Physician assistants (PAs) are playing a bigger role in shaping the future of healthcare in Texas, where patient demand continues to grow across telemedicine, wellness, and aesthetics. As of 2024, more than 12,335 board-certified PAs practice in Texas.
With this shift comes a big question for many: Can a PA legally serve as a medical director in Texas? The answer is no, but that doesn’t mean PAs can’t lead clinics, manage staff, or build thriving practices. It simply requires the right structure, support, and state law–compliant supervision.
Let’s break down what’s allowed, what’s not, and how physician assistants can move forward with confidence in Texas.
Can a PA Be a Medical Director in Texas?
In Texas, a medical director must be a licensed physician (MD or DO) in good standing with the Texas Medical Board (TMB). This role holds specific legal and clinical authority, including oversight of clinical protocols, delegation of prescriptive authority, and responsibility for ensuring patient safety and legal compliance under Texas laws.
Although PAs are highly trained and perform critical medical tasks across many practice settings, current TMB rules do not allow them to serve as qualified medical directors. According to state regulations, this restriction exists because medical direction involves duties that go beyond clinical practice, including oversight of prescription drug orders, delegated medical acts, and supervision of advanced practice registered nurses and other healthcare providers under both state and federal laws.
A delegating physician must review medication orders, approve medical procedures, and remain available (often physically or by telephone) to address patient emergencies and complex cases. The TMB has made clear that only physicians with an active medical license can supervise medical spas, approve the use of controlled substances, and perform other functions considered medical acts.
What Roles Can a PA Play in Practice Management?
While a physician assistant cannot legally act as a medical director in Texas, there are still several leadership roles they can hold within a healthcare business or facility-based practice, as long as they operate under proper delegation and supervision from a licensed physician.
In most practice settings, PAs can serve as:
- Clinic Directors: Oversee daily operations, scheduling, and coordination of healthcare staff to ensure smooth clinic performance under physician supervision
- Lead Providers: Manage direct patient care, oversee medical services, and implement clinical protocols in collaboration with the supervising physician
- Supervising Team Members: Support the training, delegation, and workflow of medical assistants and nursing staff, while operating within Texas delegation rules
- MSO (Management Services Organization) Owners: Handle the nonmedical aspects of the business, such as operations, branding, and marketing while partnering with a licensed physician to meet Texas Medical Board compliance requirements
In fact, more than 30% of PAs across the U.S. hold formal or informal leadership roles, such as department heads, clinical leads, or med spa managers.
With the proper structure and physician supervision, a PA can manage resource allocation, lead operational excellence, and contribute to public health innovation, while leaving medical direction responsibilities, including prescription drug orders, laser treatments, and delegated acts, to the supervising physician. This setup protects patient safety, ensures legal compliance, and supports sustainable growth for nonphysicians operating in the Texas healthcare industry.
Physician Supervision Requirements for PAs in Texas
The Texas Medical Board provides clear rules regarding the supervision of physician assistants across various practice settings, including med spas, telemedicine platforms, and facility-based practices. These requirements are critical to ensure legal compliance, protect patient safety, and define the boundaries of delegated medical acts.
Key supervision elements include:
- Delegating physicians must be licensed in Texas and actively registered with the TMB.
- A prescriptive authority agreement or formal delegation agreement must be in place, specifying the scope of practice, chart review responsibilities, and any limits on medical procedures or prescription drug orders.
- The supervising physician must be available for consultation, either physically present or accessible by telephone, depending on the procedure and clinical risk.
- Texas law imposes a limit on the number of full-time equivalent PAs that a delegating physician can oversee.
- Prescriptive authority must be clearly delegated and documented, particularly when prescribing dangerous drugs or controlled substances.
- Physician assistants cannot supervise advanced practice registered nurses (APRNs) or other nonphysicians without involvement from a qualified medical director.
What to Do If You’re a PA Looking to Launch a Clinic
If you’re a PA with a vision for your own clinic, telemedicine platform, or aesthetic practice, you still have options. Here’s how to do it legally and effectively:
- Form an MSO. You can own and operate the business infrastructure staff, software, marketing, and operations while leaving clinical oversight to a medical director.
- Partner with a licensed physician. A medical director can provide the required oversight, sign off on protocols, and ensure compliance with Texas law.
