Med Spa Compliance Series: Area of Focus – Scope of Practice and Supervising Physician Compliance
As the med spa industry expands, physician supervision and compliance with regulatory requirements have become central concerns for state regulators, as well as businesses. As noted in our previous article, med spa services, including injectables and laser treatments, are generally classified as the practice of medicine. Therefore, they fall under the purview of state rules governing who is permitted to perform medical services and under what level of physician oversight.
State licensing boards provide differing positions on healthcare practitioner scope of practice and oversight requirements. It is important to be aware of such provisions when making med spa ownership, management, operational, and staffing decisions. In many states, med spas offer a unique opportunity for ownership, leadership, and involvement by non-physician practitioners. Ultimately, however, many states still require varying degrees of physician involvement and oversight to fully comply with state licensing requirements and practitioner scope of practice regulations.
Understanding the abilities and limitations of each level of practitioner involved in a med spa is a critical step in maintaining compliance with state law. In California for example, Botox injections and treatments utilizing lasers or intense pulse light devices to remove hair, spider veins, and tattoos may only be performed by a physician or, alternatively, a physician assistant or a registered nurse who is acting under a physician’s supervision.1 No unlicensed persons, including medical assistants, may perform these services in California, with or without physician supervision.2 On the contrary, in states like Arizona, physician supervision is not a requirement for med spas, as nurse practitioners are afforded a full independent scope of practice authority. In fact, nurse practitioners in Arizona may even assume the role of med spa medical director, providing the offered services independently or providing required supervision to other non-physician practitioners, including, depending on the services offered, registered nurses (RNs), licensed practical nurses (LPNs), and cosmetologists.3
Further, just as each type of practitioner’s scope of practice and corresponding physician supervision requirements vary by state, so does the structure and format of such supervision arrangements. Requirements may range from direct supervision, where the physician must be physically present in the room during a procedure, to indirect supervision, requiring only an on-site presence, to remote supervision, where the physician remains off-site but available for consultation.
To illustrate, Iowa provides a cross-section of these standards, permitting med spa services to be performed by nonphysician practitioners only when delegated by the medical director and carried out under close oversight.4 Specifically, the medical director or another qualified practitioner must provide direct, in-person, on-site supervision for at least four hours each week and remain physically located within 60 miles of where the delegated services are performed.5 The medical director must also be available, either in person or electronically, at all times in the event of an injury or emergency.6 Similarly, Oklahoma allows for more generalized and less intensive supervision when healthcare services are delegated to a licensed RN.7 However, when services are delegated to LPNs, licensed estheticians, medical assistants, or other unlicensed personnel, the supervising physician must be physically available before, during, and after the procedure.8
Compliance becomes even more complex when factoring in physician and nurse protocols, standing orders, service delegation restrictions, collaborative practice agreements, and telehealth provisions, all of which can expand or limit the scope of practice for nonphysician providers and can impact physician supervision standards.
Helpful Compliance Tips
Failure to comply with state physician supervision requirements may expose a med spa to significant risks, including allegations of unlicensed practice of medicine leading to discipline, fines, or sanctions. To avoid these outcomes, it is essential for med spas to understand and follow their state’s statutes and regulations governing practitioner scope of practice and physician oversight. State medical and nursing board websites are valuable resources, often providing detailed scope of practice guidelines and decision trees, advisory opinions, and policy statements that can inform business structures and staffing decisions. Leveraging these resources enables med spas to align their operations with state law, support safe and appropriate patient care, and minimize regulatory and legal exposure. Additionally, it will be important to check the state statutes and regulations governing physicians, physician assistants, nurses, and other types of practitioners. For example, specific supervision requirements may be found either in the medical practice act or the nursing practice act or both.
Considering the ever-evolving requirements for med spa practices, our team of attorneys will continue to monitor updates related to physician supervision requirements across the country. If you have any questions regarding practitioner scope of practice, physician supervision requirements, or general med spa compliance, please contact your Quarles attorney or:
- Aaron Sagedahl: 612-351-5050 / aaron.sagedahl@quarles.com
- Bailey Walden: 602-229-5432 / bailey.walden@quarles.com
- Amy Cotton Peterson: 602-229-5530 / amy.cottonpeterson@quarles.com
- Kenya Hagans: 414-277-5456 / kenya.hagans@quarles.com
END NOTES
1 Medical Board of California, Frequently Asked Questions- Cosmetic Treatments, available here.
2 Id.
3 Arizona State Board of Nursing, Advisory Opinion- Medical Aesthetic Procedures Performed by Licensed Nurses, Licensed Cosmetologist, Licensed Aestheticians, and Certified Laser Technologists, available here.
4 Iowa Admin. Code r. 481-655.6.
5 Id.
6 Id.
7 Oklahoma State Board of Osteopathic Examiners, Osteopathic Medical Spa Guidelines, available here.
8 Id.