American Association for Physician Leadership

Health Services Aimed at Improving Wellness: What All Physician Leaders Should Know

Anthony Slonim, MD, DrPH, CPE, FAAPL

May 8, 2023

Volume 10, Issue 3, Pages 13-15


Recently, I have taken notice of health services that continue to cross over to areas that were traditionally called beauty, cosmetic, and wellness services. These services are increasingly being offered by healthcare providers around the country. Admittedly, I knew very little about this area despite being a physician leader in several roles over the course of my career. I quickly came to learn that there are important implications for ensuring the delivery of high-quality services in the health, wellness, and beauty space that have relevance for physician leaders more broadly.

Physicians have been responsible for leading health and healthcare programs across the industry in a variety of roles for decades. Depending on the role, a “day-in-the-life” of the physician leader will often cut across several content areas, including clinical quality, operations, finance, and informatics; thus, staying abreast of emerging health and healthcare trends is essential in being able to inform discussions for the benefit of patients.

Recently, I have taken notice of health services that continue to cross over to areas that were traditionally called beauty, cosmetic, and wellness services. These services are increasingly being offered by healthcare providers around the country. Admittedly, I knew very little about this area despite being a physician leader in several roles over the course of my career. I quickly came to learn that there are important implications for ensuring the delivery of high-quality services in the health, wellness, and beauty space that have relevance for physician leaders more broadly.

Health Vs. Healthcare

For the purposes of this discussion, I want to distinguish, albeit somewhat artificially, between health and healthcare services.

Health services can be defined as those services that are targeted at preserving wellness for those who seek them out. Health services are very broadly based, and the audience is aimed more generally at people who may be free from illness or disease yet are interested in living a healthier lifestyle from the perspectives of mind, body, and spirit.

Alternatively, healthcare services are provided to those who are sick and injured and are primarily aimed at restoring them to health. Healthcare services are often aimed at patients with an explicit goal of addressing a condition so that, to the degree possible, patients are returned to a state of health.

Health Services Oversight and Competency

Table 1 lists some of the more common health services that are increasingly being offered by physicians and other healthcare providers at medical or health spas to improve the way people feel. This list has several important considerations for physician leaders.

First, several of these services may be licensed by state boards that have oversight of clinical practice issues. Examples of this include acupuncture and chiropractic, which are clinical disciplines unto themselves.

Second, many of the services listed are performed by physicians who have completed post-graduate training in a discipline that assures their competency. For example, dermatologists and plastic surgeons may administer botulinum toxin, fillers, and hair replacement therapies and have been deemed competent through their training and board certifications.

Urologists and gynecologists may use hormonal therapy and other modalities to address sexual health. Anesthesiologists and pain specialists have increasingly advanced newer, evidence-based methods of pain control that allow a patient’s pain to be addressed without the use of narcotics. Bariatric programs often have comprehensive nutritional components to address weight loss before offering surgery.

Finally, the provision of other services, like massage or psychological therapy, may be licensed separately at the state level from an oversight perspective.

Ensuring Wellness Through Healthcare Delivery Channels

The definition of what it means to be “well” is a very individual conceptual frame. A physician cannot will a patient to be well; patients have to believe and feel it for themselves.

For centuries, people have fought back not only on the physical performance side of aging, but also on the cosmetic side of aging. To some extent, this has been kept in check by ensuring that modalities are prescribed only by licensed providers who are thoroughly trained and competent in providing the service.

For example, if your lifestyle is affected by degenerative joint disease in the knee, a trained and licensed orthopedic surgeon can clinically evaluate the knee, perform diagnostic testing, and offer a range of therapeutic options to treat that degenerative joint disease.

Another layer of oversight is derived from payers who have helped determine whether a particular therapy or treatment will be approved and paid for in a given condition. This approach has, to some extent, proved effective.

Wellness Services Offered Through Newer Delivery Channels

Critics of using the healthcare delivery channels for wellness services would argue, however, that the approaches described above may not be the best approach for wellness services. One reason for this is that the availability of healthcare services is constrained.

Using the prior example, not everyone needs access to the skill set and expertise of an orthopedic surgeon for their knee pain. Sometimes a primary care provider can perform an examination, offer diagnostic tests, perhaps even therapies and injections that are non-surgical in nature to address the patient’s problem.

In addition, some patients may not even need the skill set and expertise of a primary care physician to address their knee pain when more homeopathic therapies, like massage or Reiki, may have potential benefits for patients. These services may not be recommended because they may be outside of what western medicine traditionally prescribes for patients with knee pain, and they are not covered by payers, in part because the evidence base is limited or non-existent.

