical spas employ estheticians, and are thus faced with the issue of whether estheticians may perform certain services at all, and, if so, whether they may do so independently or under physician supervision. Also relevant in the age of telemedicine is whether supervision must be provided by a physician present onsite, or if they must just be “readily available”. The primary regulatory body that governs many of these issues is the Department of Health, who, unfortunately, also deals with the same limited and unclear laws and regulations in the medical spa industry.

In some situations, a physician does not necessarily have to perform the service or even supervise it in person. Some providers require only distant supervision, while others require direct, onsite supervision. Supervision via telehealth is just starting to become an option in Florida for some licensees. With the impact COVID-19 had on patient care and access, that trend might continue to other licensees. Still, there are many more regulations that come with the use of telehealth in practice.

What risks are imposed by the current uncertain regulatory landscape?

The potential risks to medical spa owners, providers, and device suppliers under the present regulatory climate are significant. Risks include penalties related to scope of practice, facility licensure, supervision, marketing, and referrals. Medical Spa owners should continue to stay aware of the ever-changing regulatory landscape, including how regulations are enforced and how governing bodies are seeking to affect the industry.