Free medical director job description templates for small practices: urgent care, med spa, hospice, SNF, and behavioral health. MD/DO and compliance notes.
6 templates by setting, plus a part-time agreement. Download as DOCX.
The medical director job description is unlike most hiring documents, because in many settings it is not just a job, it is a legal requirement that must be filled by a physician. A med spa needs a supervising physician to operate, a hospice and a skilled nursing facility are federally required to designate one, and an urgent care clinic usually needs physician oversight for its providers. These are very different roles with very different rules, and a generic template handles none of them well.
At FirstHR, we build templates for the small healthcare businesses that hit this requirement, the med spas, urgent care clinics, hospices, nursing homes, and behavioral health programs where the owner or administrator has to find a qualified physician and structure the arrangement correctly. The six templates below cover the role by setting, plus a part-time agreement for the common 1099 arrangement, each with the physician requirements and compliance notes built in. Fill in the brackets, and the guide to writing a job description covers the fundamentals.
TL;DR
Six free medical director job description templates by setting, General / Small Practice, Urgent Care, Med Spa, Hospice, Nursing Home / SNF, and Behavioral Health / SUD, plus a part-time / 1099 agreement. Three things this role demands that generic templates miss: it must be a licensed MD or DO, it is usually a part-time contractor, and the physician is FLSA-exempt. Always verify the rules for your setting and state with counsel.
What Is a Medical Director?
A medical director is the physician who provides clinical leadership and oversight for a healthcare organization or program: setting standards of care, supervising clinical staff, overseeing quality and compliance, and serving as the designated physician the law often requires. The role is usually classified by the Bureau of Labor Statistics under medical and health services managers (SOC 11-9111) when it is primarily administrative, though an actively practicing medical director maps to the physician occupations instead, which is why pay figures vary so widely.
For the employer, the defining features are that the role almost always must be a physician, that at a small practice it is usually part-time, and that the specific requirements depend heavily on the setting. The six templates here split by setting, urgent care, med spa, hospice, and so on, so the document reflects the actual rules rather than a generic definition.
Who Is Required to Have a Medical Director?
Several small-practice settings are legally required to designate a physician medical director, which is what makes this hire urgent rather than optional. The requirement comes from federal CMS rules in some settings and state rules in others.
Setting
Medical director required?
Source
Hospice
Yes, federally
CMS 42 CFR 418.102
Skilled nursing / SNF
Yes, federally
CMS 42 CFR 483.70(g)
Dialysis (ESRD)
Yes, with specific training
CMS 42 CFR 494.140
Med spa
Usually, by state
State medical board rules
Urgent care
Often, by state
State rules / provider supervision
Home health
Not federally required
Varies by state
Because the requirement and its specifics differ by setting and state and change over time, confirm what applies to your practice with your state medical board and a healthcare attorney. The templates below are organized by setting to reflect these differences, with the federally required settings (hospice, SNF) carrying the relevant CMS citation.
Medical Director Duties and Responsibilities
Medical director duties center on clinical leadership, oversight and supervision, quality and safety, and compliance and regulation. The specific tasks shift by setting, certifying terminal illness in hospice, supervising injectors in a med spa, but these four categories hold across the role. These are the duties grouped the way the templates use them.
Clinical leadership
Set standards of care and protocols
Approve clinical policies
Advise leadership on clinical matters
Oversight and supervision
Supervise providers and clinical staff
Review charts and documentation
Be available for escalations and emergencies
Quality and safety
Oversee quality assurance
Support patient safety initiatives
Participate in peer review
Compliance and regulation
Ensure regulatory compliance for the setting
Support credentialing
Keep oversight current as rules change
A strong posting grounds these in your specifics: the setting, the providers being supervised, the regulatory framework, and the time commitment. For a structured way to scope any role before posting, the guide to defining job responsibilities walks through the process.
Which Template Should You Use?
Pick the template by your setting, since that determines both the duties and the legal requirements. The clinical-oversight core runs through all six, but the compliance specifics differ enough that the matched version is essential. Use this guide to choose.
General / Small Practice
Any small practice
The universal baseline: clinical leadership, oversight, quality, and compliance, with the physician requirements built in. Start here.
Urgent Care
Often part-time, best SMB fit
For an urgent care clinic: protocols, supervising NPs and PAs, and clinical oversight, frequently a part-time role.
Medical Spa (Supervising Physician)
State-required oversight
For a med spa where the state requires physician supervision of aesthetic services. Includes a state-law caution, since rules vary and change.
