Out of bounds

By Ben Tesdahl, JD, LLM, and Jason Qu, JD, Contributing Writers, April 1, 2025

Dermatologists face increasing competition from non-physicians offering various types of skin care services. Provided that such services do not constitute the practice of medicine, they may be permissible, but sometimes still require a special state license. What can be done about non-physicians who are offering services that appear to constitute the practice of medicine? What if their advertising is false or misleading?

Dermatology versus mere skin care

Before they can begin practicing, board-certified dermatologists receive more than a decade of training, which includes working alongside experienced doctors and completing 12,000 to 16,000 hours of treating patients.

With this training and a valid state license to practice medicine, a dermatologist is permitted to perform diagnostic and preventative exams, prescribe medications, and perform invasive and other treatments for conditions of the skin, hair, and nails.

By contrast, there are other skin procedures that may be performed by non-physicians, with the key being that they cannot practice medicine. One example is estheticians, who often do not require a license and perform treatments to the outer layers of the skin such as facials, body scrubs, and chemical peels.

The regulation of skin procedures varies widely by state and is often very technical and sometimes inconsistent. For example, in California, if microdermabrasion is a cosmetic treatment that only affects the outermost layer of the skin or the stratum corneum, then a licensed cosmetician or esthetician may perform the treatment. However, if microdermabrasion is a medical treatment penetrating deeper levels of the epidermis, then the treatment must be performed by a physician or by a registered nurse or physician assistant under supervision. Guidance on other procedures such as light therapies, laser hair removal, and dermal fillers also varies widely.

Some dermatologists also use assistants who do not have a license to practice medicine but may have some other type of license or credential, such as being a licensed nurse. Depending on state law, such persons may perform certain kinds of medical tasks provided that they are done under the supervision of a licensed physician, with the level of supervision varying from state to state.

Unlicensed practice of medicine and false advertising

The definition of what constitutes the practice of medicine will vary from state to state, but the definitions tend to be broad. For example, in Maryland the definition of “practice medicine” includes, among other things, “diagnosing, healing, treating, preventing, prescribing for, or removing any physical, mental, or emotional ailment or supposed ailment of an individual” by various means, including tests, drugs, operations, and treatments. By negative implication, anything short of the foregoing would not constitute the practice of medicine in Maryland, and other state laws will often mention specific exceptions, such as performing a massage.

The unauthorized practice of medicine is illegal in all states, and the consequences of violating state practice of medicine laws can range from fines to imprisonment. Similarly, wrongly identifying as a doctor is also illegal, and in many states, “aiding and abetting” someone in the wrongful practice of medicine is illegal.

For example, in California, a fine of $10,000 or imprisonment for up to a year may be imposed against any person who diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition without having a proper certificate to do so. California also prohibits anyone without a proper medical certificate from using ‘doctor,’ ‘physician,’ ‘Dr.,’ ‘MD,’ or any other terms or letters implying that they are a physician or surgeon.

The use of assistants may sometimes result in even a properly licensed physician being accused of aiding and abetting the unauthorized practice of medicine by the assistant, and these cases are sometimes decided in a lawsuit involving a sanctioned physician challenging an earlier decision of the state medical board.

False or misleading advertising by those who are not licensed dermatologists is sometimes also a violation of state laws and an ethical problem. For example, one analysis concluded that the proliferation of medical spas has led to an increase in misleading advertising practices, particularly relating to the qualifications of practitioners and the risks of cosmetic procedures. The study found that aestheticians manage many spas without having the extensive and rigorous training that board-certified dermatologists undergo. It also found that these spas were sometimes advertising “physician oversight” when there is none and were promoting procedures as “minimally invasive,” thereby creating a false sense of security for patients. In efforts to protect patients from confusing or misleading professional titles, Indiana, Tennessee, and the District of Columbia have also recently passed so-called “-ologist” laws that prevent non-physicians from using physician-equivalent titles — including specialist designations such as “dermatologist” — as a component of their own professional titles.

Additionally, many licensed physicians are engaged in the practice of dermatology without proper training. While this is generally not considered to be the unauthorized practice of medicine, it may still be dangerous for patients, create ethical concerns, and may constitute false advertising in certain circumstances. For example, California law prohibits physicians from advertising that they are “board certified” in a particular specialty unless they are certified by the American Board of Medical Specialties, a specialty board with the Accreditation Council for Graduate Medical Education accredited postgraduate training program, or a specialty board approved by the Medical Board of California. Newer “-ologist” laws being passed or considered by various states also address concerns around training and competence within a false advertising framework. For example, in Tennessee, both physician and non-physician practitioners are prohibited from including information that “misrepresents or falsely describes a practitioner’s profession, skills, training, expertise, educational degree, board certification, or license” in advertisements.

