Gwen Mayes, Esq

Disclosures

December 21, 2004

You're just as likely to see patients donned in white, fluffy terry-cloth robes as you are a tattered hospital gown just covering the bare essentials. The examining tables are the setting for an annual physical and a relaxing aromatherapy massage, both under the open air. Welcome to the world of medical spas, the fastest growing component of the spa industry in the United States. Medical spas count themselves among the hundreds of new, innovative facilities with services available to women (and men) who wish to be pampered on their road to recovery. According to the International Spa Association (ISPA), between 2002 and 2004, medical spas doubled in number to well over 400[1] (personal communication with Debra Locker, ISPA Communications Director on December 1, 2004 at debra.locker@hostcommunications.com). As part of the consumer trend to lose the "ladies-who-do-lunch" image, the industry is capitalizing upon the baby boomers' obsession with looking the best they can, for as long as they can, and to do it with as many choices as possible.

Until a few years ago, day spas limited their "medical" procedures to an occasional light chemical peel, Botox injection by a visiting dermatologist, or a postsurgical medical massage by a licensed physical therapist. Today, instead of contracting with physicians in the community to stop by 1 or 2 days a week to offer updated laser treatments and advanced aesthetic procedures, physicians are expanding their outpatient facilities or partnering with existing day spas to create a medical spa. Both sides have found a more formal merger to be a lucrative and well-received union. According to ISPA, the industry generated $234 million in revenues in 2003.[1]

Not true with medical spas, says Bruce E. Katz, MD, Director, JUVA Skin and Laser Center and MediSpa in New York City (personal interview, Bruce E. Katz, MD, Director, JUVA Skin and Laser Center and MediSpa, December 3, 2004). "Unfortunately, many spas call themselves a medical spa and they put an MD's name on the door, and you call and there's no MD around," says Katz, a cosmetic dermatologist and the first to coin and trademark the term "MediSpa" in 1999. "What distinguishes a medical spa from a regular spa is that medical spas use medically based treatments. We use prescription-strength medicines in our facials, our massages, and our skin treatments."

Across the country, Richard M. Foxx, MD, Director, Medical and Skin Spa at Aqua Serena in the Hyatt Grand Champions Resort and Spa in Indian Wells, California, agrees (personal interview, Richard Foxx, Director, Medical and Skin Spa, Aqua Serena Spa, Hyatt Grand Champions Resort & Spa, December 3, 2004). "I define a medical spa as a facility where a physician is onsite who plays an integral part in the patient's evaluation and care," says Foxx, who practiced ob/gyn for decades before focusing on menopause management and more recently the use of bio-identical hormones. "It's really irresponsible to put out these numbers about the growth of medical spas, because there are plenty of spas that refer to themselves as medical spas and the internist or physician is 45 minutes away and never comes in."

Another voice in the medical spa industry is the International Medical Spa Association (IMSA), headed up by Eric Light, President of a consulting group called The Strawberry Hill Group (personal interview, Eric Light, President, The Strawberry Hill Group, December 7, 2004). In contrast to the physician-onsite definition, the IMSA endorses the definition put forth by the National Coalition of Esthetic Related Associations, an organization consisting of 16 member associations in the aesthetic and other related professions, which specifies that in order to be called a medical spa, a facility must operate under the continuous supervision of a licensed healthcare professional -- physician, osteopath, naturopath, dentist, nurse, therapist, nutritionist, or chiropractor.[2] According to Light, professionals are required to work within their scope of practice and will be held to the standards and licensure requirements of the state in which they practice. If no licensure exists, the standard of care would be the reasonable standard of a comparable professional.

Traditionally, spas have embellished the pampering, feel-good atmosphere that they are well known for. With 12,100 spas in operation in the United States, the industry at large has been one of the fastest-growing segments of the hospitality and leisure industry for the past decade.[1] No longer considered the mainstay of only the rich and famous, spas are increasingly popular locales for family reunions, bridal parties, and weekend retreats. But increasingly, spa-goers are expecting visible results and real outcomes for the repeated facial and body treatments that are being advertised as important components of one's overall health and wellness. Considering the fact that these treatments are seldom, if ever, reimbursed by third-party payers, clients are expecting more from a facility that calls itself a medical spa as opposed to a day spa.

The concept of medical spas is actually a convergence of 2 well-established industries -- traditional medicine and healing spas -- each coming at the issue from a different viewpoint, but ultimately merging somewhere in the middle under the rubric of integrated medicine. Women tired of being characterized by "bikini" medicine (with its focus on breast and reproductive care) are welcoming the holistic and overall wellness concept that medical spas promote in droves. According to Light, the industry is on track to generate $1 billion in revenues by 2007.

