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How Much to Pay a Medical Director for a Med Spa, and How to Document Oversight

Writer: Michael Madrinkian
Michael Madrinkian
4 days ago
8 min read

Updated: 1 day ago

How much to pay a medical director for a med spa comes down to the hours and duties the physician actually takes on. Published monthly figures run from about $500 to $5,000 for part-time roles, and none of those figures cites a survey. An Advisory Engagement builds the fee and the oversight record together.


By Michael Madrinkian, MBA, PhD, Founder and Principal, Luminary Strategic



THE SHORT ANSWER


  • Published fees are claims. Most come from companies selling placement, training, or compliance products, and they show no data behind the figures.

  • The one survey figure is a different job. AmSpa's $120,691 is an average full-time salary from its 2022 report, and a part-time oversight role is a different arrangement.

  • Build from hours. Monthly meetings, chart review, protocol work, consultation, and on-site time can be counted. A worked example below comes to 9 hours a month.

  • Test the implied rate. Divide the fee by the logged hours. Bureau of Labor Statistics data gives a physician wage to compare it with.

  • Pay against a record. The log that supports the invoice is also your record of oversight.


Texas rules below are summarized as of November 2026. They are general descriptions, not legal advice. Your attorney decides what applies to your practice and how the fee may be structured.


WHY THE PUBLISHED NUMBERS DISAGREE


We found no public dataset of medical director fees in Texas. A 2025 Texas bill, SB 3055, would have required physicians to report delegation agreement fees to the Medical Board for publication, and it did not pass. NP full practice authority in Texas covers that bill.


So the figures online come from the sellers in the table above, and they contradict each other. Medical Director Co., a Dallas placement firm, advertises physician placement starting at $799 a month and describes $500 to $3,000 as a typical retainer. MedSpa Standards, which sells compliance kits, calls a $300 to $800 retainer a sign of a nominal arrangement. Each may be sincere. Neither shows data, and each sells to the reader it is advising. Injectables EDU, a training company, quotes $750 to $1,000 in an interview and attributes a $100,000 figure to AmSpa without a link. We could not find that figure in AmSpa's public material.


The only survey figures we could read are AmSpa's. Its 2022 executive summary lists an average full-time medical director salary of $120,691. Its 2024 recap reports that 48% of med spas had hired a medical director in the past year, which AmSpa says overstates turnover because many of those spas had just opened. The full reports are paid products and may hold more.


Roles also vary, which explains part of the spread. A 2023 study in Dermatologic Surgery used secret shoppers to call 127 med spas around Chicago. Among those reporting, a medical director or supervising physician was always on-site at 16.5%, and a physician was off-site at 81.1% of the facilities overall. That is one metro area outside Texas. It still shows that "medical director" can describe very different amounts of work.


WHAT TEXAS RULES ASK THE PHYSICIAN TO DO


The Texas Medical Board's cosmetic delegation rules speak of a "delegating physician." The title "medical director" does not appear in §§169.25 to 169.28, so read your agreement for duties and do not rely on the title. In general terms, and as of November 2026:


  • Responsibility. Under Occupations Code §157.001, a delegating physician remains responsible for the delegated medical acts.

  • Training and protocols. Under §169.26, the physician must ensure the person performing the act has training in technique, contraindications, and managing complications, and that the person signs and dates a written protocol.

  • Before the procedure. A physician, or a physician assistant or advanced practice registered nurse acting under delegation, establishes the practitioner-patient relationship and maintains the medical record.

  • During the procedure. One of those clinicians is on-site or immediately available for emergency consultation, and the physician must be able to conduct an emergency appointment if necessary.

  • Written orders. Under §169.27, a written order names the responsible physician, the patient selection criteria, the care to be provided, and the steps for complications and emergencies.

  • Annual review. Under §169.2, general standards for standing orders and protocols include a noted level of supervision, plans for emergencies, and an annual review signed by the physician, unless a specific subchapter provides otherwise.

  • Posting. Under §169.28, the name and Texas license number of each delegating physician are displayed in public areas and treatment rooms.

  • Nurse practitioners and physician assistants. Under §157.0512, a prescriptive authority agreement requires chart review, documented meetings at least monthly, and annual review. A physician's agreements are limited to seven people or their full-time equivalent, with exceptions.


Ask your attorney which of these apply to your structure and services, and what your agreement should say.


HOW MUCH TO PAY A MEDICAL DIRECTOR FOR A MED SPA: BUILD IT FROM THE HOURS


Each duty above takes time, and time can be estimated. The table below is a hypothetical. The hours are assumptions for a planning conversation; they are not requirements or benchmarks. Change them to fit your practice.



The hourly rates are the part most open to negotiation. MedSpa Standards publishes $150 to $400 an hour, and Consentz, a software company, uses $150 to $300 in its examples. Neither gives a source. The nearest public wage data is the Bureau of Labor Statistics category for physicians, all other, with a Texas mean of $115.31 an hour in May 2023. That wage is for employed physicians across many specialties. It excludes a contractor's own insurance, overhead, and the responsibility that comes with delegation, so a contract rate above it should surprise no one.


