Yes, you can work as a self-employed cosmetic doctor in several clinics at the same time, and this is one of the most common arrangements in the sector. To do this properly, you need to have four things in order: be a registered member of the medical association, register as self-employed (or with the relevant mutual insurance scheme), have public liability insurance that covers your work at all clinics, and sign a service provision contract with each clinic that accurately reflects how you work. This guide goes through each point and what you should check before agreeing to a collaboration.
Professional registration and requirements for practising in private practice
The Law on Professional Bodies It requires registration with a professional body in order to practise medicine and stipulates that registration with the professional body corresponding to one’s sole or main place of practice is sufficient to practise throughout Spain. If you work in clinics in different provinces, you do not need to register with each one: you register with the body corresponding to where your main practice is based.
Furthermore, the Law 44/2003 on the regulation of the healthcare professions Article 4.8 sets out the requirements for practising, including not being disqualified or suspended and, in the case of private practice, holding valid liability insurance or a financial guarantee.
Registration as a self-employed person or with an alternative mutual insurance scheme
To invoice clinics as a self-employed professional, you must register with the tax authorities (census declaration) and with Social Security. Traditionally, registered doctors have been able to choose between the Special Scheme for Self-Employed Workers (RETA) and an alternative mutual insurance scheme.
That framework changed in 2026. The Act 2/2026 It provides for a voluntary transition from alternative mutual insurance schemes to the RETA, subject to the adoption of implementing regulations. If you are about to start now, check with your professional body or an adviser to find out which option is available to you before making a choice, as this decision will have long-term implications for your retirement and your benefits.
Invoicing: Income Tax and VAT
Income tax deduction
When you invoice a clinic, the clinic must deduct income tax at source. The Personal Income Tax Regulations It generally sets the rate at 15 per cent for professional activities, and at 7 per cent in the year in which the activity commences and the following two years, provided that you have not carried out any professional activity in the previous year and that you notify the payer of this. Keep a written record of this notification for each clinic.
VAT on cosmetic medicine
This is the point that raises the most questions. The Article 20(1)(3) of the VAT Act exempts the provision of care to individuals by medical professionals where the purpose is the diagnosis, prevention or treatment of illnesses. The Directorate-General for Taxation has reiterated, for example in binding ruling V1938-24, that services provided for purely cosmetic purposes are excluded from the exemption and are subject to tax, whilst those provided for restorative or therapeutic purposes may be exempt. Each case is assessed on a case-by-case basis.
In practice, if your work in clinics is predominantly cosmetic, it is advisable to have a tax adviser review how you should invoice, what VAT to charge and whether you need to separate exempt and non-exempt activities for the purposes of claiming deductions.
The contract with each clinic
Working for several clinics has one clear advantage: it reduces the risk of financial dependence. The Statute on Self-Employment It defines an economically dependent self-employed person (TRADE) as someone who receives at least 75 per cent of their income from a single client, and in such cases requires a written and registered contract. If a single clinic accounts for almost all your turnover, check whether you fall into this category.
It is also important that the contract reflects a genuine commercial relationship. If the clinic sets your full working hours, takes you on as a member of staff, pays you a fixed sum regardless of your workload and you do not bear any risk, the relationship may be more akin to that of an employee. Before signing, check that the contract clarifies at least the following:
- What services do you provide, and to what extent do you have clinical autonomy in deciding on treatments?
- How your remuneration is calculated (as a percentage, a fee per service or per day) and when it is paid.
- Who purchases and stores the product, and how batches are recorded.
- Who is responsible for patients’ medical records and the processing of their personal data?
- If there is a non-competition clause or a clause requiring you to work exclusively for one clinic, and what its scope is, as this may prevent you from working with other clinics.
- What happens to patients and their follow-up care if the collaboration comes to an end?
Health authorisation and responsibility at each centre
Every clinic you work at must have its own health authorisation to operate, which must include the U.48 aesthetic medicine unit as set out in the Royal Decree 1277/2003. Ask them to provide you with proof of this before you start: if the centre isn’t authorised to carry out that activity, you’ll be affected too. If at any point you want to see a doctor on your own, you’ll need your own authorisation; we explain this in Requirements for setting up a cosmetic medicine practice.
With regard to clinical documentation, the Law 41/2002 on patient autonomy It assigns responsibility for the medical records to the practice, whilst the self-employed healthcare professional is responsible for the documentation they produce. Make sure this is set out in writing in each contract to clarify how it applies to your situation.
As for insurance, check that your policy covers you as a cosmetic doctor at any clinic where you practise, not just one, and ask each clinic for details of their own cover. You can find more details in our guide on the civil liability insurance for cosmetic medicine.
Practical organisation
Working in several different places requires organisation. Keep a single diary listing all your working days, your own record of invoices and tax deductions for each clinic, and an up-to-date copy of every contract, authorisation and insurance policy. Check every year that your insurance still covers all the activities you carry out, particularly if you introduce new techniques.
Frequently asked questions
Do I have to register with the professional body in every province where I work?
No. Membership of the professional body in the area where you have your sole or main place of business is sufficient to practise throughout the country.
Can I combine an employment contract with self-employment in clinics?
Yes, it is possible to hold multiple jobs, provided that your employment contract does not include a full-time clause or a non-competition clause that prevents this. You will make contributions under both schemes.
Should I charge VAT to the clinic?
It depends on the purpose of the services. According to the DGT’s guidelines, treatments carried out for cosmetic purposes are not exempt, whilst therapeutic treatments may be. Check this with your adviser.
Who buys the product I use?
This is determined by the contract. The important thing is that the product comes from an authorised channel and that the traceability of each batch applied is recorded.
Medars for doctors working across several practices
In The Medars Hall you can get in touch with other verified cosmetic doctors and share experiences about working with clinics. And if you’d prefer to have your own space on certain days, at Spaces You’ll find consultations available to book by the hour, day or month, available from Gold level onwards.
Related guides
- Requirements for setting up a cosmetic medicine practice in Spain
- Malpractice insurance for aesthetic medicine: what it should cover
- Renting a clinic room for aesthetic medicine: a guide for doctors
- How to get started in aesthetic medicine as a doctor: a realistic roadmap
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