Guide
Do you need a medical director to offer peptides?
Not for a telehealth peptide program run through a licensed medical practice: the practice brings its own medical director, prescribers and collaborating physicians, and that is what ConduitMD supplies. Yes for anything your staff physically do to a client on your premises, such as injections, IV therapy or laser, in most states. The whole question comes down to one sentence: you need your own medical director for what you do to a client, not for what a licensed practice does over telehealth.
Three roles
What does a medical director actually do, and how is it different from a prescriber?
Most confusion in this area comes from treating three jobs as one. They carry different licenses, different liability and different pay logic, and a peptide program needs all three covered.
| Role | What it is | Who can hold it |
|---|---|---|
| Prescriber | Evaluates the client and writes the prescription. Must be licensed in the client's state. | MD, DO, NP or PA with prescriptive authority |
| Collaborating or supervising physician | Required where nurse practitioners or physician assistants lack full practice authority. A written agreement, often with chart-review duties. | MD or DO only |
| Medical director | Governance: protocols, standing orders, screening logic, chart review, quality assurance and staff competency. Frequently a facility-level requirement under state law. | Usually MD or DO |
Takeaway: a medical director is a governance role, not a prescribing role. Hiring one does not give you a prescriber, and hiring a prescriber does not give you medical direction.
Who needs their own
When do you need your own medical director?
Whenever you physically do something to a client. Never for what a licensed practice does over telehealth. By partner profile:
| Partner | Needs their own medical director? | What they need from the practice |
|---|---|---|
| Gym, trainer, coach, no clinical operation | No | Everything clinical for the telehealth program: practice, prescriber, collaborating physician, medical director |
| Wellness brand or investor-backed brand, telehealth only | No | Everything clinical, at scale, under a contracted clinical network |
| Licensed clinic with a physical location | Yes, for its own premises | Telehealth prescribing in states where the clinic is not licensed |
| Med spa doing injectables on site | Yes, and it is a statutory facility requirement in most states | The telehealth peptide line only, kept cleanly separate from in-person services |
Texas requires a physician to delegate any medical act performed at a med spa. California requires a medical director who signs the standardized procedures. A practice directing a telehealth encounter does not reach a nurse injecting in someone else's clinic, and the partner agreement says so in writing.
Covered
What does the practice's medical director cover?
Everything clinical for the telehealth peptide line.
- Protocols, contraindication logic and standing orders for the telehealth peptide programs
- Chart review and quality assurance on screenings, prescriptions and refills
- The prescriber licensed in each client's state, on every order
- A collaborating physician wherever a nurse practitioner requires one
- Malpractice coverage for the practice and its clinicians
Not covered
What does it not cover?
Anything inside your building, and any decision that is not the practice's to make.
- Injections, infusions, laser or any procedure your staff perform on your premises
- Your facility's medical director requirement under your state's med spa or clinic rules
- Any clinical decision made by you or your staff, which the agreement prohibits
- Controlled substances, which are not offered on the platform
This boundary is an explicit clause in every partner agreement. A partner who assumes the practice's director covers their infusion suite is the most common and most expensive misunderstanding in this business. More on the compliance page.
Scale
Why can one physician not direct an unlimited number of partners?
Because state supervision rules cap it. Twenty-seven states plus DC give nurse practitioners full practice authority. The rest require a written collaborative agreement, chart review or a supervision ratio, and several cap how many clinicians one physician may cover. South Carolina, for example, limits a physician to six full-time APRN practice agreements.
ConduitMD capacity model, about 600 asynchronous reviews per nurse practitioner per month
| Patients | Reviews per month | Nurse practitioners | Collaborating physicians in ratio states |
|---|---|---|---|
| 1,000 | 857 | 2 | 1 |
| 2,500 | 2,143 | 4 | 1 |
| 5,000 | 4,285 | 8 | 2 |
| 10,000 | 8,570 | 15 | 3 |
Takeaway: at 5,000 patients a program already exceeds a six-clinician cap in the states that impose one. That is why a second physician is a first-enterprise-partner cost, not a thirtieth-partner cost, and why medical direction is priced into a flat fee rather than sold as a retainer.
What replaces the retainer
What does medical direction cost through a platform?
Nothing separate. The practice's medical director, prescribers, collaborating physicians and malpractice for the telehealth line sit inside two flat fees: a provider fee per visit and a platform fee per month, with medication and shipping at pharmacy cost.
Sources
Where the rules on this page come from
- AANP, State Practice Environment
Which states give nurse practitioners full, reduced or restricted practice authority.
- Texas Occupations Code, Chapter 157
Physician delegation of prescriptive authority to APRNs and PAs in Texas.
- California Business and Professions Code 2725
Nurse practitioner practice under standardized procedures in California.
- South Carolina Code 40-33-34
APRN practice agreements and the cap on how many a physician may hold.
- American Med Spa Association
What a med spa medical director is responsible for, and why it is a facility role.
- Gym Lawyers PLLC via Two-Brain Business
Operator-side exposures for gyms offering GLP-1s and peptides, and referral to a licensed provider as the safe path.
Not sure which side of the line your business is on?
Tell us what you do on your premises and where your clients live. We answer in one business day, and the answer goes through counsel before any agreement.
Frequently asked
Medical director questions
Do I need a medical director to offer peptides?
Not for a telehealth peptide program run through a licensed practice. The practice supplies its own medical director, prescribers and collaborating physicians, and its medical director governs that telehealth service. You do need your own medical director for anything your staff physically do to a client on your premises, such as injections, IV therapy or laser, in most states.
What is the difference between a medical director, a prescriber and a collaborating physician?
The prescriber is the clinician who evaluates the client and writes the prescription, and must be licensed in the client's state. A collaborating physician is an MD or DO who supervises nurse practitioners in the roughly 23 states without full practice authority. The medical director owns protocols, standing orders, chart review and quality for a service or facility. They are three jobs, often confused, and a peptide program needs all three covered.
Does a gym or coach need a medical director to offer a peptide program?
No. A gym, trainer or coach running a telehealth peptide program through ConduitMD does no clinical work, so no facility-level medical director applies. The practice's medical director covers the screening review, prescribing and refills.
Does a med spa need its own medical director for peptides?
A med spa that offers a telehealth peptide program gets the practice's medical direction for that program. A med spa that injects, infuses or performs procedures on site still needs its own medical director for those services under its state's law; the telehealth practice's director does not reach them, and the agreement says so.
Can one physician be medical director for many partners?
For the telehealth service, yes, up to the point state supervision caps bite. Twenty-seven states plus DC let nurse practitioners practice fully; the rest require a collaborating physician, and some cap how many clinicians one physician may cover. That is why ConduitMD plans a second physician at the first enterprise partner rather than the thirtieth.
What replaces a medical director retainer?
Two flat fees: a provider fee per visit and a platform fee per month, with medication and shipping at pharmacy cost. The practice's medical director, prescribers, collaborating physicians and malpractice are inside that, for the telehealth line only.
Nothing on this page is legal advice. State requirements vary and change, and every partner structure is reviewed by healthcare counsel before launch. ConduitMD provides software and management services to an independent medical practice and its partners; it does not prescribe or dispense.