Virginia Med Spa Medical Director Requirements (2026)

If you are opening or auditing a med spa in Virginia, one question decides whether you are operating lawfully: who, specifically, holds the authority to diagnose and prescribe here — and are they actually doing the job?

Virginia never wrote a med spa law. No med spa license, no facility inspection regime, no statute naming a "medical director." Operators read that vacuum as permission. It is the opposite: because Virginia wrote no special rules, your treatment rooms are governed by the full weight of the general Medical Practice Act, the Board of Medicine's delegation and laser regulations, the Board of Nursing's scope rules, and the Drug Control Act — statutes written for hospitals and physician practices, applied without modification to a storefront on a commercial strip.

This guide covers who qualifies, the one real Virginia alternative to a physician, what the role requires day to day, the numerical caps that quietly limit multi-site operators, cost, liability, and what your agreement must contain to survive a Department of Health Professions inquiry. Pair it with our Virginia med spa compliance checklist and the rest of the Virginia compliance hub.

Does a Virginia Med Spa Legally Need a Medical Director?

Functionally, yes — for nearly every med spa in the Commonwealth. The requirement is structural rather than titular, which is why it gets missed.

Virginia Never Wrote a Med Spa Statute

Search the Code of Virginia for "medical spa" and you will find nothing governing how one is staffed or supervised: no licensure category, no medical director registry, no annual filing. What exists on the facility side is an occupational license — if you offer esthetics services, the Board for Barbers and Cosmetology requires a spa establishment license under 18VAC41-70-80. That is a cosmetology permit, not a health care facility license, and it says nothing about who may inject a neurotoxin in the next room. The absence of a med spa statute is not a gap; it means the general law applies in full.

The Practice-of-Medicine Trigger

Va. Code 54.1-2900 defines the practice of medicine, and Virginia treats aesthetic medicine as squarely inside it. Botulinum toxin, dermal filler, deep chemical peels, laser and light-based treatments, IV hydration, hormone pellets, and prescription weight-loss injections all involve diagnosis, prescribing, or the administration of prescription drugs. Va. Code 54.1-2902 makes it unlawful to practice a branch of the healing arts without a license, and Va. Code 54.1-111 makes unlicensed practice a Class 1 misdemeanor escalating to a Class 6 felony on a third conviction within thirty-six months.

The question is therefore whether every act performed on a patient traces back to a licensed practitioner with authority to order it, through a delegation chain the Board of Medicine would recognize. The person who builds and owns that chain is your medical director, whatever the contract calls them.

Virginia Has No Real CPOM Doctrine — And That Changes Less Than You Think

Virginia does not enforce a strict corporate practice of medicine prohibition, so a non-clinician entrepreneur, an RN injector, or an investor group can own the business entity — genuinely more permissive than California or New York. Two constraints survive. Va. Code 13.1-543 restricts who may form a professional corporation to practitioners of the healing arts licensed under Chapter 29 of Title 54.1, which includes physicians and advanced practice registered nurses, so a PC structure binds the ownership. More important in practice: owning the business is not controlling the medicine. A lay owner cannot decide who gets treated, what drug is used, or what dose is appropriate, and any management agreement letting a non-clinician override clinical judgment is a problem however the entity is papered.

Who Qualifies as a Virginia Med Spa Medical Director

The pool is narrower than the job postings suggest: one credential, plus conditions Virginia takes seriously.

The Baseline: An Active, Unrestricted Virginia MD or DO

Your medical director must be an MD or DO holding a current, active Virginia license from the Board of Medicine, free of restriction, probation, or suspension. Verify it through the Department of Health Professions license lookup rather than a scanned wall certificate; DHP publishes status and public disciplinary history. A physician on Board-ordered probation may hold a license that is technically active while carrying terms prohibiting supervision of others — read the order, not just the status field.

No Specialty Requirement, But Real Competence Is Required

Virginia does not require a dermatologist or plastic surgeon. Family medicine, internal medicine, emergency medicine, OB-GYN — any of them may serve. What Virginia does require sits in 18VAC85-20-29, the Board of Medicine's practitioner-responsibility rule: a practitioner shall not knowingly allow subordinates to jeopardize patient safety or provide care outside the subordinate's scope of practice, and shall delegate patient care only to subordinates who are properly trained and supervised.

