Can a Physician Assistant Open a Med Spa? Ownership and Supervision Rules by State

A physician assistant can open a med spa in many states, but not in all of them, and the answer varies more than most guides acknowledge. Whether you can own the clinical entity outright, hold a minority interest, or must operate entirely through a management services organization depends on your specific state's Corporate Practice of Medicine (CPOM) doctrine and its rules governing PA scope of practice.

This guide covers the three ownership structures available to PAs, the state-by-state breakdown of what is and is not permitted, the supervision requirements that apply regardless of ownership, and what you need to get the structure right from the start.

The Three Ownership Structures Available to PAs

Before looking at what your state allows, it helps to understand the three models PAs use to participate in med spa ownership. The correct structure for you depends on which model your state permits.

Full ownership: In states without strict CPOM enforcement, a PA can own 100% of the clinical entity providing medical services. This is the simplest structure and the least common. Even in these states, physician oversight of clinical protocols is typically still required, even if the PA holds all the equity.

Minority co-ownership with a physician: In many states that enforce CPOM but permit some non-physician involvement, a PA can hold a minority interest in a Professional Corporation (PC) or Professional Limited Liability Company (PLLC), provided a licensed physician holds the majority and maintains clinical control. The specific percentage caps vary by state.

MSO structure: In strict CPOM states where PA ownership of the clinical entity is prohibited, a PA can own a Management Services Organization that provides business services, which are marketing, billing, staffing, HR, and facility management, to a physician-owned PC. The PA owns the business infrastructure; the physician owns the clinical entity. This is the most widely applicable structure across restricted states and the one that enables PA-led med spas to operate compliantly in states like New York, Ohio, and Georgia.

Understanding which structure applies in your state before you form any entity is the most important decision you will make in this process.

State-by-State Ownership Table

State laws change. Verify current requirements with a healthcare attorney in your state before forming any entity.

States Where PAs Can Own Fully or Partially

Arizona

Arizona does not enforce the common law CPOM doctrine, making it one of the most favorable states for PA-led med spa ownership. A PA can form a standard LLC and own the practice entirely. The key requirement is maintaining a Collaborative Practice Agreement with a licensed physician who oversees clinical protocols, prescribing authority, and chart review. The business ownership and the clinical oversight function are separate, and Arizona treats them that way.

Florida

Florida is classified as a weak CPOM state, meaning non-physicians can own medical practices provided they obtain a Health Care Clinic License (HCCL) from the Agency for Health Care Administration, or operate under the HCCL exemption. A PA can own 100% of a Florida med spa, but must appoint a licensed physician as Medical Director to oversee all medical procedures. Florida law also restricts certain profit-sharing arrangements tied to physician services, so the ownership agreement and compensation structure need careful legal review.

Texas

Texas enforces strict CPOM and is one of the most frequently misunderstood states for PA ownership. A PA cannot own the majority of a Texas medical practice. A physician must hold the controlling interest in the PC. A PA can hold a minority interest in some structures, but the physician must maintain genuine clinical control, which goes beyond holding equity on paper. The Prescriptive Authority Agreement between the physician and PA must be filed correctly, and the physician's involvement must be real, not nominal. The MSO structure is the most reliable path for Texas PAs who want business ownership without the legal exposure of attempting majority equity.

California

California enforces some of the strictest CPOM rules in the country. A PA can hold up to 49% of a PC, but a physician must hold at least 51% and maintain actual clinical control. The MSO-PC structure is standard for PA-led practices in California: the PA owns the MSO, which provides management services to the physician-owned PC. California's SB 351 (effective 2026) added additional scrutiny to MSO arrangements involving investors, so the management services agreement must be carefully structured to avoid CPOM violations.

New York

New York strictly enforces CPOM and does not permit PAs to hold equity in a PC or PLLC providing medical services. The PA's path in New York is through an MSO structure, where the PA owns the business entity and the physician owns the PC 100%. New York's OPMC (Office of Professional Medical Conduct) actively investigates nominal physician arrangements, so the physician in any New York med spa structure must be genuinely engaged in clinical oversight.

Supervision Requirements That Apply Regardless of Ownership

Regardless of which state you're in or how much equity you hold, one thing is consistent: clinical procedures at a med spa require physician oversight. Ownership of the business entity does not grant clinical independence.

