MedSpa & Aesthetics

The medspa industry grew rapidly over the past decade, and compliance structures often lagged behind business growth. Many medspas are operated by non-physician entrepreneurs with a physician "on call" — but without proper physician ownership of the medical entity. State medical boards have been increasing enforcement, and this structure is legally insufficient in most CPOM states.

Any service that requires a physician's order, a medical license to perform, or constitutes the practice of medicine requires the delivering entity to be physician-owned in CPOM states. This includes: botulinum toxin (Botox, Dysport) injections, dermal fillers, platelet-rich plasma (PRP) treatments, laser and light-based procedures, IV therapy, hormone therapy and optimization, weight loss prescription medications, and any other service classified as medical under state law.

The standard structure for a CPOM-compliant medspa is the MSO-PC framework. The medspa's business operations (marketing, staffing, equipment, real estate) are managed by the MSO, which can be owned by the non-physician entrepreneur. The medical services entity is the PC, which must be physician-owned. The MSO provides services to the PC under a Management Services Agreement. The PC owns the medical side of the business and contracts with or employs the clinical providers.

California medspas must preserve the clinical authority required by the baseline CPOM rules. SB 351, effective January 1, 2026, adds restrictions for covered private equity and hedge fund involvement in physician or dental practices, including arrangements with their controlled entities. It does not create a blanket new Medical Board audit program. Have healthcare counsel identify investor coverage and review management, ownership, and clinical control; the California state guide links to the chaptered law and current developments.

Multi-location medspa operators face additional complexity. Each location may require its own state-specific physician PC if the locations are in different CPOM states. A single national PC is often insufficient for a medspa chain operating across multiple strict-enforcement states. Structure should be reviewed by state for each location.