Is a Medical Director Right for Your Practice?

In recent years, there has been increased excitement around ocular aesthetics, and many eye care practitioners have expanded their services to include advanced treatments for dry eye disease (DED) that have origins in aesthetics and dermatology. However, not every state allows aesthetic practice by an optometrist, despite the modality’s FDA approval for DED. Each state has specific laws that may require supervision by a medical director, such as an MD or nurse practitioner, if certain procedures are performed for aesthetic benefit.1 In some states, optometrists cannot perform intense pulsed light (IPL) therapy on the face for facial rosacea, whereas, in other states, they may perform these procedures independent of a medical director. In this article, I will offer some important points to consider, as well as information that was helpful to me on my path to opening my dry eye center.

WHY IS OPTOMETRY INTERESTED IN AESTHETICS?

IPL therapy targets chromophores such as oxyhemoglobin found in telangiectatic vessels and melanin located in solar lentigines. Radiofrequency, on the other hand, works by targeting water molecules and creating friction to facilitate neocollagenesis and reduce fine lines and wrinkles. This overlap of improvement in the aesthetic appearance of skin and DED symptoms with such treatments is what encompasses ocular aesthetics. Aesthetics can grow more generally from here to include facial and body procedures that are truly only for aesthetic benefit.

Given our knowledge and training, optometrists are best poised to discuss adnexal and eyelid anatomy with our patients in a primary care setting. Patients are seeking solutions for droopy eyelids, fine lines, and wrinkles, and if we do not have this conversation with them, someone else will. It is a missed opportunity to not talk about the aesthetic appearance of our patients’ eyes. Many may not even think to ask their eye doctor about ocular aesthetics until we mention it to them. This conversation often segues into facial and body procedures.

A natural progression that I have noticed in my clinic is that once patients enjoy the aesthetic “side effects” of IPL for DED, they start to inquire about other aesthetic procedures, asking for recommendations and/or referrals. Offering aesthetic procedures, when done correctly and compliantly, can facilitate practice growth.

WHAT DOES A MEDICAL DIRECTOR DO?

What a medical director does, exactly, is state-dependent. The establishment of a med spa is regulated by the corporate practice of medicine doctrine, which is a common law policy that prohibits standard corporations from practicing medicine. For example, in the state of California, an optometrist can neither legally own a med spa independently, nor perform aesthetic procedures; however, they can partner with a licensed medical physician who employs an aesthetics practitioner to perform these procedures.

A management services organization (MSO) is formed by a nonphysician owner (ie, an optometrist) who then enters into a management services agreement (MSA) with the med spa physician owner. The MSO performs all of the nonphysician-related activities of owning the business (ie, HR, accounting, etc) and is paid for these management services by the physician who owns the med spa (Figure).

The medical director supervises the practitioner performing the aesthetic procedures, assists in developing safety protocols, and accepts liability of any complications related to procedures. Med spas and aesthetic practices are subject to specific OSHA regulations, which the medical director can assist in navigating. They may also perform good faith exams (GFEs), although in some states an aesthetic practitioner can perform them if the medical director signs off, which requires reviewing any complications with the patient and having them sign waivers. In some states, there are companies that provide access to medical directors who are able to perform virtual GFEs for a small fee.

The medical director is typically not present in the clinic, although your state may require that they are for certain procedures, but it is always recommended that they are close by and available in the case of any complications or emergencies.

Medical directors are paid a monthly fee for their services.

IS A MEDICAL DIRECTOR RIGHT FOR MY PRACTICE?

Determining whether a medical director makes sense for your practice depends on two major factors: which procedures/treatments your state scope allows and which aesthetic services you are interested in offering. Contact your state board to enquire if an optometrist can perform these services independently. If not, then a medical director is necessary.

It is important to understand the type of model you are offering in your practice. Your business model may be considered a med spa if you offer aesthetic procedures such as laser, injectable, and cosmetic procedures for aesthetic benefit on the face and body. If you offer only photobiomodulation and/or radiofrequency for dry eye, this is not legally considered an aesthetic practice, though you may market those benefits accordingly.

HOW DO I FIND A MEDICAL DIRECTOR?

Consulting companies and law firms that specialize in the setup of med spas can assist in finding a medical director. Oftentimes, patients are great sources of information for MDs/nurse practitioners who may be interested in a partnership. There are, of course, job posting forums; however, given how intricate and involved this process can be, I would recommend making use of one of the former methods.

Optometrists will typically enlist the help of an attorney and/or certified public accountant to assist in contract and MSO/MSA formation, which outlines how much the medical director will be paid for their services, who will pay their liability insurance, and if you need to set up a new “doing business as” to go along with the new entity.

State laws will typically also outline how an OD must advertise services outside of their scope. For example, in the state of California, the medical director must be listed on the website that lists the aesthetic services.

MY EXPERIENCE

I made the decision to include aesthetic services in my cold start advanced dry eye center after patients began inquiring about anti-aging techniques and preventive ocular skin care. My established patients trust me as their go-to eye care provider for all things eye-related. I started small, so to speak, investing in a well-known microneedling device to gauge the true interest of my patients. Because I cannot perform neuromodulator injections in California, I may add this as a service in the future, careful to only choose appropriate candidates with ocular health as a priority.

For me, the most challenging aspect of bringing on a medical director was navigating California’s strict laws and regulations. If you determine that your practice could benefit from—or will be in need of—a medical director, then I recommend finding a law firm with experience and knowledge in forming med spas that can assist in every step. They may even be able to recommend a medical director local to your area.