Specifically, physician oversight is required for:

Protocol development and approval. The physician must develop or review and sign the clinical protocols governing every service offered. This includes injectables, laser treatments, GLP-1 programs, IV therapy, and any other medical-grade service. The PA cannot self-authorize clinical protocols.

Good Faith Exams. In most states, a licensed prescriber must perform a Good Faith Exam before treating a new patient with a medical procedure. In some states, a PA with prescriptive authority can conduct the GFE; in others, the GFE must be performed by or directly supervised by a physician. Confirm your state's requirement before your first patient. Good Faith Exam services are a core part of building a compliant intake workflow.

Standing orders. An RN or other clinical staff member cannot administer treatments based solely on a standing order without a physician having established the underlying protocol. The standing order is the mechanism of delegation, not the authorization for clinical decision-making.

Chart review. Many states mandate that a defined percentage of patient charts, commonly 10% in supervised practice states, be reviewed and co-signed by the supervising physician. This is a legal requirement, not a best practice suggestion.

Ongoing availability. The physician must be reachable during clinic operating hours for clinical questions. A physician who is consistently unavailable is not meeting their supervisory obligations, regardless of what the agreement says.

What to Have in Place Before You Open

The entity structure, physician placement, and agreement documentation all need to be complete before a PA-led med spa treats its first patient. The sequence matters.

1. Determine your state's ownership category. Full ownership, minority co-ownership, or MSO-only. This decision drives every other structure choice.

2. Form the correct entities. In full-ownership states, a standard LLC is typically sufficient. In co-ownership states, a PC or PLLC is usually required. In MSO-only states, two entities are needed: the PA's MSO and the physician's PC.

3. Secure physician placement. The physician must be licensed in your state, available for genuine engagement, and clear on what the supervisory role actually requires. A nominal arrangement that looks compliant on paper but lacks substance is the fastest path to enforcement action. Medical director and collaborating physician placement matched to your state and service menu is a critical step.

4. Execute the correct agreement. The type of agreement required, whether a Collaborative Practice Agreement, Delegation of Services Agreement, or Prescriptive Authority Agreement, depends on your state. The agreement must name the services being authorized, the chart review requirements, and the physician's availability obligations.

5. Obtain required licenses. Depending on your state, additional facility licenses may be required before opening. Florida's HCCL is one example. Confirm state-specific facility licensing requirements separately from entity formation.

Wellness MD Group helps PAs build the compliant ownership structure for their state, including physician placement, agreement preparation, and business consulting for entity formation. Contact our team to confirm what your state requires and get the structure right from day one.

Frequently Asked Questions

Can a PA own a med spa without a physician?

In a small number of states, yes. Arizona, Florida, Utah, Wyoming, Iowa, and Mississippi allow PAs to own the clinical entity outright. However, physician oversight of clinical protocols, Good Faith Exams, and standing orders is still required in virtually all states, even when the PA holds 100% equity. Ownership and clinical independence are two separate questions.

What is the MSO structure and why do PAs use it?

A Management Services Organization is a separate business entity owned by the PA that provides non-clinical services, which are marketing, billing, staffing, facility management, and administrative operations, to a physician-owned Professional Corporation. The PA owns the MSO and receives management fees. The physician owns the PC and receives revenue from clinical services. This structure is how PAs legally own and operate the business side of a med spa in strict CPOM states like New York, Georgia, Ohio, and Texas.

Can a PA be the medical director of a med spa?

In most states, no. The medical director role requires an MD or DO. A PA may serve in a clinical leadership role under physician oversight, but cannot fulfill the legal function of a medical director in states where that role is defined as physician-only. In some full-practice states, the distinction is less rigid, but most med spa operators should assume an MD or DO is required for the medical director position.

What happens if a PA operates a med spa without the correct structure?

Enforcement consequences include cease-and-desist orders, license suspension or revocation, fines, and in some cases referrals for criminal prosecution for unauthorized practice of medicine. State medical boards in New York, Ohio, California, and Texas have all taken enforcement action against non-compliant ownership structures in 2025 and 2026. The structure must be correct before the clinic opens, not corrected after a complaint is filed.

How do I know which ownership structure applies in my state?

The three factors that determine your structure are your state's CPOM classification (strict, weak, or none), the PA practice authority rules in your state, and the specific licensing requirements for the facility type. A healthcare attorney in your state and a placement partner familiar with your state's requirements are the two resources needed to answer this accurately. Contact Wellness MD Group to confirm your state's requirements before forming any entity.