Laser Credentialing - State Licensing - Certificates of Training - Laser Registrations - Laser Certifications
- Let's straighten out the confusion - Feb06

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Directory of State Medical Boards and Licensing Agencies - State Agency Information States Status on Licensing - courtesy of Tawni Weaver
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How do I get Laser Certified?
This is one of the most frequent questions we get, and it's usually not what the person really means at all. What individuals really want to know is how they obtain proper permission or authorization to perform cosmetic laser procedures as a non physician. Nurses in hospitals or clinics want proper documentation of their training or laser skills validation, and medical facilities want to know how to setup guidelines and requirements for physician credentialing. Here's an overview that might help clear up some confusion and provide some resources to help you find the answers for your own situation.

Laser Certifications:
Certifications in various areas of health care laser use are available through a variety of organizations. The National Council of Laser Excellence (NCLE) provides certifications for non-physicians as laser safety officers and laser operators such as surgical laser assistants (laser nurses), or aesthetic or hair removal laser operators. Other organizations such as the Board of Laser Safety or Academy of Laser Dentistry also offer these voluntary certifications. A Laser Certification is a professional credential that recognizes a high level of academic knowledge or achievement in that area. It is a credential to be proud of and that reflects your professionalism in the field. However, laser certifications are currently not required by law in any state for licensure nor mandated by any regulatory agency. Laser Certifications reflect professionalism and personal accomplishment. The training requirements that are pre-requisites for Laser Certification however also frequently meet these regulatory or state licensing requirements. Certifications require that you meet certain background and educational requirements to qualify, and then take a supervised proctored examination. The NCLE works with ETA International at over 750 proctored testing sites worldwide. Click Here to find a site nearest you. The Candidate Handbook explains the requirements and types of Certifications, and you can print and complete an application form from the website.

Laser Training Certificates:
This is entirely separate from the question of "Laser Certifications". Attendees at a formal Laser Training program receive a "Certificate of Training" or "Certificate of Attendance". Both our Home Study and our in-person Seminars provide these Certificates of Laser Training to attendees. These simply document your attendance at the program. They do not attest to your level of comprehension or achievement in that area like a Certification would. Most programs are accredited by some organization for nursing or physician continuing education credits. Some states such as Texas or Arizona base their licensing requirements on documentation of such training and these Certificates provide the proof of your training.

Laser Credentialing:
American National Standards Institute (ANSI) publication 136.3 "Safe Use of Lasers in Health Care Facilities" is not law, but has become the defacto standard enforced by various states, licensing and regulatory agencies. ANSI specifically says that it is the individual health care facility (hospital, clinic, private office or medical spa) that determines what the credentialing requirements will be for both physicians and non physicians either assisting in laser procedures or providing the actual patient treatments. The facility therefore has flexibility in determining exactly what these requirements are, but they must establish these criteria for their laser operators and assistants. General guidelines are provided for recommended requirements for credentialing by both ANSI and organizations such as the American Society for Laser Medicine & Surgery. As a general rule this requires training in core laser concepts including Laser Biophysics (actually laser & energy concepts), general tissue effects and laser safety. Physicians and operators then should additionally have training in the specific lasers and applications including possible preceptorships and hands-on experience. These general requirements apply to all areas of health care laser use whether it's surgical laser training, or laser hair removal by a trained cosmetologist. Our 2 day Laser Course provides this initial foundation training, which must then be built upon afterwards with the more specific training in one's area of specialization. Attendees at our two day laser course for instance choose additional materials depending on their area of interest - either the Aesthetic Laser Procedures home study program or the Laser Safety Officer program. In any event the facility sets the credentialing standard which is generally a training requirement of some type. Some facilities simplify the process by accepting the Laser Certifications, with the understanding that the training was required prior to even qualifying to sit for the certification exams.

Physician Credentialing:
Let's be clear about the requirements for physicians to utilize medical lasers in their practice. In their own office or practice settings, physicians who are licensed to practice medicine within any given state may utilize whatever tool they wish - including laser - for whatever medical procedure they choose to perform. Practicing medicine outside one's area of expertise is not a particularly good idea (author's opinion), but as a general rule there are no laws to restrict the practice of medicine by properly licensed physicians. Hospital privileges though are a different matter. Physicians gain practice privileges within a hospital facility by administrative permission by the executive committee or equivalent credentialing body of the institution. The physician may practice medicine by virtue of their state medical license, but the hospital decides what specific privileges they have within that facility - including laser privileges for any given procedure. There currently are no "Certifications" for physicians for performing laser or other aesthetic procedures, although groups such as the American Society for Dermatological Surgery and the American Society for Laser Medicine and Surgery currently (February 2006) are considering programs for procedure specific certifications. In the interim physicians generally show evidence of laser training, along with one or more preceptored cases, and are granted laser privileges. Our Laser Course provides the foundation laser training that is required by physicians before moving on to the specialty application.

