Okay so good questions!  I'll try to clarify.  Many good dermatologists or plastic surgeons will delegate procedures.  I don't have a problem with this as long as the laser provider has a medical degree, for example, a PA-C (certified physicians assistant) or ARNP (a registered nurse practioner), a RN or even an MA (medical assistant).  AND, this is tricky part, that laser provider is bright, capable, well trained and well supervised. 

What I really object to is clinics who hire non medical staff, train them for a week and let them loose on the unsuspecting public.   They supervise them poorly and call them "laser technicians."  Ask - what medical degree does this laser technician have?  If they are evasive, go somewhere else.  Also ask - is the doctor on site (unless on vacation) full time?  Some clinics have the doctor come in 1/2 day a week and then advertise themselves as having a doctor on site.

The "special interest" part is fine as long as the doctor is a board certified dermatologist or plastic surgeon.  Many of the medispa style clinics will hire a family practice doc or an ER doc, someone with no training in skin, to be their "doctor."  See my Regional Guide of Good Dermatologists (there is one in Vancouver at the bottom of the list). Also, my article on How to Find a Good Dermatologist will give you some more tips! Hope this helps!  Dr. I