Medical Spa Healthcare Providers Scope of Practice Answers
1. What is a physician assistant? What is a physician assistant’s scope of practice?
Physician assistants (PAs) are healthcare professionals who work under the supervision of physicians. Their scope of practice includes the following:
- services within the training and experience of the physician assistant;
- patient services customary to the practice of the physician assistant and the practice agreement; and
- services within the parameters of the laws, rules, and standards of the facilities in which the physician assistant practices.
https://www.revisor.mn.gov/statutes/cite/147A/pdf
a. What is the scope of practice of a physician assistant in a medical spa?
- Performing patient evaluations for medical spa services
- Injecting patients
- Administering an IV (Minn. Stat. §144E.28 and §144E.001)
- Using lasers on patients Minn. Stat. §147.081
b. Do physicians have to be physically present when a physician’s assistant is performing services in a medical spa?
No, a physician does not need to be present while a PA is performing services, however PAs practice as members of a team, so it is expected that a PA will have access to the support of a physician, as needed for patient care.
PAs must also practice under a practice agreement and that agreement must be reviewed annually by a physician who is associated with the practice. The practice agreement outlines the PA’s intended practice in that specific clinical setting. So while a PA can own and operate a practice, they would either employ or contract with a physician for the legal practice requirements.
https://www.revisor.mn.gov/statutes/cite/147A.09
2. What is a nurse practitioner? What is a nurse practitioner’s scope of practice?
A nurse practitioner is an individual licensed as an advanced practice registered nurse by the board and certified by a national nurse certification organization to be a clinical nurse specialist, nurse anesthetist, nurse-midwife, or nurse practitioner. Their scope of practice includes but not limited to:
- providing health assessment and screening activities;
- diagnosing, treating, and facilitating patients’ management
- ordering, performing, supervising, and reading diagnostic studies, excluding interpreting CT scans, MRI’s, PET scans, nuclear scans, and mammography
3. Does a physician have to be physically present while a nurse practitioner is performing services in a medical spa?
No, an NP does not need supervision from a physician. *This is not to be confused with the 2080 collaborative practice hours.
https://www.health.state.mn.us/data/workforce/nurse/docs/2019aprnb.pdf
4. Does a physician have to examine every new patient before the patient is treated at a med spa?
No. While some medical spas prefer to take a more conservative approach and have every patient either seen by a physician, PA, or an APRN, other clinics allow RNs to examine patients before being treated and the physician serves as a medical director, but is not present during the examination or when providing services, unless necessary for patient care. A good standard of practice is to have a comprehensive medical history reviewed by an MD or NP before the procedure starts (since all licensed healthcare providers are still under the scope of authority of their respective healthcare boards.)
a. What about nurse practitioners and physician assistants? Can they see new patients or must a physician do it?
In Minnesota an APRN or a PA can see new patients and they do not need to consult with a physician, unless it is necessary for patient care.
b. Are there special written requirements for any orders or patient charts for physician assistants?
No, other than a PA must practice under a practice agreement that is reviewed by a physician on a yearly basis. PAs can independently see and treat patients and they do not need a physician to oversee or co-sign their work.
https://www.revisor.mn.gov/statutes/cite/147A.09
c. Can a PA perform cosmetic procedures such as operate lasers, inject Botox, and perform microdermabrasion?
Yes, under Minnesota law, the use of lasers and injection of Botox can be done by PAs (Minn. Stat. §147.081).
d. Can a PA hand pre-packaged medication to patients?
Yes, as long as whatever medication that is being prescribed is within the PA’s scope of practice to prescribe and dispense.
Before PAs can dispense legend drugs and controlled substances, they first must fill out and submit a form with the Minnesota Board of Medical Practice that notifies the board that the PA will be dispensing medications for profit. Additional registrations may be required.
https://mn.gov/boards/assets/DrugDispenseUse%202021-Done_tcm21-36590.pdf
https://www.revisor.mn.gov/statutes/cite/147A.185
5. What is a registered nurse or a licensed vocational nurse?
A registered nurse (RN) is an individual licensed by the board to practice professional nursing.
https://www.revisor.mn.gov/statutes/cite/148.171
a. Can a registered nurse perform medical spa treatments?
