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." Whether that is the law depends on how the med spa is structured, and for most Florida med spas the answer is closer to yes than owners often assume. The medical director designation itself, under section 400.9905(5), Florida Statutes, and Rule 59A-33.008(2), F.A.C., requires an active, unencumbered Florida license as an allopathic physician (Ch. 458), osteopathic physician (Ch. 459), chiropractic physician (Ch. 460), or podiatric physician (Ch. 461), and does not on its own compel a specialty. But that is only part of the framework.
The other, and often decisive, part is section 458.348(3), Florida Statutes, for allopathic physicians (MDs), and its osteopathic parallel at section 459.025(3), Florida Statutes, for osteopathic physicians (DOs). When such a physician supervises an advanced practice registered nurse or a physician assistant at an office other than the physician's primary practice location, and the APRN or PA is not under the onsite supervision of a supervising physician, section 458.348(3)(c) (or § 459.025(3)(c) for DOs) imposes specific structural requirements if the services offered at that office are "primarily dermatologic or skin care services, which include aesthetic skin care services other than plastic surgery." That description covers most of the services a typical med spa performs: injectables, chemical peels, laser resurfacing, microneedling, radiofrequency, IPL, and related aesthetic treatments.
When section 458.348(3)(c) or the osteopathic parallel at section 459.025(3)(c) applies, the statute requires that:
- The supervising physician be board certified or board eligible in dermatology or plastic surgery, as recognized by the Board of Medicine pursuant to section 458.3312 for MDs (§ 458.348(3)(c)(2)) or by the Board of Osteopathic Medicine pursuant to section 459.0152 for DOs (§ 459.025(3)(c)(2));
- The physician supervise only one office other than the physician's primary practice location (§ 458.348(3)(c)(4); § 459.025(3)(c)(4)); and
- The additional office be within 25 miles of the physician's primary practice, or in a county contiguous to the county of the physician's primary practice, with distance between any of the offices not to exceed 75 miles (§ 458.348(3)(c)(3); § 459.025(3)(c)(3)).
Separately, section 458.348(2) (and its osteopathic parallel at § 459.025(2)) requires direct supervision by an allopathic or osteopathic physician for laser or light-based hair removal performed by non-physicians. Sections 458.348(3)(e) and 459.025(3)(e) each provide a narrow exception for offices whose exclusive (or, in the osteopathic subsection, "only") service is hair removal by an advanced practice registered nurse or physician assistant. That exception is real but narrow — the moment the office adds injectables, chemical peels, or any other aesthetic service, the section 458.348(3) or § 459.025(3) framework returns.
The takeaway from the statute is not that "the medical director must be a dermatologist or plastic surgeon" as a categorical rule, and it is not that specialty is irrelevant. It is that the medical director's specialty and the office's supervisory structure are keyed to what the office actually does and who performs the services. A physician-owned aesthetic practice where the physician is on site and providing the services is on different terrain than a lay-owned med spa with an off-site physician supervising an APRN injector. The 2025 petition described earlier would have overlaid a transparency requirement on top of this framework; it did not become a rule, but the statutory framework it was reacting to has been on the books for years, and section 458.348(3)(c) does the work the petitioners were trying to make more visible.
The precise application of section 458.348 to a specific med spa depends on ownership structure, the physician's on-site presence, the classification of each service, who performs it, and how supervision is documented. Med spa owners and physicians serving as medical directors should confirm the applicable subsection with counsel rather than rely on any general summary, including this one.
