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Laser treatments are a popular offering at medical spas, but Illinois law places limits on who can perform them. If your spa offers or is considering these services, it’s essential to understand the legal requirements and roles involved.
Updated: October 2024 to reflect the passage of HB4357
Medical spas (or medspas) are increasingly popular destinations for consumers to undergo non-surgical cosmetic procedures. Some of the most common and popular procedures at medspas are laser treatments for skin rejuvenation. Typically, these procedures are either ablative or non-ablative. Ablative therapy involves the removal of the top layer of skin, while non-ablative therapy generates new collagen by heating the underlying skin tissue without harming the surface.
In Illinois, medspa operators should be aware that both ablative and non-ablative laser treatments are considered the “practice of medicine,” meaning that only a physician may perform them. However, a physician may delegate these treatments to a qualified non–physician under specific supervision rules. It’s crucial to ensure that your staffing plan follows these rules, as non-compliance could result in criminal and civil penalties for illegally practicing medicine. (Learn more in our post: How to Open a Medical Spa if You’re Not a Physician)
Below are some key questions and general guidelines that medspa operators should consider regarding physician delegation and supervision of ablative and non-ablative laser treatments.
Must a physician have special qualifications to delegate laser treatments to other medspa staff?
Yes. Physicians may delegate to others only those tasks or duties within the scope of the physician’s own practice, education, training, or experience. Thus, to delegate ablative and non-ablative laser treatments to other medspa staff, the physician must be educated, trained, or experienced in ablative and non-ablative laser treatments.
To whom may a physician delegate laser treatments?
A physician may delegate both ablative and non-ablative laser treatments to licensed practical nurses (LPNs), registered professional nurses (RNs), and other qualified individuals. The medspa staff performing the delegated procedures must have received appropriate, documented training and education in the safe and effective use of the system.
Must a physician conduct an in-person visit with a patient before delegating laser treatments to other medspa staff?
As it stands now, yes. But starting January 1, 2025, a new law (HB4357) goes into effect as an amendment to the Medical Practice Act of 1987. This changes the requirements for non-ablative laser procedures. Under this new law, a physician will not have to examine a patient in person before a non-ablative laser procedure if all of the following conditions are met:
- The facility follows a physician delegation protocol
- The in-person examination is performed by an advanced practice registered nurse (APRN)
- The procedure is delegated by a physician and performed by an APRN, LPN, or RN who has received appropriate, documented training and education
- A physician is available by telephone or other electronic means to respond quickly to any questions or complications that may arise
However, when it comes to ablative laser procedures, a physician must still examine all patients in person and determine a course of treatment appropriate to each patient before other medspa staff may perform any delegated laser treatment. The physician examination is required only at the initial session, even if the treatment requires multiple sessions.
What are the physician supervision requirements for delegating laser treatments to other medspa staff?
If the laser treatment is ablative, the delegating physician must provide on-site supervision of the medspa staff. While the physician doesn’t need to be present in the treatment room, they should typically be in the same office or building as the staff performing the procedure. Generally, the delegating physician should remain on-site whenever a patient undergoes a delegated ablative procedure.
If the laser treatment is non-ablative, the delegating physician may provide on-site supervision but is not required to do so. If off-site, the physician must ensure supervision via telephone, email, or other electronic communications. The delegating physician must be prepared to respond promptly to any questions or complications that arise.
Are there any laser procedures that a physician may not delegate?
Yes. A physician may not delegate any ablative or non-ablative procedure that can potentially disrupt the eye (cornea to retina).
Is the supervising physician legally liable for the acts of the medspa staff?
Potentially, yes. Any delegated ablative or non-ablative procedure that a medspa staff member performs falls under the authority of the delegating physician and is part of the delegating physician’s patient-physician relationship. In essence, the staff member is acting as an “agent” of the physician. For this reason, medspas and supervising physicians must ensure proper insurance and indemnification arrangements between them are in place, along with clear policies and procedures to maintain proper oversight.
Can physician assistants and advanced practice registered nurses perform laser treatments?
It depends. Generally, physician assistants (PAs) and APRNs may perform procedures that align with their education, training, and experience.
However, medspa operators should note that PAs and certain APRNs who have not yet completed the required continuing education or training and clinical experience hours must maintain a written “collaborative agreement” with a physician. The exact requirements for a collaborative agreement differ for APRNs and PAs, both in both cases, the agreement should specify the ablative and non-ablative laser treatments that the APRN or PA is authorized to perform.
See our related article: “Collaborative Agreements: Key Considerations for Physicians.“
What laser treatments may an electrologist provide at a medspa?
Illinois law requires a license to perform electrology, which is defined as services for permanent hair removal using only solid probe electrode type epilation, including thermolysis (shortwave, high frequency), electrolysis (galvanic), and a combination of both (superimposed or sequential blend). A licensed electrologist may perform these services without physician delegation or supervision.
An electrologist may also perform other ablative and non-ablative laser treatments under the physician delegation and supervision rules discussed above. When providing such additional services, the electrologist is no longer acting as an electrologist but as an unlicensed practitioner acting under the delegating physician’s authority.
Get Legal Support.
If you’re planning to offer ablative and non-ablative laser treatments at a medical spa in Illinois, it’s essential to have a staffing plan, policies, and contracts that comply with laws on physician delegation and oversight.
The attorneys of Jackson LLP have experience preparing these documents and advising on the legal boundaries for licensed and unlicensed staff in the medspa setting. If your medspa is in Illinois (or one of the other states where we have licensed attorneys), schedule a complimentary phone consultation to see if we’re the right fit for your needs.
This article is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.
