Believe it or not, this is not always simple. The Botox™ laws can be unclear, downright frustrating, and expensive to decipher. There is a lot of variation in different states about who and how providers can perform aesthetic injections. Sometimes the answer you find is “it’s a grey area”. I answer some general questions on this in my previous post, but I’m going to give you a blueprint on researching your state-specific regulations here.
1. Contact your state’s professional association
Hopefully, you support your local chapter of whichever profession you belong to. You pay your dues to this organization, and it’s their role to advocate for your profession. Examples of this are AANA & AANP. Your professional group has lawyers that work for it. The local chapter of your professional association is a great first place to contact. Find you, local representative, for your area and shoot them an email. This is likely going to be your best ally, and one of the first places to reach out to.
2. Find a practicing provider
The next practical step to try is to find another same practice provider in your state who is doing aesthetic injections. This person at a minimum knows a lot more about the field and could be a great resource. While finding out the details of how this practitioner is providing botox services is not a replacement for legal advice, it can give you an idea of how to get your business set up. One idea is to go see this provider as a patient for treatment yourself and start the conversation that way. Another way to reach providers in your area is Facebook groups for your profession and ask if anyone is doing this. A provider from a different city may be willing to talk with you and be less likely to view you as future competition.
It is not always a warm and welcoming environment in aesthetics. Frequently newcomers are regarded as competition instead of colleagues. I think this is totally understandable, but for the most part unnecessary. The population seeking aesthetic injections is growing exponentially, and the market needs good injectors. One bad injector or shady business practice shines a negative light on the entire industry. It also threatens the scope of practice if states were to restrict it further. The more we educate and build our aesthetics community the stronger we will all be.
3. Consult a medical malpractice attorney on your state’s Botox™ laws
This is the most expensive option, but if you are serious about starting your business, you will likely end up on this road. At a minimum, it will show that you did your due diligence going forward. While it is helpful to hear how other providers set up their practice, it doesn’t mean they necessarily adhered to all the state regulations-even unknowingly.
You will want to find a local malpractice attorney, or sometimes an attorney that specializes in MSO (Management Service Organization) /MSA (Management Service Agreement) if your state requires one. This attorney can give you the most accurate opinion on your ability to perform these medical procedures. An attorney will also be able to draft a collaborative agreement and fee agreement if you need one. One issue with just using an agreement you find off the internet is that requirements vary between states. Also, frequently these agreements get tweaked multiple times from their original legal form. Then by the time you use it, it’s like a bad game of telephone, not really resembling the original statement.
4. Contact the Board of Nursing or Board of Medicine regarding state Botox™ laws
This is listed last on my list for a reason. The BON and BOM exist to protect patients. They do not exist necessarily to protect the providers. If you email them with a scope of question practice that is at all in a grey area, they are likely to air on the side of extreme caution, and that’s assuming you are able to get in touch with the appropriate person who knows the answers. The state board may be helpful to answer a specific question such as, “Can a CRNA in Virginia perform a H&P?”
There is a Decision Making Scope of Practice Flowchart that you can follow to help clarify what your state’s botox laws entail for NPs. This chart helps to “identify, describe, or clarify the activity, intervention or role under consideration”. Each state should have Guidance Documents and possibly specific flowcharts for your state. For example, you can find some VA state materials here.
Find more resources addressing provider specific scope of practice on the Free Resources Page