Certificates of Laser Training - Laser Certifications - Laser Credentialing - State Licensing -
- Let's straighten out the confusion - June 2009

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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, and that usually means a Certificate of Training. 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. If you do want to pursue one of several Laser Certifications that are available you generally must meet some type of background or educational requirement, and show evidence of documented laser training from any organization. Some certifications additionally require documented clinical cases. 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.

About Laser Certifications: - Available to anyone who meets the published requirements.
Certifications in various areas of health care laser use are available through a variety of organizations. The National Council of Laser Excellence (NCLE) provides National Certifications for Medical Laser Safety Officers and Laser Operators such as Surgical Laser Assistants (laser nurses or techs), or Aesthetic or Hair removal Laser Operators. Other organizations such as the Board of Laser Safety (BLS), International Laser & Aesthetic Association (IALA), or Society for Clinical Medical Hair Removal (SCMHR) also offer some of these voluntary certifications. All but the SCMHR work through the NCLE. 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 not required by law in most states for licensure (except Texas which requires it for Laser Hair Removal as of 2009) 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. National 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.
Go to http://www.LaserCertification.org to find the following information and documents:

Candidate Handbook - explains the various certifications and requirements
Locations for Proctored Testing through ETA International (note - Proctored testing is also offered in conjunction with any of the Laser Training Institute seminars and workshops.
Download and complete an application form to apply for Certification and sit for an examination.

About Laser Training Certificates: - Provided as evidence of Training and includes associated credits for continuing education.
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 Online/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, Arizona and others base their licensing requirements on documentation of such training and these Certificates provide the proof of your training. They are also required by many insurance companies for aesthetic laser practices or providers.

About Laser Credentialing: - You decide what the criteria are, provided the State does not have a requirement that would supercede this
American National Standards Institute (ANSI) publication 136.3 "Safe Use of Lasers in Health Care Facilities" is not law, but it 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 Seminars and Home-Study/Online courses provide this initial foundation training, which then may be built upon afterwards with additional clinical training in one's area of specialization. For instance a nurse attending one of our Aesthetic Laser Procedures Seminars would go back to her clinic or office and start performing cases under the direction of her medical director or a more senior laser operator. 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 National 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, or malpractice insurance coverage 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 AMA Board Certifications for physicians for performing laser or other aesthetic procedures, although many physicians do obtain one of the National Laser Certifications (such as Certified Aesthetic Laser Operator) as documentation of academic knowledge in these areas . This is particularly true for non-dermatologists or plastic surgeons such as Family Practitioners or Emergency Medicine Physicians performing aesthetic procedures in their office. In hospitals, physicians generally just 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-ablative 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, although fractional resurfacing is much less invasive and a case can be made for its safe performance by properly trained nurses or advanced level technicians. 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. Some States have also begun to include Intense Pulsed Light Sources (IPL) in their regulations.

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 (www.LaserTraining.org/agencies.htm) is posted on our 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, and all other States of which we are aware). If establishing a new aesthetic laser business, your attorney can provide the most definitive answers to State licensing requirements. Laser Certifications are a requirement for licensure in only Texas at present (2009), but we understand that several other States have Certification requirements under consideration. Recommendations to State's for incorporating Certifications into the licensure process is contained in the Candidate Handbook (http://www.lasercertification.org/Administrative/Library/0904NCLECandidateHandbook.pdf) 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 Registrations, and Medical Laser Safety Officers (MLSO):
Some states, such as Florida, Illinois, Massachusetts, TX 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 States of Arizona, TX, OH and FL (in 2009) require not only the registration of the lasers, but that the appointed safety officer provide documentation of formalized training (Certificate from an 8 hour or more Course). Our own Medical Laser Safety Officer Seminars or Home-Study/Online courses (http://www.lasertraining.org/laser_course.htm) meet this requirement. Further evidence of accomplishment in this area may be achieved through the Certified Medical Laser Safety Officer designation of the NCLE. (since it requires a minimum of 16 hours of documented training before being allowed to take the exam)

So - The requirements for Laser Safety Officer in a nutshell are:

Every facility is required by ANSI standards to have an "Appointed" Laser Safety Officer (if you have several offices in one geographical area, one LSO may serve them all)
Note - Laser "Assistants" are the nurses & techs who run the control panels for physicians performing surgical laser procedures, and they work under the authority of the LSO
Non-Physician Laser "Operators" do patient treatments. They also operate under the authority of the LSO for laser safety, but clinically under the Medical Director for patient safety & effectiveness.
Formally Documented LSO Training is required by several States, but not by others. Aesthetic Practice managers or business owners should really obtain the same LSO training because they are responsible for ensuring that their program is setup properly. LSO's may receive their training anywhere. Our MLSO course provides a certificate for 16+ contact hours of training. A Certificate of Laser Training is the common denominator for an LSO appointment. Many insurance companies will wish to see this as a minimum, and groups such as OSHA or JCAHO (hospitals) may ask for it during inspections.
MLSO Certification - This is not a requirement in any State as of 2009, but is a professional credential that reflects a high level of academic knowledge in this area. It has been adopted by groups such as the International Aesthetic & Laser Association (IALA) as a requirement for their members to reflect the high level of professionalism of the organization. The MLSO Certification is being adopted by many Hospital groups for similar reasons.

Still Confused?
Me too - and I've been doing this for more than 30 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
PO Box 997, Grove City OH 43123
Tel: 305-851-8081, Fax: 305-946-0232
http://www.LaserTraining.org