You cannot certify that a laser technician is properly trained if you do not know what proper training for that device looks like, and you cannot supervise complication management if you have never managed a vascular occlusion. The regulation imposes no specialty, but it does impose competence in the specific thing delegated — and it puts that judgment on the delegating physician, not the delegate.

Out-of-State Licenses Do Not Travel

A live problem in Northern Virginia, where a practice's physician network often sits in the District or Maryland. A physician licensed only in DC, Maryland, North Carolina, or West Virginia cannot serve as medical director here or treat Virginia patients, telehealth included. Licensure follows the patient's location, so multi-state operators need a Virginia-licensed physician for the Virginia sites.

Who Cannot Hold the Role

• Nurse practitioners without Board-granted autonomous practice (they require a patient care team physician)
• Physician assistants (they require a practice agreement — see the HB 746 discussion below)
• Registered nurses and LPNs, regardless of injecting experience
• Medical assistants, laser technicians, and estheticians, including Virginia master estheticians
• Chiropractors, naturopaths, and dentists outside their own licensed scope
• Physicians without an active, unrestricted Virginia license

Can a Nurse Practitioner Be the Medical Director in Virginia?

Here Virginia diverges from most states, and the wrong assumption costs money in both directions — paying a physician you do not need, or operating without one you do.

Virginia's Three-Year Autonomous Practice Threshold

Virginia is not a full-practice-authority state by default. A nurse practitioner begins practice as part of a patient care team, under a written or electronic practice agreement with a patient care team physician, governed by Va. Code 54.1-2957. That agreement must describe the services provided, the process for consultation and chart review, referral criteria, and the parameters of prescriptive authority.

But Virginia offers an exit. Under Va. Code 54.1-2957 and the Board of Nursing's rule at 18VAC90-30-86, an NP who completes the equivalent of three years of full-time clinical experience may apply for autonomous practice and, once granted, practice without any agreement. The three-year threshold took effect for applications received on or after July 1, 2024, reduced from five years by HB 971. The regulation measures full-time clinical experience at 1,800 hours per year based on a minimum thirty-six-hour week, and the application requires an attestation from a patient care team physician or a qualifying attesting nurse practitioner. Published totals vary — both roughly 4,500 and 5,400 hours are quoted in secondary sources — so confirm your figure with the Board of Nursing rather than any third party, this article included. Autonomous practice is unavailable to CRNAs and clinical nurse specialists; nurse midwives have their own track.

What Autonomous Practice Does and Does Not Buy You

An autonomous NP needs no patient care team physician and no medical director. That is real independence, and it is why NP-owned med spas are common in Virginia. What it does not do is expand scope: the NP still practices as a nurse practitioner, within the category and patient population of their licensure, and within the nurse practitioner standard of care. Autonomy removes the physician relationship; it does not convert the NP into a physician. So if your menu stays inside NP scope, an autonomous NP can own and lead the clinic with no physician — but if it reaches procedures the standard of care puts in physician hands, you need a physician regardless of autonomy status.

The NP-Led Virginia Med Spa Model

A large share of Virginia aesthetic practices run this way: an autonomous NP as owner and lead clinician, RNs administering on the NP's orders, estheticians handling the cosmetology side. It is lawful and defensible — and it still requires everything a physician-led practice requires minus the physician relationship: written protocols, a documented bona fide relationship before prescribing, correct delegation, proper drug handling, consent, records. Autonomy transfers the oversight burden onto the NP; it does not delete it. Many autonomous NPs still retain a physician on an advisory basis for complication management and higher-risk protocol review, which is sound even though Virginia does not compel it.

What a Virginia Medical Director Must Actually Do

Virginia publishes no duty checklist. What follows is the composite of the statutes that do apply — effectively the list an investigator works from.

Delegate Only to Properly Trained, Properly Supervised People

18VAC85-20-29 is the closest thing Virginia has to a medical director job description: delegate patient care only to subordinates who are properly trained and supervised, and never knowingly allow a subordinate to work outside their scope. Va. Code 54.1-2901 supplies the delegation exemption that makes a med spa possible at all, permitting a practitioner to delegate to supervised personnel those activities that are nondiscretionary and do not require professional judgment. The director decides who may perform what, verifies the training behind that decision, and documents both.

