Visiting IPL technicians in your clinicVisiting IPL technicians in your clinic
Visiting IPL technicians in your clinic:
A guide to a harmonious relationship
By Florence & Ralph Barrett-Hill
This article was written in response to a situation one of my graduates recently found themselves in where an individual who provides Intense Pulsed Light (IPL) treatments approached her with a view to offer these services in her clinic on a casual basis.
At first the clinic owner thought this was a good idea, and consequently contacted me to seek advice and opinion on how to proceed.
As we discussed the various pros and cons of what was offered, we unearthed a number of very relevant questions, potential issues and pitfalls that we provide as an overview here.
concept of being able to provide specialist treatments in your clinic
without the cost of equipment and investment in training sounds like a
potentially good idea, however it is important to understand what the
requirements and protocols are to make this type of arrangement work in
your favour. There are many things to consider:
Getting past the attitude
There are many people with varying types of backgrounds who embrace IPL treatments as a new career, and (unfortunately) a majority of operators offering these services to therapists have the attitude that they are doing the therapist a favour by increasing their service offerings with specialty skills the therapist does not have. (This is debatable) Further, there seems to be an attitude of technical superiority that comes from those with medical or nursing background. (Sorry for any offence caused, but there is a pattern here!)
Intense Pulsed Light (IPL) treatments are a rapidly growing modality for pigmentation and rejuvenation
let this fool you in to thinking all of the people who operate an IPL
device know as much about the skin as you do. In my experience this is
often not the case.
Operators of IPL devices need to be prepared to meet the standards that professional therapists and aestheticians expect from associates of their business, and these are standards that should be non-negotiable.
The bottom line is that the IPL operator needs to make their device pay its way. They need you as much as you need them.
Training & Competence
Skin treatment professionals know that IPL treatments require a thorough knowledge of the skins structure and a complete understanding of the Fitzpatrick skin type and how melanin reacts to light and heat energy. Remember that IPL delivers a non-ablative inflammatory response to achieve its objective. However because of the plethora of brands and models of IPL devices currently on the market, there is a perception that IPL is an easy money-maker that requires little skill, ( I have seen IPL in the hands of nail technicians who had no formal training in A&P!) and too many people from outside the skin care industry purchase IPL devices who have little knowledge of the skin in detail and only an understanding of how to operate the device itself.
These are largely arising from not correctly assessing the clients skin type and susceptibility to adverse reactions.
I have seen many examples of these disappointments courtesy of operators with medical backgrounds and supposed expert training. This kind of oversight is both professionally negligent and unethical.
Case in point: A supposed professional IPL technician offering to give a therapist a sample facial rejuvenation treatment without a consultation or conducting test patches!
Thankfully the alarm bells of competence rang loudly and the offer was tactfully declined.
The message here is to check the credentials of the operator. Check their levels of postgraduate training, specifically relative to melanogenesis and vascular disorders. Do they have a recognised Laser/IPL safety certificate?
An example of poor preparation and technique. Settings too high & spot location too randomWhat depth of pre-treatment consultation do they offer? What do their previous clients think of their work? How much experience do they have? What is their background? Do they have an indemnity document for the client to sign? Do they understand their local occupational health and safety regulations?
If operators are not willing to (or dont think they need to) appropriately educate themselves or take suitable steps to reduce risks, then give them a wide berth; there are plenty of operators that want to do it properly.
Another thing to consider is that many visiting IPL operators may only want to come to your clinic once every two weeks or even once a month. This raises a new set of issues with regard to client consultation and test patching.
Respected International IPL trainer and expert Trudy Fleming believes a professional consultation and Fitzpatrick type analysis along with a test patch should be carried out before a treatment can be undertaken. The test patch must be left for a minimum of five days to monitor the reaction before a treatment can be given. In darker skins this time to monitor reaction can be up to two weeks.
This type of attention to detail is not likely to happen if the operator only sees the client once a month, as they will want to get the treatment out of the way and take their money.
This is where the whole IPL service can come unstuck, as it is considered poor practice to test patch and treat on the same day.
It is also becoming mandatory for
some type of melanin measuring devices to be used as part of the
consultation procedure, as it is becoming too difficult to correctly
determine clients Fitzpatrick types due to cross ethnicity and ambient
sun exposure changing base skin colour.
The devices are also used to monitor levels of sun exposure to reduce pigmentation risks between treatments, as clients often do not admit they have been in the sun between treatments, and this could affect device settings.
Trudy Fleming advocates the use of every measure to ensure the treatment will be a success. It should be your professional responsibility, she says.
Another question to ask is does the operator have and use an informed consent document that they have the client sign before treatment. This document should outline the risks and potential outcomes of the treatment.
Misjudging the Fitzpatrick type can have disastrous results
Preparation of the facilities
Another question often faced is the preparation of the work area that will be used by the visiting operator. Any area should be shielded light-wise from the rest of the clinic.
An example of this is cubicle walls that do not go all the way to the ceiling, with the resulting flash from the lamp reflecting around the clinic. Rooms where IPL treatments are carried out should not have mirrors for obvious reasons, and there should be a sign warning of flash lamp risk exposure at the entrance to the room. All people exposed to the flash should have suitable eye protection, and be aware of the risks involved. The regulations for operation of laser devices should always be followed when using IPL, as this will reduce any Occupational Health & Safety issues that may arise.
