Skin care professionals are required to have specific personal and professional skill sets to work underneath physicians. Respect for the physician and the regulations of a medical practice are critical, as is an understanding of the skin care professional's scope of practice. Working in a medical setting as a skin care professional can be both rewarding and beneficial for both the professional and their clients. Understanding the nature of advanced aesthetics and the branches of knowledge needed are paramount to success in the evolving and popular medical spa arena.

With technology such as microneedling, dermaplaning, and cosmetic laser skin rejuvenation being at the forefront of aesthetic services in 2016, skin care professionals should understand the knowledge and skills required for the competitive advantage of assisting their clients with changes at a dermal level. With the supervision of a skilled, board-certified physician, skin care professionals can assess and perform the services necessary to assist clients in achieving real change. Respecting the skill set and scope of practice for the supervisory staff and physicians, along with performing only what is contractually within the job description of the aesthetic position, is exceptionally important. Skin care professionals within any advanced setting should obtain certifications underneath their license for each individual advanced procedure. Specific courses for cosmetic lasers, for example, are crucial to add to the professional's portfolio in order to showcase added training beyond that of the fundamental aesthetics course. Skin care professionals looking to gain a competitive edge will not only obtain as much outside education as possible, but also build their skill set of public speaking, professional development, HIPAA compliance, OSHA regulations, and more.

Having a thorough understanding of the dermatology and plastic surgery procedures, in addition to new and modern cosmetic procedures on the market, is critical to assisting clients and answering questions. Constant continuing education and training on advanced techniques is paramount to the success of any skin care professional within a medical setting.
A thorough understanding of state laws and regulations through constant monitoring of any changes with state board regulatory agencies is a critical tool that must be taken seriously as a professional in today's market. Each state possesses specific requirements for aestheticians within their own board, as well as laws under the state medical and nursing boards.

COMMUNICATION
Overall, skin care professionals must always assume that the physician is the lead authority in any protocol for clients that require an advanced procedure. They must obtain written permission and treatment plans through the physician overseeing the practice, with monitoring by the physician of all notations within patient charts, products and modalities used, and any other thought process made throughout the duration of the treatment. Proper communication is exceptionally important between the physician and support staff when treating patients in a medical setting. Having daily and weekly communication when dealing with patients receiving treatment is critical. Thorough organization of charting systems, patient and employee safety and sanitation practices, and consistent monitoring by supervisory staff is the key to medical spa success.

Skin care professionals must understand and uphold a high skill level in documentation and notation skills. Through the initial consultation with clients, an understanding of medications listed, immune system dysfunctions, stress levels, ingredients in products used, and past procedures are important for assessment. The professional must also obtain the skills and knowledge needed to piece together proper patient care plans within a medical setting that consist of combinations of needed procedures, such as chemical peels, microdermabrasion, dermaplaning, microneedling, and cosmetic lasers. The physician overseeing the practice must sign off on and give permission to the professional performing the procedures.

The correct use of medical terminology is especially important when it comes to medical charting. Depending on the medical charting system of the practice, the skin care professional must frame their language in the most objective terms possible, steering clear of any biased phrases that could be misinterpreted. Diligence and accuracy in record keeping is essential and should be a very important part of the day-to-day activities of the skin care professional. In addition to daily charting, supervisory and management staff must check behind all service providers daily and/or weekly to be certain that charting is being performed to the level needed for the practice. The charts must then pass through the physician overseeing the practice in order to obtain the correct signatures, documentations, and authorization needed to move forward in treatment. Patient and client follow-up after procedures should also be documented within the charting systems and must be approved in terms of communication methods with the patient and documentation of the interaction.

UNDERSTANDING INSURANCE
A complete understanding of liability insurance is exceptionally important to skin care professionals in a medical setting as the supervisory physician must include these individuals within the malpractice insurance. A separate liability insurance policy on the practice as a whole, with policies on each individual practitioner, is also an added protection umbrella. All service providers within a practice should obtain copies of insurance policies that pertain to their performance for their own understanding. Seeking insurance providers that specialize in medical spa businesses and procedures is an absolute must.

The options for these insurance providers is more prevalent today than recent years as many individual procedures, such as microneedling, permanent makeup, or cosmetic lasers, are specifically added to policies. All persons approved by the physician for the performance of such procedures must be listed by name. Any time a new service provider is added, the insurance policies must be updated. Viewing these policies quarterly is important for all supervisory staff. Maintaining complete compliance with both national and state regulatory agencies is an important factor. If there was ever a setting where insurance was absolutely crucial, it is that of a medical spa. Liability insurance covers the facility and each practitioner on the policy, with a specific focus on individual procedures within the practice. When adding a new medical aesthetic procedure, it must be additionally added to the policy. Both the general liability coverage of the practice, in addition to the malpractice insurance of the physician overseeing the clinic, must be updated to match all standards. All records in accordance with liability insurance standards of a medical spa must be held at a high level of importance as it is the basis of administration and authority within the safety parameters of the patients within its care.

PATIENT PRIVACY
The office culture in a medical aesthetic setting can be significantly different from any other business or spa environment due to OSHA and HIPAA compliance. From the front desk receptionists to any supporting staff member, all employees within a medical spa must be in tune with state regulations and compliance. A complete system must be in place for every action within the practice. From the time a patient walks into the office, everything from the manner in which they are spoken to at the front desk to the physician consultations and the procedure itself must be systematic in nature in order to create a specific and defined flow that meets all requirements.

While independent thinking is encouraged in many spas, the medical aesthetic practice often adheres to a strict top-down human resource methodology. The understanding that a skin care professional cannot overstep their boundaries is crucial. The freedom of customization and changing of protocols can be somewhat limited, which is an important factor to take into consideration when assessing goals for an aesthetic career. Regardless of these processes, many individuals find the advanced setting of a medical practice more to speed with their own goals. Harnessing the qualities needed to advance in this setting are pieces of a puzzle that can take many years to perfect or obtain.

Skin care professionals should seek out employment in a spa setting immediately after graduation to obtain several years of experience treating the skin before transitioning to a medical setting. Job experience, additional education, and life experiences make a medical spa position that much more fulfilling and successful for both the professional and the business itself.

To be competitive in the current skin care market, professionals must obtain consistent continuing education in advanced aesthetics. The relationship between a physician and a supporting staff member, such as that of a skin care professional, must be respected from every angle. The level of professionalism of all team members of a medical spa must be held to the highest of standards, along with excellence in areas such as sanitation and medical charting. Compliance in the realm of liability and malpractice insurance is exceptionally important and should be in the top priority list at the beginning of any medical spa business. The skin care industry is exceptionally rewarding in assisting clients with their physical care, emotional health, and personal confidence. By changing the lives of clients, professionals ultimately change their own life. Living and breathing the spa industry is an experience only the select few are lucky enough to embody. Treating a career as an art and respecting the laws and regulations that encompass that craft are important aspects of any endeavor in the advanced aesthetics field.

Courtney Freeman is the owner and lead instructor at Southeastern Esthetics Institute in Columbia, South Carolina, the leading institute in the southeast for the advanced aesthetics licensure course. Freeman is also the owner of Pura Medical Spa in downtown Columbia and has dedicated her life and career to exceptional aesthetic education through advanced skin science knowledge with a medical focus.