Own the Bona Fide Practitioner-Patient Relationship

Virginia does not use the phrase "good faith exam." Virginia says bona fide practitioner-patient relationship, codified at Va. Code 54.1-3303 with Board of Medicine expectations at 18VAC85-20-25. Every prescription drug your spa uses — toxin, filler, lidocaine, a GLP-1, an IV bag — requires one first: a history, an appropriate examination, a risk discussion, and a follow-up plan, performed by a practitioner with prescriptive authority. Telehealth can satisfy it; an online questionnaire alone cannot. In high-volume injectable and weight-loss practices this is the most common failure, and the director owns it. Our Virginia GLP-1 and weight-loss compliance guide covers the prescribing side.

Approve Written Protocols and Standing Orders

Every service on the menu needs a written protocol the director has reviewed, signed, and dated: patient selection and exclusion criteria, pre-treatment assessment, technique and dosing ranges, device settings and endpoints, post-care, and adverse-event response. Standing orders derive from those protocols. Virginia's repeal of 18VAC85-20-90, the weight-loss pharmacotherapy rule, effective February 27, 2025, and of the PA counterpart at 18VAC85-50-181 in July 2025, removed a state-supplied template. What replaced it is the standard of care, which you now write down and defend yourself. Fewer rules means more documentation, not less.

Match the Supervision Standard to Each Act

This is the detail that trips up directors trained in another state. Virginia does not use one supervision standard; it uses several, attached to specific acts:

• Laser hair removal — Va. Code 54.1-2973.1 permits a properly trained person to perform it under the direction and supervision of a physician, PA, or APRN who need not be physically present but must be readily available.
• Unlicensed staff administering drugs — Va. Code 54.1-3408 requires direct and immediate supervision. Not readily available. On site, immediately.
• Registered nurses — an RN administers on a valid, patient-specific order from a practitioner with prescriptive authority, following the bona fide relationship. No physician need be on the premises.
• Nondiscretionary delegated tasks — Va. Code 54.1-2901, under the supervision the practitioner establishes and documents.

Applying "readily available" to an act requiring direct and immediate supervision is a violation even when the outcome is fine. The director's job is knowing which standard attaches to which act and building the staffing schedule around it. Our Virginia injector scope guide maps this role by role.

Sign, Maintain, and Actually Follow Practice Agreements

For every NP without autonomous practice and every PA on staff, the director signs a practice agreement and keeps it current. Both statutes require periodic chart review, collaboration and consultation guidelines, joint evaluation of services delivered, and physician input in complex cases, emergencies, and referrals. A boilerplate agreement describing services no one performs is worse than none — it is a written admission that the paper and the practice diverge.

Conduct Documented Chart Review and Quality Assurance

Chart review is the duty investigators most reliably ask to see and the one most often absent. Virginia sets no statutory percentage, so you set a defensible cadence and keep the log: dates, charts, findings, corrective actions, follow-up. Pair it with adverse-event review and device maintenance records. "I review charts regularly" with no log reads, to a board, as no review at all.

Records, Consent, and Schedule VI Drug Handling

18VAC85-20-26 governs patient records: six-year retention following the last encounter for adult patients, plus the patient notice the regulation requires. Consent must be procedure-specific — a blanket "aesthetic treatments" form does not describe the risks of a vascular occlusion or a laser burn. Separately, botulinum toxin, fillers, lidocaine, and most of what a med spa stocks are Schedule VI controlled substances in Virginia, pulling the Board of Pharmacy and the Drug Control Act into your operation; stock held by an entity rather than an individual practitioner implicates the separate registration provisions at 18VAC110-20-690. The director sets the consent standard, audits it, and answers for a vial sourced from an unlicensed reseller.

Supervising NPs, PAs, and RNs: How Delegation Really Works

Virtually every Virginia med spa runs on mid-level and nursing staff, so those supervisory relationships are where compliance is won or lost.

The Nurse Practitioner Practice Agreement

Until the Board grants autonomous practice, an NP practices as part of a patient care team under a written or electronic practice agreement with at least one patient care team physician. The agreement should describe the aesthetic services the NP actually provides — not a generic primary-care template — and specify how consultation happens, how charts are reviewed, when the physician must be involved, and the boundaries of prescriptive authority. When the menu changes, the agreement changes with it. One Virginia trap: if the patient care team physician becomes unable to serve, Va. Code 54.1-2957 provides a continuity-of-care path. Know it before you need it, because the alternative is an NP practicing with no agreement at all.

The Physician Assistant Practice Agreement and What HB 746 Changes

A PA practices as part of a patient care team under a written or electronic practice agreement with one or more patient care team physicians, governed by Va. Code 54.1-2952 with regulatory detail at 18VAC85-50-101. The agreement covers the acts performed, periodic chart review, collaboration and consultation guidelines, joint evaluation of services, and physician input for complex cases, emergencies, and referrals.

