The Real Math on Medical Directorship for a Nurse-Owned Practice
Every nurse-owned practice pays for medical oversight somewhere. The harder question is whether you know what you're getting for the number, because most practices sign a directorship agreement once and never look at it again.
Here's what the market looks like in 2026. A nominal arrangement, where a director signs protocols, takes the occasional phone call, and rarely sees your practice, runs $500 to $1,500 a month. A moderately engaged director who reviews charts, trains, and shows up runs $2,000 to $5,000. Significant on-site involvement climbs past $5,000. Those ranges come from published law firm and industry compensation guides, and they match what nurses tell us they're paying.
Two things hide inside those numbers.
The first is how the fee is structured
Paying your director per treatment, or as a percentage of revenue, creates fee-splitting and anti-kickback exposure in most states. The compliant structure is a flat retainer.
This one catches good practices off guard, because a per-treatment arrangement feels fair. It scales with the work. If your agreement pays your director more when you treat more, that's worth a conversation with a healthcare attorney before a board has that conversation with you.
The second is what a cheap retainer actually buys
A $500-a-month director who signs your protocols and disappears isn't watching your charts, and they're not picking up when a patient needs a real evaluation before treatment. Then a state board asks how supervision worked at your practice and you're the one answering.
You're paying for a signature and carrying the risk yourself. Boards in Texas, New York, and elsewhere have spent the last two years demonstrating exactly what that looks like on the day it goes wrong. (We wrote up what compliant Good Faith Exam documentation requires here, since that's usually the first thing an inspector asks for.)
Run the math on your own setup
Start with your monthly director fee, then add your exam volume times whatever you pay per Good Faith Exam. On-demand services market-wide charge $27 to $28 each. Product's the third piece, and buying alone means buying at retail.
That's your real number. For most established practices it lands somewhere between $1,800 and $5,500 a month.
Now the comparison. Five Square's Established Nurse Membership is $799 a month, month to month. It includes the medical director, a compliant practice structure, vendor and product pricing, community access, and on-demand Good Faith Exams at $19.99 each, available seven days a week. We subsidize the exam price for our members because we believe in nurse success. There's no new-injector training folded in, because if you're reading this, you don't need it and you shouldn't be paying for it.
For a practice paying an engaged director $2,500 a month, the move saves a little over $20,000 a year before you count the exam and product savings.
For a practice on a $500 sign-and-disappear arrangement, $799 costs more. What that buys is a director who's actually involved and a paper trail that holds up. Whether that trade is worth it depends on how much risk you're comfortable carrying, and only you can price that for your own practice.
Send us what you're paying now and we'll show you the side by side, including the scenario where staying put is the right answer. Book a few minutes here and we'll go through it with you. Nobody's going to pitch you.
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