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Medical Spa Business Forum > How to compensate my cosmetic nurse injectors

Compensation or hourly for RN cosmetic nurses
What are the different ways to compensate RN cosmetic specialist. I am curious to see if there is a better and/or fair way to pay the RN's and still be profitable for the practice. Currently I pay a base rate of $32 an hour OR 20% of the total revenue brought in a 2 week period. Which ever is higher is the pay for those 2 weeks. Please if you would share with me other pay structures that are working for you, or have not worked.

11.26 | Unregistered CommenterDr. C

Seriously needing some imput on this subject as I am re evaluating my compensation for the next year. Any help or advise would be appreciated! Thank You

11.30 | Unregistered CommenterDr. C

Dr. C

I have paid out and have seen all kinds of compensation. A few ideas follow;

Salary/hour wage plus flat bonus per pt

Salary/hour wage plus % of gross revenue (must be small bonus)

Salary/hour wage plus % of gross net (can be larger)

You have to be careful with % of total revenue because you have overhead cost above and beyond fixed expenses.


Botox is $5.25 per unit. Say you charge pt $10 per unit. If you pay $525.00 plus 20% gross revenue ($200), you pay out $725 per vial. Profit $275.

Same with hr wage say 2 hr at $64 plus 20% net revenue. $64+(20% of $475) = 95 + 64 = 159
159 + 525 = 684

$1000 - $684 = $316 (your profit)

I think it would be in your best interest to pay $32 per hour and 10% of NET revenue. This is fair to both parties and allows you to remain in business with some profit.

Florida Pa,

You are not calculating the advertising $'s it takes to get the patient in for Botox. Paying a commission for the RN just to perform the injection is not a good idea for the clinic. The clinic has to make a profit before any commissions are paid out.

At the end of a 2 week period you could pay an RN a certian % and the clinic may not be making a profit. You have to look a the revenue on a weekly and or monthly volume basis and determine a commission or bonus structure that is a win win for the clinic and employee(s).

Clinic expenses have to be met before any bonuses are paid.

Being a RN is not a sales job and a RN should not expect a 10 or 20% commission on services plus a high hourly wage. Most commission only sales jobs will pay between 10% and 25% with no salary. You have to base any bonus or commission structure on clinic revenue, that way the employees will cross sale to keep the other treatment rooms busy.

12.1 | Unregistered CommenterSBJ

Thank you for your imputs, this gives me some different ways to look at restructoring wages. I have been looking for that win, win situation. Still any additional ideas are welcome.

12.1 | Unregistered CommenterDr. C


You are absolutely right. That is why I mentioned fixed costs (lease, insurance, marketing, etc...) These would be in place with or without the RN. I was speaking specifically about Dr C's question. Another consideration is when you are in start up or growing phase, the staff salary and commission IS overhead and you may suffer a loss with the hopes of ROI down the road. I also have to agree 10-20% commissions are excessive, I was making the numbers easy to show a point.

A RN performing revenue generating services is just as much a salesperson as a physician owner who profits from services rendered by themselves. An RN at a cosmetic practice needs to be treated as the professional she is, and be compensated at a minimum rate of what the local hospital would pay.It is time that nurses working directly for physicians be compensated fairly. $32.00/hr with a 5 or 10% net commission seems excessively cheap.

08.27 | Unregistered CommenterJbw


Do not confuse being a professional with compensation percentages. The simple fact of the matter is that RN's or ARNP's will always make far more in a hospital than at a mom and pop doctor office/MedSpa. As has already been stated, when you factor in the cost of goods sold, insurance, marketing, leases for equipment, operational cost etc, the margins on Botox & Fillers are barely enough to keep the doors open. Most MedSpa owners I know (over 100) are "still" loosing money and struggling to keep their doors open. Most have the entire life savings tied up in this business and stand to lose everything. If you want a hire paying position, hospitals and larger practices offer that. It's not a question of anyone's worth rather the reality of what any position can be paid based on net margins.

08.30 | Unregistered Commenterbks

Agree. If the nurse or p.a not happy with the compensation, they are more than willing to go back to work in the hospital or some other medspas which I doubt will offer better compensation.

Folks, get real here, yes , I do believe what other say " if you want the best, you get the best, and pay the premium". But in this economy, not many are willing to spend, the foreclosures rate is still climbing.A lot of medspas are just not making enough money to survive. $32.00/hr with a 5 or 10%, I dont think me or any other medspas can afford such high pay scale.

Just my 2 cents.