In 2026 Virginia enacted HB 746 (Chapter 418), signed April 8, 2026, creating an attestation route that lets a PA with three years of full-time clinical experience practice without an agreement — the PA analogue to HB 971. It is not self-executing: the operative provisions depend on Board of Medicine implementing regulations not final at publication. Until those rules land, your PAs need current agreements. Start the attestation file now — hours, attesting physician, documentation.

Registered Nurses and Unlicensed Staff

An RN may administer injections and treatments on a valid, patient-specific order from a practitioner with prescriptive authority, within Board of Nursing scope and the director's protocols. The RN never selects the drug or dose and never performs the bona fide relationship. Below that line, unlicensed staff may administer drugs only under the direct and immediate supervision Va. Code 54.1-3408 requires, and estheticians — including Virginia master estheticians — stay inside the cosmetology scope, with chemical exfoliation limited to the agents 18VAC41-70-250 enumerates. Estheticians do not inject in Virginia, and no medical director can delegate that.

Laser and Energy-Device Oversight in Virginia

Energy devices get their own statute in Virginia, more specific than most states manage.

The Laser Hair Removal Statute and Its 10 Proctored Cases

Va. Code 54.1-2973.1 provides that laser hair removal must be performed by a properly trained physician, physician assistant, or advanced practice registered nurse, or by a properly trained person acting under their direction and supervision. The supervising practitioner need not be physically present but must be readily available at the time of treatment — and must personally see and evaluate any patient whose treatment resulted in a complication before that patient's treatment continues.

18VAC85-20-91 puts numbers on the training duty: a licensee delegating laser hair removal to someone other than a PA or NP must ensure that person completed training including a minimum of ten proctored patient cases with demonstrated competency across skin types, plus didactic content on laser physics, safety, and complications. 18VAC85-50-191 mirrors this for a PA. Keep the training records on file — they are among the first documents an investigator requests, and the director signs off that the standard was met.

Where the Statute Runs Out

The statute addresses hair removal specifically. Ablative resurfacing, fractional lasers, IPL for pigment and vascular lesions, and RF microneedling fall outside 54.1-2973.1 and revert to the general delegation framework — which is, if anything, more demanding, since they carry more risk with no statutory safe harbor. The prudent reading: the more a device can injure, the closer the supervision and the higher the operator's credential. A director who applies the hair-removal standard to an ablative laser has misread it in the direction that produces scars and lawsuits.

How Many Med Spas Can One Virginia Medical Director Oversee?

Virginia answers this better than most states: it caps providers with actual numbers, even though it says nothing about facilities.

Virginia's Hard Numbers: Six and Six

Va. Code 54.1-2957 prohibits a physician from serving as a patient care team physician on a patient care team, or entering into a practice agreement, with more than six advanced practice registered nurses at any one time — with a narrow exception permitting up to ten in the psychiatric-mental health category, which does not help an aesthetic practice. Va. Code 54.1-2952 sets the parallel limit for physician assistants: no patient care team physician may collaborate or consult with more than six PAs on a patient care team at any one time.

Do the arithmetic against your own staffing. A physician already holding agreements with four NPs elsewhere has room for two more anywhere — across all clinics, not per clinic. A three-location group running two non-autonomous NPs per site has consumed a director's entire NP capacity. These caps are why a director who says "I cover fifteen spas" is either working exclusively with autonomous NPs and RN-on-order models, or is over the line.

The Real Limit Is Chart Review

Beyond the statutory caps, the binding constraint is whether supervision genuinely happens. A director listed at eight locations who reviews no charts, has visited none, and cannot be reached during a complication is providing nothing the Board of Medicine would recognize as oversight — and 18VAC85-20-29 makes that the physician's own violation, not merely the owner's. Before retaining a director, ask three questions and get the answers in writing: how many practice agreements do you hold, how many facilities do you serve, and what is your chart-review cadence at each? A director who cannot answer precisely is telling you something.

What Does a Virginia Medical Director Cost?

Virginia is a mid-market state with a sharp internal split, and pricing that ignores it gets one region wrong.

