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Entries in Restylane (18)

Monday
Nov192012

Nurse Practitioner Pay In New "Medical" Spas

Nurse Practitioner Medical Spa PayWhat's a good Nurse Practitioner pay in a new 'medical spa' that wants to offer Botox?

I get lots of individual emails looking for information about pay for PAs, NPs and MDs who are being recruited by a local medical spa. Some of these are just entering aesthetics and others are old hands.

Here's an example email that's typical from a NP who's being solicited by a day spa who's wanting to offer Botox and fillers:

Hello, I am a Nurse Practitioner from Wyoming and I am going to start doing some medical aesthetics for an established spa that up to this point has offered everything except medical aesthetics. The owner of the spa and I are having trouble figuring out a fair pay for me. The products are being ordered under my license and I will also be doing all the injections. Right now we are just starting out with Botox and Fillers. She pays her staff an hourly wage plus commission, but I have also talked with other spas that pay straight commission. Both of us are new to this and we are having a hard time finding out what other medical spas pay. Any insight on this would be helpful.
Sincerely,
Stephanie

Ok, so here's where we're going to drop some knowledge-bombs on you. (For this post I'm not going to go too deep on whether these types of setups are good ideas on their own.)

First, think about what you're asking and how you're thinking about this new business. You're counting your eggs a little before you've got any eggs.

The fact that you're asking how much you should be paid reveals a number of problems with your understaning of how this is going to work and who's going to be responsible. (This isn't uncommon at all and we're going to disucss business models at lenght in future posts.) Since you're the clinician, you're going to be responsible for everthing to do with this business with the probable exceptions of: #1, paying for stuff and #2 supplying the 'patients'.  So let's look at what you're going to be responsible for:

  • Purchasing all the Botox, Restylane and Juvederm under your medical license
  • Patient care
  • Charting and compliance
  • Malpractice insurance

Since you're going to be practicing medicine, the fulcrum in this relationship is you as the clinician. It's going to be your reputation, medical licence, malpractice insurance, and your ass on the line.

I'm reminded from a line from the science fiction novel Dune in which goes something like, "He who has the ability to destroy a thing, controls that thing." Meaning, that this is effectively going to be your business, not the spas. (Note, I'm not denying that the spa could probably find someone else to do this same deal, just that it's never going to be the spas business.)

The spa will invariably take the tact that this will be an add-on to their existing business and that the 'patients' are their customers etc. This is both wrong in practice and illegal. This will be the practice of medicine and that's pretty cut and dried. You're still going to regulated, HIPPA compliant, etc. and that's it.

You're also going to need to set this up legally in your state. In most states you can't become an employee of or partner directly with a non-physician. (Not sure about how this applies to NPs so if anyone knows, please leave a comment.)

The patients are going to be yours, the responsiblity will be yours, the insurance will be yours etc., and you can't just be paid for performing medical treatments by a non-physician. All that being said, there are ways that this can be done if you're smart, and the spa owner is reasonable.

  1. Set up a legal entity for yourself. (Have a real lawyer do this who has knowledge with clinicians.)
  2. Make sure that the spa has a legal entity. (Different lawyer there.)
  3. The agreement will be between these two entities. (There are different ways to set this up depending on state. In some cases it might be the NP's entity that is 'renting' space from the spa but there are other options. Read through the forum threads on this site for those.) The agreement should also clearly define scopes and responsibilities and what will happen if the business fails. In cases like this, the spa is often 'paid' for rent and/or 'marketing' expenses, not fee splits or referrals. A technicality maybe but an important one.

People always try to overlook the 'business fails' part of the equation but it's a necessity to outline this up front since this business will end at some point in the future, even if both parties are happy.

Since it's illegal in most states to be a clinician who is an employee of a non-physician, that becomes somewhat problematic since you can't be 'paid' in the normal way. I would also suggest that all monies go though your legal entity before being distributed. In effect, you take all payments, not the spa. Headache yes but medicine in the US is the most highly regulated and litigious market there is. Don't sit around on your thumbs with this.

