Monthly Archives: April 2019

Johnson Dermatology is not a Medi-Spa

Recently the political climate for nurse practitioners has been HOT! I personally know and respect two of our state representatives who voted against a bill that would allow nurse practitioners that work in a RURAL healthcare setting and have at least FIVE YEARS of experience with a collaborating physician to practice independently in the state of AR. I believed the bill would improve access of care after hearing about a nurse practitioner in AR that closed her small rural practice due to her collaborating physicians death and the inability to find a collaborating physician in her area. Over 4,500 Arkansans lost access to healthcare in their hometown. This blog isn’t the place for me to debate that bill not to mention some of the physicians that upset me during the legislative session. In summary, I don’t want to debate it. I want us all to agree on a plan that makes Arkansas healthcare the best in the USA. I want all healthcare providers to work together on this plan and not bash each other to the point of employers getting calls. What a great world it would be if it was that simple. I struggled slightly with this post Dr. Sandy wrote for me because I didn’t want to be portrayed as bashing a medi-spa. I know owners of medi-spas that I really respect. I believe medi-spas have their place and can be really good. I also have seen my patients come to me after an untrained person they thought they could trust scarred them or botched them or worse. My first responsibility as a health care provider is to do no harm. I have people reach out to me asking me to do procedures I feel are unsafe (like silicone injections). They would pay me for that procedure but I still refuse. Why? Is that good business? No, it’s good healthcare though. Unfortunately, the lines blur between business and healthcare sometimes. This blog is meant to show the black and white lines. The laws. The truth that some patients don’t know. It’s not to debate nor argue about someone’s scope of practice or skill set . It’s to educate my readers so they can choose where they are injected with knowledge and confidence. So know your stuff. Dr. Sandy wrote it more eloquently than I ever could.

Johnson Dermatology is not a medi-spa
Written by Dr Sandy AKA Sandra Marchese Johnson MD, FAAD

I love skin and am blessed to be a board certified dermatologist. I am blessed to have fallen in love with skin and the care of skin while in my second year of medical school when I met my professional mentor and friend Dr. Bob Brodell. He taught me to love the anatomy and physiology of skin. He taught me to love and respect skin in both sickness and health. He helped me to match into a 4 year dermatology residency after medical school at UAMS where I stayed on faculty for 4 years and started their cosmetic dermatology training program with another friend Dr. Suzanne Yee. After Dr. Brad’s four years of college, four years of medical school, four years of dermatology residency and 2 years of dermatology surgery fellowship we opened Johnson Dermatology in 2006 in his hometown. 12 years later, we are blessed to have such an amazing team at Johnson Dermatology who work closely together with the core values to be effective, efficient, empathic and empowering. Our mission statement written by Dr Brad and myself in 2005 is that “The Johnson Dermatology Clinic strives to deliver efficient, quality, compassionate, comprehensive, patient-centered skin care. We endeavor to provide a team oriented, productive work environment. We strive to be a responsible corporate citizen and contributing member of the community through education and service.”

Now to turn the topic to something less fun and positive. We are going to address the elephant in the room. Nina wrote an excellent blog about that elephant recently. The elephant I am referring to is that unfortunately, she and I have seen quite a few complications from patients who were treated elsewhere. It seems like we have recently seen even more of those patients. Our first comment to those patients, as she pointed out, is to go back to the person who treated you, after all, they should know what they did and want to make it better. Unfortunately, everyone has complications–yes even us. If you have a complication or less than favorable result from us, please come back to us and let us make it right—we want to make it right.

Unfortunately and surprisingly also, we are getting many phone calls from “laser techs” in the community asking us questions about how to treat patients. Our answer to them is to “ask your medical director”. Unfortunately, many of them have no idea what we are talking about–they have no idea what a medical director is. In an attempt to empower all of you and re-educate myself, I thought that I would write a blog about medispas and medical directors. I started by reviewing our state laws set by the Arkansas Medical Board. I also looked at guidelines set forth by the AAD, the ASPS, American MedSpa Assocation, etc. I want to educate and empower all of you and myself in the most positive way possible. Unfortunately, this blog may upset some people–for that I apologize in advance and offer to discuss any issues in person, on the phone or by email with you. I may not have all of the facts and would love to be educated by you if need be.

My first comment is that I am NOT a medical director. I am one of 3 board certified dermatologists who practice at Johnson Dermatology with 1 board certified dermatopathologist, 2 certified nurse practioners/ licensed advanced practice registered nurses, and 1 certified diplomate of the Society of Dermatology physician assistants. We work closely under the same roof with a team of good people who we have trained, work closely alongside with and to whom we have delegated procedures according to the Arkansas State Medical Board Practices Act and Regulations. You should know that in the state of Arkansas, all medical practices must be owned by a medical doctor according to Regulation 4-29-305. For example, I need and have 2 medical licenses for the state of Arkansas. One is for me personally to practice medicine and one is for Johnson Dermatology for the practice of medicine to occur here. This means that a nurse or an esthetician cannot own a medical practice in the state of Arkansas since they cannot apply for the practice of medicine at their location. Regulation number 22 outlines the rules for the practice of laser medicine. I would encourage you to read the regulation before going to a laser center or medispa under or not under the same roof as a physician.

The American Med Spa organization also has clear guidelines about the practice of medicine with in a medical spa. There is a link to an article from their website. The American Academy of Dermatology has a position statement about medispas that ” Medical spas are facilities that offer a range of services, including medical and surgical procedures, for the purpose of improving an individual’s well-being and/or appearance. The distinguishing feature of medical spas is that medicine and surgery are practiced in a nontraditional setting. Procedures by any means, methods, devices, or instruments that can alter or cause biologic change or damage the skin and subcutaneous tissue constitute the practice of medicine and surgery. These include but are not limited to the use of: scalpels; all lasers and light sources, microwave energy, electrical impulses, and all other energy emitting devices; thermal destruction; chemical application; particle sanding; and other foreign or natural substances by injection or insertion. Any procedure that constitutes the practice of medicine, including but not limited to any procedure using a Food and Drug Administration (FDA)-cleared or regulated device that can alter or cause biologic change or damage, should be performed only by an appropriately-trained physician or appropriately-trained non-physician personnel under the direct, on-site supervision of an appropriately-trained physician in accordance with applicable local, state, or federal laws and regulations.”

I could write ad nauseam about this topic. Instead, I will state that the injection of a substance (botox, juvederm, etc), laser, or any manipulation of your skin or body with the above definition is considered medical care. Medical care is regulated by laws for a reason. If you are a consumer of medical care, I will state “buyer beware”. If you are a licensed medical provider or working with a licensed medical provider, I would encourage you to know your state laws. If you are someone who is thinking about providing medical care including injections or lasers, I would also encourage you to know your state laws.

The team of Johnson Dermatology strives to provide the most effective, efficient, empathic and empowering care all under one roof at 5921 Riley Park Drive in Fort Smith Arkansas. We strive to know and follow the state and federal rules. We strive to follow the Hippocratic oath “first do no harm”. We want to be your partner in all of your skin care needs, wants, desires, dreams, etc. If I or anyone at Johnson Dermatology has not treated you with the most effective, efficient, empathic or empowering care then I would like to know. We want to treat you with the highest level of care possible. If we did not then we need to learn from you so that we can make our good better and our better best. Below are some websites from which I gathered some information for this post and thought you might be interested in reading if you wanted to learn more.

You Want A Doctor To Perform Cosmetic Procedures