Delegation in Texas Med Spas: Who Can Do What Under the Law?
The med spa industry in Texas is booming, but along with the growth comes a wave of regulatory questions. One of the most common is: Who can perform treatments, and under what authority?
Because med spas blend medical and aesthetic services, Texas law requires strict compliance when it comes to delegation of medical tasks. Failing to understand these rules can put both the provider and the business at risk.
Why Delegation Matters in Med Spas
In Texas, only licensed physicians can independently practice medicine. That means nearly every procedure in a med spa from injectables to laser treatments falls under the practice of medicine. Physicians may delegate certain tasks to non-physicians, but only within the boundaries set by state law.
Understanding who can legally do what ensures patient safety, protects your license, and shields your business from liability.
Who Can Be Delegated To?
In a med spa setting, not everyone who wears scrubs can legally perform medical treatments. Texas law is very specific about who can carry out procedures under a physician’s supervision and how that delegation must occur. Understanding these distinctions is essential to avoid unauthorized practice of medicine, one of the most common compliance pitfalls for med spa owners.
Texas law allows physicians to delegate tasks to:
Nurse Practitioners (NPs)
May provide medical services under a physician’s supervision, often with greater autonomy.
Physician Assistants (PAs)
Can perform many delegated tasks, including prescribing, under physician supervision.
Registered Nurses (RNs)
May carry out delegated tasks within their scope of practice.
Licensed Vocational Nurses (LVNs)
More limited scope; may perform basic delegated tasks under supervision.
Unlicensed Medical Assistants
Here in Texas an MD can delegate to unlicensed persons so long as there is no specific statute that limits their ability to delegate the task and provided that the person is trained and protocols are provided.
What Tasks Can Be Delegated?
The scope of delegation depends on the provider’s license and training. Generally:
Injectables (Botox, fillers, etc.)
Can be delegated to anyone in the organization. However, IVs can only be delegated to NPs, PAs, and RNs.
Laser and Energy-Based Treatments
May be delegated if the individual is properly trained and supervised.
Microneedling, Chemical Peels, and Similar Procedures
Delegation depends on the invasiveness of the treatment and the training of the staff.
Routine, Non-Medical Tasks
Tasks like taking photos, scheduling, and skincare consultations may be handled by unlicensed staff.
**Important: Delegation does not eliminate physician responsibility. The supervising doctor remains ultimately accountable for patient care.**
The Supervision Requirement
Delegation doesn’t mean handing off responsibility and walking away. Under Texas law, physicians remain ultimately accountable for every medical act performed under their supervision. That’s why the state requires adequate oversight with clear documentation, defined procedures, and active involvement from the delegating physician. In practice, proper supervision includes:
Written protocols and standing delegation orders
Documentation of training and competency
Availability of the supervising physician for consultation (in person or by telecommunication)
Regular review of delegated activities
Risks of Improper Delegation
When med spas operate outside the limits of Texas law, both the supervising physician and the business itself are exposed to liability. Regulatory investigations, civil lawsuits, and reputational damage can follow even a single incident of unauthorized practice. Common outcomes include:
Disciplinary action by the Texas Medical Board
Civil liability if a patient is harmed
Loss of professional licenses
Damage to the reputation — and future — of the med spa
Protect Your Practice Through Compliance
Delegation in Texas med spas is a legal responsibility that carries real consequences for how your business operates. The key is understanding who can do what under the law and making sure supervision and documentation are always in place.
If you’re opening or managing a med spa and want confidence in your compliance, LDG PLLC can help you set up proper delegation protocols and protect your practice.