08.30 | Unregistered CommenterAriel

Early on I split the payment of each injection. The nurse made a healthy profit, and I didn't quite break even. I now pay an hourly wage plus a productivity bonus. In northern California nurses are very well paid, so I pay $50/hour plus a bonus only if the productivity goal is reached. I learned long ago that if a nurse receives a bonus for every injection, the nurse can make a lovely salary while the doctor sees nothing but red. By setting an ambitious but reasonable goal, the nurse is motivated to not leave work early or cancel a full day because it's her child's birthday or send late clients out the door. Instead she is motivated work hard to provide the best service. Her goals are now in line with my goals. In the past I was working really hard for nothing, and the nurse made $70,000 working 2 days a week! Live and learn!

11.8 | Unregistered CommenterDr. F

I'm an International Medical Doctor, Dermatologist, having experience in all medical aesthetic procedures; especially injectables as Botox, Fillers, Mesotherapy, and Injection Lipolysis, but not licensed as a Medical Doctor in Canada.(I'm a landed immigrant)
I'm searching for a job as a Medical Aesthetician in Toronto, Canada.Could it possible? my email is

I am a recently graduated nurse and am very very interested in becoming a nurse injector. I live in New Brunswick,Canada. I just wanted to get some information about it and if it is a good idea. My plan was to keep working at the hospital and work as an injector as a part time job. I have always been interested in working in a spa and even more so now that i am a nurse and have heard about the nurse injector jobs. Can anyone give me some how much it cost to become educated, how long the education takes, how much a nurse injector makes.

Thank you,

04.13 | Unregistered CommenterAundrea


I am from Australia and currently battling with this situation as well.

Any nurses or Drs from Aus wish to comment on this post? Not sure if our operating environment is the same as the US.



09.7 | Unregistered CommenterKim papp

I have a real novel idea how about the doctors just do medicine and perform the procedures themselves like we did 30 years ago.

How abut this.....if a nurse wants to be an injector when the S hits the fan at lawsuit time how about they continue to play with the big boys and face the lawsuit head on. As of now they tend to just turn and say....uh.....the doctor was in charge......uh....I was only injecting like he said...uh ....Its not my fault

09.7 | Unregistered Commentergm

Make it easy. Give privder 25% of the rev. Also get provider to sign up for liability coverage @ I have coverage for $2,5m/$500k/per event @ $85 per annnum

Give the RN a fair hourly for your area and set up a bonus plan. The hourly @ a medical clinic will be lower than the hourly @ a hospital, but the hours will be better.

For the bonus plan to work in the advantage of the clinic owner the RN will have to be able to cross sale to get patients in other treatment rooms. The RN will need to meet and exceed the bonus plan goals and no bonus should be paid to any employees until and ONLY UNTIL a certain revenue number is met by the clinic, whether it be a weekly or monthly revenue number.

I am the clinic owner and no one will get a bonus until my weekly and monthly revenue numbers are met. I did not go into business to have and pay employees salary and bonus. I went into business to make a profit. I will keep the 25% of revenue if I do not need it to pay expenses.

09.8 | Unregistered CommenterJames

RN's, CRNP's, if you are reading these posts beware. I am an expert injector. I see anywhere from 10-20 patients per day for injectable fillers and neurotoxins. I also do laser treatments, sclerotherapy and permanent make up. I am an artist. If you are lucky enough to find a stepping stone clinic to provide you with enough volume (clients) to get the experience, and you are very artistic, you ARE worth more than what an RN or NP in a hospital is worth. It is a special, RARE skill that very few mid level or RN's have in this country. There are many that can say they do it technically, but the creativity and understanding of how a face should look youthful NATURALLY, is a skill/art that is very, very difficult to come by. I ran a clinic alone, did the treatments, and the silent owners did NOT want to compensate me what I was worth. I have a LARGE client base that I am responsible for obtaining, converting, up selling AND retaining with no help from anyone but word of mouth. Please protect yourselves from greedy practice owners who see your earning potential. MAKE them compensate you what you are worth according to your experience and ability.

I'm a nurse injector in a small Med spa that is hospital owned. I currently make $26/per, 10% on Botox and Filler and a sliding % for laser treatments and 15% for products. My employer is wanting to change my pay, saying I make too much per hour with my commission figured in. I'm trying to find out what the average hourly and % or bonus is.

05.14 | Unregistered Commenterkara

If you are not happy with what you are getting, then just leave.
Go somewhere who appreciates your skills and compensate you accordingly.

05.14 | Unregistered CommenterMiki

As a nurse injector myself, I feel the rewards of working in a cosmetic clinic are complimentary dermal therapy treatments and injectables, well clients and no shift work!. I wouldn't have it that good in a hospital setting. A base rate that matches hospital wages is fair and equitable. It's a pleasurely environment to work in. That's compensatory enough for me.


