What is Required of a Medical Spa in California?
Under California law, a medical spa is legally classified as a medical practice. Due to the state's Corporate Practice of Medicine (CPOM) doctrine, general business investors and laypeople cannot own or control the clinical side of a medical spa. To operate legally, the clinical services must be structured as a Professional Corporation (PC) with at least 51% of its ownership held by a California-licensed physician. Administrative and non-clinical tasks may be managed by a separate Management Services Organization (MSO).
Medical spas must also adhere to strict operational guidelines. For instance, every new patient must receive a Good Faith Exam prior to their first treatment, which must be performed by a physician, Nurse Practitioner (NP), or Physician Assistant (PA), rather than a Registered Nurse (RN). Furthermore, medical spas are subject to federal regulations, including the Anti-Kickback Statute, Stark Law, and the Eliminating Kickbacks in Recovery Act (EKRA), which strictly prohibit exchanging compensation or kickbacks for patient referrals.
Who Needs a Medical Director in California?
Any facility offering medical procedures requires a medical director. This includes any clinic providing treatments such as neuromodulators (like Botox), dermal fillers, laser therapies, microneedling, or IV hydration.
To qualify as a medical director, the individual must be a physician (an MD or DO) with an active, unrestricted California medical license. Out-of-state physicians do not qualify. Additionally, starting in 2026, California Assembly Bill 890 permits qualifying Nurse Practitioners who have achieved "104" status to own a medical spa and act as the sole medical director without physician supervision. Standard NPs, RNs, PAs, and estheticians cannot serve as independent medical directors.
The Medical Board of California requires medical directors to provide active and meaningful oversight, strictly prohibiting the use of "ghost" or "paper" directors who lend their license without being involved in patient care. A compliant medical director is responsible for establishing written Standardized Procedures, conducting routine chart reviews, ensuring the competence of the clinical staff, and being immediately reachable by phone or video during all operating hours.
How to Find a Medical Director in California
Securing a dedicated medical director is a necessary step for operating a compliant medical spa. Standard avenues for finding a qualified candidate include networking through professional associations like the California Medical Association, attending industry-specific aesthetic conferences, or connecting with hospital-affiliated physicians looking for part-time oversight roles.
Additionally, practice owners can utilize dedicated matching services like We Treat. These specific platforms match medical spa owners directly with qualified medical directors who are actively seeking clinical oversight opportunities. When evaluating a potential medical director, it is important to confirm their availability, approach to chart reviews, and malpractice coverage.