A registered nurse can perform most medical spa treatments, including injectibles, under proper supervision and delegated authority in Minnesota.
6. What is a medical assistant? What role do they play in a medical spa?
Medical assistants complete administrative and clinical tasks. There is no specific rule or information in Minnesota for the scope of practice for medical assistants. General rule is that they interview patients and record their medical history, measure patients’ vital signs, such as their blood pressure and weight, help physicians with patient examinations, etc.
a. Should a medical assistant be licensed to practice in this state?
It is not required in Minnesota to be licensed or certified, but it helps with obtaining better job opportunities and many employers require a certificate.
b. What is the legal scope of medical assistants in this state?
There is no specific rule or information in Minnesota for the scope of practice for medical assistants. Medical assistants can technically be delegated authority to perform clinical tasks if done properly, but conservatively this should not be done.
c. May medical assistants perform any procedure in a medical spa so long as they are properly supervised?
No. They may only perform certain administrative or clinical tasks that are usual in their scope of practice and that won’t pose a significant risk to the patient.
https://www.bls.gov/ooh/healthcare/medical-assistants.html
d. Are medical assistants allowed to pierce the skin?
Technically, there is not a law in Minnesota that says “yes” or “no” to whether a medical assistant can pierce the skin, but according to MN law, physicians can delegate functions to an unlicensed person if they are qualified. Some interpret that statute to mean that as long as the medical assistant is knowledgeable, competent, and working under the direct, onsight supervision of a physician in an outpatient setting, he/she could give injections, immunizations, and vaccinations. For the purposes of a medical spa, it is best practice to have a licensed practitioner perform injections because most injections require skill and training related to the particular product therefore making the medical assistant unqualified in that area.
https://www.revisor.mn.gov/statutes/cite/147A.08
e. Are medical assistants allowed to administer Botox or inject collagen?
Technically, there are not any laws in Minnesota prohibiting a medical assistant from administering Botox or fillers, but it would be neither best practice nor an efficient use of person power because they would need to be closely observed and monitored by a physician or nurse practitioner or physician’s assistant during the procedure.
f. Are medical assistants allowed to use lasers or intense light devices to remove hair, scars, moles or other blemishes?
No. Under Minnesota law, the use of lasers is in the same category as surgery so only licensed practitioners can use lasers. This includes MDs, DOs, PAs, APRNs, and NPs. Additionally the statute does not allow for delegation of the use of lasers with medical supervision. *Note there are rules propagated by the Board of Cosmetology that allow for non-medical aesthetic use of lasers. Also, a more liberal legal reading of the physician’s laser rule suggests that non-surgical use of lasers is not the practice of medicine, although further legal guidance is needed in this area.
1. When is a physician-patient relationship needed? How is it established? Is a physician-patient relationship established by a consultation?
Minnesota does not have a law for physician-patient relationships. It is the general rule that a physician-patient relationship is established when an individual seeks assistance from a physician who may provide diagnosis or treatment to a health related matter and both the physician and patient agree to such assistance.
2. What type of records are medical spas required to keep for their patients?
There should be medical records of every patient. Such records include but are not limited to: the dates of all treatments; the patient’s initial visitation/inquiry; the history; progress notes; any tests performed or order and the results; diagnosis or medical impression and treatment ordered. A good rule of thumb is that a similarly situated practitioner should be able to replicate your procedure and know exactly what was done, by looking at the medical record.
3. What is a DEA Registration Number?
DEA regulations require that “only persons actually engaged in” the “dispens[ing] . . . of any controlled substance” hold a registration. 21 CFR 1301.11(a). When you register with the DEA you are provided a DEA Registration Number that identifies the controlled substance you are dispensing. Dispensing means that you are prescribing or handling the controlled substance.