In February 2025, the Florida Society of Plastic Surgeons and the Florida Academy of Dermatology stood before the Board of Medicine and asked it to do something pointed: require every physician who serves as the medical director of a medical spa to post their name, their specialty, their contact information, and the list of other med spas they supervise — on the spa's website and on a sign in the waiting room. The stated concern was blunt. Patients were receiving substandard care from undertrained staff, supervised on paper by physicians "with little to no experience in this field."
The Board declined to write the rule, concluding the change belonged to the Legislature, and instead sent a letter of support to Tallahassee. But the petition itself is the story. It is a formal acknowledgment, from two of the specialties closest to aesthetic medicine, that a recognizable problem exists: the medical director who lends a license to a med spa and is not meaningfully involved in the medicine being practiced under it.
This post explains what Florida law actually requires of a medical director, why the "name-only" arrangement is riskier than many of the people in it believe, and what both physicians and med spa owners should be doing about it. We represent medical directors and the spas that retain them, and the candid answer is that the exposure runs in both directions — it is simply structured differently for each.
First, an important distinction the marketing material gets wrong
A great deal of online content states confidently that a Florida med spa medical director "must be a board-certified dermatologist or plastic surgeon." That is not the law. It is the content of the 2025 petition the Board of Medicine declined to adopt. Under current Florida law, the medical director of a health care clinic must hold an active, unencumbered Florida license as an allopathic physician (Ch. 458), osteopathic physician (Ch. 459), chiropractic physician (Ch. 460), or podiatric physician (Ch. 461). See Rule 59A-33.008(2), F.A.C. There is no dermatology-or-plastics specialty mandate.
That distinction matters because compliance built on a misstatement of the rule is fragile. The real obligations are different — and, for the absentee-director problem, more demanding than a specialty box to check.
What a Florida medical director is actually responsible for
The framework most med spas operate under is the Florida Health Care Clinic Act, §§ 400.990–400.995, Fla. Stat. A clinic that bills third-party payors for medical services generally must hold a Health Care Clinic license from the Agency for Health Care Administration (AHCA). Many med spas — particularly those that are wholly physician-owned, or that bill only cash — fall within one of the statutory exemptions in § 400.9905(4) and never obtain a clinic license at all. That exemption is real and widely used, but it is not a release from oversight obligations; it changes which body's rules govern (chiefly the Board of Medicine's standards of practice and supervision rules) rather than whether supervision is required.
Where the Clinic Act does apply, the medical director's duties are spelled out, and they are not nominal:
- Day-to-day supervision. A clinic "may not operate or be maintained without the day-to-day supervision of a single medical or clinic director." Rule 59A-33.008(1). The statute does not set a minimum number of on-site hours, but the phrase "day-to-day" is doing real work — it describes ongoing, functional oversight, not an annual signature.
- Systematic review of billings. The director must review billings to ensure they are not fraudulent or unlawful, and must take corrective action when a problem is found. § 400.9935(1).
- Records ownership. The medical director is the clinic's records owner under Chapter 456 and is responsible for ensuring patient records are properly created, maintained, stored, and accessible. This is the obligation most directly implicated when staff are treating patients the director never sees.
- Compliance and corrective action. When the director discovers a deficiency, the statute contemplates prompt correction — not a memo to address it later.
For supervision of mid-level providers, the relevant authorities sit in the practice acts: physician-assistant supervision under § 458.347, and APRN protocols (including the autonomous-practice registration under § 464.0123) under the Nursing chapter. Injectables, lasers, IPL, radiofrequency, microneedling, and IV therapy are medical procedures in Florida; they require properly licensed personnel acting within a documented delegation and protocol structure, with the supervising physician available and accountable for the delegated act.
Why "just lending the license" is the dangerous arrangement
Here is the structural problem with the absentee model, stated plainly: Florida ties the medical director's personal license to medicine the director is not watching.
