Thinking of opening a medspa, IV hydration bar, or weight loss clinic? One of the first questions you’ll run into is this:
“Can I own this business if I’m not a physician?”
In many states, not directly.
That’s because of the Corporate Practice of Medicine (CPOM) doctrine. It prevents nonphysicians (like estheticians, RNs, NPs, or investors) from owning the medical side of a clinic. An MSO (Management Services Organization) agreement is your solution.
At Medical Director Co., we prepare MSO agreements free with every placement. Unlike attorneys who charge $5,000–$20,000, our in-house legal team customizes your MSO for compliance in all 50 states and delivers it in 24 hours.
What Is an MSO Agreement?
An MSO agreement is a contract that separates business ownership from medical practice ownership.
- MSO (Your LLC): You own this company. It controls marketing, branding, operations, staffing, and profits.
- PC (Professional Corporation): The physician owns this entity on paper. It controls patient care, prescriptions, and medical liability.
The MSO contracts with the PC to provide management services.
In practice, this means you control the business; the physician covers compliance.
Why MSOs Exist: CPOM Explained
What Is the Corporate Practice of Medicine Doctrine?
It’s a legal doctrine meant to prevent nonclinicians from “practicing medicine.”
It ensures that patient care decisions are not driven purely by profit.
Many states, like California, Texas, New York, Georgia, Illinois, and North Carolina, adopt it.
Why This Matters for Medspas & Wellness Clinics
Botox, fillers, IV hydration, and semaglutide are all classified as medical treatments.
If you’re not a physician, you cannot legally own the medical entity.
Without an MSO, you risk board investigations, fines, and shutdown.
The Risks of Bad or Missing MSO Agreements
- Loss of Business Control: Poorly written MSOs give equity to physicians, making you a minority owner.
- Legal Shutdown: Boards can close clinics operating without proper MSOs in CPOM states.
- Supplier Denials: Botox/semaglutide distributors often request MSO/ownership proof.
- Expensive Mistakes: Fixing a bad MSO later can cost tens of thousands in attorney fees.
Why Free Templates Don’t Work
Just like collaborative agreements, the internet is full of “free MSO agreement templates.”
But these are ticking time bombs.
- They’re not state-specific.
- They don’t address the CPOM doctrine.
- Many assign equity to physicians (common pitfall).
- They’re rarely recognized by boards or suppliers.
Attorney Costs for MSO Agreements
Attorneys make big money drafting MSOs because they can bill by the hour.
A few examples:
- Fenton Law Group CPOM compliance packages: $5,000–$10,000+
- Cohen Healthcare Law Group MSO structuring: $4,000–$7,500+, billed hourly
- Nelson Hardiman MSOs for medspas: Often $7,500–$15,000
- Harris Bricken healthcare compliance: $400–$650/hour
It’s common for medspa attorneys, particularly those in California and Texas, to charge $10,000–$20,000 per MSO.
Attorney vs Template vs Medical Director Co.
| Provider | Cost | Customization | Physician Included? | Risks |
| Free template | $0 | Generic | No | Board rejection, equity loss |
| Attorney | $5,000–$20,000 | Custom | No | Expensive—and this is still without the MD |
| Medical Director Co. | $799/month | Custom for all 50 states | Yes | Low |
Why Medical Director Co. Is Different
- MSO agreements prepared free with every placement
- Customized by our in-house legal team
- Valid in all 50 states
- Physicians placed within 24 hours
- You keep 100% ownership of the business (no equity given to MD)
What attorneys charge $10,000+ for, we include free in your $799/month medical director placement.
State Examples
California
- CPOM enforced
- Only MDs can own professional corporations.
- MSO allows estheticians, NPs, and investors to own the business.
Texas
- CPOM enforced
- MSO required for any nonphysician clinic owner.
New York
- Nonphysicians cannot own medical practices.
- MSO is the standard structure for NPs, RNs, and estheticians.
Florida
- CPOM is less strict, but MSOs provide liability protection and cleaner ownership.
Illinois & Georgia
- Strict CPOM enforcement
- MSOs required for medspas and IV bars owned by non-MDs
All 50 States Covered
We prepare MSOs for clients in every state.
- Alabama
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Delaware
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming
Case Studies
Case 1
A California esthetician wanted to open a Botox spa in Los Angeles.
An attorney quoted them $7,500 for an MSO.
The risk: The physician wanted an equity stake.
With us, an MD was placed in their spa, the MSO was free, 100% ownership was kept, and the spa launched for $799/month.
Case 2
A Texas business owner wanted an IV bar.
They used a free MSO template online.
The board rejected the bar’s structure, resulting in a shutdown notice.
