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Can a nurse practitioner be a medical director? What you need to know

Tanja Lepcheska
April 22, 2025
Reviewed by: Teodor Jurukovski

Gone are the days when only physicians could call the shots in medical leadership. Now, nurse practitioners (NPs) don’t just want to treat patients. 

They’re also eyeing leadership roles like medical directors.

The question is whether NPs are legally allowed to step into this role.

The answer isn’t always straightforward. It depends on where NPs want to practice and how that state regulates medical spa leadership and oversight.

In this blog, we’ll explore the current regulatory landscape and the options available for ambitious NPs who want to become medical directors. 

What does a medical director do in a med spa?

If you’re considering becoming a medical director (MD) at a med spa, the first thing to know is that the role involves overseeing the clinical side of the business to ensure treatments are safe, legal, and meet professional standards.

Let’s take a look at the scope of practice and responsibilities MDs have:

🗸 Clinical oversight: Supervising treatments and ensuring they meet safety and quality standards

🗸 Staff leadership: Recruiting, training, and mentoring a well-coordinated and skilled team

🗸 Staying on top of regulatory requirements: Stay on top of state laws and regulations to keep the business aligned with them

🗸 Setting policies: Creating and updating operational policies for smooth daily operations

🗸 Managing resources: Keeping an eye on the budget, staff resources, and ensuring the practice stays efficient without cutting corners

🗸 Growth strategies: Collaborating on growth strategies, including marketing and technology, to ensure the business is as profitable as possible

Legal and compliance responsibilities

Due to their variety of responsibilities in healthcare practices, medical directors carry a lot of legal accountability as well, such as:

  • Liability: If something goes wrong — a botched procedure, adverse reaction, or a member of staff turns out to be unqualified to practice — the medical director is often held legally responsible. 
  • Patient safety: Medical directors are legally responsible for patient safety, which means they must review treatment plans, oversee equipment use, and ensure staff follow proper protocols during appointments.
  • Compliance oversight: MDs must ensure the clinic meets state and federal regulations, the spa is licensed, staff are certified to carry out the treatments, and patient records remain secure and confidential.

Day-to-day duties of a medical director

At medical practices, a director of medicine has a multitude of responsibilities. Here are some of the routine daily tasks they typically face:

  • Working with other healthcare professionals, management, and administrators
  • Reviewing treatment approvals
  • Protocol development to align with the medical governing bodies
  • Monitoring of the activities of medical staff
  • Ensuring robust patient record-keeping processes

In short, the medical director’s role is the driving force of a medical spa, as it ensures the team is on track, patients are safe, and the spa stays compliant.

Can a nurse practitioner be a medical director?

There’s no straightforward answer with ‘yes’ or ‘no’ as it depends on the state. 

Some states give NPs full freedom to be medical directors, while others still require a physician’s oversight.

According to the American Association of Nurse Practitioners (AANP), in the states where NPs are allowed to act as medical directors, they are authorized to;

  • Diagnose patients
  • Order and interpret diagnoses
  • Initiate and manage treatments
  • Prescribe medications

This level of independence is known as Full Practice Authority (FPA).

Blog post image about nurse practitioners having full practice authority

States where NPs can be medical directors

According to the American Med Spa Association, some of the states that allow NPs to serve as medical directors are:

  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • Washington, D.C.

The rest of the other states that legally allow NPs to work as MDs are shown in the image below.

US states granting NPs full practice authority image

What if you’re in a state where NPs can’t be medical directors?

Just because an NP can’t hold the title of medical director doesn’t mean they can’t own or operate a medical spa. Here are some alternative pathways:

🤝Partnering with a medical director

In restrictive states where NPs aren’t allowed to act as medical directors, they must work around regulations by partnering with a physician. 

