US med spa compliance: Medical Directors and Good Faith Exams

In the last 16 years, med spas have been popping up around the country in record numbers. According to the American Med Spa Association, the number of med spas increased from around 1,600 in 2010 to 10,500 in 2023. This means that there are nearly as many med spas nationwide as McDonald's locations.

There is still a great and growing demand for new services and clients looking to find the right med spa for them. This makes it a great business opportunity for nurses and entrepreneurs. However, the biggest hurdle many of these ambitious owners face is managing nationwide and state compliance.

At Fresh Clinics, we support med spas across the US in operating within these compliance frameworks. In this article, we’ll walk through the role of medical directors, the importance of Good Faith Exams, and how these pieces fit together when building a compliant med spa.

Why does compliance matter at a med spa?

Ensuring your med spa is compliant is an unavoidable reality of owning one. Compliance matters because it is legally enforceable, meaning that if your business fails to be compliant, you’re not only putting your patients at risk, but also your entire business and livelihood.

At its core, when compliance is done properly, it leads to:

• Patient safety and quality of care: Supports consistent, safe treatment delivery.
• Legal protection: Reduces exposure to audits, fines, and regulatory enforcement.
• Higher trust and reputation: Strong governance signals accountability to patients.
• Risk management: Creates clear processes for identifying and addressing issues.
• Operational stability: Clarifies roles and responsibilities as your business grows.
• Data security: Protects patient information through HIPAA-compliant systems.

Compliance is serious, but it also doesn’t have to be complicated. With the right systems and roles in place (like implementing Good Faith Exams and bringing on a medical director), compliance can seamlessly be achieved day to day.

The compliance rules to be aware of in the US

Med spa compliance is a mix of nationwide requirements and rules that vary state by state, so the ‘right’ setup depends on where you operate and what services you provide.

Here is some general information about national and state-wide compliance. Keep in mind that these are always changing, and it’s best to check directly with your relevant state medical board and official regulatory guidance.

Nationwide

Most US med spas need to have the basics locked in, regardless of state. This includes:

• Patient privacy and recordkeeping: If you’re handling protected health information, your processes and systems need to align with HIPAA requirements. Our Fresh Clinics software is HIPAA-compliant.
• Accountability: Treatments considered medical must be overseen by a physician, NP, or PA; details differ by state.
• Documentation and informed consent: You need to collect and keep clear patient information, consent forms, and treatment notes so there is a record of what care was provided and why.
• Advertising rules: Your marketing must be honest and accurate, clearly stating what services are offered. You also can’t advertise prescription-only medicines by name.

State-specific

This is where medical director models, Good Faith Exam expectations, ownership restrictions, and telehealth rules can differ slightly. It’s important to check directly with your state medical board to get this compliance right.

If you want peace of mind that your med spa is always compliant in your state, join Fresh Clinics.

We help med spas stay compliant by keeping track of regulatory changes and providing medical oversight and support for your Good Faith Exams. Plus, if any rules change, we’ll be there to guide you on what needs to be updated so your med spa can continue operating compliantly.

What is a medical director, and do I need one?

Med spas offering medical aesthetic treatments that are run by nurses or non-physicians require physician oversight, which can be in the form of a medical director.

A medical director is a licensed physician who provides medical oversight to ensure patient safety and compliance with all the aesthetic treatments you offer. Their purpose is to be the bridge between the med spa and the medical world.

Day to day, they approve treatments, help manage complications, oversee Good Faith Exams, and ensure that your spa is following medical board rules and meeting documentation standards.

Traditionally, med spas have met this requirement by hiring a local doctor directly. While this can work, it's expensive and lacks flexibility. We see many med spas that use local doctors struggle with their availability, which leads to inconsistent oversight and makes it hard for businesses to scale.

A more modern approach is the Management Services Organization (MSO) model. Under this structure, platforms like Fresh Clinics act as the MSO, providing access to a network of certified medical directors who are trained and experienced in supporting med spas.

To learn more, visit our page on medical directorship.

How CPOM laws affect medical director requirements

Corporate Practice of Medicine (CPOM) laws are rules that limit who can own a medical practice and who is allowed to make medical decisions.