A physician who signs a medical director agreement, collects a flat monthly fee, and never reviews a chart has not reduced their exposure by staying away. They have increased it. The director remains the named, accountable supervisor for every injection, every laser pass, and every adverse event in the facility. If an undertrained injector causes a vascular occlusion, or a patient files a Board complaint, or AHCA conducts a survey and finds no chart-review documentation, the director's own license is the asset on the line — and "I was never there" is the admission, not the defense. As one compliance summary of Board disciplinary files put it, "I never met my medical director" is a sentence that recurs in too many enforcement cases.
There is also a contractual trap that surprises physicians. Under § 400.9935(2), any contract to serve as a medical director that is entered into or renewed in violation of the Clinic Act is void as contrary to public policy. A director relying on a flat-fee arrangement that does not reflect genuine supervision may find that the very agreement they thought defined and limited their role is unenforceable — leaving the indemnification and fee provisions they were counting on hanging on a contract a court can disregard.
Two further constraints deserve a flag, because they are where well-intentioned arrangements drift into trouble:
- Compensation cannot be tied to volume or referrals. Director pay must reflect fair market value for services actually rendered. Compensation keyed to procedure counts, revenue, or patient referrals implicates the Florida Patient Self-Referral Act and anti-kickback and fee-splitting prohibitions. A "per-injection" or revenue-share director fee is a red flag on its face.
- The business cannot direct the medicine. Florida permits non-physician ownership of a med spa, and the management-services-organization (MSO) model — physician-owned professional entity for the clinical side, separate company for operations — is common and lawful. But the MSO and the lay owner must not exercise control over clinical judgment. When a non-clinical owner is setting protocols, overriding the director, or controlling records, the structure starts to look like the unlicensed practice of medicine or improper fee-splitting.
The risk, viewed from each chair
For the medical director. The exposure is your license, your malpractice profile, and your personal liability for delegated acts you did not supervise. The protective posture is the opposite of invisibility: a defined and documented supervision schedule, real chart-review cadence you can actually sustain, written and current protocols, an honest scope-of-services agreement, and a clean fee structure. If you cannot supervise a facility meaningfully — because of distance, volume, or the number of other spas you already cover — the correct answer is to decline or resign, not to sign and stay away.
For the med spa. The exposure is operational and existential. Operating without a qualified, engaged director is a ground for emergency suspension of a clinic license and a civil fine of up to $5,000, with each day of unlicensed operation treated as a separate offense. Rule 59A-33.008(3). Beyond AHCA, the spa faces Board complaints against its providers, malpractice claims, and consumer-protection and advertising scrutiny — particularly where marketing implies a level of physician involvement that the day-to-day reality does not match. The protective posture is to retain a director who will genuinely show up, to build a documentation trail (chart reviews, QA meeting minutes, incident logs, signature/initial logs, training and competency files), and to keep clinical control on the clinical side of the house.
The interests of the two are not actually opposed on this point. A spa that wants an absentee director is buying a liability, not oversight; a physician who wants to be absent is selling one. The arrangement that protects the spa — a real, engaged, well-documented medical director — is the same arrangement that protects the physician.
Where this is heading
The 2025 petition did not become a rule, but the pressure behind it has not gone away. The Legislature received the Board's letter of support; transparency-style measures (public posting of director identity and the spas they cover) are exactly the kind of low-cost, high-visibility reform that tends to return. Florida is generally characterized as a moderate-enforcement state for med spas — less prescriptive than New York or California, but with real consequences when a complaint or a bad outcome brings AHCA or the Board through the door. The direction of travel is toward more visibility into who is actually supervising, not less.
For physicians and spa owners operating today, the practical conclusion is the same one that survives whatever the Legislature does next: structure the relationship so the medical director is genuinely directing medicine, document that they are, and make sure the paperwork and the compensation reflect the reality on the ground.
Closing note
If you are a physician weighing a medical director engagement, a med spa evaluating or restructuring your medical oversight, or either party facing a Board complaint or an AHCA survey, the questions are fact-specific and the stakes are a license and a business. Black Law P.A. advises both medical directors and med spas on these arrangements and disputes.