Hospice (CMS-Compliant)
Federally required role
For a hospice, where CMS requires a designated MD or DO medical director. Includes the certifying and oversight duties the rule expects.
Nursing Home / SNF (CMS-Compliant)
Federally required role
For a skilled nursing facility, where CMS requires a designated medical director responsible for resident care policies and care coordination.
Behavioral Health / SUD
Psychiatric oversight, DEA
For a behavioral health or substance use program: psychiatric oversight, medication management, and the DEA layer for controlled substances.
Medical Director Agreement
Part-time / 1099 terms
Key contract terms for the common part-time or 1099 arrangement: fair-market-value pay, malpractice and tail, compliance, and notice period.
Match the Template to the Setting
A small general practice: General. An urgent care clinic: Urgent Care. A med spa needing supervision: Med Spa. A hospice or nursing home: the CMS-compliant Hospice or SNF version. A behavioral health or SUD program: Behavioral Health. Structuring a part-time engagement: add the Medical Director Agreement. Every version requires a licensed MD or DO and is FLSA-exempt.
6 Medical Director Templates Plus an Agreement
Download all seven as a single Word document or copy individual templates. The six job descriptions follow the same structure: practice overview, position summary, key responsibilities, the physician requirements, the engagement and FLSA note, and fair-market-value compensation. The seventh is a part-time medical director agreement. Fill in the brackets and have counsel review.
Download All 7 Templates
Six medical director job descriptions by setting plus a part-time agreement. All in one DOCX.
Template 1: General / Small Practice Medical Director
The universal baseline: clinical leadership, oversight, quality, and compliance, with the physician requirements built in. Start here.
Medical Director Job Description (General / Small Practice)
MEDICAL DIRECTOR JOB DESCRIPTION
Practice: __ ([City, State])
Reports to: [Practice Owner / Administrator / CEO]
Engagement: [Part-time / Full-time; W-2 employee or 1099 contractor]
FLSA status: Exempt (physician; practice of medicine)
Compensation: $_ [per hour / month / year]
ABOUT [PRACTICE NAME]
[One or two sentences: your practice, setting, and the clinical
team this physician will provide oversight for.]
POSITION SUMMARY
[Practice Name] is seeking a Medical Director to provide clinical
leadership and oversight. As the designated physician, you will set
clinical standards, supervise clinical staff and providers, oversee
quality and compliance, and ensure care meets professional and
regulatory standards.
KEY RESPONSIBILITIES
•Provide clinical leadership and set standards of care
•Supervise and support clinical staff and providers
•Develop and approve clinical protocols and policies
•Oversee quality assurance and patient safety
•Ensure compliance with applicable regulations
•Be available for clinical questions and emergencies
•Review charts and clinical documentation as required
•Participate in credentialing and peer review
•Advise leadership on clinical and regulatory matters
PHYSICIAN REQUIREMENTS (CONFIRM PER STATE AND SETTING)
•Doctor of Medicine (MD) or Doctor of Osteopathy (DO)
•Active, unrestricted [state] medical license
•Board certification [specialty: ______]
•DEA registration [if controlled substances are involved]
•Malpractice coverage [and tail/runoff as agreed]
•Meets all federal and state requirements for this setting
ENGAGEMENT AND HOW TO APPLY
[Part-time / full-time; estimated hours: ______]
[W-2 employee or 1099 independent contractor: ______]
Compensation: $_ [per hour / month / year], set at fair
market value and not based on referrals or volume.
To apply, email __ with your CV.
[Practice Name] is an equal opportunity employer.
Template 2: Urgent Care Medical Director
For an urgent care clinic: protocols, supervising NPs and PAs, and clinical oversight, frequently a part-time role.
Urgent Care Medical Director Job Description
URGENT CARE MEDICAL DIRECTOR JOB DESCRIPTION
Clinic: __ ([City, State])
Reports to: [Owner / Administrator]
Engagement: [Part-time, often 1099 contractor; confirm]
FLSA status: Exempt (physician; practice of medicine)
Compensation: $_ [per hour / month]
POSITION SUMMARY
[Clinic Name] is seeking a Medical Director to provide clinical
oversight for our urgent care clinic. You will set clinical
protocols, supervise providers (including NPs and PAs), oversee
quality, and ensure our care meets clinical and regulatory
standards. This is frequently a part-time role.
