Rapidly becoming one of the most hotly-contested issues in aesthetics law is the role of the Medical Director. Who can serve as a Medical Director, what are the requirements of the person in this critical position and where do you even find someone...the list of questions goes on and go. This article is intended to supplement our previous article, “Can I Own a Medspa?” by honing in on - and attempting to demystify - the role of the Medical Director.
Who can act as a Medical Director?
You may have heard us say this before - and please don’t be upset – but, it depends. Though the answer to who can act as Medical Director of a medspa tracks closely with the question of who can own, there are some significant variances. Generally, a Medical Director candidate will fall into one of three buckets. First, due to Corporate Practice of Medicine (CPOM) restrictions, some states allow only a physician to act as the Medical Director. In strict CPOM states, such as California, despite allowing certain licensed individuals to own a minority share of a medical practice, the role of Medical Director may only be filled by a physician.[1] Next, in independent practice states that allow nurse practitioners (NPs) to own a medical practice, the NP may also act as Medical Director after meeting certain criteria.[2] The third and final bucket of directorship are those states that, in addition to physicians and NPs, allow a physician’s assistant (PA) to fill the role, as long as there is collaborative agreement in place with a doctor.[3]
What are the requirements and expectations of the Medical Director?
Once again, state statutes and medical board opinions vary widely in the list of duties required of the person filling this role. Generally, the Medical Director is tasked not only with oversight of the clinical team, but also for writing and disseminating clinical policies and procedures, hiring and training clinical staff and ensuring compliance with everything from continuing education to OSHA and HIPAA requirements. The duties list can lead down a rabbit hole rather quickly, as the regulations vary as to how initial consultations must be handled (this will be discussed in a forthcoming article), how often the Medical Director needs to be on-site and what provider head count limitations may exist (that is, how many NPs, PAs, and/or other clinical providers may one Medical Director oversee).
Let’s consider the state of Alabama for a moment, as it is a strong case study in the nuances of regulations around medical directorship. Alabama is a CPOM state with what we will call a “hybrid” practice ownership model. Though not clearly articulated in the statutes, a 2017 advisory opinion from the Alabama Board of Nursing stated that NPs may own a practice as long as they maintain on ongoing collaborative practice agreement with a physician (the requirement that a physician be continually engaged in an ongoing basis is why this is not considered a true independent practice state). However, the statutes do articulate the requirements of a collaborative relationship between NPs and physicians, limiting the number of NPs a doctor can oversee to a total of nine full-time providers.[4] The regulations also state that the Medical Director must be on-site for varying periods of time dependent upon the experience level of the NP and/or the physical location.[5] So, does this mean that the NP can act as Medical Director if the collaborative requirements are met? No, not really. Though presented in the context of various specialty practice areas as opposed to a blanket statement around medical directorship, the Alabama regulations consistently state that only a physician will qualify as a Medical Director.[6]
Unsurprisingly, this role is not one to be taken lightly, as liability for the negligent acts of the clinical team members will likely rise to the Medical Director themselves. For folks considering the role of Medical Director, it is wise to not only obtain your own medical malpractice insurance, but layer on an administrative liability policy, which aims to limit exposure stemming from the administrative duties that are a key element of the position.
Where do medspa owners find a credible Medical Director?
For medspa owners who lack a personal relationship with a properly-licensed provider who can fill the role, the number of services that will locate and contract a Medical Director for your practice continues to increase. It is worth noting, however, that not all services are created equal. As opposed to merely finding a Medical Director who has minimal (if any) involvement with your medspa, you should seek out individuals who want to be an extension of your practice and will ensure compliance with the requirements of your respective state guidelines. Simply because someone is willing to put their license on the line for a monthly fee does not mean they will properly fill the role. All it takes is one disgruntled patient or employee to file a complaint and the Office of Inspector General, the state medical board, or any number of other administrative bodies may show up at your door. If that day comes, a lack of proper clinical protocols and/over oversight by the Medical Director could result in massive fines or even criminal penalties. A collaborative approach by both non-clinical management and the Medical Director will ensure alignment between the clinical and non-clinical teams, and thus, minimize the chances of a negative outcome and/or how such an incident is handled.
At Marti Law Group, our goal is to put medspa and medical practice owners in a position of long-term success with minimized liability. Bringing together the right Medical Director, and implementing a strong Medical Director Agreement, is key to that success. If you are a medspa owner searching for a Medical Director or trying implement a compliant Medical Director Agreement, or a Medical Director yourself seeking review of an agreement you have been presented, please reach out to us at (860) 552-7770 or email info@martilawgroup.com.
[1] This is expected to change with the enactment of AB890 earlier this year, which will allow nurse practitioners to own a medical practice, and presumably, act as Medical Directors. [2] For a current map of independent practice states, see the American Association of Nurse Practitioners state practice environment map here. [3] Idaho is one such state pursuant to Idaho Code §54-1807(A)(3). [4] Ala. Admin. Code r. 610-X-5-.05. [5] To expand, Ala. Admin. Code r. 610-X-5-.09 requires the collaborating physician to be on site with the NP no less than 10% of the time for the first two years of the collaborative arrangement, then drops to quarterly meetings thereafter. For “remote practice sites,” the collaborating physician must visit at least twice per year. [6] An example is Ala. Code §34-24-606, which articulates the requirements of a Medical Director of a pain management practice.
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