Vol. 15 •Issue 10
• Page 65
Women's Health Care in a Spa Setting
An Inviting Intersection of Disciplines
By Mary Eberhart, NP
Well woman examinations are a fundamental component of our health care delivery system aimed at promoting health, wellness, disease identification and disease management throughout a woman's life. It is no secret that healthy habits and early detection of disease increase the length and quality of life. Periodic well woman examinations can help women achieve both goals — by providing guidance for self-care throughout life.1
For many women, the well woman examination is an unpleasant experience because it involves collection of a Papanicolaou smear. Throughout my years of practice as a women's health nurse practitioner, I have heard many patients make negative comments about annual examinations for this reason. These feelings were the impetus for my venture into independent nurse practitioner practice offering gynecologic services in a spa environment. I developed this environment because I believed it would make a difference in how women perceive their well woman examination.
Background
Today's consumers are demanding one-stop shopping for all types of services, including medical care. At the same time, they are also searching for ways to live healthier lives and to integrate complementary approaches with conventional therapies. Consumer spending on holistic spa-type modalities is increasing rapidly.2 The medical spa is a convergence of two well-established entities, traditional medicine and healing spas. Their differing perspectives merge somewhere in the middle, under the rubric of integrated medicine. Patients welcome the holistic and overall wellness concepts that medical spas promote.3
Medical spa structures range from the day spa that hires a physician or NP to provide cosmetic services at scheduled times to the physician or NP who brings an esthetician into the medical setting to augment traditional practice income. At the other end of the spectrum are medical spas that fully integrate medical and spa services.4
Several factors have contributed to the emergence of medical spas in the United States. First, technology has advanced to allow consumers to obtain cosmetic enhancement through safe, comfortable and noninvasive procedures without the inconvenience of extended recovery time. Second, consumers have more appreciation for the mind-body connection and the environment's role in healing. Third, medical spas are more aesthetically appealing than traditional medical offices.4
Few women would disagree that Pap smears are an unpleasant routine experience. Women may avoid such tests because they fear a diagnosis of cancer, or they may be embarrassed or anxious about the procedure itself. A 2002 poll revealed that more than 50% of women in the United States avoid routine gynecologic examinations.5 Their reasons, in order of frequency cited, were lack of insurance coverage for the visits, language or cultural barriers, embarrassment, inconvenience, fear, and the belief that they were not at risk for cervical cancer.5
But the well woman exam is much more than the mere collection of a Pap smear. Opinions about what should be included in a well woman examination vary greatly. From my perspective and in my practice, the components of a well woman examination include, but are not limited to, the following:
health maintenance evaluation and education
screening and treatment for sexually transmitted infections
breast health assessment and education
bone health assessment and education
psychosocial health assessment
discussions about diet and exercise.
An Integrative Environment
The overall objective of blending well woman examinations into a spa environment is to positively influence women's perceptions of gynecologic care. To accomplish this objective, I partnered with an experienced esthetician to offer gynecologic health services to women in a spa environment, using the concept of holistic advanced practice nursing as a foundation.
Defined as the enhancement of healing the whole person from birth to death, holistic nursing encompasses two frameworks: the study and understanding of the interrelationships of the biopsychosocial and spiritual selves and recognition that the whole is greater than the sum of its parts, and the appreciation that each person is an integrated whole who is interacted with and acted upon by internal and external environments.6 Holistic nursing accepts both views, believing that the goals of nursing can be achieved within either framework.6
To create a space in which healing can occur, holistic theorists recommend shaping the physical surroundings and providing a personal environment that evokes the healing process.7 Because holistic nursing focuses on wellness rather than illness, this framework and its associated concepts provided the foundation for developing a practice that blends well woman examinations and the spa environment.
The idea for my practice received an extra push when the medical office where I worked stopped providing obstetric services. This prompted some physicians to leave the practice and resulted in a proliferation of empty rooms within a large office. An esthetician leased one of the rooms and provided skin care services within the medical practice.
Concurrently, the physicians in the practice became involved in the establishment of a new hospital and decided to relocate to a new office suite near it. My idea of combining women's health care and a spa environment quickly gained steam at that point, and the esthetician and I decided to pursue the business together.
Initially, we sought to purchase or remodel an existing facility. It quickly became evident that leasing would be the better option. We found space in an office building that would provide a build out as part of the lease costs.
Our goal was to create a calming and soothing environment in which a patient would feel relaxed and free of anxiety. We chose all furnishings and decor with the comfort of the patient in mind. The selection of staff was also important. We carefully selected a receptionist who could successfully interact with the public. We interviewed and selected professionals to provide therapeutic massage, manicures, pedicures and sculptured nail services on an independent contractor basis. We sought only professionals who subscribed to the same holistic philosophy that is the core of our business.
We divided startup expenses equally between us, and we continue to divide operating expenses in the same way. I am a sole proprietor, and the esthetician is an independent contractor. To cover startup costs, we each obtained loans. I spent the funds on medical equipment and waiting room setup; she purchased lasers and other aesthetic equipment and shared the expenses of waiting room dŽcor. We charge weekly rent to the independent contractors who provide other spa services. Each contractor was responsible for equipping and decorating his or her leased space, and their individual contracts required that the décor match the atmosphere we had established.