KEY RESPONSIBILITIES
•Set and maintain urgent care clinical protocols
•Supervise NPs, PAs, and clinical staff per state rules
•Oversee quality, safety, and clinical outcomes
•Review charts and provide clinical guidance
•Ensure compliance with state and federal requirements
•Be reachable for clinical escalations
•Support credentialing and provider onboarding
•Advise on equipment, formulary, and scope of services
PHYSICIAN REQUIREMENTS (CONFIRM PER STATE AND SETTING)
•Doctor of Medicine (MD) or Doctor of Osteopathy (DO)
•Active, unrestricted [state] medical license
•Board certification [specialty: ______]
•DEA registration [if controlled substances are involved]
•Malpractice coverage [and tail/runoff as agreed]
•Meets all federal and state requirements for this setting
PREFERRED
•Emergency medicine, family medicine, or urgent care background
•Experience supervising advanced practice providers
ENGAGEMENT AND HOW TO APPLY
[Part-time; estimated hours: ______]
[Often a 1099 independent contractor; confirm classification]
Compensation: $_ at fair market value, not based on
referrals or volume.
To apply, email __ with your CV.
[Clinic Name] is an equal opportunity employer.
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Template 3: Medical Spa Medical Director / Supervising Physician
For a med spa where the state requires physician supervision of aesthetic services. Includes a state-law caution, since rules vary and change.
Medical Spa Medical Director / Supervising Physician Job Description
MEDICAL SPA MEDICAL DIRECTOR (SUPERVISING PHYSICIAN) JOB DESCRIPTION
Med Spa: __ ([City, State])
Reports to: [Owner]
Engagement: [Part-time, typically 1099 contractor; confirm]
FLSA status: Exempt (physician; practice of medicine)
Compensation: $_ per month [or per hour]
POSITION SUMMARY
[Med Spa Name] is seeking a Medical Director / Supervising Physician
to provide the physician oversight that most states require for
aesthetic medical services. You will establish protocols, oversee
delegated procedures, review charts as required, and ensure the
practice meets your state's medical-supervision rules.
KEY RESPONSIBILITIES
•Provide the physician oversight required by state law
•Establish and approve treatment protocols and standing orders
•Oversee good-faith exams and delegation of procedures
•Review charts and clinical documentation per state rules
•Ensure injectors and staff work within their scope
•Be available for clinical questions and emergencies
•Keep oversight current as state rules change
PHYSICIAN REQUIREMENTS (CONFIRM PER STATE AND SETTING)
•Doctor of Medicine (MD) or Doctor of Osteopathy (DO)
•Active, unrestricted [state] medical license
•Board certification [specialty: ______]
•DEA registration [if controlled substances are involved]
•Malpractice coverage [and tail/runoff as agreed]
•Meets all federal and state requirements for this setting
IMPORTANT STATE-LAW NOTE
Medical spa supervision and ownership rules vary significantly by
state and change often. Some states limit who may own the practice
(corporate practice of medicine) and require genuine, documented
oversight, not a name-only arrangement. Verify current requirements
with your state medical board and a healthcare attorney.
ENGAGEMENT AND HOW TO APPLY
[Part-time; estimated hours and on-site presence: ______]
[Typically a 1099 independent contractor; confirm classification]
Compensation: $_ per month at fair market value, not based
on referrals or treatment volume.
To apply, email __ with your CV.
[Med Spa Name] is an equal opportunity employer.
Template 4: Hospice Medical Director (CMS-Compliant)
For a hospice, where CMS requires a designated MD or DO medical director. Includes the certifying and oversight duties the rule expects.
Hospice Medical Director Job Description (CMS-Compliant)
HOSPICE MEDICAL DIRECTOR JOB DESCRIPTION
Hospice: __ ([City, State])
Reports to: [Administrator / Governing Body]
Engagement: [Employee or under contract, per CMS]
FLSA status: Exempt (physician; practice of medicine)
Compensation: $_ [per hour / month / year]
POSITION SUMMARY
[Hospice Name] is seeking a Hospice Medical Director, the designated
physician CMS requires every hospice to have. You will oversee the
medical component of the hospice's patient care program, certify
terminal illness, and lead the interdisciplinary clinical team.
