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How to Find a Medical Director for Your Med Spa

A medical director isn't a name on a form. Here's what the role really involves, three ways to find one, what to put in the agreement, and the red flags to walk away from.

By Karena Zolner

If you're opening a med spa, finding a medical director is probably the step that worries you most. It should get your attention. It's one of the few decisions that can shut a med spa down if it's done wrong, and some of the websites you'll find when you search for one are run by companies that place medical directors for a fee.

This is the guide I'd want if I were starting today: what a medical director actually does, the three main ways to find one, how they're paid, what belongs in the agreement, and the red flags I'd walk away from.

That comes from working firsthand with dozens of medical directors over my career, across multiple locations and operational models.

This post is general information, not legal advice. Med spa rules are set state by state and they change. Have a healthcare attorney in your state review your structure and your agreement before you sign.

What a medical director actually is

Many new owners picture a medical director as a license number that makes the business legal. In most states the role is much more than that. Depending on your state, the medical director (or supervising physician) is typically responsible for some or all of:

  • Delegation. Deciding which medical procedures can be performed by which non-physician providers, such as registered nurses, nurse practitioners or physician assistants, within what the state allows.
  • Supervision. Being available to the providers they supervise, at the level the state requires. Some states spell out supervision requirements in detail; others leave more to the physician's judgment.
  • Protocols and standing orders. Written instructions for each procedure: who can do it, for which patients, with which products, and what to do when something goes wrong.
  • Patient assessment. Many states require a qualified practitioner to examine a patient or establish a treatment plan before a delegated procedure.
  • Chart review and quality. Reviewing documentation and outcomes on a regular schedule.
  • Complications. Being reachable when a patient has a reaction, and having a plan for emergencies.

The details vary a lot by state. My med spa laws by state reference links to the official rules for the states we've verified so far.

Here's what that looks like in one state. In Texas, the Texas Medical Board treats nonsurgical cosmetic procedures, including cosmetic injections, as the practice of medicine that a physician may delegate (22 TAC §169.25). Before a delegated procedure, a physician (or a PA or APRN acting under the physician's delegation) must establish a relationship with the patient and keep a medical record. The physician, PA or APRN must be on site or immediately available for emergency consultation, and someone trained in basic life support must be present (§169.26). The written order has to name the delegating physician and cover patient screening, appropriate care, and how complications and emergencies are handled (§169.27). The delegating physician's name and Texas license number must be displayed in public areas and treatment rooms (§169.28). Those rules took effect in January 2025. Other states handle each of these points differently.

Ownership comes first

Before you look for a medical director, know who's allowed to own your business. Many states follow some form of the corporate practice of medicine doctrine, which limits who can own a business that provides medical services. In those states a nurse, esthetician or business investor generally can't own the medical side of the spa outright. Other states are more permissive.

Your ownership structure shapes what kind of medical director arrangement you need. Sort out the structure with a healthcare attorney first. My how to open a med spa guide puts this step in order.

Texas is an example of a strict state: its Medical Practice Act makes it an offense for an unlicensed person or corporation to hold itself out as entitled to practice medicine (Tex. Occ. Code §165.156), and a physician who aids or abets an unlicensed entity's practice of medicine can be disciplined (§164.052(a)(17)). California goes further on the medical director question itself: the Medical Board of California says a physician may not act as "medical director" of a practice the physician doesn't own, and gives a spa offering Botox as its example (Medical Board of California). It also says nurses may not employ or contract with a physician for supervision (MBC cosmetic treatments FAQ). So in California, "hiring a medical director" for a spa you own as a non-physician isn't the answer at all.

Three ways to find a medical director

1. Your personal and professional network

The physicians you already know: the dermatologist, plastic surgeon or family physician you've worked alongside, trained with, or referred patients to.

The upside: you know how they practice, they know how you practice, and trust is already there. A local physician can be physically present when your state or your comfort level calls for it.

The tradeoff: a physician with a full practice of their own may not have the time the role needs. Friendship can make it harder to hold each other to a written agreement. Make it formal anyway.

Where to look: physicians you've trained with, local dermatology and plastic surgery practices, device and product reps who know which physicians in your area work with aesthetic practices, and local medical society directories.

2. A medical director marketplace or placement company

Companies that match med spas with physicians, usually for a fee or a recurring charge.

The upside: speed. If you're mid-build and need someone, a marketplace can introduce candidates quickly, and some handle paperwork and protocols.

The tradeoff: check how many practices each physician already supervises, whether they're licensed in your state, how often they'll actually review charts, and whether they'll ever be on site. Read the contract for who you're actually contracting with and what happens if the physician leaves.

3. A physician-owned practice

In states with strict corporate practice of medicine rules, the physician may need to own the medical practice, not just supervise it. Some owners pair a physician-owned practice with a separate company that provides non-medical business services. States limit how far that can go: California's Medical Board, for example, says a management company may not arrange, advertise or provide medical services (Medical Board of California).

The upside: in some states it may be the only lawful way to offer medical services, and it gives the physician a real stake in the practice.