- Choose a collaborative model. Build a clinic where you lead operations and brand identity while the medical director supports oversight, delegation, and protocol review.
- Work with a platform like Medical Director Co. We connect PAs with licensed Texas-based physicians who understand your goals and are ready to support you within the law.
Let Medical Director Co. Connect You with the Oversight Your Clinic Needs
Physician assistants in Texas may not be eligible to serve as medical directors, but that doesn’t limit their ability to build successful, compliant clinics. With strong clinical experience, leadership skills, and the right legal structure, PAs can run thriving businesses in aesthetics, wellness, and telehealth.
If you’re ready to scale your vision, let Medical Director Co. help. We match PAs with experienced, licensed physicians who can provide the medical direction needed for compliance, patient safety, and long-term success.
Ready to launch your clinic or healthcare brand? Contact us to get matched with a Texas-based medical director who supports your leadership and helps you deliver the care your patients deserve.
Frequently Asked Questions
Can a PA legally serve as a medical director in Texas?
No. In Texas, the role of medical director must be filled by a licensed physician (MD or DO). While physician assistants are critical members of the care team, state law does not allow them to provide official medical direction or serve as the supervising authority for clinical protocols.
What’s the difference between a clinic director and a medical director?
A clinic director, often a PA or lead provider, manages daily operations, staff, and patient workflow. A medical director, on the other hand, is legally responsible for clinical oversight, including protocol approvals, delegation of prescriptive authority, and ensuring compliance with state regulations. Only physicians can serve as medical directors in Texas.
Can a PA own or co-own a clinic in Texas?
Yes, PAs can own or co-own the business side of a clinic through a management services organization. This structure allows the PA to oversee branding, marketing, and administration, while a collaborating physician provides the required medical supervision and clinical direction.
Can a PA supervise nurses or other healthcare providers?
Not directly. In Texas, only a supervising physician can delegate medical tasks to healthcare staff like nurses or other mid-levels. While a PA may lead day-to-day activities, they must work under a physician’s authority when it comes to clinical delegation or direct supervision.
What kind of clinics can PAs open with physician supervision?
PAs can launch a wide range of healthcare businesses, including telemedicine platforms, aesthetic practices, weight loss clinics, and IV hydration services, as long as they partner with a licensed physician who can provide proper medical direction and support legal compliance.
What are the risks of operating without a medical director?
Running a clinic without a qualified medical director can lead to serious issues, including:
- Violations of state and federal regulations.
- Insurance claim denials.
- Legal liability for noncompliance.
- Potential loss of license for providers involved.
It’s critical to maintain regulatory oversight and protect both patient safety and your business.
How can Medical Director Co. help PAs in Texas?
Medical Director Co. matches PAs with Texas-licensed physicians who understand the unique needs of PA-led clinics. We help you structure your model, draft compliant agreements, and ensure your practice meets all state-specific requirements.
Blaz Korosec is the CEO and co-founder of Medical Director Co., a nationwide platform that connects aesthetic and wellness professionals with licensed physicians for medical oversight, supervision, and compliance support. With a background that bridges healthcare operations, regulatory compliance, and entrepreneurial growth, Blaz has worked closely with hundreds of nurses, physician assistants, and clinic owners to help them legally launch and scale medical spas, telehealth weight loss clinics, IV hydration businesses, and aesthetic practices.
Blaz holds a degree in finance from Southern Methodist University (SMU) and has built a diverse portfolio of businesses ranging from healthcare to hospitality, including a national network of RV parks and medical clinics. Through MedicalDirector.CO, he’s developed a deep understanding of the state-by-state rules that govern collaborative agreements, PC/MSO structures, telemedicine protocols, and injectable treatments—translating complex legal frameworks into easy-to-implement solutions for clinicians and business owners.
Blaz is particularly passionate about helping nurses and mid-level providers unlock business ownership opportunities, and he’s known for designing systems that streamline operations, boost revenue, and ensure long-term legal protection. His team includes former prosecutors, senior RNs, and physicians who together support a growing number of clinics across all 50 states.
When he’s not working, Blaz enjoys mountain biking, restoring properties, and exploring the outdoors with his wife. He’s based in Texas but works with clients nationwide.