With us, a custom MSO was drafted in 48 hours, an MD was placed, and their business was relaunched.
Case 3
A New York NP downloaded a CPA template without an MSO.
The pharmacy denied their semaglutide orders (ownership mismatch).
With us, they got an MD placement, plus a CPA and an MSO for free. Their account was approved in 1 week.
FAQs
Do all states require MSO agreements?
No, only CPOM states. But we prepare them free where needed.
Do physicians get equity in my business?
Not with us. Our MSOs keep you in control.
How much do attorneys charge?
$5,000–$20,000. With us, free.
Can I use a free template?
Not safely. Most are rejected.
Takeaway
If you’re Googling “MSO agreement template,” here’s what you need to know:
- Free templates won’t protect you.
- Attorneys will bill $10,000+, often hourly.
- Without an MSO in CPOM states, you risk losing your entire business.
At Medical Director Co., we include MSOs free with every placement.
- Customized for all 50 states
- Prepared by our in-house legal team
- Physician placed within 24 hours
- Just $799/month. No placement or setup fees
Get your MSO agreement today and protect your clinic from day 1.
Bolton M. Harris, J.D., is a seasoned attorney with a formidable background in criminal law and a focus on healthcare law and compliance. As the in-house legal counsel at Medical Director Co., Harris brings a unique blend of prosecutorial experience and regulatory expertise to support healthcare professionals across Texas. Her career spans roles as a prosecutor in multiple counties and now as a trusted advisor on the legal intricacies of medical practice operations.
Education & Early Career
Bolton Harris completed her undergraduate studies at Southern Methodist University (SMU) in 2013. During her time at SMU, she was not only a dedicated student but also a competitive athlete on the university’s women’s swimming team. She went on to earn her Juris Doctor from Texas A&M University School of Law in 2016 and became a member of the Texas Bar that same year. Armed with a strong academic foundation and discipline honed as a student-athlete, Harris embarked on a career in criminal law immediately after law school.
Prosecutorial Experience in Texas
Bolton Harris began her legal career in public service as a criminal prosecutor. She served as an Assistant District Attorney in multiple jurisdictions, where she quickly rose through the ranks and handled a broad spectrum of cases. Some highlights of her prosecutorial career include:
- Assistant District Attorney, Dallas County, Texas: Prosecuted a high volume of criminal cases in one of the state’s busiest DA offices, gaining extensive trial experience in both misdemeanor and felony courts.
- Assistant District Attorney, Ellis County, Texas: Continued to hone her courtroom advocacy skills, known for meticulous case preparation and a tenacious pursuit of justice on behalf of the community.
- Assistant District Attorney, Navarro County, Texas: Broadened her legal expertise by handling diverse criminal matters in a smaller county, working closely with law enforcement and community leaders to uphold the law.
Through these roles, Harris built a reputation for being a tough but fair advocate. She brought numerous cases to trial and developed an in-depth understanding of the criminal justice system. This distinguished prosecutorial background laid a strong foundation for the next phase of her career in the private sector.
Healthcare Law & Compliance at Medical Director Co.
After her tenure as a prosecutor, Harris shifted her focus to healthcare law, applying her legal acumen to the medical field. She recognized that the same attention to detail and tenacity that served her in criminal law could benefit healthcare providers navigating complex regulations. Embracing this new direction, Harris became well-versed in the intricate laws governing medical practices – from licensing requirements to patient safety and privacy standards – and is passionate about helping practitioners stay compliant.
In her current role as the in-house attorney for Medical Director Co., Bolton Harris oversees all legal and compliance matters for the organization and its clients. Medical Director Co. is a nurse-owned firm that connects nurse practitioners (NPs), physician assistants (PAs), and registered nurses with qualified medical directors and collaborating physicians, offering fast placements and comprehensive compliance support for healthcare practices. Harris ensures that each of these partnerships and clinical ventures adheres to all applicable state and federal laws. She is responsible for drafting and reviewing collaborative practice agreements, advising on regulatory requirements, and providing ongoing legal counsel as clients establish and grow their clinics. Drawing on her prosecutorial eye for risk management, Harris proactively identifies potential legal issues and addresses them before they escalate, giving healthcare professionals peace of mind.
Bolton M. Harris’s multifaceted expertise – spanning high-stakes courtroom litigation to detailed healthcare compliance – makes her a formidable legal ally. Whether advocating in front of a jury or guiding a medical practice through regulatory hurdles, she remains committed to the highest standards of the legal profession. Her blend of courtroom-tested skill and healthcare law knowledge ensures that clients of Medical Director Co. receive elite-level counsel and steadfast protection in an ever-evolving legal landscape.
