The short version. North Carolina’s Medical Board published a worked example of an arrangement it considers aiding the unlicensed practice of medicine: a physician paid $2,000 a month to be a med spa’s “medical director”, assured he need not be on site — and unaware he was the supervising physician for the NPs and PAs delivering care.
What this is. An analysis of a public record — a decided case or a licensing board’s own publication. It is not a client engagement and no client is described here. Everything below is sourced and cited at the foot of the page.
The published scenario
On 30 August 2024 the North Carolina Medical Board published guidance titled “Lessons from NCMB’s Disciplinary Committee: Are you aiding the unlicensed practice of medicine?”. It sets out a fact pattern that will be uncomfortably familiar:
- An experienced physician agrees to serve as medical director of a med spa under an employment agreement paying $2,000 per month.
- He is assured he does not need to be on site, and the owner tells him the role does not require him to work hours at the spa or attend procedures or consultations.
- The med spa is owned and operated by an entrepreneur with no medical training.
- Clinical services are delivered by nurse practitioners and physician assistants.
- The physician does not know he is their supervisor.
What the Board says about it
That a physician practising in an arrangement that does not comply with the Professional Corporation Act may be found to have aided the unlicensed practice of medicine — and may also face findings of unethical fee-splitting.
The Board has separately linked physician supervision to the corporate practice of medicine and restated its concerns about “straw” practices. This is not a commentator’s theory about what a board might do. It is the board describing what it does.
Why this is the more dangerous of the two failure modes
In Allstate v. Northfield the exposure was money, and it fell on a business. Here the exposure is a licence, and it falls on an individual physician who in the Board’s own scenario did not even understand what he had agreed to.
The fee is the tell. $2,000 a month buys a signature; it does not buy protocol review, chart review, delegation oversight, availability and adverse-event response. When a director is paid for a signature, the Board’s inference is that a signature is what was supplied.
What real oversight looks like
- Written, signed and dated protocols for every service on the menu, reviewed when the menu changes.
- A good faith examination and treatment plan before treatment, by a practitioner permitted to make it.
- Delegation only to practitioners whose licence and training support the task, documented.
- Genuine availability — a named physician reachable while patients are being treated, and a named covering physician when they are not.
- Chart review on a defined cadence, and a documented adverse-event pathway.
- Knowing, in writing, exactly which practitioners you supervise.
If you are being offered a directorship
Two questions. Whom do I supervise, and where is that in writing? And what happens to this business if I am unavailable for two weeks? If the answer to the second is “nothing changes, we keep treating”, the oversight is nominal — and in North Carolina the Board has already published what it calls that.
MDside’s directors are paid to do the work in that list, which is also why we will decline a menu we cannot actually supervise.
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Frequently asked questions
What did the North Carolina Medical Board publish?
Guidance dated 30 August 2024, “Lessons from NCMB’s Disciplinary Committee: Are you aiding the unlicensed practice of medicine?”, built around a med spa medical director fact pattern.
What was the arrangement?
A physician paid $2,000 per month as medical director, told he need not be on site, at a med spa owned by a non-licensed entrepreneur where NPs and PAs delivered care.
What is the exposure?
Discipline for aiding the unlicensed practice of medicine, and potentially unethical fee-splitting — against the physician’s own licence.
Is a low fee itself the problem?
The fee is evidence, not the offence. The offence is oversight that does not happen. A fee that could only ever buy a signature invites the inference that a signature is all that was provided.
Sources. North Carolina Medical Board, “Lessons from NCMB’s Disciplinary Committee: Are you aiding the unlicensed practice of medicine?”, published 30 August 2024; NCMB position statements on practice ownership and physician supervision; North Carolina Professional Corporation Act.
General information, not legal advice. This page analyses a public record or a published statute and describes no client of MDside. Confirm your own position with healthcare counsel licensed where you operate.