07.22 | Unregistered CommenterJane

I am a very busy RN injector in a medical cosmetic practice. I initially started out on $35/hr and recieved 10% on injectables after a certain target was reached. As the practice has grown and my patient base has expanded due to word of mouth, extensive advertising and search engine optimising, I am now the 'main' income provider for the clinic. My income has also grown and changed as the practice has evolved. The dr appreciates my work and I do, I work extremely hard, not only to help the pracitce grow but more importantly achieve high patient satidfaction. This inturn is reflected by our growth of patients and increased revenue. Currently my income is $44/hour (but is paid as a salary) and I recieve 10% on all injectables I inject and no target needs to be met. Last year my income was just shy of 180k and will continue to grow. its a win win situation for the Dr and myself

Hello I am a nurse injector in Sydney with 10 years experience. I initially started on $35 an hour which had an additional 10% commission after 3 years. At about 6th year I negotiated 25% commission (no hourly rate) on profit for dr's clients and 50% for clients I had introduced to clinic. For the last 3 years I have got paid 40% with a minimum day rate of $550 if it was a quiet day at one clinic and at another clinic I negotiated 65% of profits as have gathered a bit of a following. So yes nurse injectors can do very well. I make an average of $1000-$2000 a day. Us good injectors are few and far between.

11.12 | Unregistered CommenterScd

I am an expert RN Injector at a LA derm office. My base pay is $40/hr. Before my sliding % commission kicks in, the profit from my services must exceed a set number- which covers a percentage of overhead costs. My commission % increases according to profit. Commission % starts at 5% and max is 20%.

Fortunately, we purchase our injectables in large volume, so the average cost per item is significantly lower than the normal list price. In turn, the profit is increased, making it easier to break my minimum goal for commission to kick in. This is a win-win arrangement. My yearly income is about $95K.

01.20 | Unregistered CommenterAura

I am an intermediate level injector meaning I do neurotoxins, and fillers in cheeks, lips, tear troughs, marionette etc. I also do laser procedures. I am making a little over 30 an hour and work in Northern California. I get no commission on services and a meager % on sales (and I usually sell a lot). Does this sound like a fair wage and if not, does anyone know WHERE I could get better pay. Also there are no benefits, PTO or 401K offered:(

04.13 | Unregistered CommenterCat

I'm hiring another nurse for injectibles Botox and Juvederm in Phoenix AZ does anyone know the starting hourly and commission for this. Thank-you Maria PS if you are a nurse and you are looking for a job at our Senza Pelo Med Spa please call 602-246-1966

07.23 | Unregistered Commentermaria

Let me first present my credentials, before you possibly get mad at what I have to say. I have started, managed, consulted-to, appraised and brokered medspas, derm & plastic practices for 25 years; was faculty for AADermatology for a decade; and been a paid faculty sponsored by Steifel/Connetics and Reliant/Fraxel to do studies and presentations to physicians on cosmetic procedure profitability.

Consider this alternative approach in states (like CA) wherein most expert medical attorneys recommend that the RN-injector be a bonafide employee of the physician. You can substitute ratios to fit your situation. The following answer was to a physician client acquiring RNs with existing injection practices, with some RNs owning lasers and other instrumentation they will bring to the job.

You can set up "departments" in Quickbooks bookkeeping for each employee; tracking income, expenses, and compensation.

Injectables are becoming a price-sensitive "commodity" in many places, and are used as a loss-leader for higher level, higher-profit procedures, which is usually OK for bonafide employees (verify with your attorney in your state).

Consider a compensation rate of 40-50% of collections, minus costs of injectables and supplies, and minus direct costs of employment. For example, you subtract work comp insurance, med-mal insurance, state-mandated benefits, employer-contributions like FICA/FUTA; and if they work more than 20 hours/week, they might have to be included in a company retirement plan. Then don't charge them extra for rent, receptionist, furnishings, etc. You have to withhold income taxes too. I think you will be required to pay them at least minimum wage, but that better not be an issue! Your CPA can easily set it up and your state medical society can provide guidelines or referral to expert attorneys. Pre-tax income to the employer, net of costs, is commonly then still less than 10% of collections, depending on the going rate of services and competition in your area. Have your CPA double-check your data and adjust as necessary.

If the RN brings assets, you can simply rent the equipment they own from them, and either expense it and 1099 them and hope they do their taxes right, or bonus it to them on a W-2 but with withholdings. I've heard though that issuing a W-2 and 1099 to the same person in the same year can trigger IRS audit, but ask your CPA.

To rent their equipment, just amortize current Fair Market Value of item over 5 years (or whatever the remaining life) -just like a lease- divided by full time equivalence (ie you don't pay full price of the lease-equivalent if they are only using it with you 10 hours/week; you pay [10/40 x rate].
Loan payment calculators are easily found online.
I'd suggest using 5-6% as the interest rate, as that's what the medical bankers are getting now. Rates do change, so check.
Fair Market Value (used items) can be found on actual sales (not asking prices) at eBay or online dealers, just search by brand, model and age. Lasers can drop in value the day of purchase, and there is a rich online market of used instrumentation to examine for values.