In med spas, you typically need a medical director if you aren’t a physician. This is because treatments performed at med spas are legally considered medical care. While many nurses and non-physicians can perform these treatments, they usually cannot prescribe medications or make medical decisions on their own.

Some states also require the physician to own the medical side of the med spa. Other, more flexible states allow non-physicians to own the business, as long as a doctor is responsible for medical decisions.

The exact laws depend on the state, so we recommend looking at your state's rules or joining Fresh Clinics for support.

What is a Good Faith Exam (GFE)?

A Good Faith Exam is a medical check done before some med spa treatments to make sure the treatment is safe and appropriate for the patient. In many states, it is a legal requirement and must be performed by a qualified medical professional.

In most cases, a GFE must be completed by a qualified medical professional such as a physician, nurse practitioner, or physician assistant. It can be done either in person or via a compliant telehealth model.

Why speed and access matter for GFEs

When you’re ready to have a patient complete a GFE, it can be incredibly disruptive if your medical director isn’t available. This can derail an appointment, frustrate patients, and lead to lost revenue when appointments need to be delayed or canceled.

This is a common issue for med spas that rely on in-person physicians, who may be unavailable during busy hours or tied up with other patients.

Telehealth offers a competitive advantage here. In this hybrid healthcare model, nurses work in person with patients, while a physician joins via telehealth. This provides instant access to a physician who can perform a GFE without delay.

The result is fewer disruptions, continued compliance, and a smoother patient experience.

How Fresh Clinics supports med spa compliance

Fresh Clinics supports med spas with the clinical infrastructure and compliance support needed to operate safely and in line with regulatory requirements. Here are some of the key services we offer to our members.

Medical directors

Med spas gain 24/7 access to certified, experienced medical directors who support prescribing, medical oversight, complication management, and Good Faith Exams where required.

Good Faith Exams (GFEs)

Get access to workflows that support compliance in day-to-day practice. This includes infrastructure that allows physicians to be accessed via telehealth to complete GFEs when needed, without disrupting appointments.

Hybrid healthcare model

You’ll be able to operate under a hybrid healthcare model, where nurses work in person with patients and physicians provide clinical oversight and support via telehealth.

HIPAA-compliant software

Gain access to practice management software designed to securely manage patient records and support HIPAA-compliant data handling.

Ongoing training

With support from our ongoing training, your med spa can stay up to date as national and state-specific regulations evolve over time.

For a single, structured way to manage medical oversight, GFEs, compliance, and more as your med spa grows, join Fresh Clinics.

Running a compliant med spa

Med spa compliance is a foundational, legally enforceable requirement. While traditional models can struggle to scale as regulations evolve, MSO-backed hybrid healthcare offers a more sustainable path forward.

Start your journey with Fresh Clinics today to support compliance and growth with the right structure, oversight, and ongoing guidance in place.

FAQs

Does Fresh Clinics operate in my state?

As we’ve covered, med spa regulations vary by state, and because of that, our availability depends on local requirements. While we initially launched our infrastructure in Texas and California, our network now connects medical directors with med spas across the United States.

We’d love to hear more about your med spa. We’ll be able to advise if we are able to support you in your state. Contact us here to get started.

Will I get locked into a contract with Fresh Clinics?

No. We operate on a flexible, subscription-based model rather than long-term contracts or revenue-sharing arrangements.

This means that spas pay a medical director fee through the platform, with additional services available on a pay-per-use basis. This approach allows you to access the right amount of medical oversight without being locked into a rigid contract.

When does a Good Faith Exam need to be completed?

Generally, GFEs can be performed on the day of the potential treatment. With access to a physician who can perform a GFE straight away, it’s common to get this exam finished at the start of the appointment and then proceed from there based on the outcome.

Can a med spa be owned by a non-physician?

Yes, in some states. A med spa can be owned by a non-physician, such as a nurse or entrepreneur, but ownership rules depend on state law.

In states with stricter Corporate Practice of Medicine laws, a physician may need to own or control the medical side of the practice. We recommend that you always check your state’s regulations to confirm what’s allowed.