Visiting IPL technicians in your clinic
Visiting 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.
The
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!)
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Intense Pulsed Light (IPL) treatments are a rapidly growing modality for pigmentation and rejuvenation
Dont
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?
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An example of poor preparation and technique. Settings too high & spot location too random
What 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.
Consultation procedure
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.
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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.
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Business relationship
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:
The
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
percentage.
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.
Even
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.
Subcontractor
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)
A
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
company benefits.
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.
Because
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.
What
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.
Financial aspects
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.
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- 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!)
A
lot to think about and some good questions to ask.
2006 Virtual Beauty Corporation Ltd