KEY RESPONSIBILITIES
•Serve as the designated physician for the hospice program
•Provide and oversee the medical component of patient care
•Certify and recertify terminal illness as required
•Review eligibility and the plan of care
•Lead or support the interdisciplinary group
•Supervise clinical staff and consult on complex cases
•Ensure compliance with hospice Conditions of Participation
•Be available for clinical guidance
PHYSICIAN REQUIREMENTS (CONFIRM PER STATE AND SETTING)
•Doctor of Medicine (MD) or Doctor of Osteopathy (DO)
•Active, unrestricted [state] medical license
•Board certification [specialty: ______]
•DEA registration [if controlled substances are involved]
•Malpractice coverage [and tail/runoff as agreed]
•Meets all federal and state requirements for this setting
CMS REQUIREMENT
Federal rules require every hospice to designate a physician as
medical director who is an MD or DO and is an employee of or under
contract with the hospice (42 CFR 418.102). Confirm current
requirements with counsel.
ENGAGEMENT AND HOW TO APPLY
[Employee or contractor, per CMS; estimated hours: ______]
Compensation: $_ at fair market value, not based on
referrals or volume.
To apply, email __ with your CV.
[Hospice Name] is an equal opportunity employer.
Template 5: Nursing Home / SNF Medical Director (CMS-Compliant)
For a skilled nursing facility, where CMS requires a designated medical director responsible for resident care policies and care coordination.
Nursing Home / SNF Medical Director Job Description (CMS-Compliant)
NURSING HOME / SNF MEDICAL DIRECTOR JOB DESCRIPTION
Facility: __ ([City, State])
Reports to: [Administrator / Governing Body]
Engagement: [Part-time, often 1099 contractor; confirm]
FLSA status: Exempt (physician; practice of medicine)
Compensation: $_ [per hour / month / year]
POSITION SUMMARY
[Facility Name] is seeking a Medical Director, the designated
physician CMS requires for skilled nursing facilities. You will be
responsible for implementing resident care policies and
coordinating medical care across the facility.
KEY RESPONSIBILITIES
•Serve as the facility's designated medical director
•Implement and oversee resident care policies
•Coordinate medical care and clinical standards
•Support quality assurance and performance improvement
•Advise on infection control and clinical protocols
•Supervise and consult with attending physicians and staff
•Ensure compliance with SNF Conditions of Participation
•Participate in regulatory surveys as needed
PHYSICIAN REQUIREMENTS (CONFIRM PER STATE AND SETTING)
•Doctor of Medicine (MD) or Doctor of Osteopathy (DO)
•Active, unrestricted [state] medical license
•Board certification [specialty: ______]
•DEA registration [if controlled substances are involved]
•Malpractice coverage [and tail/runoff as agreed]
•Meets all federal and state requirements for this setting
CMS REQUIREMENT
Federal rules require each skilled nursing facility to designate a
physician to serve as medical director, responsible for resident
care policies and coordination of medical care (42 CFR 483.70(g)).
Confirm current requirements with counsel.
ENGAGEMENT AND HOW TO APPLY
[Part-time; estimated hours: ______]
[Often a 1099 independent contractor; confirm classification]
Compensation: $_ at fair market value, not based on
referrals or volume.
To apply, email __ with your CV.
[Facility Name] is an equal opportunity employer.
Template 6: Behavioral Health / SUD Medical Director
For a behavioral health or substance use program: psychiatric oversight, medication management, and the DEA layer for controlled substances.
Behavioral Health / SUD Medical Director Job Description
BEHAVIORAL HEALTH / SUD MEDICAL DIRECTOR JOB DESCRIPTION
Practice / Program: __ ([City, State])
Reports to: [Executive Director / Administrator]
Engagement: [Part-time or full-time; W-2 or 1099; confirm]
FLSA status: Exempt (physician; practice of medicine)
Compensation: $_ [per hour / month / year]
POSITION SUMMARY
[Program Name] is seeking a Medical Director to provide clinical and
psychiatric oversight for our behavioral health and substance use
disorder program. You will set clinical standards, oversee
medication management and providers, and ensure compliance with the
regulations specific to behavioral health and SUD treatment.
KEY RESPONSIBILITIES
•Provide psychiatric and clinical oversight for the program
•Set clinical protocols for behavioral health and SUD care
•Oversee medication management, including MAT where applicable
•Supervise prescribers and clinical staff
•Ensure compliance with behavioral health and SUD regulations
•Support quality, safety, and outcomes measurement
•Be available for clinical escalations and emergencies
•Advise leadership on clinical and regulatory matters
PHYSICIAN REQUIREMENTS (CONFIRM PER STATE AND SETTING)
•Doctor of Medicine (MD) or Doctor of Osteopathy (DO)
•Active, unrestricted [state] medical license
•Board certification [specialty: ______]
•DEA registration [if controlled substances are involved]
•Malpractice coverage [and tail/runoff as agreed]
•Meets all federal and state requirements for this setting
ADDITIONAL FOR SUD PROGRAMS
•DEA registration is required to prescribe controlled substances,
including medication-assisted treatment (MAT)
•Confirm current federal and state requirements for SUD treatment
•[Psychiatry or addiction medicine background preferred]
ENGAGEMENT AND HOW TO APPLY
[Part-time or full-time; estimated hours: ______]
[W-2 employee or 1099 contractor; confirm classification]
Compensation: $_ at fair market value, not based on
referrals or volume.