Use of Lasers by Non-Physicians:
Here we're referring to patient treatments with lasers by non-physicians - mostly with non-invasive cosmetic laser procedures. These include primarily laser hair removal and skin rejuvenation, but can also include treatment of small blood vessels (telangiectasia, spider veins, etc) or pigmented lesions (age spots, freckles, etc). It generally DOES NOT include use of skin resurfacing lasers such as CO2 or Er:Yag which are much more invasive and therefore performed directly by the physician. Requirements vary widely from State to State and here's where your research has to start. Some states have strict regulations that require closely supervised laser operation by advanced practitioners, some States just have general academic training requirement minimums, and some States have no regulations at all. Though the State Medical Board would ultimately have the responsibility of licensing and regulating this practice, in many instances the State Medical Board delegates the responsibility to another organization. In Florida for instance it lies with the State Electrolysis Association. In Ohio it's with the State Cosmetology Board. The problem in researching this from state to state is that when you call the medical board, nursing board or other agency, they frequently don't have any information on this - whether it's regulated in that state or not. Ultimately these cosmetic laser treatments must be performed under the direction of a physician, but the real question is the degree of supervision required. There is no consistent standard at present. Some groups have recommended on-site supervision by the physician at all times, and other groups allow for more arms-length medical direction of otherwise properly trained personnel. Regardless of the actual requirements, documented training is required in all cases.

State Licensing:
Ultimately it is the State Medical Board that regulates use of health care lasers for any procedure, including cosmetic. As mentioned, the requirements vary widely from State to State. A directly of regulatory agencies is posted on this website to help you with your research. Not all states have regulations. Those that do primarily have documented training requirements (our programs are approved for the State of Arizona, and meet the requirements for Texas when that legislation takes effect). If establishing a new aesthetic laser business, your attorney can provide the most definitive answers to State licensing requirements. Laser Certifications are not a requirement for licensure in any State that regulates this at present, but we understand that several States have Certification requirements under consideration. Recommendations to State's for incorporating Certifications into the licensure process is contained in the Candidate Handbook of the National Council on Laser Excellence.

For a Definitive Answer to Laser Use Regulations by State, please contact:
Boston Medtech Advisors
Zvi Ladin, PhD - Principal
Dedham, MA
www.bmtadvisors.com - Tel: 781.407.0900 x104 - E-mail: zladin@bmtadvisors.com

For a very reasonable fee this group provides definitive answers on licensing and regulations state by state, to either individuals or practices. The information we have provided below on this website is useful, but it is incomplete, not kept current and it's original accuracy must be verified.

Laser Registration, and Laser Safety Officers:
Some states, such as Florida, Illinois, Massachusetts and others require that any health care laser system be properly registered with that State. This too varies widely from State to State and you must research this for each one. When the State does require registration, they all require that the name of the Laser Safety Officer for that facility be listed on the registration form. Laser Safety Officers are required in every health care facility that utilizes lasers, including small offices or medical spas. The only requirement by ANSI is that the facility administration appoint such a safety officer who manages the laser safety program. The State of Arizona requires not only the registration of the lasers, but that the appointed safety officer provide documentation of formalized training. Our own 2 day Laser Course, Laser Safety Officer Home Study, or in-house training programs meet this requirement. Further evidence of accomplishment in this area may be achieved through the Certified Laser Safety Officer / Medical designation of the NCLE.

Still Confused?
Me too - and I've been doing this for more than 27 years!!
If I can help you with any general questions please feel free to ask me - email to Absten@LaserTraining.org .
I can't really help much with specific questions state by state however. We are a post graduate medical education organization and don't deal directly with these regulatory issues. If you do need more in depth help I can direct you to a regulatory consultant who, for a fee, can help you through the process.

Regards,
Gregory T. Absten
Executive Director, Professional Medical Education Assn.
Laser Training Institute
4243 Diplomacy Drive, Columbus OH 43228
Tel: 305-851-8081, Fax: 305-946-0232
http://www.LaserTraining.org