Certificates of Laser Training - Laser Certifications - Laser Credentialing- State Licensing -
- Let's straighten out the confusion – June 2012
Copyright 2006-2012, Professional Medical Education Association, Inc.
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NCLC Laser Certifications
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 (with the hours specified on the Certificate) 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 three organizations. The National Council of Laser Certification (NCLC) provides National Certifications for Medical Laser Safety Officers and Laser Operators such as Aesthetic or Hair Removal Laser Providers. 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 NCLC.
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 which reflects your professionalism in the field. However, laser certifications are required by law only in Texas and Florida (as of 2011 which require it for higher levels of Laser Hair Removal providers). Other States are considering these requirements and will most likely follow the lead of Texas and Florida. Laser Certifications reflect professionalism and personal accomplishment.
The training requirements that are pre-requisites for Laser Certification however also frequently meet 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 NCLC works with ETA International at over 750 proctored testing sites worldwide for exam administration, or we offer them at the end of most training programs conducted by Professional Medical Education Association and its Laser Training Institute™. Go to http://www.LaserCertification.org to find the following information and documents:
Certification 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, and a few select affiliated programs).
Download and complete an application form to apply for Certification and sit for an examination.
About Certificates of Laser Training:
- 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 Computer Based Learning Courses and our in-person Seminars provide these Certificates of Laser Training to attendees. These Training Certificates 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 sometimes alternate methods) 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 supersede 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 (running the control panel) 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 users. 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. (See our Course Catalog for Computer Based Learning programs that will meet these requirements, besides our Seminars) 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 or aesthetician. Our Seminars and Computer Based Learning 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 their 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.
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. Cosmetic laser procedures are easily learned and practiced by physicians in any specialty. Hospital privileges, or malpractice insurance coverage though are a different matter. Physicians gain practice privileges within a hospital facility by administrative permission of 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-dermatology physicians 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 Courses provide 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 ablative 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 Board. In Texas it’s the Dept of State Health Services, and in Arizona it’s the Arizona Radiation Regulatory Agency.
Confusing isn't it? 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. Sometimes 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 where there is some regulation. Some States have also begun to include Intense Pulsed Light Sources (IPL) in their regulations.
Ablative Vs. Non-Ablative Laser & IPL Procedures:
Illinois (2011) differentiates the procedures that must be done by a physician, or at least with direct physician supervision, based on whether or not it is an "ablative" procedures. An ablative procedure would be one that actually vaporizes tissue to remove it, such as would be seen with CO2 laser skin resurfacing. These ablative procedures generate laser plume (smoke) which must be removed with a smoke evacuator. Non-ablative procedures utilize levels of heat that do NOT achieve temperatures sufficient to vaporize the tissue, and instead would cause tissue warming, or at the most controlled coagulation of specific structures (selective photothermolysis), and do not require the use of a smoke evacuator. These non-ablative procedures with laser or IPL would include things like laser hair removal, skin rejuvenation including acne treatment, and removal of benign brown spots or superficial red blood vessels. Tattoo removal with a Q-Switched laser would also be a non-ablative procedure (photoacoustic).
Ultimately it is the State Medical Board that regulates use of health care lasers for any procedure, including cosmetic procedures. As mentioned, the requirements vary widely from State to State. Those that do primarily have requirements for documented training. 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 and Florida at present (2011), but we understand that several other States have Certification requirements under consideration. Recommendations to State Agencies for incorporating Certifications into their licensure process, and working cooperatively with the NCLE to facilitate communication, is contained in the Certification Handbook of the National Council on Laser Certification.
Our Training Organization CANNOT answer your specific State Licensing questions.
For a Definitive Answer to Laser Use Regulations by State, please contact:
BostonMedtech Advisors, Zvi Ladin, PhD - Principal
www.bmtadvisors.com - Tel: 781.407.0900
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 our website is useful, but it is incomplete, not kept current and its original accuracy must be verified.
Laser Registrations, and Medical Laser Safety Officers (MLSO):
Some states, such as Florida, Illinois, Massachusetts, AZ, 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 generally 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 utilize 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. Some States require not only the registration of the lasers, but that the appointed laser safety officer provide documentation of formalized training (Certificate from an 8 hour or more Course). Our own Medical Laser Safety Officer Seminars or Computer Based Learning programs meet this requirement. Further evidence of accomplishment in this area may be achieved through the Certified Medical Laser Safety Officer designation of the NCLC, (since that requires a minimum of 16 hours of documented training before being allowed to take the exam) although there are no current requirements (as of 2011) by any State for Certification of Laser Safety Officers.
So - The requirements for Laser Safety Officer in a nutshell are:
1. 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 "Operators" 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.
2. 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 JCAH (hospitals) may ask for it during inspections.
3. MLSO Certification - This is not a requirement in any State as of 2011, but is a professional credential that reflects a high level of academic knowledge in this area. The MLSO Certification is being adopted by many Hospital groups for similar reasons.
I don’t blame you - 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 .
HOWEVER - I can't really help much with specific questions in your State.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 the Boston MedTech Advisors, listed in this article, who for a fee can help you through the process.
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