Can a Nurse Practitioner Own a Medical Spa?
Are you an NP with dreams of operating your own practice? Or perhaps, you already do! In this article, we discuss the ins and outs of owning a medical spa as a nurse practitioner. (Spoiler alert: it is possible.)
Want more information on medical spa ownership? We wrote an entire ebook on the topic: Navigating the Legalities of Medspa Ownership. Download it for free here.
State-by-State Regulations
There are currently 27 states in which a nurse practitioner (NP) can practice independently (that is, without physician oversight). Generally, independent practice status is obtained after some amount of time working in collaboration with a physician. Once granted, the NP can own and operate a practice independently. Given that states all agree that medical aesthetic services are considered the practice of medicine (perhaps the only thing they agree on), NPs in these states are able to own a clinical entity providing these services.
There are three levels of practice authority for NPs:
Full: NPs can prescribe, diagnose, and treat patients without physician oversight. Nurse practitioners who operate in full-practice states are allowed to establish and operate their own independent practices in the same way physicians do.
Reduced: NPs can diagnose and treat patients, but need physician oversight for certain tasks, such as to prescribe medications.
Restricted: NPs need physician oversight to prescribe, diagnose, and treat patients.
When a state allows an NP full practice authority (see the full list of 27 states here), they can own and operate a medical spa independently. An NP living in a state without full practice authority can still take a quasi-ownership role through an MSO model. (Learn more about MSOs in our article here.)
Hiring Considerations for NP-Owned Practices
As your practice grows, you’ll need to bring in more hands to handle patient demand. Here are a few considerations for nurse practitioners as they hire and build their teams.
Employees vs. Independent Contractors:
Will you consider your providers and staff employees or independent contractors? There are benefits and challenges to both classifications. For example, hiring employees allows you, the owner, to maintain control over your practice, including setting the schedule and other important decisions. On the other hand, independent contractors offer cost savings for the owner, since you won’t be obligated to provide benefits or equipment.
The most important thing to keep in mind, however, is that the classifications are not arbitrary and are heavily regulated. We wrote an article about the differences between the classifications here.
Hiring a Physician’s Assistant as a Nurse Practitioner
If you plan to add a PA to your practice, they will need to have a Collaboration Agreement in place with a physician. You’ll also need a clear, written Employment or Independent Contractor Agreement. It’s best to have a legal partner review your agreements to ensure compliance.
Non-Competes
If you’re adding non-competes into your employment agreements (common for injectors with a loyal patient following), there are a few things to keep in mind. The Federal Trade Commission (FTC) recently released sweeping reform nationwide, attempting to render non-competes unenforceable. While this legislation is not yet enacted into law and was immediately met with a number of lawsuits challenging its constitutionality, it is something to closely monitor.
For now, at a federal level and in most states, non-competes remain enforceable if “reasonable.” Reasonableness is a subjective test that measures the geographic scope (how many miles) and duration (how long) of the non-compete language.
Legally Complicated Medspa Services
Some medical spa treatments are straightforward, like injectables or lasers. Others, however, have ambiguous (at best) regulations. Can you offer IV therapy in your practice? What about medical weight loss? Who can administer or prescribe treatments?
That answer, of course, depends on your state. Even if you’re an NP owner in a full-practice authority state, you’ll need to thoroughly understand your state’s guidance on compounding, off-label use, and more. We wrote extensively on these two services in articles linked below:
Buying a Practice as an NP
Rather than starting a practice from the ground up, NPs may also have the option to purchase an existing practice. This is an excellent path to choose if you can find the right practice, as it comes with a built-in patient bse. There are two primary ways to purchase an existing practice: an asset purchase or a stock purchase. Below, we’ll outline the differences.
Asset Purchase: In an asset purchase, the seller remains the legal owner of the existing (selling) business entity. The buyer (in this case, the NP) forms a new legal entity (think: PC or PLLC), which offers a clean slate and avoids “successor liability” (inheriting debts or outstanding obligations of the seller). The buyer would purchase the assets (the goodwill, equipment, patient lists, inventory, and more) in the name of the newly-formed entity. The downside of an asset purchase for the buyer is that they take on the administrative burden of setting up a new entity and vendor/insurance relationships in the process, but again, the liability limitations may outweigh the costs.
Stock Purchase: In a more straightforward stock purchase, the buyer purchases the business as-is, essentially stepping into the shoes of the seller. It’s a clean continuation of the existing business. Keep in mind that a stock purchase can come with legacy issues, so it’s important to perform due diligence on any business you’re considering acquiring.
For more considerations for medspa practice buyers, check out our article here.
Finally, an MSO model remains a possibility for nurse practitioners who live in states with reduced or restricted practice authority.
Legal Counsel for Nurse Practitioner Owners
If you are an NP and a current (or future) medspa or clinic owner, find legal counsel who can help you start, grow, and even sell your practice. From establishing your legal entity to employment agreements and more, our team understands the ins and outs of medspa ownership and how it varies by state. Reach out to us to learn more about how we can support your practice.