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 tenders charges for reimbursement for medical services generally must hold a Health Care Clinic license from the Agency for Health Care Administration (AHCA). Many med spas fall outside the Act by one of two paths. The first is the practitioner-ownership exemption at § 400.9905(4)(g), Fla. Stat., which covers a sole proprietorship, group practice, partnership, or corporation "wholly owned by one or more licensed health care practitioners" (with a family-member allowance) as long as a practitioner-owner is supervising the business and is legally responsible for the entity's compliance; a narrower physician-specific carve-out sits at § 400.9905(4)(f). The second is definitional: the HCCA's definition of "clinic" at § 400.9905(4) reaches only entities that "tender charges for reimbursement for such services," so a med spa that operates on a strict cash-pay basis and does not seek third-party reimbursement may fall outside the definition rather than "into" an exemption. Notwithstanding either path, § 400.9905(4) provides that an entity seeking reimbursement under Florida's Motor Vehicle No-Fault Law, §§ 627.730-627.7405, "shall be deemed a clinic and must be licensed under this part," unless the narrow exemption at § 627.736(5)(h) applies. These paths are real and widely used, but they are not a release from oversight obligations; they change which body's rules govern (chiefly the Board of Medicine's and Board of Osteopathic Medicine's standards of practice and supervision rules, and the section 458.348(3) or § 459.025(3) framework already discussed) 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), F.A.C. The rule 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.
- Conspicuous signage. The director's identity must be posted on a sign in a conspicuous location within the clinic, readily visible to all patients. § 400.9935(1)(a).
- Licensure and credentialing of every practitioner. The director must ensure that all practitioners providing health care services or supplies to patients maintain a current active and unencumbered Florida license, and that every practitioner has "active appropriate certification or licensure for the level of care being provided." § 400.9935(1)(b), (d).
- Review of patient referral contracts. The director must review any patient referral contracts or agreements executed by the clinic. § 400.9935(1)(c).
- Records ownership. The medical director serves as the clinic's records owner as defined in section 456.057, Florida Statutes, and is responsible for ensuring patient records are properly created, maintained, stored, and accessible. § 400.9935(1)(e); § 456.057. This is the obligation most directly implicated when staff are treating patients the director never sees.
- Recordkeeping, office surgery, and adverse incident compliance. The director must ensure clinic compliance with the recordkeeping, office surgery, and adverse incident reporting requirements of Chapter 456, the respective practice acts, and the rules under Part X of Chapter 400 and Part II of Chapter 408. § 400.9935(1)(f).
- Systematic review of billings. The director must conduct systematic reviews of clinic billings to ensure they are not fraudulent or unlawful, and upon discovery of an unlawful charge, must take immediate corrective action. § 400.9935(1)(g).
Two related points deserve a flag. First, if the med spa performs a liposuction procedure in which more than 1,000 cubic centimeters of supernatant fat is temporarily or permanently removed, a Level II office surgery, or a Level III office surgery, section 458.328(1) requires a separate designation: a "designated physician" who is responsible for the office's compliance with the office health and safety requirements of § 458.328. That designated physician must have a full, active, and unencumbered license under Chapter 458 or Chapter 459 and, notably, "shall practice at the office for which he or she has assumed responsibility." § 458.328(1)(b). The HCCA medical director and the section 458.328 designated physician are two different roles, and a facility performing office surgery must have both in place, in compliance with each set of requirements. Second, section 458.328(2)(a) subjects a physician who performs a covered procedure outside a registered office setting to a $5,000 per-incident fine.
For supervision of mid-level providers, the relevant authorities sit in the practice acts. Physician assistants practice under section 458.347, Florida Statutes, which requires the supervising physician to be "qualified in the medical areas in which the physician assistant is to perform" and to be "individually or collectively responsible and liable for the performance and the acts and omissions of the physician assistant." § 458.347(3). The same section caps a physician's PA workload at 10 concurrent PAs. Section 458.347(14) restates the physician's liability. Advanced practice registered nurses generally practice under protocols established with a supervising physician under section 464.012, Florida Statutes. A separate track for autonomous APRN practice exists at section 464.0123, but it is meaningfully narrower than owners often assume: autonomous practice is limited to "primary care practice, including family medicine, general pediatrics, and general internal medicine," § 464.0123(3)(a)(1), and an autonomous APRN "may not perform any surgical procedure other than a subcutaneous procedure," § 464.0123(3)(c). Aesthetic med spa services are not primary care and typically fall outside § 464.0123's autonomous scope; an APRN performing them is doing so under supervision, and the § 458.348(3) or § 459.025(3) framework applies to that supervision. 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 qualified in the relevant medical area 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.