What is a Medical Director, and Why Do I Need One?

These examples are intended to provide information and inspiration for your journey and are not a recommendation or endorsement.

What is a medical director?

A medical director of a Medical Aesthetics practice is a trained physician who provides supervision and oversight of the medical treatments provided under the authority of a medical director’s license to ensure that patients are treated to the standard of care required.¹

The medical director typically oversees the operations of a healthcare facility and assumes medical responsibility of the patients and procedures in the practice. Depending on the state, a medical director is typically required to have experience or specialty in Medical Aesthetics, and they may also be required to have financial ownership.²

The medical director will take ultimate responsibility for all patients treated at a med spa—they will have an employment agreement that spells out his or her roles and responsibilities and addresses aspects of state medical practice to be compliant with local laws.³

Why do I need a medical director?

If you are practicing Medical Aesthetics in the United States, you may need a medical director. Simply stated, having a medical director enables you to legally provide medical services if you are not licensed to practice independently in your state.⁴ Since rules and regulations vary depending on your state, you should always check your state’s specific guidelines. The medical director is responsible for medical supervision and overall regulation of all medical facets of the practice.⁵

“Your medical director is basically the backbone of the practice,” says board-certified nurse-practitioner and aesthetic specialist Racquel Frisella, RN, MSN, AGPCNP-BC, who offers injectables, lasers, body contouring, and skincare at a plastic surgery office in St. Louis, Missouri. 

While the medical procedures on the med spa menu are considered non-surgical, med spas are still medical facilities, and must follow the same rules and regulations as doctors’ offices.⁶ That’s where a medical director comes in.

Note: it’s important to research and follow your state’s guidelines.

Read on to learn the functions of a medical director, and how they may work within a Medical Aesthetics practice.

Who needs a medical director?

Whether you need a medical director comes down to your individual state’s rules and regulations—it’s not just about who can perform certain procedures independently, but also about which procedures are considered “medical,” defined as having to be administered by a licensed, certified medical professional.

 “Anytime you’re injecting a medication, it requires medical training, and depending on the state, can that medicine be injected by a nurse, a nurse practitioner, a doctor, a physician’s assistant, or a licensed practical nurse?” says Connie Brennan, MSN, RN, PHN, CANS, CPSN, CPC, ISPAN-F a national aesthetic education director at a med spa in Long Lake, Minnesota. “Who can inject medication in that state? And can they inject it on their own without a physician being present? And would you be considered an independent provider as a PA, NP, or an MD?” she adds.

On the whole, registered nurses delivering injectables—even if they’ve trained in aesthetic procedures—must work under the supervision of a board-certified physician or medical director. There’s more flexibility with nurse practitioners and physician assistants, who have greater medical privileges, though it’s always important to check with an individual state’s medical board to learn their specific regulations.

Can any doctor be a medical director in an aesthetics practice?

“It's not a good idea to pick an MD for a medical director who has no knowledge of or experience in aesthetics,” according to Racquel Frisella, RN, MSN, AGPCNP-BC, a board-certified aesthetic nurse practitioner with over 12 years of experience in the Medical Aesthetics industry. Ideally, your medical director should be a “core doctor,” a board-certified plastic surgeon or dermatologist, as both specialties align with the industry in fundamental ways.

Most states now require that med spa medical directors specialize in, or at least have experience and training in, aesthetic medicine, so they can properly delegate and supervise these procedures and treatments.

This experience will also enable them to help in the case of an emergency complication or a liability situation. “Because if you have a problem, you should be able to call on your medical director,” Brennan says. “Their license would be the one you fall back on. That medical director has to take ultimate responsibility for what could happen.”

Does the medical director need to own the practice?

The rules vary across the country, but many states follow a doctrine called “the corporate practice of medicine,” which holds that only a physician or physician-owned corporation can receive payment for medical services. It also dictates that physicians or physician-owned corporations need to be the owners of the medical facility (or med spa), not merely employees or contractors. If that’s the rule in your state, no employment agreement between you and a board-certified physician will make your med spa legal.⁷

What is the role of the medical director in a Medical Aesthetics practice?

Medical directors are responsible for all medical aspects of the business whether or not they’re on the premises. Chief among those tasks is compliance. Medical directors must ensure that every procedure performed at the practice is properly delegated and supervised and that there’s protocol for non-medical employees to follow in order to maintain their compliance with the state’s regulations.⁸

Exactly what medical directors do vary by practice and by state but, generally, med spas with more advanced providers, such as physician assistants, nurse practitioners, and advanced practice registered nurses—who can examine patients and develop treatment plans—need less day-to-day supervision than those without licensed medical personnel.

In Minnesota, where Brennan is an RN, for example, a medical director is needed to sign off on neurotoxin and filler orders, on patient charts, and on product for staff training. Her medical director is responsible for ordering medications, with the accounts set up under his name. A state’s guidelines, and the type of medical license of the delegate, will determine whether the medical director needs to be on site or within a certain call distance.

What are the duties of a medical director in an aesthetics practice?

According to The Function of a Medical Director in Healthcare Institutions: A Master or a Servant in the Health Services Insights journal, published by the National Institutes of Health, a medical director performs the following functions:

• Develops, approves, and continually updates general institutional policy, protocols, and procedures in compliance with state regulations
• Supervises directly or appoints medical commissions (reviews) to ensure that these procedures are being followed and that standards are being met
• Establishes regulations for medical care in case of emergencies, for use of prescription drugs, and for use of medical equipment and supplies
• Fosters cooperation among all medical personnel and departments
• Monitors, evaluates, and seeks to improve the performance of the practice, including that of individual staffers
• Schedules medical audits to assess the quality of care and address any potential deficiencies in clinical performance
• Pursues continuing education programs and requires staffers to do the same, earning certifications for education and training programs to stay up to date in a continuously evolving field 
• Evaluates and manages any medical mishaps and can be available on short notice to do so
• Has sufficient knowledge and awareness of potential problems and incidents as well as is able to anticipate them and prepare to address them
• Ensures physician protection against malpractice and maintains malpractice insurance
• Models exemplary behavior and cultivates the spirit of trust and professionalism ⁹

How can I find a medical director?

To find a reputable medical director, be prepared to do some research. Consider networking at professional society events and asking existing medical directors if they have physician colleagues who may be interested. Local dermatology and plastic surgery programs may know about new graduates seeking positions; on the flip side, semi-retired doctors may be interested in the lower-key environment and extra income.¹⁰

Once you have potential candidates, it’s a good idea to verify their credentials with the proper licensing bodies and get a sense of their professional track record from peers, patient reviews and overall ratings of any clinics where they’ve worked.