To apply, email __ with your CV.
[Program Name] is an equal opportunity employer.
Template 7: Part-Time / 1099 Medical Director Agreement
Key contract terms for the common part-time or 1099 arrangement: fair-market-value pay, malpractice and tail, compliance, and notice period. Read the employee-vs-contractor section below before using it.
Part-Time / 1099 Medical Director Agreement (Key Terms)
MEDICAL DIRECTOR SERVICES AGREEMENT (KEY TERMS)
This is a template of common terms, not legal advice. Medical
director arrangements carry licensing, classification, fair-market-
value, Anti-Kickback, and state corporate-practice-of-medicine
implications. Have a healthcare attorney prepare and review before
use.
This Agreement is between:
Client: __ ([City, State])
Medical Director (Physician): Dr. __
Effective date: _
1. SERVICES
The Physician will serve as Medical Director and provide the
clinical oversight services described in the attached job
description [insert setting-specific scope].
2. ENGAGEMENT AND TIME COMMITMENT
[Part-time / full-time; estimated hours per week or month: ____]
[On-site presence and availability requirements: ____]
[W-2 employee or 1099 independent contractor: ____]
3. COMPENSATION (FAIR MARKET VALUE)
Compensation: $_ [per hour / month], set at fair market
value for the services and time required. Compensation is NOT based
on the volume or value of referrals or services, consistent with
Anti-Kickback and Stark requirements. [Invoicing / payment terms.]
4. LICENSURE, CREDENTIALS, AND DEA
The Physician will maintain an active MD/DO license, required board
certification, malpractice coverage, and, where applicable, DEA
registration, throughout the term.
5. MALPRACTICE AND TAIL COVERAGE
[Specify who carries malpractice coverage and whether tail/runoff
coverage is required on termination.]
6. COMPLIANCE
The Physician will provide genuine, documented oversight consistent
with applicable CMS Conditions of Participation, state medical-board
rules, and corporate-practice-of-medicine and fee-splitting laws.
7. INDEPENDENT CONTRACTOR STATUS (IF 1099)
[If 1099: the Physician is an independent contractor responsible for
their own taxes; not eligible for employee benefits. Confirm
classification under IRS rules.]
8. TERM AND TERMINATION
Term: [start date and term].
Either party may terminate without cause on [60-90] days written
notice, to allow for succession and continuity of oversight.
[Termination for cause provisions.]
9. SIGNATURES
Client: __ Date: ___
Medical Director: ______ Date: ___
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This is the structural reality that shapes the whole hire: at a small practice, the medical director is usually part-time and often a 1099 contractor, not a full-time employee. Getting the structure and the compensation right is a compliance matter, not just a budgeting one.
Factor
Typical small-practice medical director
Time
Part-time: oversight, availability, chart review
Structure
Often 1099 contractor on a stipend; confirm classification
Pay
Fair market value for time and services, not referrals
FLSA
Exempt (physician), regardless of hourly or salaried
Contract
A services agreement with a 60 to 90 day notice period
Compensation Must Be Fair Market Value, Not Referral-Based
Medical director pay must reflect fair market value for the actual time and services and must never be tied to the volume or value of referrals, because Anti-Kickback, Stark, and state fee-splitting rules govern these arrangements. The employee-versus-contractor classification is also a real determination, not a free choice. These arrangements carry licensing and compliance risk, so have a healthcare attorney prepare and review the agreement.
The agreement template above captures the terms that matter for a part-time engagement. Because the medical director is usually a contractor rather than a W-2 hire, this role is the exception to normal onboarding, a point the onboarding section returns to.
Physician Requirements and Credentials
The medical director must be a physician, and in regulated settings this is non-negotiable. List the credentials clearly in the posting so you attract only qualified candidates and satisfy the requirement.