Hence, the expansion of health and wellness services across the country is notable for several reasons.

The demand for wellness services is higher than ever. People share openly on social media channels how unwell they feel across a variety of domains, and there is a commensurate response from both professionals and the public on social media about how they can feel better. This advice ranges from self-help to alternative providers who offer suggestions on purchasing products directly through online supply chains or delivery houses.

Another reason for the search for something better may be that traditional medicine has been unsuccessful in helping people with the things that concern them most about their health. For example, weight control is an important problem facing a large segment of Americans, and people are often desperate to try new approaches to help them lose weight. When they attempt to access weight loss pharmacotherapy from their primary care provider only to have the medications denied by insurance, they will find alternative avenues for these services.

Because these services often fall outside of traditional payment models of care delivery, if you want something and can afford to pay for it, you can often find someone to provide the service. This approach has created financial incentives for providers. Providers who may not have been trained in a specific specialty may be able to attend a continuing medical education activity that provides didactic and hands-on training to perform these services even though they have not demonstrated competence through traditional post-graduate training and board certification in a particular specialty.

Physicians and providers trained in one specialty, like family medicine or internal medicine, may augment their practice by providing services on a cash basis to patients who want the service and are able to pay out of pocket for them. These important societal and professional pressures are driving the increasing availability of these services outside of traditional medical or regulatory oversight, and some will argue that this lack of oversight may be harmful, while others will argue that these providers are filling a void by offering needed service to those who otherwise might not be able to get it.

What Can We Learn from These New Approaches?

Perhaps there are things that can be learned by understanding the evolution of wellness services into this new and more available state. There may be some health services that people want to access to feel better, and only they can make that judgment. If true, then democratization of low-risk procedures in a market economy that improves access to these wellness services where the benefit to the individual is valued may be an interesting alternative delivery approach.

We know that the current approach to payment for medical and healthcare services may be imperfect when applied to services focused on wellness, and this alternative approach may create a mechanism that should be explored. For example, we know that despite the fact that botulinum toxin and fillers are not covered by insurance, people are more than happy to continue to access these services through a self-pay model to feel better about themselves.

The implications and opportunities for physician education and competence are also important to consider. Some procedures may be easily and safely performed even when the provider has not completed five years of residency training and passed the boards.

The categorical distinctions between specialists and generalists have been around for a long time, and this example of wellness has blurred the lines between what ought to be done only by specialists and what could be done by those who undergo some form of training, demonstrate competency, are able to use their assessment skills for appropriate patient selection, and even though rare, are able to manage the complications of the procedures should they occur.

Physician careers may be fluid. Nurses, physician assistants, and nurse practitioners may begin their career in one area and migrate to other areas as their career progresses. Physicians usually train for a given specialty and consistently deliver that care for their careers. Maybe this new training in wellness procedures is an example of where continuing medical education complements the foundational knowledge of all physicians and provides them with alternatives as their career progresses.

Implications for Physician Leaders

The implications for physician leaders are extraordinary. There are certainly areas where patients may know what is best for them. If a patient gets relief from nausea during chemotherapy by using aromatherapy, why not? If weighted blankets soothe anxiety, maybe they’re worth a try instead of pharmacologic therapy. If a patient is in mid-life and struggling with menopause or andropause, hormone therapy may assist in managing their symptoms and contributing to their state of well-being. We certainly do this already with other more well-known conditions like thyroid disease, where hormone replacement is essential.

In addition, for those of us with oversight functions on clinical practice in our organizations, ensuring the training and competency of those who choose to expand their practice into these areas of wellness is important. We always want to prioritize safe, high-quality clinical care for our patients. There are ways to do this through mentorship, case logs, monitored procedures, and specialty backup for rare complications.

We must also be aware of the turf battles that arise from those who may be trained in a certain way and are unwilling to consider alternative training pathways for credentialing in our institutions.

Finally, consider this wellness conversation in the context of other modalities that may not have yet reached the mainstream. While evidence-based medicine has become the mantra that we live by, we should also be humble enough to know that for many approaches that may add value to patients, the evidence base is less than robust.

Perhaps as physician leaders, we might advocate for patients to ensure that they are able to gain access to needed services when traditional approaches have let them down or they are feeling unwell.

Anthony Slonim, MD, DrPH, CPE, FAAPL

Editor-in-Chief, Physician Leadership Journal.

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