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How to hire a Medical Director - The right way

Jennings "Ryan" Staley, M.D.
18 Nov 2022

Your selection of a medical director is perhaps the single most important decision you will make as a medical spa owner.

In many states, your business will be legally dependent upon the proper involvement of a licensed physician. To those who are not familiar with this reality, here are “The Four R’s” to consider as you approach hiring a medical director. First of all, this may feel like an antiquated requirement, because for the most part, it truly is. That being said, If you hire a medical director without understanding “The Four R’s”, you might get a low cost medical director to "supervise" your med spa, but who adds zero value and who is likely lacking the proper experience to supervise properly or defend your setup in the event of a board inquiry. This will spell disaster when you see that inquiry turn into a full blown investigation - and we do mean “when”, not “if”. Planning for an inevitable investigation is the mindset you need from the beginning of launching your medical spa, as we live in a world where our competitors know exactly how to file false complaints to try and take us out. Those who are willing to prepare for this risk now will have a strong foundation that protects them from the costs of these common threats, no matter how nice we try to be. So, are you ready? Great! Once you understand “The Four R’s”, your medical spa’s quality of care, patient satisfaction, and revenue generation will flourish with the right medical director. What are these “Four R’s”? They are the key to turning your medical director into a business booming impact, and by the end of this article, you will be an expert on them! To effectively hire a medical director for your medical spa, you MUST know “The Four R’s”!
  1. Right to hire a licensed physician in your state
  2. Requirements for your medical director's "scope of practice"
  3. Regulations regarding the definition of supervision
  4. Responsiveness and availability of your medical director
Now let’s delve into each R… Right To Hire In Your State - Investigate The Legality Of Hiring A Medical Director For Your Medical Spa Do you have the legal “Right” to hire a medical director? The answer to this question is the answer to the first “R”. In many states, it is unlawful for a layperson or business entity to direct the labor of a licensed physician, as this is seen as undue influence on the practice of medicine. This notion is often referred to as “the corporate practice of medicine” (CPOM or CPM) and is based on the “corporate practice of medicine doctrine”, which was first developed by the American Medical Association many decades ago. Individual state adoption of CPOM rules vary, as do their degree of enforcement. Many states that do follow the doctrine indicate specific exceptions to it. It is also important to know the position of your state’s medical licensing board. In some states, while you cannot “hire” a medical director, you can instead “associate with their practice”. The best way to assess the legality of hiring a medical director is to consult with a healthcare attorney within your state. They will be able to tell you if you can hire a medical director, associate with one, or if neither is permitted. Once you know the answer, you can cross the first “R” off your list of four. The Requirement Of Experience - Verify The Medical Director’s Scope of Practice So you’ve solved the “first R” and determined that you can legally hire (or associate with) a medical director - perfect! Let’s move on to the second “R”. The second “R” refers to the “Requirement of experience”. It is not enough for your medical spa’s medical director to have specialized training in dermatology, plastic surgery, or etc - in most states, they must also have specialized skills and specialized experience that fall within the "scope of service" for which they are supervising. If your medical spa is providing Botox and fillers, your medical director needs to have worked with these in the past. Weight Loss and wellness services are generally not in the scope of practice for physicians who work in aesthetics either, so be careful. If your medical director is inexperienced, the medical board will not consider their participation in your medical spa as even counting if faced with an audit or investigation. It may be best if you have more than one medical director, such as participation with a professional group of physicians, so make sure there are plenty of skills to cover all that you manage in your med spa business.

Your medical spa needs a medical director who has experience with adverse events, too.