Typical 2026 ranges for Virginia:

• Part-time oversight, most of the Commonwealth: roughly $1,500–$4,000 per month
• Part-time oversight, Northern Virginia: roughly $3,000–$6,000+ per month, competing against the DC metro market
• Hourly for protocol drafting, chart review, and consultation: roughly $200–$500 per hour
• Full-time employed physician: uncommon outside larger multi-location groups

What moves your number: the risk profile of the menu, how many NPs and PAs the director must carry under agreements (a director near the six-and-six caps prices accordingly), the number of locations, energy devices, controlled-substance oversight, and how much of the protocol library you need built from scratch rather than reviewed.

What is not negotiable: compensation must be fair market value for services actually rendered, structured as a flat retainer or an hourly rate. It must never be a percentage of revenue, a per-treatment fee, or any structure that ties the director's pay to volume or referrals — that is the shape regulators read as a kickback, and it corrodes the independence the arrangement exists to establish. For deeper treatment of pricing and contract structure, see our national guides on medical director cost and agreements and the complete 2026 medical director guide.

The right framing: a director at $3,000 a month is $36,000 a year. A single DHP enforcement action — investigation, legal defense, a consent order, penalty, and lost revenue — dwarfs that, and a malpractice claim from unsupervised care dwarfs it again. This is not a line item to bargain-hunt. If the constraint is building the oversight documentation rather than finding the physician, our ready-to-use med spa compliance SOPs cover the protocol, delegation, and record-keeping side of the role.

The Virginia Medical Director Agreement — What It Must Include

Virginia prescribes no form, so the document has to carry its own weight. It is the first thing a DHP investigator or a plaintiff's attorney asks for, and a vague one converts a defensible practice into an indefensible one.

Required Elements

1. Parties, credentials, and term. Legal names, Virginia license numbers for the physician and clinical principals, the entity's structure, effective dates, renewal, and termination with notice periods.

2. Scope of services and locations. The specific procedures overseen and every location covered. If you add a service line or a site, amend the agreement — an unamended one is evidence the director did not know what was happening.

3. Delegation and supervision structure. How delegation works under Va. Code 54.1-2901 and 18VAC85-20-29, how standing orders operate, and — critically for Virginia — which supervision standard attaches to each category of act: readily available for laser hair removal under 54.1-2973.1, direct and immediate for unlicensed staff administering drugs under 54.1-3408, patient-specific order for RN administration.

4. The bona fide practitioner-patient relationship. Who performs it, in what modality, and how it is documented before any prescription drug is used.

5. Practice agreements. How NP and PA agreements are executed, reviewed, and updated, and how they relate to this one. Attach or incorporate them by reference.

6. Chart review and quality assurance. Frequency, sampling method, documentation format, and what happens when a review finds a problem — plus adverse-event review and device-maintenance oversight.

7. Availability. Response-time commitments for clinical questions and complications, coverage when the director is unavailable, and a specified on-site visit cadence.

8. Compensation. Amount, schedule, and an express statement that it is fair market value for services rendered and not tied to revenue, referrals, or procedure volume.

9. Malpractice coverage. Required coverage and minimums for each party, and who carries tail coverage when the arrangement ends.

10. Protocols, records, and transition. How protocols are reviewed and updated; custody of records consistent with the six-year retention 18VAC85-20-26 requires; and transition obligations on termination, including triggers such as license action or loss of coverage.

Virginia-Specific Clauses Most Templates Miss

Agreements copied from a national vendor or a Maryland practice routinely omit four things Virginia needs: the six-provider caps plus the director's representation as to current agreement count; the readily-available versus direct-and-immediate distinction; the ten-proctored-case laser training verification and where those records live; and Schedule VI drug-handling responsibility, since Virginia's classification pulls in the Board of Pharmacy. Add them — and make sure the agreement describes supervision that actually occurs. One promising monthly on-site review by a director who has never visited is not protection; it is a signed admission, in your own file, that the standard was known and not met.

Medical Director Liability in Virginia

The medical director is not a signature on a wall but the person legally responsible when something goes wrong — which is precisely why a serious director charges serious money.

What the Physician Is Exposed To

Va. Code 54.1-2915 gives the Board of Medicine broad authority over unprofessional conduct: it may reprimand, place on probation, impose monetary penalties, suspend, or revoke a license. Inadequate supervision, improper delegation, and lending a name without providing oversight all live inside that authority, and 18VAC85-20-29 supplies the specific hook — allowing a subordinate to practice outside their scope, or delegating to someone not properly trained and supervised, is the physician's own violation. Beyond board discipline, the director can be named in malpractice litigation over any procedure performed under their protocols by a person they authorized, and their carrier may dispute coverage for oversight the policy never contemplated. For the national picture, see our deep-dive on medical director liability.