If you look at what you're going to be required to do, the conversation with the spa should be much clearer and should help the negotiations. If the spa owner refuses to understand how this should be set up, don't do any deal. You can't negotiate in good faith with someone who is willing to put you at risk right at the start.

About your Pay?

The real question is, "how much money are you going to make?". 

Business 'partners' always run into personal conflict when; they don't make any money, or.. they make a lot of money. I would suggest that you make sure that you go into this with your eyes open and the spa owner does the same. If you can't resolve the above issues then the money won't matter.

Comments welcome.

Friday
Sep282012

Interview With Certified Allergan Botox Cosmetic Trainer Marc S. Scheiner MD: Part 2

Allergan Certified Botox Cosmetic Trainer and the physician instructor on Botox Training MDPart 2: Filler Injections

Name: Marc S. Scheiner, MD
Clinic: O'Leigh Aesthetic Surgery Center
Location: Elkton, MD
Clinic Website: oleigh.com
Training Website: Botox Training MD

I this three part series we're discussing Botox and fillers with Marc Scheiner MD who trains clinicians through 14 credit CME two-day hand's on seminars with the American Society of Aesthetic Medical Professionals and Botox Training MD, an online Botox training site for clinicians.

Part 1: Botox injections
Part 2: Filler Injections
Part 3: Complications of Botox and Filler Injections

And how about for filler injections? Are there different levels of expertise in treating different areas?

Filler injections also have this kind of heirarchy of possible complications. If we just review briefly where the fillers are used commonly, and then we can kind of discuss which is the most elementary to the advanced techniques

Click to read more ...

Thursday
Sep272012

Interview With Certified Allergan Botox Cosmetic Trainer Marc S. Scheiner MD: Part 3

Botox TrainingPart 3: Complications with Botox & Filler Injections

Name: Marc S. Scheiner, MD
Clinic: O'Leigh Aesthetic Surgery Center
Location: Elkton, MD
Clinic Website: oleigh.com
Training Website: Botox Training MD

I this three part series we're discussing Botox and fillers with Marc Scheiner MD who trains clinicians through 14 credit CME two-day hand's on seminars with the American Society of Aesthetic Medical Professionals and Botox Training MD, an online botox training site for clinicians.

Part 1: Botox injections
Part 2: Filler Injections
Part 3: Complications of Botox and Filler Injections

So Dr. Scheiner, tell me about some of the typical complications you've seen and how you deal with them?

In general, the complications are separated with regard to what product we're using. There are different complications with each filler within the filler class. We're going to see different complications from one filler to the next, but in general all the fillers are going to... Well, let me rephrase that. All the nonpermanent fillers are going to result in similar complications. That is to say that I believe you may experience a different set of complications with

Click to read more ...

Wednesday
Jun202012

Dr. Lisa Lynn Sowder, A Female Plastic Surgeon In Seattle

Dr. Lisa Lynn Sowder

Dr. Lisa Lynn Sowder manages an accredited surgical facility and plastic surgery practice in Seattle, WA.

Name: Lisa Lynn Sowder MD FACS
Clinic: Seattle Plastic Surgery
Location: Seattle, WA
Website: sowdermd.com

That's interesting: Dr. Lissa Lynn Sowder is past president of the Northwest Society of Plastic Surgeons and the Washington Society of Plastic Surgeons, past chair of the King County Medical Society Grievance Committee and former Trustee of the King County Medical Society.

Your operating room is certified by the American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF). How much benefit is there for a physician who owns their own surgical suite instead of using other facilities?

The headaches are staffing and supplying the operating room. Equipment needs to be maintained and replaced. Supplies need to be ordered. The floor needs to be mopped, etc. Employees need to be trained. There is a boat load of paperwork necessary for AAAASF certification. Just doing it all right isn’t enough – it all has to be documented and documented and documented. It’s expensive and

Click to read more ...