While the spa portion of the business was settling into place, I had to establish an independent practice. In addition to writing a business plan that satisfied my lender, I obtained all licenses and certificates required by local and state regulations and hired a specialist to obtain credentialing with relevant hospitals and insurance companies. I established a new relationship with a supervising physician as required in Texas (a physician must be available by phone and review charts once a week).
Impressions and Results
Our business, Bellissima Spa and Wellness Centre, opened in June 2005. By January 2006, my portion of the business (the medical services) was generating a small profit and comfortably paying the loans required to start it. For the 2006 tax year, I collected $20,000 in income from my practice.
I see approximately 25 to 32 patients per week. As payment for medical services, I accept most insurance plans. I pay my billing staff (a friend with medical billing experience) 6% of collections. All other services at Bellissima Spa and Wellness Centre require cash or credit card payment at the time of service.
Word of mouth is essential to the growth of my practice, as well as our spa services. I rely heavily on the fact that my patients tell their friends and family members about our unique setting. A majority of my patients followed me from my previous practice setting. Now that I have been in independent practice for 2 years, I receive referrals from other providers and pharmacists in the community and have developed a network of providers that will accept referrals from me. I send handwritten thank-you notes for every referral.
Recommendations
It has been rewarding to blend women's health care with a spa setting. The soothing environment supports my philosophy of providing a holistic approach to women's health care.
When you're considering an independent practice, I advise planning at least 6 months to 1 year prior to the projected opening date. This time is needed to become credentialed, obtain proper licensing and certifications, and to acquire funding. An independent NP practice requires long hours and appropriate attention to the entire operation — not just patient care. If money is not set aside for startup expenses, it may be necessary to obtain loans and a line of credit. I purchased most of my equipment secondhand, which reduced some of the expense. Some equipment is worth purchasing new: I bought an expensive electric table to accommodate patients with disabilities.
A big challenge for any independent practice is marketing. We spent more than $5,000 on advertising in the first year, some of which produced no business. But advertising in a local magazine that spotlighted area businesses proved to be a cost-effective endeavor. This year, we began advertising on a Web site and phone directory specific to our city. We also purchased a Web domain name and set up a link from it to the local Web site. Word of mouth continues to be our most fruitful marketing strategy.
When planning a spa atmosphere for independent NP practice, surroundings are essential. Choose wall insulation and soundproofing techniques that will provide quiet and relaxation (for the spa clients) as well as privacy and confidentiality (for the medical patients). Additionally, I recommend the use of electronic medical records to reduce the need for storage space.
Putting It Into Practice
Based on our experiences thus far, I recommend offering women's health care in a spa setting to encourage a holistic approach to gynecologic care. Through our interactions with women every day, we see that the setting positively influences the well woman experience. Medical spas address the busy lifestyles of consumers today, and adding women's health care to the model is an idea whose time has come.
References
1. Wertz B. The well woman exam. The University of Tennessee Medical Center. Available at http://www.utmedicalcenter.org/center_for_womens_health/wh_medical_services/gynecology/the_well_woman_exam. Accessed July 12, 2007.
2. Wickersham E. Report on the Medical Spa Conference and Expo — mindful of the past, movement of the future. Available at: http://www.spas.about.com/library/weekly/aa050403ewg.htm?terms=phd+medical. Accessed July 12, 2007.
3. Mayes G. Beyond the examining room. Are medical spas for real? Medscape Ob/Gyn & Women's Health. Available at: http://www.medscape.com/viewarticle/496073. Accessed July 12, 2007.
4. Bryant R. Medspas fill niche, offer appealing aesthetics. Dermatology Times. Available after free registration at: http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=140976&ts=071207010937. Accessed July 12, 2007.
5. Washington State Department of Health. The health of Washington state. Invasive cervical cancer. Available at: http://www.doh.wa.gov/HWS/doc/CD/CD_CVCN.doc. Accessed July 12, 2007.
6. Dossey B. Holistic nursing practice. In B Dossey (ed.). Core Curriculum for Holistic Nursing. Baltimore, Md.: Aspen Publishing; 1997: 4-12.
7. McKivergin M. The nurse as an instrument of healing. In Dossey B (ed.). Core Curriculum for Holistic Nursing, Baltimore, Md.: Aspen Publishing; 1997: 17-25.
Mary Eberhart is a women's health nurse practitioner who owns Bellissima Spa and Wellness Center in Denton, Texas. For information on her practice, visit www.bellissimaspacentre.com. Or, contact her at mhe923@verizon.net.
Overview of Services at a Women's Health-Med Spa Hybrid
Nurse Practitioner Services
Well woman exams
Contraception
Hormone replacement therapy
Bioidentical hormone therapy
STD screening, counseling and treatment
Osteoporosis treatment
Preventive screening (cholesterol, hypertension, diabetes, etc.)
Spa Services
Massage therapy for relaxation
Therapeutic massage for well-being, pain or other conditions
Manicures and pedicures
Facials (for relaxation, skin health, acne treatment)
Microdermabrasion
Body wraps for contouring and detoxification
Laser treatments for removal of abnormal pigmentation, skin resurfacing, hair removal, etc.
|