To many, the surge of medical spas is not that surprising. "The field is actually being driven by our patients," says Katz. "Patients would be coming to us saying, "Doctor, can't you do something about these wrinkles" or "I had this facial and they promised my skin would improve, can't you do better than this?" According to Katz, it's a natural evolution of consumers' desire to see better results, regardless of whether it's from a massage or cosmetic surgery. It's also a concept that apparently has few boundaries. "We opened our health and wellness center earlier this year and now have on staff an internist, 2 nutritionists, a psychologist, and a personal trainer. This helps us ultimately personalize our clients' needs," says Katz. "For example, our nutritionist will go to the grocery store with you and help you select foods and show you how to prepare healthy meals and eat right."

Even outside the realm of medical spas, traditional healthcare facilities known as "hospitals" are finding their way back to a more hospitable environment. At Memorial Sloan-Kettering Cancer Center in New York, an off-site Integrated Medicine Center has been offering yoga, Reiki, medical massage, and herbal remedies since 1999. "We don't refer to ourselves as a medical spa per se," says Melanie Johnson, spokesperson for the Center (personal interview, Melanie Johnson, spokesperson, Memorial Sloan-Kettering Cancer Center, December 7, 2004). "It's relaxing for our cancer patients, and we know it is very much like a spa, but it's also a lot more. People are doing these sort[s] of things anyway, so we are just trying to integrate them into our treatment so that it's better for the patient."

A troubled healthcare system and frustration among practicing physicians have also been cited as reasons for the growth of medical spas. "Physicians are getting tired of the constraints put upon them in the traditional practice of medicine," says Foxx. Citing his own experience with the long hours required in the practice of obstetrics and gynecology, he believes that physicians' desire to take back some control of their practice and their revenue stream is just as important as consumer demand in shaping the industry. "But ultimately," he adds, "patients have felt deprived of a genuine connection with their physician and are yearning to reconnect with them." Finding services ranging from aromatherapy under an open-air private veranda to a complete chemistry profile all within a single locale offers convenience to the physician and patient alike, according to Foxx.

For the flurry of new facilities calling themselves medical spas, those respectfully hoping to further the industry are welcoming the need for oversight and scrutiny. "We're not actually inventing anything new," says Foxx, "we are reinventing medicine as it was practiced hundreds of years ago." Despite the rewording of the names on the doors, the industry recognizes the need to establish standards and guidelines for practice in hopes of managing the growth and expansion of medical spas and to instill confidence in the public and among their peers.

"A group of us, including cosmetologists, dermatologists, internists, and consumers, have formed the Medical Spa Society, a national non-profit organization, to look at the guidelines and standard of care that should apply to any facility that calls itself a medical spa. We want to raise the bar on the criteria and make sure that there is some uniformity in practice," says Katz. "We expect to have published guidelines in the next 6 to12 months."

"When you call, there should be a doctor available to you on the other end of the line," says Foxx. "Two things are needed -- a physician on premises actively involved in the patient's care and a level of care that will stand up to conventional scrutiny by accepted standards."

According to Katz and Foxx, medical spas are defined first and foremost by the presence and involvement of a physician in the treatment and care of its patients. Some patients come to them via routine annual gynecologic evaluations, such as in Foxx's practice, and are introduced to cosmetic and skin care treatments that require administration and monitoring by health professionals . And the reverse is just as likely. "About 70 percent of the patients come in for cosmetic procedures and end up being evaluated for diet, nutrition, lifestyle changes, and hormone balancing," says Foxx. "I've always been interested in holistic medicine and the importance of lifestyle practices such as yoga, meditation, and alternative medicine. This approach naturally integrates them."

Despite the industry's challenge to find a common definition of what constitutes a medical spa, the need to focus on wellness appears universal to all involved. "For the industry to have legs it will need to shift from a technology-driven industry to one that focuses on wellness and preventive health," says Light. "We have all this new technology at our fingertips and the opportunity to make a major contribution to someone's health. But right now we are being short-sighted by focusing on the superficial, the face and skin. We need to be looking at preventable lifestyle problems and include wellness in our approach."

Wellness centers such as the Cooper Wellness Center and the Hilton Head Health Institute are well known for their comprehensive medical evaluations and lifestyle modification programs, which incorporate first-rate spa facilities with onsite physicians. Hackensack University Medical Center in New Jersey has dedicated space on premises for a medical spa, called BEYOND, that advertises to be a "serene environment where ancient massage techniques are combined with modern medicine to offer a unique therapeutic approach to beauty, health and wellness."[3]

Capitalizing on the belief that good health is more than the absence of disease, these institutions, and more to follow, are finding innovative ways to create a complete picture of health that involves physical, mental, and emotional balance. "What we do is definitely science, but it is not perfection," says Katz. "We can help someone improve their health and appearance, but there are no guarantees."

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