In today’s video, we return to physician supervision of nurses within a medical spa.

Hi, I’m Michael H. Cohen, founding attorney of the Cohen Healthcare Law Group. We help healthcare industry clients just like you, navigate healthcare and FDA legal issues so you can launch or scale your healthcare business.

Here are some frequently asked questions (FAQs) about how physicians, nurses, and other clinicians can operate, co-operate within the medical spa space within the law.

1. What documents are needed for physicians to supervise nurses?

For registered nurses, the medical spa should have standardized procedures which specify how the RN can operate under MD or DO supervision.

As well, the Medical Board of California requires that the physicians ensure the experience, training and education of the RNs.

The supervision must be real, meaning that the physician must oversee, direct, have charge, inspect, provide guidance and evaluation of the RN.  The MD must ensure that the RN is knowledgeable and competent in and capable of performing the procedure.

The physician must be immediately reachable to provide guidance in the event of an emergency or if the situation requires a higher level of care than the RN can provide.

For Nurse Practitioners (NPs), there is more practice autonomy and that usually requires at least a collaboration agreement with the MD, possibly a supervision agreement, depending on the State.

2. What about Physician Assistants (PAs)?

In California, PAs operate under a different document, known as a Delegation of Services Agreement.  The law requires a certain amount of chart review by the physician, this is not uncommon.

One caution—beware of making the PA a shareholder automatically in your professional medical corporation, if you’re a physician.  Having shareholders can be trouble when you unwind the professional relationship, because you might need to find a lawful way to extricate them from their role as shareholders, whereas you can end a Delegation of Services Agreement without any legal pushback.

In other videos and blog posts, we’ve addressed other questions such as: Should you become, or have, a Medical Director in your medical spa?  Who has to control the medical space?  What is required for the appropriate, prior, good faith exam and who can do it? What about informed consent and standard of care? And what arrangements best help protect the physician and their professional corporation, as well as the MSO, from corporate practice of medicine issues.

Thanks for watching. As always, go ahead and contact us with your questions. We toast to your success, and we look forward to working with you soon.