Texas Medical Board Requirements for Medspas and Wellness Clinics

Texas Medical Board (TMB) regulations directly govern how medspas, wellness clinics, and aesthetic facilities must operate when they offer services involving medical procedures. Understanding these requirements is essential for clinic operators — non-compliance can result in citations, fines, cease-and-desist orders, and potential criminal liability. This article provides an informational overview of the key TMB regulations that apply to Texas medspa and wellness clinic operators.

What Is the Texas Medical Board?

The Texas Medical Board (TMB) is the state regulatory agency that licenses and disciplines physicians in Texas, and oversees the practice of medicine throughout the state. Established under the Texas Medical Practice Act (Texas Occupations Code, Chapter 151), the TMB has authority over any medical practice or clinic where medical procedures are performed by or under the supervision of licensed physicians. Medspa and wellness clinic operators whose services involve physician delegation or supervision fall under TMB jurisdiction.

Which Texas Clinics Require a Physician?

Under Texas law, a broad range of services commonly offered at medspas and wellness clinics are classified as the practice of medicine or require physician delegation: injectable treatments (Botox, fillers, Kybella), IV infusion therapy, laser and energy-based treatments (depending on device class and procedure), hormone therapy and prescription medications, and diagnostic or laboratory services. If your clinic offers any of these, you are likely required to have a qualified physician involved in the oversight of those services.

Standing Delegation Orders (SDOs)

A Standing Delegation Order is a written physician order that authorizes specific non-physician healthcare providers — such as registered nurses (RNs) or advanced practice nurses (APRNs) — to perform designated medical procedures. Under Texas Occupations Code Chapter 157, a physician may delegate medical acts to qualified non-physician providers through an SDO, provided the physician: maintains licensed supervisory authority, is in a supervisory capacity at the facility, and retains overall clinical responsibility. SDOs must be specific, documented, and updated regularly.

Texas Occupations Code Chapter 157: Physician Delegation Rules

Chapter 157 governs medical delegation in Texas. The key principles are: a physician can delegate medical acts to an appropriate non-physician, but cannot delegate acts that require physician judgment beyond the training of the delegate; the physician must be immediately available (by phone, telemedicine, or in-person) when delegated acts are performed; and the physician retains legal and professional responsibility for the delegated actions. Delegating to an NP or RN who is performing procedures outside the physician's direct oversight is a common compliance violation.

Consequences of Non-Compliance

TMB enforcement actions against non-compliant medspas and clinics can include formal complaints against the supervising physician, monetary penalties, cease-and-desist orders against the clinic, and referral to the Texas Attorney General for unauthorized practice of medicine. Patient harm from unsupervised medical procedures can also result in civil liability. TMB inspections are complaint-driven and can occur at any time.

What a Compliant Medspa Medical Director Relationship Looks Like

A properly structured medical director relationship includes: a written Medical Director Agreement; documented standing delegation orders tailored to the clinic's specific services; regular physician chart reviews and protocol updates; documented availability of the physician for real-time consultation; and ongoing training attestation for all clinical staff. Focus Physicians Group PLLC provides these services to wellness clinic operators across Texas.