Medical director services for med spas, clinics and telehealth startups
Caracola Medical is a physician-led, white-label telehealth medical group. We provide medical director services for med spas, clinics and telehealth startups, with remote coverage where state law allows and in-person requirements handled case by case. Our physicians also sign collaborating and supervising physician agreements for nurse practitioners and physician assistants. Founded by J. Chance Miller, MD and Stephanie Miller.
Last reviewed October 11, 2026 · Reviewed by J. Chance Miller, MD
What does a medical director do for a med spa or clinic?
A medical director is the licensed physician who takes clinical responsibility for how care is delivered in your practice. A medical director for a med spa or clinic signs off on protocols, sets the rules for who may do what, reviews charts and is reachable when a clinical question comes up.
Our founder has worked the clinician side of messy operations: orders that arrived with no intake, patients no one was clearly assigned to, escalations split across email threads. A good medical director closes those gaps early.
- Written clinical protocols, standing orders and delegation rules matched to your services
- Good faith exam and eligibility standards for each treatment
- Chart review on an agreed schedule, with feedback to your clinicians
- Clear escalation paths for adverse events and out-of-scope cases
- Clinician onboarding, competency sign-off and scope checks
- Support when a state board asks questions
Dr. Miller still sees patients every week. Read about our physician leadership.
Fractional and remote medical director services
Most med spas and early telehealth companies need a fractional medical director who knows the work, shows up on a defined schedule and answers when something unusual happens. Where state rules allow it, a remote medical director for a med spa can handle much of this from a distance.
Our physicians work inside the systems you already use. We do not sell software, so we have no reason to push you toward a platform. English and Spanish physician coverage is available.
Protocol ownership
We write or revise your protocols and keep them current as your services and states change.
Reachable oversight
Your team knows who to contact with a clinical question and what happens next.
Chart review
Regular chart review with feedback your clinicians can use.
State awareness
Protocols built around the rules in the states you serve.
Medical direction is remote where state law allows. Some states require on-site presence or an in-person evaluation for certain services; those requirements are handled case by case, and we tell you up front.
Collaborating and supervising physicians for NPs and PAs
A collaborating physician for a nurse practitioner, or a supervising physician for a physician assistant, fills the oversight role a state requires for that clinician to practice. Our physicians sign collaborating and supervising physician agreements for NPs and PAs, in every state that requires one; we confirm your state's requirements on the discovery call.
Some states give NPs full practice authority. Others require a written collaborative agreement, chart review at set intervals or limits on how many clinicians one physician may oversee. PA rules have their own variations, and prescriptive authority can carry separate requirements.
| Question | Why it matters |
|---|---|
| Does the NP or PA need a collaborating or supervising physician? | Decides whether you need this service in that state at all. |
| What must the written agreement contain? | Missing terms are a common problem when a board looks at a practice. |
| How much chart review is required? | Sets the physician's workload and your documentation process. |
| Must the physician hold a license in that state? | Affects which physician can be assigned to your clinicians. |
We then match a licensed physician to your NPs and PAs, put the required agreement in place and run the review process the state expects. When you add a state, we repeat the mapping before anyone sees patients there. Our compliance approach explains how state rules shape our protocols.
Physician oversight for IV therapy and aesthetics
Physician oversight for IV hydration and aesthetics means a licensed physician sets the protocols, defines who may be treated and stays accountable for the clinical side. An IV therapy medical director matters because IV treatments carry real clinical risk and draw regulatory attention.
- IV therapy: screening criteria, formulary and dosing protocols, contraindication lists, infusion monitoring and reaction management
- Aesthetics: injectable and laser protocols, delegation rules, good faith exam standards and complication pathways
- Both: adverse event reporting, staff competency sign-off and periodic chart audits
If your clinic uses compounded products, your protocols and patient materials should say so plainly. Compounded medications are not FDA-approved.
Telehealth medical director for startups
A telehealth medical director for a startup builds the clinical side of the company before the first patient arrives: protocols, clinician coverage, documentation standards and escalation. For a fractional medical director at a telehealth startup, the job is to make the clinical model hold up as you grow and add states.
Early teams often design the product flow first and the clinical flow second. From the clinician's chair, that looks like an order with no intake, a patient no one owns and an adverse event discussed across several email threads. We design both together.
- Clinical protocols for each service line, written to the rules in the states you serve
- Intake and eligibility logic reviewed by a physician before it goes live
- One documented escalation path that your whole team knows
- Documentation standards that hold up under review
If you also need licensed physicians to deliver care under your brand, see our white-label telehealth medical group model and how we support telehealth brands.
How an engagement works
An engagement moves from scoping to agreements to live oversight, with review built in from the start. Each step is shaped by your services and the states you serve.
Discovery call
We learn your services, team, states and current setup.
Scoping and state mapping
We map the oversight rules for each state and service, then define the physician's role, review schedule and escalation path.
Agreements
We put the medical director or collaborative agreements in place, along with the HIPAA agreements the relationship requires, before launch.
Protocols and onboarding
We write or revise your protocols, meet your clinicians and confirm who does what.
Live oversight
Chart review, clinical questions and escalations run on the agreed schedule.
Ongoing review
We revisit protocols when you add services or states, or when the rules change.
How pricing works
Pricing is quoted after scoping, because the work depends on your services, states, team size and review needs. Most engagements use one of these models.
Monthly retainer
A set monthly fee for defined oversight duties, such as protocol upkeep, chart review and availability for clinical questions.
Per-consult
Fees tied to physician activity, such as consults or chart reviews.
Hybrid
A base retainer for oversight, plus per-consult fees for clinical work beyond it.
We do not publish prices. You get a written quote once we understand the scope. Request a discovery call to start.
Frequently asked questions
Can a remote medical director for a med spa oversee my clinic from another state?
Often, yes. Medical direction is remote where state law allows, as long as the physician holds the licenses your state requires. In-person requirements are handled case by case, and we confirm this during scoping.
What is the difference between a medical director and a collaborating physician?
A medical director takes clinical responsibility for a practice's protocols and care. A collaborating or supervising physician fills the oversight role a state requires for an NP or PA. One physician can sometimes hold both roles.
Can you provide a collaborating physician for nurse practitioners in more than one state?
Yes. Our physicians are licensed in all 50 states and DC, and they sign collaborating and supervising physician agreements in every state that requires one. We confirm your state's requirements on the discovery call.
Does a supervising physician for an NP have to review charts?
It depends on the state. Some set a required amount of chart review, some leave it to the written agreement and some do not require physician oversight at all. We build the review process around what your state requires.
Do IV hydration clinics need physician oversight?
Generally, yes. IV therapy is a medical service, so a qualified clinician must assess each patient and an order or protocol must authorize treatment. Who may do each step varies by state. An IV therapy medical director sets those protocols and stays accountable for them.
Is a fractional medical director a good fit for a telehealth startup?
For many early teams, yes. A fractional medical director for a telehealth startup builds protocols, reviews intake logic and sets up escalation before launch, then stays on as you grow.
Will you work inside our existing EHR or platform?
Yes. We work inside the platform you already use, or help you choose one. We do not sell software, so our advice is not tied to a product.
How is pricing for medical director services set?
After scoping. We offer a monthly retainer, per-consult fees or a hybrid, and we quote in writing once we understand your services and states. More answers are on our partner FAQ.
Let’s build your care program.
A 30-minute discovery call is the fastest way to see if we’re a fit.