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Good Faith Exam (GFE) Essential Facts

Almost all aesthetic services provided by med spas are considered ‘practice of medicine’. Med spas must establish the physician-patient relationship and ensure that a med spa patient is a good candidate for the procedures he or she is seeking. This is the purpose of the good faith exam(GFE). Good faith exams go by many names, and, in fact, the term “good faith examination” has been replaced in many states’ laws. It is common to hear the good faith exam referred to as the “initial exam,” “physical exam” or “initial consult.”

Do Med Spa offices need to perform physical examination before a treatment is done?

Furthering this argument from our perspective is to liken our physical exams (GFEs) to acute care telehealth appointments and/or private practice telehealth appointments that are currently standard practice, legitimized furthermore through insurance coverage for these “visits”. During said telehealth visits, “physical exams” are conducted by the MD/PA or NP performing the exam and carrying out the telehealth visit. In other words, if I can currently and legally conduct a telehealth visit and perform a physical exam for a patient that likely has more chronic and/or acute medical conditions than any patient seeking medical spa treatment for an aesthetic procedure, why would a (GFE) telehealth visit not be seen as legitimate and adequate for a medical spa physical exam? As long as the NP is viewing the area of the body and/or asking appropriate questions about said body part to assess the patient and determine that they are a good candidate for treatment, then they are conducting an adequate physical exam according to current telehealth practices.

Do Med Spas Regulated as Medical Practices?

Med Spa offices must follow the same laws and regulations that govern the practice of medicine. If you are operating a Medical Spa, you are held accountable to the same standard of care as they are for their routine medical practice. This means standards of informed consent, good-faith exams, delegation to appropriate supervised health care professionals, patient –physician confidentiality, rules about maintaining medical records as well as responsibility and liability of supervision. Medical Spa procedures are considered prescriptive medical devices and “dangerous drugs” and as such are considered medical procedures. These require a trained and licensed healthcare provider to evaluate patient suitability via a “Good Faith Evaluation”. And the management of a medical spa requires the same oversight (supervision and administration) of medical care as a medical office vis-a-vis licensing rule.

Are you in Violations?

Medical Directors and physicians who are somehow linked with the operation of Med Spas should understand the risks to their medical licenses associated with this expansion of their medical practices. Med Spa offices must conduct a preliminary GFE for patients before they are treated. As of October 11, 2019, the California legislature amended and liberalized Section 2242 to provide that an appropriate prior examination does not require a synchronous interaction between the patient and the licensee and can be achieved through the use of telehealth, as specified, provided that the licensee complies with the appropriate standard of care. It is critical to remember that the GFE is an encounter that must occur before a patient receives a treatment to assess their current condition, note their medical history and ensure they are fit for the procedure. The goal of the GFE is to make a diagnosis and determine an appropriate treatment plan for the patient.

What constitutes a good faith exam?

The good faith exam proceeds in obtaining a patient’s medical history and performing an appropriate examination of the patient and to determine the procedure is safe for patient

Can nurse practitioners open their own practice in California (AB 890)?

The law went into effect on January 1, 2023, enabling NPs in specified practice settings across California to begin practicing without physician supervision and expand access to much-needed care. During the first phase, NPs work without physician supervision for three years at certain practices where a physician or surgeon also practices. The first phase allows NPs to practice independently, but they can consult a physician if needed