Requirement
Detail
License
MD or DO with an active, unrestricted state license
Board certification
Usually required; specialty depends on setting
DEA registration
Required where controlled substances are involved
Setting-specific
Dialysis requires specific nephrology training
Malpractice
Coverage, and tail/runoff as agreed
Nurse practitioners and physician assistants generally cannot serve as the medical director in these regulated settings; they are the providers the medical director supervises. Keep the requirements job-related and the language neutral, since the EEOC prohibits job advertisements showing a preference based on protected characteristics. For a fuller framework, the SHRM guide to writing a job description covers the standard sections. For the physician hires the director supervises, see the physician job description.
FLSA: Are Medical Directors Exempt or Non-Exempt?
A medical director is exempt. Physicians get a particularly clear exemption, but the staff they supervise often do not, which is the distinction to watch.
Physicians Are Exempt, Even If Paid Hourly
Licensed physicians are exempt from overtime under the professional exemption for the practice of medicine, and federal rules specifically exempt them from the salary-basis test that applies to most other exempt employees (29 CFR 541.304). So a medical director is exempt even if paid hourly. The supervised staff, NPs, PAs, medical assistants, and front-office workers, are often non-exempt; classify each on its own facts.
Mark the medical director role exempt, but do not assume the rest of your clinical and administrative team shares that status. For the underlying rules, the exempt vs non-exempt guide and the Fair Labor Standards Act guide explain the tests. This is general information, not legal advice; confirm with an employment attorney, since state rules can be stricter than federal.
Compensation and Fair Market Value
Medical director pay varies enormously because the role spans administrative management and practicing-physician work, and because small-practice arrangements are usually part-time stipends rather than full salaries.
Medical Director Pay Anchors (BLS)
Primarily administrative medical and health services managers had a median annual wage of $117,960 in May 2024 (10th percentile $69,680; 90th percentile $219,080), with the field projected to grow 23 percent through 2034. A medical director who actively practices medicine is better reflected by physician pay, which the BLS reports at a median of $239,200 or more (U.S. Bureau of Labor Statistics).
For a small practice hiring part-time, the real figure is usually a stipend: med spa oversight commonly runs a few thousand dollars a month, and urgent care oversight is often hourly or a monthly fee. Whatever the structure, the compensation must reflect fair market value for the time and services and must not be based on referrals or volume. National compensation surveys and a healthcare attorney can help you set a defensible rate.
Hiring a Medical Director for a Small Practice
A hospital recruits physician executives through a credentialing office. A small practice does this directly, and faces three realities most hiring guides skip: the role must be a physician, it is usually a part-time contractor, and it is rarely the onboarding case the practice actually needs to solve. Here is how to handle all three.
A medical director must be a licensed MD or DO, not an NP or PA
In the settings where the law requires a medical director, the role must be filled by a physician, a Doctor of Medicine (MD) or Doctor of Osteopathy (DO), with an active state license and usually board certification. Nurse practitioners and physician assistants, however skilled, generally cannot serve as the medical director in these regulated contexts; instead, they are the clinicians the medical director supervises. This is the single most important thing to get right in the posting, because hiring the wrong credential does not satisfy the requirement and can put your license, contracts, and reimbursement at risk. Some settings add further specifics: dialysis centers require particular nephrology training and experience, and substance use programs require DEA registration to prescribe controlled substances. Every template here states the physician requirement explicitly and leaves room for the board certification, DEA, and state-specific items your setting demands. Confirm the exact requirements with your state medical board and a healthcare attorney, since they vary by state and by setting.
At a small practice, the medical director is usually part-time and often a 1099 contractor
Unlike a hospital, a small practice, med spa, urgent care clinic, or hospice rarely needs, or can afford, a full-time physician executive. In practice, the medical director role at this scale is usually part-time and frequently structured as a 1099 independent contractor on a monthly or hourly stipend rather than a W-2 employee. Compensation has to be set at fair market value for the actual time and services, and it must not be tied to the volume or value of referrals, because Anti-Kickback and Stark rules and state fee-splitting laws govern these arrangements. The 1099-versus-employee question is also a real classification decision, not a free choice, so confirm it under the applicable rules. The agreement template on this page captures the terms that matter for the part-time arrangement: fair-market-value pay, malpractice and tail coverage, genuine documented oversight, independent-contractor status where it applies, and a notice period for ending the engagement. Because these arrangements carry licensing and compliance risk, have a healthcare attorney prepare and review the contract.