The tradeoff: it's the most complex and the most expensive to set up correctly, and the physician must keep control of medical decisions. Never try this without a healthcare attorney in your state.

What a medical director costs

Compensation usually takes one of these forms, or a mix:

  • A monthly retainer for oversight, protocols and availability.
  • Per-chart review fees, which scale with volume.
  • A share of the business, only where state law allows and only with a lawyer's structure. Be very careful with any arrangement tied to referrals or revenue; state fee-splitting rules, and federal anti-kickback rules if you bill government health programs, may apply.

In the arrangements I've worked with, the usual structure is a flat monthly retainer, typically $2,000 to $5,000 a month. Depending on state oversight requirements and how much hands-on clinical volume there is, I've seen it as low as about $1,500 and above $5,000. Some agreements add chart-review fees, usually $10 to $25 per chart, and in multi-location group models I've seen equity in the company as part of the arrangement. That's my own experience, not an industry survey.

Budget for the months before you open, too: protocols, standing orders and training happen before the first patient.

What belongs in the agreement

Get it in writing, have your attorney draft or review it, and make sure it covers:

  • Scope. Which services the physician oversees, and which providers.
  • Supervision and availability. How the physician will be reachable during business hours, the response time for urgent questions, and when they'll be on site.
  • Protocols and standing orders. Who writes them, how often they're reviewed, and how changes are communicated.
  • Patient assessment. Who examines patients before delegated procedures, and how.
  • Chart review. A defined cadence and a defined sample, written down. "As needed" isn't a cadence.
  • Malpractice coverage. The physician's own coverage, the practice's coverage, and that the physician's policy covers this role.
  • Licensure. Proof of an active, unrestricted license in your state, and the physician's duty to tell you immediately if anything changes.
  • Compensation. Amount, timing and basis, structured to comply with state fee-splitting and federal anti-kickback rules.
  • Termination. Notice periods on both sides, and what happens to patient care during a transition.
  • If the license lapses. What you do the same day: stop delegated procedures, notify your attorney, and find interim coverage. Write this plan down before you need it.
  • Records. Who owns patient records and how the physician can access them.

Red flags

  • The absentee director. You can't reach them, they've never visited, and they've never reviewed a chart.
  • Too many practices. A physician supervising a very large number of clinics can't give yours real attention. Ask how many. Some states set limits: in Florida, when a physician supervises nurse practitioners or PAs at an office outside their primary practice with no onsite supervising physician, and that office mainly provides dermatologic or aesthetic skin care (other than plastic surgery), the physician may supervise only one such office, within 25 miles or a contiguous county, and must be board certified or eligible in dermatology or plastic surgery. Offices whose only service is laser hair removal by an APRN or PA are excluded (Fla. Stat. §458.348).
  • No chart-review schedule. If the agreement doesn't say how often, it won't happen.
  • Out-of-state license only. The physician needs to hold a license in the state where you practice.
  • Pay tied to procedures or referrals in a way your attorney hasn't approved. In New York, for example, sharing professional fees with someone outside the practice can be professional misconduct (Educ. Law §6530).
  • No written protocols. If there aren't written standing orders for each service, your providers are improvising.
  • Pressure to sign quickly. A good medical director wants the agreement to be right.

The red flag I've seen most is the "ghost" medical director: the one who never steps foot in the clinic, provides zero clinical protocols, won't answer an urgent complications call on a Saturday night, and treats the relationship as a passive check-cashing exercise rather than a true clinical partnership.

Questions to ask in the first conversation

  1. Are you licensed in this state, and has your license ever been disciplined?
  2. How many other practices do you supervise?
  3. What's your aesthetic training and experience?
  4. How will my providers reach you during treatments, and how fast will you respond?
  5. How often will you review charts, and how many?
  6. Will you write our protocols and standing orders, or review ours?
  7. What does your malpractice policy cover, and does it cover this role?
  8. How would you handle a serious complication at 7 p.m. on a Friday?
  9. How do you want to be paid, and has an attorney reviewed that structure?
  10. What would make you end the arrangement?

Make the relationship visible in your records

Chart review only works if the charts are complete and easy to review. Whatever software you use, your medical director should be able to see the treatment notes, the signed consent, the photos and the product lot numbers for each visit, without asking someone to pull files. My post on med spa EMR software covers what good charting looks like.

That's part of what I'm building Software by Jade to do: client records that keep intake, signed consent, photos and treatment notes on one profile, with lot numbers attached to chart notes. If you're mid-build and want a say in how it works, apply for the Founding 50. Or join the waitlist to hear when it launches.

Keep reading

This post is general information, not legal advice. Talk to a healthcare attorney licensed in your state before you choose a structure or sign a medical director agreement.

About the author: Karena Zolner is the founder and CEO of Software by Jade. She has over 25 years in the aesthetics industry as an esthetician, brand rep and operations director. Her approach: no fluff, just operational reality and tech that actually works.

Sources

All accessed 2026-10-14.

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