The short answer
If your med spa performs any procedure that constitutes the practice of medicine — neuromodulators, fillers, prescription-strength peels, lasers penetrating living tissue, IV therapy or prescribing — you need physician oversight. In corporate practice of medicine states such as California, Texas and New York, the rules also restrict who may own the clinical entity, not just who supervises.
Supervision and ownership are two different questions
Med spa owners usually ask about a medical director when what they actually face is two separate legal problems.
The first is clinical: someone with prescriptive authority must order the treatments, and someone must supervise the people performing them. That comes from the Medical Practice Act and the delegation rules — Texas Medical Board rule 22 TAC section 193.17 for nonsurgical medical cosmetic procedures, for instance, or the Medical Board of California's requirements around the examination mandated by Business and Professions Code section 2242.
The second is structural: the corporate practice of medicine doctrine, which in many states prohibits a corporation or a non-licensee from practicing medicine, employing physicians to practice medicine, or controlling clinical decision-making. A medical director contract does not fix an ownership structure that CPOM prohibits.
Which states restrict ownership?
| State | Ownership posture |
|---|---|
| California | Strong CPOM. The medical entity must be a physician-owned professional corporation; a general LLC cannot own the medical practice. Nurse practitioners meeting the AB 890 independent practice criteria gained an ownership pathway that took effect in 2026 |
| Texas | Strong CPOM. Clinical entity must be physician-owned; MSO structures are common and are scrutinized |
| New York | Strong CPOM. Professional service corporations must be owned by licensees in the profession |
| Florida | Restrictive; the clinical entity generally requires physician ownership, and the Health Care Clinic Act licensure question turns on the exemption relied on |
| Colorado, New Jersey, Illinois | CPOM applies with varying strictness; ownership limits are real |
California tightened the picture further with SB 351, signed in October 2025 and effective January 1, 2026, which codifies corporate practice restrictions and bars private equity groups and hedge funds from interfering with clinical judgment — including decisions about diagnostic tests, referrals, patient volume and coding — and makes certain noncompete and non-disparagement clauses in provider agreements unenforceable. Enforcement sits with the Attorney General.
The standard workaround in CPOM states is the friendly PC plus management services organization model: a physician-owned professional corporation holds the clinical practice, and an MSO owned by the non-licensee provides administrative services under a management services agreement at fair market value. It works when the clinical control genuinely sits with the physician. It fails — and is being enforced against — when the MSO controls hiring of clinicians, clinical protocols, pricing of medical services, or the physician's ability to exercise judgment.
What does a real medical director do?
Boards distinguish sharply between a medical director and a rented signature. A defensible arrangement includes an actual physician-patient relationship framework, written and dated clinical protocols reviewed at least annually, documented training and competency verification for each injector or device operator, availability for consultation and emergencies during operating hours, adverse event review, chart review at a defined frequency, and a role in product sourcing and formulary decisions.
A "medical director" who has never visited the location, cannot name the staff, does not review charts, and receives a flat monthly fee unrelated to work performed is the fact pattern that produces board discipline for the physician and unlicensed-practice exposure for the owner. In some structures it also raises fee-splitting and kickback questions under state law.
What this means for your paperwork
Your file should contain a written medical director agreement specifying duties, time commitment, compensation methodology and term; a current roster of standing clinical protocols with review dates and physician signature; delegation and supervision agreements naming each individual and the specific procedures delegated; documented hands-on training records per person per procedure; a chart review log; and an adverse event log with the director's review noted.
If you use a friendly PC and MSO, keep the management services agreement, the stock transfer restriction agreement, and evidence that the arrangement is priced at fair market value and that clinical decisions sit with the licensee. Have counsel in your state review the structure before you open a second location, and again whenever ownership changes — because the structure is the thing that gets examined first when anything else goes wrong.
Related questions
This answer is educational and is not legal or medical advice. Requirements vary by state and change over time — verify with your own legal and clinical advisors before applying anything here in practice.