The medical director is rarely your onboarding case; the rest of your staff is
Here is the honest part: because the medical director is usually a part-time contractor rather than a W-2 hire, this specific role is not a typical onboarding case. What is a typical onboarding case is everyone else the practice employs, the nurses, medical assistants, aestheticians, front-office staff, and clinicians the medical director supervises. Those are the W-2 hires who need offer letters, I-9 and tax forms, confidentiality and policy acknowledgments, role and compliance training, and credential tracking, and they are exactly where a small practice without a large back office benefits from a repeatable process. FirstHR fits that people side: e-signature for offer letters, the medical director agreement, and policy acknowledgments, document management to store signed contracts, licenses, and credentials, task workflows for onboarding and offboarding, training assignments for role and compliance onboarding, an HRIS with an org chart and employee profiles to track licenses and renewal dates, and a self-service portal. FirstHR does not run payroll or administer benefits, so pair it with your payroll and benefits providers for those. Applicant tracking is coming soon to FirstHR.
After You Hire: Onboarding Your Team
The medical director is the exception to normal onboarding, since the role is usually a part-time contractor rather than a W-2 hire. For the medical director, the main steps are executing the services agreement and collecting and storing the license, board certification, DEA registration where applicable, and malpractice information, plus documenting the oversight arrangement.
What you actually onboard is the rest of your staff, the nurses, medical assistants, aestheticians, front-office team, and supervised clinicians the medical director oversees. Those W-2 hires need the offer letter and the full new hire paperwork (I-9 and tax forms), confidentiality and policy acknowledgments, role and compliance training, and credential tracking. The documents follow the usual sequence: the offer letter template for the terms and the onboarding checklist template for the first days, with signed onboarding documents kept in one place.
FirstHR fits this people side: e-signature for offer letters, the medical director agreement, and policy acknowledgments, document management to store signed contracts, licenses, and credentials, task workflows for onboarding and offboarding, training assignments for role and compliance onboarding, an HRIS with an org chart and employee profiles to track licenses and renewal dates, and a self-service portal, all of which help a small practice handle its staff cleanly even when the medical director sits outside the usual flow. FirstHR does not run payroll or administer benefits, so connect your payroll and benefits providers for those functions. Applicant tracking is coming soon to FirstHR.
Key Takeaways
A medical director provides clinical leadership and oversight, and in many settings the role is a legal requirement, not optional.
The role must be a licensed MD or DO; nurse practitioners and physician assistants are supervised by the medical director, not the reverse.
CMS requires a medical director for hospices, skilled nursing facilities, and dialysis; states often require one for med spas and urgent care.
At a small practice the role is usually part-time and often a 1099 contractor, with pay set at fair market value and never based on referrals.
The physician medical director is FLSA-exempt even if paid hourly, but the staff they supervise are often non-exempt.
The medical director is usually not your onboarding case; the W-2 staff they supervise are, which is where a repeatable process helps.
Frequently Asked Questions
What does a medical director do?
A medical director provides clinical leadership and oversight for a healthcare organization or program. The core work is consistent: setting clinical standards and protocols, supervising clinical staff and providers, overseeing quality and patient safety, ensuring regulatory compliance for the specific setting, being available for clinical questions and emergencies, and advising leadership on clinical and regulatory matters. The exact duties and legal requirements vary sharply by setting. An urgent care medical director supervises providers and sets clinic protocols, a med spa supervising physician provides the oversight states require for aesthetic services, a hospice or nursing home medical director fills a federally required role with specific duties, and a behavioral health medical director adds psychiatric oversight and medication management. Because the requirements differ so much, the templates on this page split by setting rather than offering one generic version, and each spells out the physician credentials the role demands.
Can a nurse practitioner or physician assistant be a medical director?
Generally no, not in the settings where a medical director is legally required. The medical director role in regulated contexts like med spas, hospices, skilled nursing facilities, and dialysis centers must be filled by a licensed physician, an MD or DO, usually with board certification. Nurse practitioners and physician assistants, however experienced, are typically the clinicians a medical director supervises, not the medical director themselves. In some states with full practice authority, an NP may own a practice or hold a title like clinical director, but that is a different role from the physician medical director the regulations require. Getting this right matters: hiring the wrong credential does not satisfy a legal requirement and can put licensing, contracts, and reimbursement at risk. Always confirm who may serve in the role with your state medical board and a healthcare attorney, since rules vary by state and by setting.
Which small practices are required to have a medical director?