Start by thinking about the kind of medical director you want — perhaps think of some medical director interview questions you’d ask if they were to interview with you. Then, you can proceed with:

  • Research on state requirements: Medical director requirements vary by state. To be sure, check your state’s medical board website or consult a healthcare attorney for the specific qualifications and licensing needed.
  • Network at industry events: Share the news that you’re looking for an MD by attending local conferences or workshops, like The Medical Spa Show or Aesthetic Boot Camps, to connect with industry professionals.
  • Leverage online sources: Explore online physician directories like DoctorFinder or Doximity to look for board-certified physicians in your area.
  • Set up a contract: Outline responsibilities and compensation strategies
  • Ensure compliance: Comply with state regulations on medical ownership 

To successfully hire a medical director, you’ll need to carefully evaluate these steps and ensure that you meet all the legal and practical requirements.

🌟Alternative leadership roles for NPs in med spas

Even if some states don’t allow NPs to operate as medical directors legally, there are still options for them to take on med spa leadership roles, such as:

  • Co-owners or a managing partner of the med spa
  • A clinical director who supervises the treatments and med spa protocols
  • An advanced aesthetic educator/mentor 

These roles allow NPs to take charge, grow their careers, and still significantly impact a med spa’s success — without having to be a medical director.

How to ensure compliance when operating a med spa

No matter your role, staying compliant is non-negotiable. 

Med spas operate in a heavily regulated industry, and missing key legal requirements can lead to costly fines and reputational damage.

💻The importance of proper documentation

One crucial part of staying compliant at your med spa is keeping meticulous records of sensitive patient medical information. 

This means: 

  • Storing patient information safely and securely
  • Maintaining accurate, up to date patient records
  • Ensuring all patient communication is documented
  • Ensuring only authorized personnel have access to records

By keeping up with these record-keeping practices, you not only protect your patients and your business but also ensure that your med spa is running smoothly, safely, and within the bounds of the law.

⚙️Automating compliance and regulatory tracking

Keeping up with compliance and state regulations can seem like a full-time job. However, it shouldn’t be with automation tools to help you.

You can use technology solutions (such as practice management software) to help track regulatory compliance effortlessly. Use features like:

  • Real-time tracking: You’ll get alerts before anything expires, such as upcoming staff licensing and certification renewals
  • Real-time tracking on consent forms: If they’re incomplete or unsigned before treatment, you’ll always be notified about it
  • Smart alerts with reminders and notifications: For missing client documentation or incomplete medical forms

Basically, it acts like your digital compliance assistant, minus the coffee breaks.

📈Improving operational efficiency for med spas

Operational inefficiencies at med spas manifest in many different ways. 

Here are just few examples: 

✅Double bookings

✅Forgetting to get intake forms signed 

✅Not being able to find patient records when needed

✅Having out of date licenses for staff  

✅Out of date patient records  

Regulatory compliance (HIPAA, OSHA, state medical board rules, etc.) requires you to follow specific procedures for patient record management. 

If you don’t have sound processes, you may run into trouble.

Efficient operations help ensure you have standardized workflows built into your day to day. For example, automatically sending forms before appointments.  

This helps to minimize any errors and ensure you stay compliant. 

🔄Simplifying medical director collaboration

For NPs working with a physician, staying in sync is key. 

This means clear, constant communication on clinical decisions, patient care, and treatment protocols. Software can makes this easier by:

  • Sharing treatment notes in real-time: With Pabau, treatment notes can be made accessible to other medical professionals, keeping both the NP and medical director on the same page on client care
  • Keeping track of each other’s responsibilities: You can set permissions for who can approve what and who handles which tasks
  • Keeping a digital trail of every clinical decision: This ensures that both parties understand the medical protocols and patient safety measures

All of this is right at your fingertips in one place, making communication and collaboration seamless and stress-free.

Pabau helps med spas operate smoothly and stay compliant

It’s one thing being an NP working in a med spa and completely another being an NP who just took the position of a medical director.

It’s an exciting journey that gives you the freedom and autonomy to run it on your own terms, but it also has many moving parts.

That’s where Pabau aces it.

It’s an all-in-one practice management software that takes the heavy lifting out of running a healthcare business. In other words, it handles the busy, day-to-day work so medical directors can focus on the big picture.

It can help you with:

🚀 Booking and scheduling

🚀 Client record management

🚀 Automated client communications

🚀 Built-in marketing suite

🚀And more…

Take a leap and book a demo today to see Pabau in action! It might be just what your med spa needs to operate efficiently and compliantly.