[anhedonia]

I have recently learned how to inject botox and dermal fillers. I am looking for a Medical Director but really do not know what they are required to do to be one. I also don't know what I would need, although I have been told I need liability insurance but cannot find a company that will write a policy in Massachusetts. I would be off-site at my own location. I would like to put together a proposal to present to the doctor I want to approach. If anyone can give me some information on what I need to know here in MA I would be most appreciative. Thanks in advance for your help.

[pthalg]

Have you had any luck getting infomation on this subject? Where did you get your training to do the injections.

[suzanne4]

Please, please do more research on this before you even attempt to find a physician for medical back-up. You need to be aware of licensing in your state and must have insurance before you will be able to do anything.

Not sure where you took your training from, but if it was in your state, they should have gone over all of this with you.

How many hours was your training and what did it cover? Where are you planning on purchasing your Botox from? It normally needs to be ordered by a physician.............

[anhedonia]

Originally Posted by suzanne4

Please, please do more research on this before you even attempt to find a physician for medical back-up. You need to be aware of licensing in your state and must have insurance before you will be able to do anything.

Not sure where you took your training from, but if it was in your state, they should have gone over all of this with you.

How many hours was your training and what did it cover? Where are you planning on purchasing your Botox from? It normally needs to be ordered by a physician.............

I have done a great deal of research on the legalities of doing this in my state. I did secure a medical director, but he is not a derm or PS so I have decided to confine my service to Botox only, as there is much less chance of having a problem. I can get a PS for fillers, however, he wants too large a percentage for someone so small and without my own place to offer enough services to offset the costs.

The bigger problem we face her is legislation that would require that nurses work in a physician's office and only inject while the physician is in the office. I find this absurd, as nurses work in many settings without a doctor in the building. We are organized and trying to fight it, but eventually the sponsors will probably win. It is very hard to find a job injecting with a derm or PS as they keep the work for themselves. And some of us would rather be self employed entrepreneurs rather than hourly employees. Nurses still do not get the respect they deserve; I'm not sure we ever will

I learned from a nurse who has done this for many years. I know a couple of nurses who went to one day classes, very expensive, had to travel, and they only injected two or three people; I'm not sure it's worth all that money, particularly in the climate (political) I'm in.

[suzanne4]

Good luck but you will have problems not working in an office with either a plastic surgeon or dermatologist. Many are actually too busy now to do the work themselves, it is just finding the right fit. You would be much further ahead by finding someone that you could even rent space from.

The referral base that you can get from them, is amazing. I have done medical dermagraphics in the past and got most of my referrals from palstic surgeons as they did not have the time to do this. But you need to have experience working with them to begin with.

[anhedonia]

Originally Posted by suzanne4

Good luck but you will have problems not working in an office with either a plastic surgeon or dermatologist. Many are actually too busy now to do the work themselves, it is just finding the right fit. You would be much further ahead by finding someone that you could even rent space from.

The referral base that you can get from them, is amazing. I have done medical dermagraphics in the past and got most of my referrals from palstic surgeons as they did not have the time to do this. But you need to have experience working with them to begin with.

So far here most docs still do their own; many are in groups and you'll find there's one in the group who does the botox and fillers. Plastics should be too busy, but even one I met who told me he'd be looking to hire someone isn't as yet; he even got himself into a beauty salon and does patients there. I, too, do permanent make-up; not very popular here right now, but I did try to break into it to do areola repigmentation and started with a major cancer center and large hospital based PS center. I was told since it is part of the reconstruction fee the docs do themselves. We are in a tough medical climate here; many docs leave the state due to low reimbursements, high malpractice and whopping housing costs. You can't see a neurologist in under 4-5 months. I'll just have to keep plugging along. Today I have a meeting with an esthetician who would like to add botox to her menu of services. That's where I'm looking for business for now; I'm still trying docs and have good contacts but nothing yet.

[PioneerNP]

I am a nurse practitioner trying to establish a skin care clinic along with a family practice clinic and I want to do some Botox and maybe some fillers as well as peels and acne care. I also want to do some semi-permanent make-up and tattoo removal. The problem I am running into is getting malpractice insurance to cover me since I am in my own clinic. I need to be employed by a physician in order for my current malpractice insurance to cover me for any of these procedures. Have you found that to be true in your state? I have been trained by reputable people. I practice in Kansas. Are there any Kansas nurses or nurse practitioners out there doing these procedures? Thanks for any help you can offer.