For the middle practice, 9 hours at $150 to $400 comes to $1,350 to $3,600 a month. Hourly work does not capture availability, which is the physician's standing commitment to answer an emergency call when a complication happens. Price that as its own line.


The implied rate test


Divide any fee by the hours the physician actually logs. On the 9-hour example:


  • A $500 monthly fee implies about $56 an hour, under half the Bureau of Labor Statistics mean.

  • A $799 fee implies about $89 an hour.

  • A $3,000 fee implies about $333 an hour.


A low implied rate raises a practical question: is the work being done, or is the fee buying a name? A high one raises a different question: what else is it paying for? Bring either answer to your attorney. The arithmetic alone says nothing about whether an arrangement is proper.


How the fee is structured


Published guidance conflicts on structure as well as size. Consentz describes flat, hourly, and combination models and calls per-procedure fees outdated. Medical Director Co. lists per-chart and per-consultation arrangements. MedSpa Standards says a fee should never be a percentage of revenue, a per-procedure amount, or a volume bonus, and it describes fair market value as the test. Texas Occupations Code §102.001 makes it an offense to pay remuneration for securing or soliciting patients for a licensed provider. Whether a given structure raises that or any other concern is your attorney's call. Put the question to counsel before you sign, especially if the physician also holds the medical side of your ownership structure.


HOW TO DOCUMENT OVERSIGHT


The record that proves the oversight happened and the record that supports the invoice should be the same record, in Luminary's view. Keep one monthly log with these items and pay against it.


  • Meetings. Date, attendees, and topics for each monthly meeting under a prescriptive authority agreement.

  • Chart review. Which provider, how many charts, who reviewed them, and when. The physician and nurse practitioner set the number under §157.0512.

  • Protocols and orders. The last signed date for each, with the next annual review on a calendar.

  • On-site time. Arrival and departure, and what was done.

  • Consultations and complications. Who called, when, and how it resolved.

  • Registrations. The date each delegate was registered with the Medical Board, which §169.5 sets at 30 calendar days from delegation, plus the date of any termination notice.

  • Agreement copies. Each party keeps a prescriptive authority agreement until the second anniversary of its end, and it must be available to the boards by the third business day after a request.


This log is a management tool, and it also helps in diligence when a buyer asks how supervision worked. The med spa compliance binder covers where it sits among the other records, and Texas med spa regulations covers the wider rules.


Watch for supervision thinning as volume grows


A common gap we describe on our med spa compliance page is a schedule that doubles while chart review stays at the same few hours a month. A monthly log makes that visible. Review the hours against provider count and treatment volume each quarter, and reprice on a schedule the agreement allows.


TERMS TO SETTLE BEFORE YOU SIGN


These are business questions to answer in writing, with your attorney drafting and reviewing the agreement:


  1. What duties does the fee cover, and what is billed separately?

  2. How many hours a month are expected, and who keeps the log?

  3. Who covers when the physician is away, and has an alternate been designated?

  4. How many other agreements does the physician hold against the seven-person limit?

  5. How does the fee change as providers or services are added?

  6. How much notice does either side give to end the arrangement? A departure can halt every delegated service until a replacement is in place.


WHAT THIS WORK COSTS


Compliance operations is one of the four lenses in the Practice Diagnostic, from $5,000, which checks whether these records exist and are current. The Advisory Engagement, from $15,000, covers medical director governance and economics in its Compliance Operations and Risk focus area. Luminary is a firm of medical spa consultants. It takes no compensation from device makers, distributors, lenders, or software vendors. How Luminary stays independent. Luminary does not give legal advice, draft or review agreements, or source or place medical directors.


FREQUENTLY ASKED QUESTIONS


How much do med spa medical directors make?


Part-time retainers published by vendors run from about $500 to $5,000 a month, with higher figures for on-site clinical roles, and none shows data. AmSpa's 2022 report lists an average full-time medical director salary of $120,691.


Does a med spa in Texas need a medical director?


Injections, prescription devices, and other medical procedures must be performed by a physician or delegated by one, and nurse practitioners and physician assistants practice under agreements with a supervising physician. Your attorney confirms the specific requirements for your structure and services.


Does the medical director have to be on-site in Texas?


Medical Board rule §169.26 describes a physician, physician assistant, or advanced practice registered nurse being on-site or immediately available for emergency consultation during the procedure, with the physician able to conduct an emergency appointment if necessary. Your attorney confirms how that applies to each service.


How many hours a month does a med spa medical director work?


No published standard exists. Texas sets duties, such as monthly meetings under a prescriptive authority agreement, and leaves many of the hours to the parties. Our worked example runs from 4.5 to 17.5 hours depending on practice size, and those hours are assumptions to adjust.


Can a medical director be paid a percentage of revenue?


Ask your attorney before agreeing to any fee tied to revenue, procedures, or volume. Vendors' guidance conflicts, and Texas law restricts paying for securing or soliciting patients.


REQUEST A SCOPING CALL


Luminary works with med spa and wellness practice owners in person across Dallas-Fort Worth and virtually nationwide. A scoping call is 30 minutes and confirms which engagement fits. Request a scoping call or call 469-894-8793.


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