Haircut, manicure, and a little medicine

Steven Freedman, a West Hills, CA ob/gyn, says he has found a way to fight back against low reimbursements and keep control over his destiny. Faced with "precipitously" dropping income, he was forced to consider expanding his repertoire of treatments. He never expected the path to lead him to the tony world of an upscale beauty salon.

More than 10 years ago, Freedman began taking courses in the use of various lasers, starting with the CO₂ laser. "I did it with the idea of expanding my surgical skills," he says, "not to practice plastic surgery. I love my work as an ob/gyn." The impetus to use lasers for cosmetic procedures came from his patients' constant complaints about having to wax their bikini and facial areas.

Freedman first began doing cosmetic procedures in his office four years ago, when he teamed up with his next door "office neighbor," otolaryngologist Jerome D. Vener, who's also a head and neck plastic surgeon, to share the cost of a CO₂ laser. In short order, Freedman and Vener realized that their new practice areas and office hours didn't mix. "Our patients weren't crazy about their pregnancies and gyn problems being mixed with the cosmetic work," Freedman recalls. "My patients also were used to handing me an insurance card, and they couldn't for this kind of work. It was cash and carry."

Going where the beauty-conscious are The move to the salon was prompted by a friend of Vener's, anesthesiologist Jeffrey B. Glaser, who was already working out of the Michael Joseph Furie Salon in Tarzana, CA. He asked Freedman and Vener if they wanted to join him.

Glaser had gotten his start in the salon when the manager asked if he would give Botox injections there. Salon customers who'd had the injections elsewhere were complaining about droopiness around their eyes. They also had lopsided lips from poorly injected collagen. "As an anesthesiologist, I knew special ways of diluting the substances," Glaser says. He also knew that using the smallest needles possible would make the procedures more comfortable.

At first Glaser had doubts about the salon idea. But since he had already gone to several training sessions on the finer points of wielding the Botox needle, he decided to approach the state medical board and his malpractice carrier, anyway. To his surprise, both gave him the okay. So Glaser set up shop in the salon, where he was practicing 10 hours a week.

Like Glaser, Freedman and Vener initially had misgivings about the salon setting, but they countered them with meticulous attention to detail. Before agreeing to join Glaser, they had their malpractice carrier come to the salon and check it out. The carrier also recommended that they have patients sign an arbitration agreement and consent forms for each procedure.

All the doctors keep "stringent" medical charts, as Glaser puts it, and make all appointments through a separate system rather than the salon receptionist, so patients' medical records are safeguarded as required by HIPAA.