Originally Posted by anhedonia

So far here most docs still do their own; many are in groups and you'll find there's one in the group who does the botox and fillers. Plastics should be too busy, but even one I met who told me he'd be looking to hire someone isn't as yet; he even got himself into a beauty salon and does patients there. I, too, do permanent make-up; not very popular here right now, but I did try to break into it to do areola repigmentation and started with a major cancer center and large hospital based PS center. I was told since it is part of the reconstruction fee the docs do themselves. We are in a tough medical climate here; many docs leave the state due to low reimbursements, high malpractice and whopping housing costs. You can't see a neurologist in under 4-5 months. I'll just have to keep plugging along. Today I have a meeting with an esthetician who would like to add botox to her menu of services. That's where I'm looking for business for now; I'm still trying docs and have good contacts but nothing yet.

[anhedonia]

It is not possible here in MA to get this type of insurance. I do not think it exists. You can get insurance to do permanent cosmetics; I use Marine Midland Insurance. As for the botox, etc., we need a medical director here but right now we don't have to work in that person's physical location. Nor do we have to be on their payroll. It isn't easy to find someone to be a medical director. If you can maintain your own location but need a director, start calling plastic surgeons, derms and even internists you know. Call spas and see if they do the proecedures and ask who is their director. If you aren't geographically close, maybe that person will act as your director. If your state has a law stating that you have to be employed by an MD, you may be able to maintain your own location but you would be paid by that person. The laws are not clear in this area or aren't even in existence, so check with the state to make sure you understand and see in writing what they require, if they require it. If they don't have laws governing it, then try my suggestions. With a medical director, you work under that person's license.

This is one way in which states are seeking to keep us from making a good living on our own. There is legislation here that would make it harder for us to practice, but I am hoping the bill will be changed to something more reasonable before it is passed.

Here, once you find someone as a director, you have certain procedures to follow, need policies and procedures, and then you work out a split arrangement with the doc. As for peels, etc., you should check and see if your nursing insurance would cover you for those; my assumption is that it should. Let us know if you find out anything more. Those of us trying to enter this field are having a hard time doing so; don't give up, though.

Originally Posted by PioneerNP

I am a nurse practitioner trying to establish a skin care clinic along with a family practice clinic and I want to do some Botox and maybe some fillers as well as peels and acne care. I also want to do some semi-permanent make-up and tattoo removal. The problem I am running into is getting malpractice insurance to cover me since I am in my own clinic. I need to be employed by a physician in order for my current malpractice insurance to cover me for any of these procedures. Have you found that to be true in your state? I have been trained by reputable people. I practice in Kansas. Are there any Kansas nurses or nurse practitioners out there doing these procedures? Thanks for any help you can offer.

[marySanFranRN]

I am a California R.N. looking for a "supervising physician" with a California License ( or a physician that is interested in applying for one. ) to supervise me and or my N.P. in performing botox/fillers in my established weight loss center outside of San Francisco.( The M.D. I am working with is retiring ) I have access to hundreds of patients through my weight loss center and many of those patients have told me they are receiving botox treatments and if I get trained and get a supervising physician they would definetely come to me. My N.P. is already trained so I am seriously exploring this option. I have done a lot of research and I would appreciate if anyone could assist me in finding a physician that is comfortable with this type of setup.
California law is very liberal and the M.D. does not have to be onsite and the nurse can practice under strict policy and procedure guidelines set up by the physician. As long as the physician receives 51% of the profit this is legal. I will take care of all the overhead costs and perform the botox/filler myself if the physician prefers. ( I have talked to a few California Physicians and they checked with their malpractice insurance in California, the malpractice companies do not raise the physicians malpractice if a R.N. performs botox but will slightly increase the rate if a N.P. performs this task.)
I am a pleasant, compassionate and hard working 46 y.o. female nurse with 20 years experience and never have had a malpractice claim against me and would very much appreciate if any colleages could assist me in finding a California Physician or an out-of-state Physician that is interested in obtaining a California License and start this extremely profitable business in my established weight loss center.

I AM A NEW MEMBER TO ALLNURSES.COM AND FOR SOME REASON I DO NOT KNOW HOW TO POST THIS MESSAGE SO IT WILL GET A LOT OF EXPOSURE SO IF ANYONE READING THIS KNOWS OF A BETTER PLACE TO POST THIS PLEASE TELL ME HOW!!!

Thanks for your time,
Mary

I can be reached at 925-846-5614 if any physician or nurse would like to discuss this.

[jahra]

Originally Posted by marySanFranRN

I am a California R.N. looking for a "supervising physician" with a California License ( or a physician that is interested in applying for one. ) to supervise me and or my N.P. in performing botox/fillers in my established weight loss center outside of San Francisco.

Hi Mary,

I do not know what other services you offer, but you may be interested
to see the new revised ruling for Laser Hair removal in Massachusetts.
Not sure what your advisory is for California.
Here is our current one---

http://www.mass.gov/?pageID=eohhs2mo...r&csid=Eeohhs2