Anyone can supervise a medical spa when things are going smoothly, but the value of a medical director really comes into play when trouble occurs - be it unusual swelling a laser burn or medication side effect. Your medical spa’s medical director must have experience in dealing with these matters, and also have validated protocols on how to best handle tough situations - because, let's face it, they are eventually going to happen. If your candidate for medical director is lacking specialized skills and experience, including with adverse events, do not hire them. Instead, look for a medical spa group which has a 24/7 hotline for any adverse events nationwide so that you and your patients are given the support you deserve. You will also want to get a sense of your candidates general clinical experience and standing. What type of physician are they? When and where did they complete residency training, and in what specialty? Did they do a fellowship? Are they board-certified? What is their post-training employment history? In which states are they licensed? Be sure to verify that their license in your state is current and valid. Cross-reference what you find in your state’s medical board database with a national certification database. You will also want to check the Federation of State Medical Boards website, where you can learn if any legal action has been taken against your candidate for medical director. This will prove important as you begin to search for affordable malpractice insurance protection. Do not discount the importance of confirming a physician’s clinical qualifications, skills, and specialized experience before hiring them. Remember specialized experience is an absolute requirement, as indicated by the second “R”. If it turns out your candidate falls short of having the proper experience, you can move on to the next candidate knowing your due diligence likely prevented a regrettable situation. Regulations Regarding Supervision - Confirm The Medical Director’s Ability to Comply Our third “R” stands for “Regulations regarding supervision”, and this “R” is just as critical as the previous. Although supervision can be difficult to define, you must find a medical director capable of properly supervising. What this means exactly, will once again, depend on the state in which you live. Most licensing boards require, at least, chart review, protocols, and standing orders, as well as someone being accessible for adverse events. California medical spa attorney Debra Scheufler advises, “you must both be familiar with compliance laws in your state and your state’s definition of supervision… and they absolutely must do medical director’s reports. In the event of a board investigation, you need to be able to turn over a file.” Regardless of which state you live in, your medical director cannot supervise properly if they do not live and work in close proximity to your medical spa. Some states specify the exact distance, while others do not. In California, for example, the board states: “While there is no actual mileage limit relating to supervision, this requirement certainly means that the physician must be immediately reachable and able to provide guidance in the event of an emergency or the need for a higher level of care that must be provided by the physician. Physicians must be within a geographical distance that enables them to effectively provide supervision and support when needed or upon request.” Florida law, however, is more specific, stating: “offices that are not the physician’s primary place of practice must be within 25 miles of the physician’s primary place of practice or in a county that is contiguous to the county of the physician’s primary place of practice. However, the distance between any of the offices may not exceed 75 miles.” You want to hire a medical director who is familiar with the regulatory landscape. Do they know your states take on proper supervision? Do they know your state’s proximity rules? Are they aware of the importance of their past experiences? When interviewing your medical spa’s potential medical director, steer the discussion in the direction of state regulation, and let them do the talking. If this conversation falls short, you need to politely pause. And remember, you are not the only one opening yourself up to potential liability with your planned medical spa - any medical director is certainly doing the same. Did the physician you are thinking of hiring ask you questions to assess their own liability? Did they request a business plan, or certificates of training? Did they mention documents that their insurance policy will need? Did they inquire into whether you have any experience in the industry? Did they ask if you’ve spoken to an attorney? Put yourself in their shoes - what questions would you have for you? Consider a lack of questions on their part to be a red flag. If they understand the regulatory landscape, they will have questions for you. Do not hire a medical director who is unfamiliar with our third “R”. Responsiveness - Gauge The Medical Director’s True Availability Our last “R” stands for “Responsiveness”, as your medical spa’s medical director must be responsive with a capital R! Living and working within close proximity is not alone sufficient, they must also be truly available to your spa. A medical director cannot properly supervise if they are not sufficiently responsive. If you already have a staff in place, make sure they get a chance to meet the medical director you may hire and to provide you with feedback. Ask your staff if they could see themselves learning from the physician. Ask your staff if they feel the physician will be responsive. Remember that a medical director needs to know how to direct. Does your candidate seem like a good leader? Does your staff feel comfortable relying on them? You want your medical spa’s medical director to lead a unified and cohesive team. It is your job to select and hire someone who seems capable of this.

And remember, bedside manner matters in medicine!

While some seasoned subspecialty surgeon in some academic hospital may get away with having questionable bedside manner, the medical director of your medical spa should not. Poor bedside manner is correlated with poor responsiveness. Check your candidate’s Google and Yelp reviews to learn what past patients have said. Ask their previous and current employers for opinions, too. And use your own judgment - would you want this person involved in your healthcare? Did they seem robotic? Did they make eye contact? Did they interrupt you incessantly? If you aren’t vibing with them now, there is certainly no reason to take things any further. Do not enter a serious long-term business relationship with someone unless you feel excited about their addition to your life. Only hire a medical director if you are confident that both yourself and your medical spa’s patients will truly get along with them. One last question to consider is - why does your candidate want to be hired as the medical director of your medical spa? Are they a tired ob/gyn who heard medical spas are “easy work”? A broke family practitioner who could use the extra cash? A plastic surgeon who is at odds with his current business partners and looking for any out? There are many different scenarios under which a physician may decide to become a medical director, and some of these scenarios foreshadow trouble. Be sure to get an understanding of what your candidate’s motives are for wanting to work in your medical spa. Do not hire a medical director who is only motivated by financial gain or ease of work. Instead, try to find a medical director who has demonstrated a genuine passion for aesthetic and wellness medicine. Passionate medical directors make for responsive medical directors. Responsive medical directors make for happy medical spa owners. If you have verified that you have the Right to hire a medical director who meets the Requirement of experience and who can comply with the Regulations regarding supervision with great Responsiveness - congratulations! This is no small feat. You are well on your way to creating the medical spa of your dreams.  

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