By Alex R. Thiersch, JD

In many states, medical spas must be owned by a physician or a physician-owned corporation, so scores of physicians have chosen to become directors of medical spas. However, there are some pitfalls to medical spa directorship that may not be readily apparent to the uninitiated and, if physicians are not aware of these issues, they could be in for a nasty surprise.

The medical aesthetics industry has grown enormously in the past 20 years—in 2014, approximately $4.9 billion was spent on nonsurgical cosmetic procedures. Medical spas are becoming fixtures in retail centers, and the average age at which people begin receiving treatments is getting lower each year. The industry is well-established and, because medical spas in most states must be owned by a physician or a physician-owned corporation, physicians stand to be the ones to reap these benefits.

And these benefits are often easier to reap in a medical spa environment than they would be at a traditional medical practice. Medical aesthetic procedures are all elective, so medical spas don’t need to deal with insurance companies ever. It’s a cash-and-carry business. And, if physicians want to engage in marketing opportunities that would typically be incongruous with a traditional medical practice, they can as a medical director at a medical spa.

What’s more, in most states, physicians do not even need to be present at a medical spa of which they are the director. Provided a medical professional—a physician assistant or a nurse practitioner, for example—is on-site at all times, a physician can delegate medical spa procedures to properly trained associates. The physician must be reachable by the medical spa in case of emergency, but his or her presence is often not required.


If something seems too good to be true, it usually is. If physicians become involved with the wrong medical spa or fail to provide adequate oversight, they can end up in a great deal of trouble—both financially and professionally.

Medical spas are medical facilities, and, as such, they must be run according to the same strict laws under which more traditional medical facilities operate. Because the atmospheres of most medical spas more closely resemble those of traditional spas and salons, it can be easy to overlook the need for stricter practices, protocols, and procedures. However, because of the unprecedented growth of the industry, state investigative bodies are looking more closely than ever at the ways medical spas are run and, if they find violations, the facility’s medical director is the person who will pay the price.

And that price can be steep. Physicians’ medical licenses can be put at risk by the actions of their medical spa staff. If a poorly performed procedure results in a malpractice suit, it’s the medical director who will ultimately face the most severe sanctions. And, if the medical spa is battered by fines for healthcare violations, the physician’s personal finances could be adversely affected.

Dealing with medical spa patients tends to be a bit more complicated than a physician might expect. By their nature, medical spas attract people who are concerned about their appearance to a somewhat unusual degree, and these people tend to be fairly difficult to deal with if a procedure or treatment doesn’t meet their likely outsized expectations.

Ultimately, pairing up with a medical spa is a business partnership. A business partnership is a lot like a marriage: Each side relies on the other to do the right thing, and disputes will likely be part of the arrangement. And like a marriage, communication is key.

Medical directors must make sure that their facility’s staff is properly trained and up to speed with the legal issues facing the industry. A properly run medical spa should be quite profitable and, if physicians are willing to work at keeping their facility on the straight and narrow from a legal standpoint, the relationship should be a fruitful one.

Thiersch_AlexAlex R. Thiersch, JD, is the founder and director of the American Med Spa Association (AmSpa). Look for more of his articles in PSP. Thiersch can be reached at [email protected].