Hiring Injectors in Texas Med Spas: W-2 vs. 1099 Classifications

As Texas med spas continue to grow, many owners are hiring aesthetic injectors such as nurse practitioners, physician assistants, or RNs to meet demand. But a common legal and tax compliance question arises: should your injector be classified as a W-2 employee or a 1099 independent contractor? Getting this wrong can expose the business to liability, fines, and even back taxes. Here is what Texas med spa owners need to know.

The Basics: W-2 vs. 1099

W-2 Employees

• Paid a salary or hourly wage.

• Employer withholds income taxes, Social Security, and Medicare.

• Eligible for benefits (if offered), such as health insurance or paid time off.

• Business controls when, where, and how work is performed.

1099 Independent Contractors

• Paid per job, shift, or commission without tax withholdings.

• No benefits and responsible for their own taxes.

• Operate with more autonomy.

• May provide services to multiple clients/businesses.

The Legal Risk of Misclassification

Many med spas attempt to classify injectors as 1099 contractors to save on employment taxes and benefits. However, misclassification can lead to serious consequences, including:

• IRS audits and back taxes.

• Penalties from the Texas Workforce Commission.

• Lawsuits for unpaid overtime, unemployment, or wrongful termination.

• Issues with the Texas Medical Board if medical supervision or delegation is improperly structured.

In general, if your business:

• Dictates work hours,

• Requires use of your equipment,

• Sets pricing or treatment protocols,

• Prohibits working at other locations,

• Or otherwise exercises control over how injectors do their job…

…then those injectors should likely be classified as W-2 employees.

Supervision and Delegation: A Texas-Specific Concern

Under Texas law, aesthetic procedures such as Botox or dermal fillers are considered medical acts and must be properly delegated by a physician. Even if the injector is a nurse practitioner or PA, they must work:

• Under physician delegation, and

• With appropriate supervision and protocols in place.

If your injector is not truly independent - for example, they cannot lawfully perform procedures without a supervising physician and delegation - then it further supports W-2 classification.

When Can a 1099 Relationship Work?

While less common, it may be possible to engage an injector as a true independent contractor if:

• They run their own business,

• Carry malpractice insurance,

• Have multiple clients,

• Provide their own equipment and supplies,

• Set their own schedule and pricing, and

• Operate independently within the scope of lawful delegation.

Best Practices for Med Spa Owners

1.     Consult an attorney and CPA familiar with Texas med spa law and IRS classification rules.

2.     Use a written contract but remember that calling someone a contractor does not make it legally true.

3.     Avoid over-controlling 1099s. Autonomy is key if you want the classification to hold.

4.     Review supervision requirements under Texas Medical Board regulations.

5.     Consider the whole relationship, not just cost savings.

Final Thoughts on Hiring Injectors in Texas Med Spas: W-2 vs. 1099 Classifications

Hiring injectors can be a powerful way to grow your med spa, but you must carefully evaluate whether a W-2 or 1099 classification is appropriate. In many cases, especially where medical delegation is involved and injectors operate under your protocols and control, a W-2 relationship is the safer and more legally compliant choice in Texas, although under certain circumstances a 1099 affiliation may work.

Feel free to reach out if you need more specific information or further clarification.

Weitz Morgan is a leading law firm in Texas in providing comprehensive advice and guidance to med spas. With a deep understanding of the unique challenges and complexities faced by this rapidly growing industry, our team of experienced attorneys is dedicated to helping med spas navigate the legal landscape successfully.

We recognize that med spas operate at the intersection of healthcare and beauty, which necessitates a multifaceted approach to representation. Our firm offers a range of services, including a flat-fee med spa formation package and an outside general counsel subscription, tailored to meet the specific needs of med spas, ensuring compliance, mitigating risks, protecting licenses, and fostering a legally sound business environment.