A conversation with Dr. April Foster, Chief Medical Officer at Diamond Accelerator
If your med spa were audited tomorrow, would your medical director relationship protect you or expose you?
That’s the question Katlin Cauffman, founder and owner of Diamond Accelerator, posed to Dr. April Foster in a recent conversation about one of the most overlooked risk areas in the aesthetics industry: the medical director relationship. What follows is a breakdown of the red flags, audit checklist, and compensation questions every med spa owner needs to understand.
It’s a Relationship, Not a Signature
The single biggest misconception med spa owners have about their medical director is that the role is transactional: someone signs papers, lends a license number, and moves on. Dr. Foster pushes back hard on that idea.
Her first diagnostic question for any owner: can you actually get a hold of your medical director? She says she regularly hears from prospective clients who don’t have their medical director’s phone number, or who wait weeks for a signature they need urgently.
As Katlin put it during the conversation:
"It's just not checking the box overseeing it, but really strengthening your practice."
That distinction between a rubber-stamp signature and an active, engaged partnership is the foundation for everything else in this discussion.
Red Flags to Watch For
Dr. Foster outlined several warning signs that a medical director relationship isn’t built to protect the practice:
- You can’t reach them. No direct line, no response time standard, no clear process for urgent needs (shipments, signatures, patient questions).
- They’re giving outdated or incorrect guidance. For example, telling providers that good-faith exams aren’t necessary.
- They haven’t trained in the treatments they’re overseeing. A medical director should have hands-on knowledge of the procedures performed under their license, not just a general medical background.
- No written protocols or standing orders, or protocols that exist but were never signed or updated.
- Staff doesn’t know who the medical director is. If the team can’t identify who to call in an emergency, that’s a structural failure, not a minor oversight.
What an Auditor Actually Looks For
Dr. Foster walked through what she’d check first if she were auditing a med spa:
- Identity and accessibility of the medical director – some states legally require this information to be posted on the website or at the front desk.
- Written protocols and standing orders – these must be printed, current, and signed by both the provider and the medical director. Unsigned paperwork is treated as non-compliant.
- Physical space and inventory – emergency kits, refrigeration, sterile areas, medication expiration dates, and lot number tracking.
- Documentation of monthly audits – Dr. Foster personally reviews 10–20% of client charts every month through view-only EMR access, and keeps records of every audit.
Katlin summarized the underlying principle clearly:
"But if you're someone that has gone through this, you are so glad that you have your stuff together, because the ones that don't - it's detrimental.”
What Should You Actually Pay a Medical Director?
This is one of the most common and most misunderstood questions in the industry. Dr. Foster’s answer may surprise some owners: paying too little is itself a red flag.
Legal counsel has flagged a growing industry term, the “rented doctor” or “rent an NPI” arrangement, where a practice pays minimal fees purely to use a physician’s license number without any real oversight. Regulators are actively looking for this pattern.
Typical ranges she’s seen run from roughly $750–$850/month for part-time oversight up to $1,500–$1,600/month for more involved relationships, though pricing varies by market, patient population, and scope of services. The price should reflect the level of service availability, training, auditing frequency, and legal/compliance engagement.
Questions to Ask Before Signing an Agreement
Before agreeing to a fee structure, Dr. Foster recommends asking prospective medical directors:
- What is your availability? Can I reach you daily if needed?
- How often will we meet, and how will you communicate with my team?
- How do you conduct audits, and how are those audits documented?
- Are you actively tracking changes in board regulations and relevant legal cases?
- What training and support will you provide to me and my staff?
- How will the relationship scale as my practice grows and adds new services?
Katlin framed the value of a truly engaged medical director this way:
"Someone that is really proactive, right? And not just waits to be called on if there is a problem, but someone that's proactive and supporting you and protecting you and helping you to grow."
When Things Go Wrong
Dr. Foster shared real examples of what happens without a strong medical director relationship:
- A provider couldn’t reach her medical director for weeks and had to pause client appointments while waiting for a neurotoxin shipment signature.
- The medical director was out of the country for three weeks, and there was no designated backup physician identified to provide coverage during the absence.
- An RN discovered after years of practice that she had never conducted a required good faith exam, leaving her exposed to significant compliance risk.
These stories are why Diamond Accelerator now requires backup physicians for coverage gaps and why proactive emergency planning (identifying nearby specialists for vascular occlusions, reversals, or complications) is built into their process from day one.
Katlin closed with a warning that applies to every med spa owner who assumes a crisis “won’t happen to me”:
"If you're someone that has gone through this, you are so glad that you have your stuff together because the ones that don't, it's detrimental."
The Bottom Line
A medical director relationship isn’t a compliance formality; it’s one of the most important structural safeguards in your practice. The right relationship includes:
- Clear, fast communication
- Written, signed, and current protocols
- Regular documented audits
- Ongoing training aligned with your services
- A real plan for emergencies and coverage gaps
If any of this sounds unfamiliar, or if today’s conversation surfaced questions about your own setup, it’s worth getting a professional review before a regulator does it for you.
Ready to Find Out Where You Stand?
Don’t wait for an audit to discover the gaps in your medical director relationship. Get expert guidance on building a compliant, protective, growth-ready structure for your med spa.