Several settings are required by federal or state rules to designate a physician medical director. Federally, CMS requires one for hospices (the hospice must designate an MD or DO as medical director), skilled nursing facilities (a designated physician responsible for resident care policies and coordination of care), and dialysis centers (with specific nephrology training and experience requirements). At the state level, most states require physician supervision for medical spas and aesthetic services, and many require a medical director or supervising physician for urgent care and certain behavioral health and substance use programs. Home health is generally not federally required to have a medical director, though some agencies appoint one anyway. Because requirements differ by setting and state and change over time, confirm what applies to your specific practice with your state medical board and a healthcare attorney. The templates on this page are organized by setting to reflect these differences.
Is a medical director a full-time employee or a part-time contractor?
At a small practice, the medical director is usually part-time and frequently a 1099 independent contractor rather than a full-time W-2 employee. A small clinic, med spa, urgent care, or hospice rarely needs or can afford a full-time physician executive, so the role is commonly structured as a monthly or hourly stipend for oversight, availability, and chart review. That said, the employee-versus-contractor classification is a real determination under the applicable rules, not a free choice, so it should be confirmed rather than assumed. The compensation must be set at fair market value for the actual time and services and must not be tied to the volume or value of referrals, because Anti-Kickback, Stark, and state fee-splitting rules govern these arrangements. The agreement template on this page covers the terms that matter for a part-time engagement, including fair-market-value pay, malpractice and tail coverage, and a notice period. Have a healthcare attorney prepare the contract.
Is a medical director exempt or non-exempt under the FLSA?
A medical director is exempt. Physicians are exempt from overtime under the Fair Labor Standards Act through the professional exemption for the practice of medicine, and the federal rules specifically exempt licensed physicians from the salary-basis test that applies to most other exempt employees. That means a medical director is exempt even if paid hourly. This is the opposite of many of the roles the medical director supervises: nurse practitioners, physician assistants, medical assistants, and billing or front-office staff are often non-exempt and owed overtime, so do not assume the supervised clinical and administrative staff share the physician's exempt status. Classify each role on its own facts. For the medical director specifically, mark the role exempt, and confirm with counsel if you have any doubt about a particular arrangement. This is general information, not legal advice, and state rules can differ from federal.
How much does a medical director make?
It depends heavily on whether the role is a management position or a practicing physician role, which is why salary figures vary so widely. The Bureau of Labor Statistics classifies primarily administrative medical and health services managers with a median annual wage of $117,960 in May 2024 (10th percentile $69,680, 90th percentile $219,080). But a medical director who is an actively practicing physician is better reflected by physician pay, where the BLS reports a median at or above $239,200. For a small practice hiring a part-time medical director, the real number is usually a stipend rather than a full salary: med spa oversight commonly runs in the range of a few thousand dollars a month, and urgent care part-time oversight is often structured hourly or as a monthly fee. Whatever the structure, the compensation must reflect fair market value for the time and services and must not be based on referrals. National compensation surveys and a healthcare attorney can help you set a defensible rate.
Is a medical director required for home health?
Not federally. Unlike hospices, skilled nursing facilities, and dialysis centers, home health agencies are generally not required by federal CMS rules to designate a medical director. That said, a growing number of home health agencies appoint one anyway, for clinical oversight, quality, and sometimes to support specific services or certifications. State rules can also impose requirements, so the absence of a federal mandate does not mean there is no requirement in your state. If you run a home health agency and are deciding whether to bring on a medical director, treat it as a clinical and business decision rather than a default legal obligation, and confirm any state-level requirements with a healthcare attorney. If you do appoint one, the general and the part-time agreement templates on this page give you a starting point for the scope and the contract terms.
What happens after I hire for my practice?
The medical director is usually the exception to normal onboarding, since the role is typically a part-time contractor rather than a W-2 hire; what you onboard is the rest of your staff. For the medical director, the main steps are executing the services agreement, collecting and storing the license, board certification, DEA registration where applicable, and malpractice information, and documenting the oversight arrangement. For everyone else the practice employs, the nurses, medical assistants, aestheticians, front-office staff, and supervised clinicians, you run a normal onboarding: the offer letter, I-9 and tax forms, confidentiality and policy acknowledgments, role and compliance training, and credential tracking. FirstHR fits that people side: e-signature for offer letters, the medical director agreement, and policy acknowledgments, document management to store signed contracts, licenses, and credentials, task workflows for onboarding and offboarding, training assignments, an HRIS with an org chart and employee profiles to track licenses and renewal dates, and a self-service portal. FirstHR does not run payroll or administer benefits, so connect your payroll and benefits providers for those. Applicant tracking is coming soon to FirstHR.