If you dont have an area in the clinic that can be properly equipped, you must agree on who foots the bill for preparation of the work area.
This is the most important aspect of the relationship, as it will define exactly what the responsibilities of each of the parties will be and where liability will ultimately lie.There are two types of potential relationship, a free agent under contract and a subcontractor.
Free agent under contract
This is the most common type of relationship and is similar to the hairdressers chair for hire association. There are variations to this type of relationship, but the basics are thus:
clinic owner effectively rents space in the clinic to the free
agent to perform the specialist treatments. All responsibility and
liability to the client lies with the agent, and the client pays the
agent directly. The agent then pays the clinic owner a commission on the
value of the treatment undertaken. Generally it is a straight
In this scenario, the agent will need to put their own financial infrastructure in place, such as EFTPOS and credit card facilities for Payment. The agent issues a GST receipt to each client under their own business identity. The clinic and agent generally share marketing costs to maintain business volume to remain viable.
It would appear that the clinic owner has less control in this situation, however the clinic owner can make specific demands of the agent in respect of conduct and minimum standards of performance. Examples of this are consultation procedures and a policy of conducting test patches etc.
though the client is undergoing the treatment from the agent, if
anything goes wrong the clinic where the treatment took place can
invariably get drawn in to the situation.
This is where a good contract between the agent and clinic that outlines liability is vital. The agents insurance must also be robust and cover many contingencies.
In the case of the subcontract relationship, the person or entity enters into a contractual agreement with the owner of the clinic to perform specific services using their own equipment. The subcontractor is supervised by, is paid by, and is responsible to the clinic owner. (Contractor)
person or entity that performs work and is usually paid on an hourly or
volume basis, but is not considered on the payroll and does not receive
Generally the subcontractor will not be liable to the client receiving treatment unless there are particular circumstances such as negligence or breaches of the fair trading act.
the clinic owner has majority control of the situation, they can set
minimum standards of performance, set treatment prices and provide the
marketing of the services.
The clients pay the clinic owner, who then pays the subcontractor a set fee per treatment type. Responsibility to keep the equipment used for the treatments in working order is that of the subcontractor, as they own it.
Marketing of the services is generally by the clinic owner, but costs may be shared by agreement. This type of arrangement is beneficial for the IPL operator as they do not to set up EFTPOS or Credit card facilities to undertake their own individual transactions.
can go wrong? What are the pitfalls?
In a circumstance where the subcontractor causes injury or acts in a manner that affects the relationship between the clinic owner and client, the clinic is affected and it is a little bit harder to deal with than in the case of a staff member. The clinic should be suitable insured against anything that may have financial implications such as a claim for medical expenses or in a worse case scenario, being sued. The subcontractor should also be suitably insured. Again, a good contract that specifies responsibility and remedies is vital.
This is the second most important aspect, and this needs to be viable to make it worth your while. You must ask yourself if you can make as much money in the same amount of time in the treatment room conducting other types of activity than what you can earn renting it out to the IPL operator. Do you have extra space available to conduct the treatments? What level of commission do you need to be viable?
If a relationship looks to be on a semi permanent or permanent basis, you could have an arrangement based on the ground cost + commission. In this scenario, the base rate ground cost is a percentage of the overall cost of business occupancy. Example: If an IPL operator uses 20% of your total clinic space to conduct treatments, and your total clinic occupancy cost is $750 per week, then the base ground rate would be 20% of that $750 = $150 per week+ commission.
If the earning potential looks impressive, then take the equation one step further: what would it take for you to purchase or lease your own machine, undergo training and be in total control by offering the services yourself?
Liability and insurance
What happens if a treatment goes wrong or you have a dissatisfied client? Who takes responsibility to put things right?
Will any dissatisfaction be blamed on your business or the subcontractor?
The insurance risks are numerous, but as we have stated earlier the quality of preparation and client consultation will reduce those risks considerably.
Be aware that insurance could be refused if the IPL operator has insufficient training or has not taken recognised safety precautions. Above all, always ensure they have robust Statutory Liability and Professional Indemnity insurance.
The check list for a green light to enter in to an agreement
- Are you comfortable with the type of relationship on offer? (Free agent vs subcontractor)
- Is the operator appropriately qualified in all aspects of the treatments? (Not just training on how to use the device)
- Does the operator have a recognised laser/IPL safety certificate?
- Are you happy with the methods used by the operator to determine clients Fitzpatrick skin type and their policy and procedures for test patching before treatment?
- Does the operator have preventative strategies to avoid complications and appropriate Statutory Liability and Professional Indemnity insurance?
- Is the commission earned from the IPL operator greater than the cost of the space used or earning potential from other activity?
- Is the operator willing to enter in to an agreement that protects your business from their mistakes?
- Will the operator be coming to the clinic on a frequent basis? (Not monthly!)
lot to think about and some good questions to ask.
2006 Virtual Beauty Corporation Ltd