Reporting suspected unauthorized practice of medicine or false advertising

Given the extensive education and training that dermatologists have and their commitment to providing safe, high-quality care, it is understandable that they would want to prevent non-physicians claiming to offer similar services from unfairly competing with them, from falsely advertising their services, and from practicing without required licenses.

The best course of action if a dermatologist believes someone may be practicing medicine without a license or is engaging in false advertising is to report it to the appropriate authorities and then let those authorities investigate and decide the outcome of the matter.

Each state has its own reporting procedures, and therefore, it will be necessary to consult state law on such matters. In most cases, the unauthorized practice of medicine is reported to the state medical board or similar enforcement body, as well as in some cases the state attorney general. Some states allow such complaints to be filed verbally or in writing, and some also allow such complaints to be submitted anonymously. However, because state medical boards often receive dozens of complaints a year involving a wide range of medical practice issues, the process in any one case may be quite slow in reaching a final resolution.

Some states also bring enforcement actions targeting the unauthorized practice of medicine through the state’s attorney general or other consumer protection agency. For example, in New Jersey, the State Division of Consumer Affairs brings enforcement actions against unlicensed medical providers, and in 2023 it brought an enforcement action against the unlicensed provider of cosmetic skin treatments such as dermal filler injections, Botox injections, cosmetic tattooing, and platelet rich plasma treatments that could only be provided by licensed medical professionals in New Jersey. In addition to the unauthorized practice of medicine, state attorneys general and their consumer protection divisions may also receive and manage complaints regarding false or misleading advertising by unlicensed or unqualified providers.

If a dermatologist could prove direct damage to their medical practice by a competitor practicing without a license, a civil lawsuit might be possible, but such situations are rare and reporting the matter to state authorities is the better option.

Examples of disciplinary actions

Sometimes, the sanction for the unauthorized practice of medicine is an agreement with the individual to cease and desist certain actions. For example, in New Jersey in 2020, the attorney general forced a pharmacist to cease and desist from practicing medicine and identifying himself as a doctor. The attorney general’s complaint alleged numerous acts constituting the unlicensed practice of medicine, including reviewing medical histories, interpreting blood results, and counseling patients with unproven treatments for COVID-19. The individual also agreed to change his website, where he used titles such as ‘Dr.’, ‘NMD’, and ‘naturopathic physician.’

Also in New Jersey, in a continuing effort to halt the unlicensed practice of medicine in spa-like settings, Attorney General Matthew J. Platkin and the Division of Consumer Affairs announced that a licensed cosmetologist and skin care specialist in Union County must pay $22,500 in civil penalties for allegedly performing invasive aesthetic treatments that only licensed medical professionals are authorized to perform in New Jersey.

And as noted above, the use of assistants may sometimes result in even a properly licensed physician being accused of aiding and abetting the unauthorized practice of medicine by the assistant. For example, in Siddiqui v. Illinois Department of Professional Regulations, the physician, who had a trained and licensed pharmacist assistant, was charged with allowing the assistant to use the physician’s own medical license, as well as aiding the assistant in the unlicensed practice of medicine, in violation of the Illinois Medical Practice Act. Assisting unlicensed persons in practicing medicine may also lead to a False Claims Act violation.

AADA advocacy efforts

In addition to state enforcement actions outlined above, the American Academy of Dermatology Association (AADA), acting in concert with the American Medical Association’s similar initiative, has undertaken efforts to identify and stop the unauthorized practice of medicine, in part by fighting against proposed state laws that would weaken the quality and safety of specialty care. The AADA’s initiatives also include fighting against false advertising. It should be noted that the AADA cannot take ethics actions against non-physicians because it does not have jurisdiction over non-members.

As noted above, the best course of action if a dermatologist believes someone may be practicing medicine without a license is to report it to the appropriate authorities and then let those authorities investigate and decide the outcome of the matter. If a dermatologist could prove direct damages to their medical practice by a competitor practicing without a license, a civil lawsuit might be possible, but such situations are very rare and would likely be expensive to pursue.

This content was created with the particular needs of early-career dermatologists in mind. See the rest of our Career Launch resources for young physicians.

This article is provided for informational and educational purposes and is not intended to provide legal advice and should not be relied upon as such. Readers should consult with their personal attorneys for legal advice regarding the subject matter of this article.

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