What the Owner Is Exposed To

An owner operating without genuine clinical authority faces unlicensed-practice exposure under Va. Code 54.1-2902 and 54.1-111 — a Class 1 misdemeanor escalating to a Class 6 felony on a third conviction within thirty-six months. Add civil liability if a patient is injured, the risk that the corporate arrangement is unwound if it violates Va. Code 13.1-543 or amounts to lay control of clinical judgment, and the real possibility that malpractice coverage does not respond to procedures performed without the required supervision. The owner and the physician are exposed together; paper protects neither. What protects them is evidence: dated protocols, logged chart reviews, agreements that match the work, laser training records, procedure-specific consent, drug logs, and a physician who answered the phone. When DHP asks whether anyone was actually doing the job, the documentation is the entire answer — and its absence is treated as the answer too.

Common Virginia Medical Director Mistakes

The Paper Director

A physician signs, collects a small monthly check, never reviews a chart, and has never seen the clinic. It is the most-cited pattern in med spa enforcement nationally, and common in Virginia precisely because the state has no registry or inspection to catch it early. It provides zero protection and converts the physician from a safeguard into a co-defendant.

Assuming Autonomous NP Status Covers Everything

Autonomous practice removes the physician relationship. It does not extend the NP's scope, and it does not relieve anyone of the protocol, delegation, documentation, or drug-handling duties. Practices that read the autonomy grant as general deregulation drop the exact records that would have defended them.

Ignoring the Six-and-Six Caps

Owners negotiate with a director without asking how many practice agreements that physician already holds. If the director is at capacity under Va. Code 54.1-2957 or 54.1-2952, the agreement you just signed may be unlawful from day one — and not asking is not a defense. The parallel error is flattening Virginia's supervision standards: treating "readily available" as sufficient for unlicensed staff administering a drug, when Va. Code 54.1-3408 demands direct and immediate supervision, is a violation on every treatment, harm or no harm.

Reaching Across the River — and Bargain-Hunting

Northern Virginia practices in particular borrow a physician or a contract template from DC or Maryland. An out-of-state license does not authorize care for Virginia patients, and an out-of-state agreement will not contain the Virginia-specific terms above — both failures are visible from the first page of a file. The related error is price: the cheapest director is almost always the one carrying the most practices and reviewing the fewest charts.

Summary: The Virginia Medical Director Checklist

1. No med spa statute and no titled medical director requirement — but aesthetic services are the practice of medicine under Va. Code 54.1-2900, so a licensed practitioner must own the clinical side.
2. For most practices that is an MD or DO with an active, unrestricted Virginia license; out-of-state licenses do not authorize care for Virginia patients.
3. An NP with Board-granted autonomous practice under Va. Code 54.1-2957 — three years of clinical experience since July 1, 2024 under HB 971 — may lead a practice with no physician, within NP scope.
4. 18VAC85-20-29 requires delegation only to properly trained, properly supervised subordinates, and makes that the physician's own responsibility.
5. Match the supervision standard to the act: readily available for laser hair removal (54.1-2973.1), direct and immediate for unlicensed staff administering drugs (54.1-3408), patient-specific order for RN administration.
6. A bona fide practitioner-patient relationship under Va. Code 54.1-3303 must precede every prescription drug, toxin and filler included.
7. Laser hair removal delegates need ten proctored cases across skin types (18VAC85-20-91) — keep the records.
8. One physician may hold agreements with no more than six NPs and six PAs at a time (54.1-2957, 54.1-2952); ask for the current count.
9. Expect roughly $1,500–$4,000 per month statewide, $3,000–$6,000+ in Northern Virginia; fair market value only, never tied to revenue.
10. The agreement must be specific, must include the Virginia-only clauses, and must describe supervision that actually happens — investigators compare the paper to the practice.

Disclaimer: This article is for educational purposes only and does not constitute legal or medical advice. Virginia oversight, delegation, and scope rules are enforced by the Virginia Board of Medicine, the Board of Nursing, and the Department of Health Professions, and they change — including the HB 746 physician assistant provisions, which depend on Board of Medicine regulations not final at publication. Confirm current requirements with those boards and consult a Virginia healthcare attorney before entering into any medical director arrangement or acting on your specific situation.