Friday
May042012

Dr. William H. Truswell: Aesthetic Laser & Cosmetic Surgery Center In Massachusetts

William H. Truswell MD, FACS, limits his practice to facial plastic surgery.

Dr. William H. Truswell Northampton MA Board Certified Facial Plastic SurgeonA Massachusetts plastic surgeon who's also running a medical spa? We got together to see what Dr. Truswell has learned in 30+ years in practice. 

Name: William H. Truswell MD, FACS
Location: Northampton, MA
Clinic: Truswell Aesthetic Laser & Cosmetic Surgery Center
Website: truswellplasticsurg.com

That's interesting: Dr. Truswellis the autor or co-author of several books including: Your Complete Guide To Nose Reshaping, Your Complete Guide To Facial Rejuvenation, Your Complete Guide To Facial Cosmetic Surgery, The Non-Surgical Facelift, and Surgical Facial Rejuenation.

A believer in returning something to the community, Dr. Truswell participates in Face to Face, the pro bono domestic violence program of the American Academy of Facial Plastic and Reconstructive Surgery. He has performed numerous reconstructive procedures for victims of domestic violence. These women are referred in from recovery programs, are completely separated from their batterers and are working to restore their self esteem. That recovery is helped by erasing the physical evidence of beatings such as scars, deformed noses and unset facial fractures.

Click to read more ...

Monday
Apr232012

Top 5 Medical Spa Treatments In 2011

The top nonsurgical treatments in 2011?

  1. Botox: 5.7 million treatments (up 5% from 2010)
  2. Filler Injections (Juvederm, Restylane, Perlane, etc) 1.9 million treatments (up 5% from 2010)
  3. Laser Hair Removal: 1.1 million (up 15% from 2010)
  4. Chemical Peels: 1.1 million (down 3% from 2010)
  5. Microderm: 900,000 (up 9% from 2010)
Source: American Society of Plastic Surgeons
Wednesday
Sep212011

Can Nurse Practitioners Offer Botox?

By Carolyn Buppert, NP, JD

Can Nurse Practitioners offer Botox, Restylane, Juvederm and other cosmetic treatments on their own?

The answer to this question is going to be state-specific. Here are the steps to follow:

  1. Read your state's Nurse Practice Act section on scope of practice for nurse practitioners to answer these questions: What acts require physician collaboration or supervision? How is collaboration or supervision defined? (Boards of Nursing in the United States: State-by-State Web Links)
  2. Go to your state's Board of Medicine Websites and search for any policies on provision of botulinum toxin (Botox®). Note that botulinum toxin is a prescription medication, so a prescription or order for the medication must be written and someone must administer the drug. If your state has policies on botulinum toxin, note the requirements for prescription and administration. Some states consider administration of botulinum toxin a medical act, and some states consider it to be within the scope of a registered nurse. Prescribing is always a medical act.

    If you live in a state that requires no physician collaboration when nurse practitioners prescribe, then as long as the Board of Medicine has no requirements with respect to botulinum toxin, you are free to proceed with your practice idea. If your state requires physician collaboration in order for nurse practitioners to prescribe, then you'll need to line up a collaborator. In most states, the collaborator does not need be on site, but in some states, the collaborator must practice at the site with specified frequency. Follow the rules as they relate to any prescribing.

About: Carolyn Buppert, NP, JD is an attorney practicing in Bethesda, Maryland.

Submit a guest post and be heard.

Sunday
Apr042010

Restylane Big Lips Overdose

If you're looking to see what a Restylane or Juvederm lip filler overdose looks like... well, then look no further.

This collection of lip augmentation overdoses is brought to you from Russia, where it looks like you can buy your Juvederm or Restylane wholesale and it's sold in 2-liter bottles.

Plastic surgery is booming thru Russia and it appears from these lip augmentation photos that the natural look isn't really in. There are enthusiasts in Russia tracking down Russian ladies with poor results on social networks and publishing them in special communities, sometimes making fun of them, but sometimes admiring their marvelous lips.

Click to read more ...

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