Serving as the Medical Director of A Med Spa: What Physicians Need to Consider About Liability, Compensation, & More
- Feb 26
- 6 min read
These days, many physicians in our online physician community are approached by nurse practitioner (NP), physician assistant (PA), or corporate med spa owners for medical director or other supervising physician roles. These roles are often presented as low time commitment ways to make easy extra money or additional income without traditional clinical responsibilities, with the added perk of being able to be done remotely and simply being available to answer questions if they arise and to satisfy legal requirements for having a physician owner or supervisor. However, the reality is more complex as supervising physicians assume significant professional and legal responsibilities. Before agreeing to supervise NPs or PAs at a med spa or serve as a medical director, physicians should fully understand the liability exposure, regulatory requirements, compensation vs. risk analysis, and implications of allowing others to practice medicine under their license, some of which we highlight below.
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What does a supervising or medical director role at a med spa involve?
Physicians in our community are often approached by a NP, PA, or other clinician who has opened or wants to open a med spa in a state where they are not allowed to practice independently. In some cases, the clinics are even owned not by other clinicians, but by those looking to get in the medical spa business.Â
While roles can vary from state to state and for each specific opportunity, these roles are typically presented as medical director positions and often include:
Chart review and documentation oversight
Protocol development and standing orders
Training and competency verification for procedures
Availability for consultation or complications
Oversight of prescribing practices, including injectables or medications
Periodic on-site visits (depending on state law)
While nothing on this list may be an immediate red flag, it’s important to understand that supervising physicians in these roles aren’t just responsible for these tasks when they’re asked about them. You can have significant legal liability for anything that happens at the site, regardless of whether you are involved in the decision making or even know about it.
Liability risks of holding a supervising role for midlevels at a med spa
Taking on a role as a medical director or supervising physician at a med spa can expose physicians to several liability risks. While procedures performed may be elective and be generally thought of as carrying less complications than some other fields of medicine, they aren’t risk free. Potential complications can include:
Blindness from improper injections
Other complications related to the anatomy or procedures
Infections
Burns from laser treatments
Adverse medication/treatment reactions
These can lead to serious issues for patients, which can open the door to potential litigation.
While some of the day-to-day responsibilities presented may not raise alarms initially, it’s important to understand why med spa owners are seeking a physician to fill this role. These clinician owners are often not allowed by their state to practice independently. In these cases, the physician in the supervisory role is allowing the clinicians at the med spa to practice under their medical license. Note that there is a reason that these states have determined that supervision is necessary and requires a medical license, and by agreeing to provide that license, you are taking on all of those responsibilities. Therefore, you can (and likely will be held) legally responsible for the care delivered under your license even if you aren’t physically present - and even if you didn’t know something was happening.
This has played out in numerous lawsuits over the years. Physicians are often surprised to learn that:
Supervising physicians are frequently named in (and have been successfully sued in) lawsuits even if they never saw the patient.
Courts may hold the physician responsible as the highest-trained clinician, and attorneys may pursue them more heavily as the physician is generally a larger monetary target with higher malpractice limits and personal assets.
Malpractice cases have resulted in midlevel providers being dismissed while physicians remained liable.
Given the significant risks these positions expose doctors to, we highly recommend thinking carefully about accepting this type of position. If you are considering a role, consult with your malpractice carrier and a local attorney to determine your state’s laws and regulations to clearly understand your potential exposure. Your malpractice insurance may not cover aesthetic supervision, especially if you don’t personally perform these types of procedures in your primary practice.
Related PSG resources:
Is it worth it? Compensation for med spa supervision
Compensation for supervisory roles at med spas are often very low, especially when weighed against the liability and potential risks of having others practice under your license. This is especially true when higher risk procedures, such as fillers and neurotoxins, are performed at the med spa.
Compensation models, which are often as low as a few hundred dollars a month, often only reflect the time commitment, which med spas pitch as low. They don’t reflect the risk doctors personally assume when holding these positions, or the opportunity cost that you put in to acquire that medical license. Consider also that if you are taking on most of the risk and you are the reason the med spa is able to be in business, you should probably be taking significant compensation.
Additionally, from a professional standpoint, it’s important to consider the implications for patients as well as the physician profession if we allow others to practice under our license without receiving the same education necessary to hold that license.
As you weigh the benefits versus risk, a few questions to consider.
Regulatory and legal considerations to consider for med spa supervisory roles
While most of the time members of our communities agree wholeheartedly that these roles aren’t worth the risk, if you are considering accepting a position, evaluate and make sure you understand:
State laws on supervision requirements:Â Definitions of supervision of non-physicians vary greatly from state to state. Some require written collaborative agreements, while others require an on-site presence and/or documentation of procedure-specific training. Failure to comply with regulatory requirements can create additional exposure beyond malpractice risks.
The roles and responsibilities of the role itself: Before accepting a role as a medical director (or other supervising position), clearly understand what the responsibilities of the role entail–not just what the company tells you. You’ll want to know the regulatory scope of non-physicians working under your license, as well as any responsibilities you carry for training midlevels, certifying equipment, obtaining informed content from patients for treatment, etc.
The expertise of those working under you: Many physicians are approached for these roles by friends or family in the medical profession who ask them to do this as a favor, or through contacts. Some are blind outreaches. Remember that while you may think someone is a very nice person, that doesn’t mean that they are a qualified clinician. Make sure you feel confident in the skills of the person working under your supervision.
The personality of the clinician working under you and whether you trust them to know what they don’t know, and when to come to you for help: While we all want to think the best of our colleagues, we know some clinicians are more confident than others and some are more likely to ask for help than others. Additionally, if somebody has laid out the opportunity as minimal to no time commitment, they may be hesitant to reach out to you. Make sure you lay out clear guidelines and expectations about when you want to be contacted - and that you trust that the clinician will follow them.
Malpractice insurance coverage:Â Never assume coverage under your existing policy. You should confirm your coverage includes aesthetic procedures and the supervision of others. Also make sure your limits are adequate to cover the potential complications for the procedures performed and that you have tail coverage if you leave the role. Learn more about tail coverage for malpractice insurance.
Conclusion
When approached to serve as medical director or supervising physician for a med spa, it’s important to carefully consider patient safety and whether the compensation offered justifies the liability exposure and other associated professional risks. Most of the time, physicians in our communities of doctors vocalize loudly that the risk isn’t worth the (typically very low) compensation for physician expertise and the license we’ve worked so hard to get.
Related resources for physicians
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