As a plastic surgical skin care specialist, I encountered general disagreements over scope of practice from my initial experience with the SPSSCS to the national level. As the years have progressed, I’ve seen smaller arguments over scope of practice between nurse and esthetician advance to scope of practice challenges from nurse to physician. The controversy over the laser legislation in the State of Georgia last year was indicative that day spas are becoming aggressive in their attempts to move injectables, lasers and other device treatments out of the supervision and treatment direction of physicians. In fact, I spent the beginning of 2007 at the Georgia State capitol building lobbying against a bill that created loopholes that would allow laser hair removal to be offered at any local salon.
States begin to define the line more thoroughly through their medical boards, cosmetology boards and legislative action. In the meantime, here are a few suggestions from this state board member in dealing with issues that may arise concerning scope of practice.
Rule #1: for any individual to remember is it is YOUR responsibility to make sure you are practicing within your scope of practice. You will not find sympathyfrom any state board whose rules you have violated because you didn’t take time to research them. You agree as a licensed individual to operate by the laws and rules of the state in which you apply for licensure.
Utilize state government websites to print out current laws, rules and regulations. If you are unsure if a treatment is within your scope of practice call your state board and ask for a ruling or statement in writing. The worst thing you can do is proceed to add a treatment to your roster without knowing for sure if it’s recognized within your scope of practice by your licensing board.
Rule #2: The board issuing your license will not recognize authority from another board or that board’s licensee. We had a young lady sit before the Georgia Board of Cosmetology with a letter from her physician authorizing her to do treatments specifically outside her scope of practice in her salon. She was instructed that physicians and the Medical Board had no authority over facilities and licenses issued by the Georgia Board of Cosmetology.
Remember, physicians may be able to delegate within their own facilities per their state law and governing boards. Once again, check with your state’s medical board to determine their rules and/or policies concerning whether the treatment can be delegated. Physicians cannot delegate to a facility licensed and governed by a cosmetology board (i.e. a salon).
I do know that some state medical, nursing and cosmetology boards are attempting to communicate to create some sort of policy on the newly expanded medical skin care field. However this is a very small group. Most state boards do not work together. Unless there is specific legislation that works with licensees from several boards (i.e. the Georgia Cosmetic Laser Law allows nurses and estheticians to apply for a laser license issued by the medical board if they meet certain educational and supervisory criteria) you should assume your answers concerning your scope of practice will be determined by the board that issued your license.
Rule #3: Working outside your scope of practice does not make you a pioneer. It makes you a danger to your patient, your peers, and your profession. Those of us sitting on boards cringe when we hear stories of individuals who belong to our organizations that blatantly operate outside their scope of practice. We have had some quite exuberantly share their stories and tout their “expertise.”
Chemical peels, injectables, lasers, permanent makeup, etc. all come with the possibility of complication. The awful truth is that it’s only a matter of time before one of these individuals has a complication that results in enough publicity to drive state lawmakers and licensing board members to aggressively regulate the field. Legislation created under such conditions is never truly productive and what is needed.
I am the first to admit there is a tremendous amount of “gray area” concerning scope of practice. Can estheticians apply chemicals? Should nurses be doing facials and waxing? With the new Master Estheticians exam and the drive to create a national certification process for the medical esthetics field, I feel over time, you’ll see our field more defined and many of these gray areas disappear.
In the meantime, those of us who have ventured into medical esthetics can do our best to operate on a daily basis with our goal being ethical and safe treatment for our patients. If you haven’t taken time to look at your state’s laws and your board’s rules and regulations concerning your license, make 2008 your year for checking in.
Michelle Cox Turley has been working in the field of esthetics for almost two decades. She has spent the past 16 years working as a plastic surgical skin care specialist in Savannah, Georgia specializing in skin care, chemical peels, facial therapy, as well as working with protocols for laser and other device treatments. Michelle is a Past President of the SPSSCS and served as Program Chair for the 2003 Scientific Program in Boston.
Michelle was commissioned by Governor Sonny Perdue in 2006 to serve on the Georgia Board of Cosmetology. She completed her first term in May of 2008 and was appointed for a second term. Since her initial appointment, Michelle has lobbied at the Georgia Capitol Building concerning Laser Law, written rules, served in licensing hearings and attended the NIC National Conference as well as regional meetings. She has spoken in regional as well as national meetings concerning the current practice of medical esthetics, licensing and scope of practice issues.
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Often our meetings are filled with information on scope of practice, however, when asking our members what their scope of practice is and why there even is a scope of practice, too often the question is unanswered or answered incorrectly.