Above is subject to your attorney and CPA's approval, yada yada yada...
Keith Borglum CHBC CBB

10.11 | Unregistered CommenterKeith

I made a flat rate of 30 dollars per hour, no commission. In BC RN's have to be careful with commissions as it can be a conflict of interest according to our bylaws. The patient must come first and foremost and the nurse not motivated by selling product to increase the RN income. It's a very fine line.

06.4 | Unregistered CommenterKelly

My name is Alyssa and I am a BSN RN, I also have a degree in Biology. I am currently working in a hospital on the med/surg floor but am wanting to specialize in injectables, laser hair removal, etc. and get out of floor nursing. What I am seeing lately is that company's only want experienced injectable nurses. Which is completely understandable! However, if someone wants to hire me and train me so that I may gain experience and meet sales numbers I will be a very loyal employee. I am motivated and a hard worker. This job market is just rough right now, so I'm spreading the word of my availability here in Scottsdale AZ.!

06.9 | Unregistered CommenterAlyssa

Nurse injectors fight for what you are worth!

10.10 | Unregistered Commenterlisa

Hi there,
I am a Registered Nurse in Melbourne and have been working in the hospital setting for 3 years now. I'm very interested in changing career paths and following an injectable/cosmetic path and was wondering how you all had started? Is it better to find a place that does on the job training or do a one year post graduate course?

01.12 | Unregistered CommenterIshtar

Iv read all these posts and comments and replies. A few are reasonable. Most are highly emotional and biased.

I'm a very well known Plastic Surgeon with a busy practice in Washington DC, Virginia, Maryland.

I have been on both sides of the table as an employee, as an independent contractor, as a medspa director and as a practice owner and employer.

Most people are just about "me me me me!" "What can you do for ME!?!"

Occasionally you get lucky enough to find someone, be it an employee or employer that is a fair team player.

Sadly most nurse injectors have their foot in several doors with no loyalty to anyone or any practice. They go to a few years of school and with just a simple RN degree expect to make what an Internist or Pediatrician would make. Except the RN has no liability, no risk, no commitment and not many years of education or sacrifice. Furthermore any of the RNs at the local hospital who are working their butts off cleaning vomit and poop from sick 300lbs patients working crazy shifts, would love the opportunity to work in a clean spa or plastic surgeons office. But you take the same RN and YOU(we) train her and suddenly she will demand an arm and a leg. They think of each practice as a "stepping stool" and with each job they learn more and demand more and move on to other higher paying jobs with no commitment or appreciation for the plastic surgeon WHO ACTUALLY GAVE THEM THE JOB AND OPPORTUNITY to start with.

It's human nature. It's the American way. Look at the Detroit autoworker and what they did to destroy Detroit!

So yes these injectors bring in revenue which is worth more than an RN who is just an assistant or just checks vitals in your office, but you have to ask yourself "could I plug anyone into this position or is this individual truly unique and gifted?" Also ask yourself "do I even need this nurse injector or can I do it myself?"

the doctor who has hired the RN who says she makes $180k per year has to realize that almost any hard working underpaid internist or family doctor would love to do the same job even if they got paid less than $180k!! Oh and they would bring an MD with their name to your office not just an RN.

Yes a good injector adds value and brings in revenue but don't get carried away.

What a completely ridiculous perspective on the value a skilled injector brings to your practice. Doctor or not, botox and dermal fillers injected by all qualified people are not the same. There is an art to creating perfect lips and cheek bones. Try and tell me people don't seek out injectors that are amazing and tell everyone they know who to avoid. Also as far as cosmetic doctors and nurses not being salespeople, give me a break, add some lipo to this procedure, some laser packages could do this, oh you just want your frown lines done but your crows feet would also look amazing. I've ran a successful medispa here in Canada for over 7 years and get more word of mouth referrals than I ever thought imaginable. Bottom line, if the nurse is worth her salt, pay her.

To Washington DC

"the doctor who has hired the RN who says she makes $180k per year has to realize that almost any hard working underpaid internist or family doctor would love to do the same job even if they got paid less than $180k!!

Play the world's smallest violin. The world does not owe an underpaid internist or family doctor a better wage anymore than it owes an underpaid nurse.

"Oh and they would bring an MD with their name to your office not just an RN "

They can bring all the letters of the alphabet however turning profit is the bottom line.

" not many years of education or sacrifice" "Furthermore any of the RNs at the local hospital who are working their butts off cleaning vomit and poop from sick 300lbs patients working crazy shifts"

No your right, nurses have not sacrificed at all.

There is no possible way that a nurse could have done a different degree and be earning double what they earn in other industries.

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