As part of our Advanced Practice Providers Guide to Starting a Botox Business training course, Injectables EDU walks injectors through the steps to understand, build, and grow a successful aesthetics business. We talk a LOT about what expenses you’ll need to keep in mind – both start-up and ongoing costs. Today, we tagged an expert to learn more about how much a collaborating physician should be paid.
Suzanne Jagger, CRNA, APRN, is the owner of Aura Aesthetics Med Spa and Aura Academy. Suzanne openly and clearly provides SO MUCH insider information that anyone looking to get into the Botox® business would benefit from.
This is the third of a series of four blog posts featuring Suzanne – learn from our expert on how much you can make opening a Botox business and more.
Interview with Suzanne
Cassie: How much should a collaborating physician be paid vs. a medical director? I know there’s no exact answer to this question and it can be very state-dependent, but can you give us a ballpark to give inquiring minds a starting point?
Suzanne: It has to do with 1. Level of risk exposure and 2. Level of practice involvement. That’s where people really need to understand what it means to be a Medical Director. That physician has medical culpability for whatever happens in your office. The outcomes of every patient you touch. In theory, a Medical Director needs to see these patients to some degree and have involvement.
I tell people if you need a medical director don’t bother getting into this business on a casual basis because you cannot make money. The laws basically state that RNs are out of scope if they are deciding how much and what product to place where on their patient. The physician is supposed to instruct them, or possibly a NP or PA. One of those providers are supposed to be instructing an RN to put 3 units of this product here -that is how precise it should be to be fully compliant. No one is doing that. It’s absurd. It does not happen, but if you ever get investigated you are in the wrong.
What about nurses?
There is no legal way that an RN can be doing this on the side. There is absolutely no way unless she is driving around with a doctor. That’s just one phone call to the BON for getting your license taken away, and getting sued for practicing medicine. Now you’re a felon. I don’t have a ton of experience with exactly how much to pay a collaborating physician vs. a Medical director because after people sign these things they don’t talk about it.
Rules of thumb, I don’t know. There are a lot of back-office dealings on this and a lot of different ways to work it. Some ask, for a collaborative role, probably $250 to $500/month. They aren’t providing any other service except that prescriptive authority. When you get into Medical Director you’re looking at $750-$1000/month. As a medical director of a fully functioning med spa you’re looking at $100,000/year. That’s on a national level from AMSPA. That’s a person who is involved, it’s a job. A Medical Director needs to be immediately available, and to be in the office.
What was your path to starting your own med spa?
I ended up getting a space and then a bigger space and then wanted to hire an advanced aesthetician to help. I wanted to have a team. My joy is creating a place where people can do amazing work. I fully let them. I make sure they are safe and learn how to do it myself as well, even if they are sick I can do it.
Do you need to offer skincare and laser treatments, such as Kybella, chemical peels, etc., to really make a profit in aesthetics?
When you get into this, it becomes a rabbit hole of all these other things you can possibly do. You have to decide are you going to be a one-trick-pony? Some people have created a ‘riches and niches’ business where you create that you are the go-to person for fill in the blank. There are Botox people who just do Botox. There are filler people who are specialists in just doing lips. You have to decide which way you want to go with your business.
Some people just want to be able to offer as many of the services that people want as possible. It’s not that much harder. So you can think about how to work in a plasma pen, or microneedling or chemical peels. You can do those mobile. They are not high risk procedures, they do need to be done clean and properly after receiving appropriate training. I know someone who bought her own massage table and pretty much offers a mobile med-spa and she loves it.
What are some considerations for a clinician to integrate Botox and fillers into their established medical office practice? Should every GP be trying to integrate this skill? I figured adding cosmetic procedures to your GP office would be easier than starting from scratch, but has its own challenges.
When you have an established office you have the infrastructure in place. And a patient population to market your new service. That is huge and cannot be overstated. That said, I find some of these providers are not the best to provide Botox because they are unfamiliar with holding a syringe, this type of assessment, and dealing with anatomy in this different way.
Having an aesthetic eye is hard to train, just like it is hard to train some to have good hands. You can’t necessarily do that. Some people are graceful, and for some people no amount of ballet lessons are going to make them look graceful. Some people get it and some people don’t. There is always that X-factor. Then there are also the people who just don’t do it enough. You need a certain amount of reps to get good at something.
What are the biggest barriers to entry of starting an injectables business? For me, a few things that come to mind are education, obtaining malpractice insurance, and finding a space to work in.
You’re thinking too much like a checklist. Marketing is the biggest barrier. Anyone can learn to do this, but getting your name out there is the biggest challenge. Disseminating that you exist and that you are a worthy person to inject them is a huge barrier. Just like finding a hairdresser or a restaurant. Another hurdle is understanding your state’s laws and regulations. These vary widely between states especially when it comes to mid-level practitioners and dentists.
A lot of providers are fearful of adding fillers to their practice. It is more of an art. It has more dire consequences if done wrong. Should a new injector even bother with this skill? Or are you better off just learning how to do Botox and expanding out once you’re proficient in that skill? Basically, should a beginning injector start with just Botox?
Yes and no. The assessment is similar but a little different. It’s sort of like saying can you learn regional (anesthesia) at the same time as you’re learning general (anesthesia)? You can, it’s a completely different skill set, but you can. Part of it has to do with reps and how often you’re using those skills.
When I teach beginner filler I only teach 2 procedures-cheeks and lips. Because those 2 procedures lay the groundwork for doing all the other areas. If you get comfortable with those 2 areas then you can expand. It’s the same technique in a different area. It’s about simplifying it as opposed to trying to learn everything and sucking at everything.
I have some students who say, ‘I do 5 things and I’m happy to refer you out until I’m comfortable doing those areas’. Eighty percent of people come in for those 5 things, so you are only referring out twenty percent. Then when you get comfortable you start to add other things in.
After reflecting on my conversation with Suzanne, I had a few takeaways. It seems there are a number of things to ask yourself when integrating botox and/or fillers into your medical practice. One being, is my patient population likely to desire this service? Also, having a practice that already includes medical procedures specifically using needles, syringes and injecting is a huge advantage.
As far as having an aesthetic eye, personally, I don’t think we can know if we are able to be a ‘natural’ at aesthetics unless we try. I do believe being passionate about a field will get you pretty far. Some people will be naturals and some will take more practice and work. Suzanne herself is a proponent of simple techniques that are rote to learn as building blocks. We won’t all have the eye to become master injectors doing pan-facial rejuvenations, but I think where there is the will to integrate this skill, there is a way.
👉Don’t forget to catch part four of our series with Suzanne. In our last post of this “Ask an Expert” series, we discuss what injectors to follow on social media, how to make the most out of your networking opportunities, and more!
👉Need your specific questions answered by an expert? Schedule a FREE 30-minute mentoring call with me, Cassie! I’ll help answer any questions you’ve got!
BOTOX®is a registered trademark of Allergan, Inc., an AbbVie company.