If you like creating care plans around nursing diagnosis such as “ineffective individual coping” or “self care deficit” then, by golly, this isn’t the blog for you!
Let’s face it, nurses are caretakers of others, not ourselves. We nurture patients, we nurture our families and we are funneled into the deadly path of hourly pay, night shift differential and 12 hour shifts. (insert: suck the life right outta me!)
I did not take one business course in college or graduate school because what would be the benefit? I was a proud biology minded student; business courses were for those who couldn’t handle the sight of blood or emesis. In fact, my thought back then was that business equates into a certain sense of hardness.
How can you be a gifted, caring sweet nurse who is business savvy? The two concepts didn’t play well together!
Now, I wish I had immersed myself in business and marketing fundamentals back in my college and graduate school days. It may have given me a leg up on the power of simple terms such as net, gross, revenue, employee costs.
By default, I have learned these terms and learned them well throughout my aesthetic career.
When I used the word “net profit” for the first time in my nursing career, I felt like I owned the world!
If you want to be a savvy, business minded aesthetic nurse, you have to know 10 essential skills in order to negotiate a killer, but ahem…very pretty…contract with your physician.
1. Know what the costs are of products and services
Depending on your “tier” level within the major industry players such as Allergan, Galderma and Merz, your costs will vary.
If you are just opening up an account with these companies, you will be entering at the bottom tier, where discounts and rebates will be little, if any.
Our cost on Botox Cosmetic is $6/unit. On Juvederm, our cost is less than $200/syringe.
Be familiar with service costs, as well, on peels, lasers, etc.
We have a peel from Young Pharmaceuticals that is more expensive, around the $125 range.
Some practices will add on management fees, marketing fees, overhead onto each of the products. For example, the practice may say that the cost of Botox is $8/unit. They are factoring in an additional $2/unit for syringes, overhead, etc.
2. Know what the price is for products and services.
In our practice, we charge $600 per syringe for Juvederm and $12.50/unit for Botox. We do offer multi syringe discounts as well, meaning if you purchase 2 syringes of Juvederm, the price is $1150. For peels, we have one from Young Pharmaceuticals that is priced $350.
An important point to make, before you negotiate your contract, you need to spell out in writing how promotionals on products ($50 off or BOGO deals) will affect your earned income. We work with our reps to see if they can give us additional product to make up for the discounts we offer, this way, no one suffers from a discount.
Let’s say that we are offering $100 off of a syringe of filler. Essentially, this equates into a $35 commission loss (assuming 35% commission on net profit). For every 6 patients who receive this special, the rep may give you a syringe of filler (at the cost of $200). This way, you don’t have to swallow the $35 hit on commission and you can sell this promotion knowing you won’t suffer on the back end.
3. Memorize the net profit for each product or service sold.
In my mind we have done our self in injustice by selling “units” and “syringes.” We need to develop the mindset of selling “results.” If a patient requires 40 units of botox, two syringes of Voluma and one syringe of Juvederm, you need to know that the cost is a little less than $1400 ($240+$750+$400).
If I quoted the price to the patient, it would be $2800 ($500+$1700+$600). The net profit (the price charged to the patient minus the cost of the product/service) is around $1400.
Your commission is typically a percentage of the net profit. You can negotiate the price to the patient better, if you know what you could earn for the time needed to delivery the procedure.
If you are okay with earning less than $500 (assuming 35% commission on $1400), then you could suggest to the patient that you can offer than package to them at $2500.
4. Determine what your time is worth.
Most practices offer commission based pay structures for nurse injectors. The most common commission pay structure I see in the field is 25%-35% of net profit. This means that if I sold a package, as described above, for $2800, I would then subtract out the cost $1390, and my net would be around $1400.
My pay on this sale and work at 35% commission would be a little less than $500. My pay on this exact sale at 25% commission is $350. That’s a huge difference! At 35% commission on net revenue, you are looking to earn around $150/syringe on filer and around $2/Botox unit. At 25% commission on net revenue, you are looking to earn around $100/syringe and $1.60/unit.
There is huge negotiating power in 25% to 35% commission structures, especially when you are seeing 10 patients a day or more on a full time basis!
5. Ask for annual revenue reports from your office manager.
This year, I produced around $800K for one practice and a little over $100K for another practice.
Annual revenue is a huge negotiating point. Most midlevel providers have on average $400K/year in revenue.
If you are a top producer, you can use this to your benefit. In addition, it allows you to set new goals for the next year! Sky’s the limit, right?!
6. Understand your setting.
My first job in aesthetics was in a medspa and I was offered a salary position for full time work. Being that it was my first gig, I was thrilled with the salary quote.
However, once I started to learn the costs of products, the monthly lease costs for space, my average hourly pay vs revenue generation, my wheels starting spinning. This is when nurses start thinking outside the box and wonder if they can afford to open their own practice.
For me, at this point in my career, I could completely start my own practice. I have thought about it, but for me, my family and my professional goals, I am very content working under the umbrella of a plastic surgery office. If I have a problem, I have two plastic surgeons who are there to support me. I have a support staff of receptionists, consultants, social media experts and fellow nurses at my disposal.
At the end of the day, even though I do have managerial responsibilities, the ship doesn’t belong to me and I am okay with that. However, you may not be okay with this work arrangement.
You have to decide what your long term goals are for your career and personal life.
7. Professional development, don’t be afraid to ask.
It’s customary for midlevel providers to have the benefit of national conference attendance. My physician told me that if I achieve the certification, specifically within plastic surgery “certified plastic surgical nurse” or “certified aesthetic nurse specialist” he would then pay for my yearly attendance to the conference. He has kept his word! In addition, he pays for my membership to two professional organizations, The Am. Society of Plastic Surgical Nurse and the Tennessee Society of Laser Medicine and Surgery. I value these memberships and conferences to be around $2500 annually.
8. Be confident yet humble.
If you are a new cosmetic nurse without a true skill set or patient base, you may have to accept an hourly wage of $30-$50 per hour with 10% commission on products. However, if you are seasoned, trained and come to the table with a well developed patient base and profit generating potential, you need to be confident that you are valuable to that practice. Ask your reps where you stand among others like you in your town or region.
9. Ask for annual performance reviews.
As the non-surgical director at my practice, I strive to provide honest and encouraging performance reviews for my employees on an ongoing basis. You want to be the employee who isn’t “okay” with working at your current level, you want to soar above and beyond your goals!
When you set goals for yourself, personally and professionally, your negotiating power just exploded!
10. Be fair to yourself and your practice.
Sometimes, I get a little sick to my stomach realizing the profit I bring into the practice but not into my own pocket. I mean, really nauseous, the kind that makes me rush for the Zofran OD! However, after I take that Zofran, I realize that I am happy with my earnings, with my practice and I love working for the physician. Is it the right business decision, I often wonder if I am choosing the right path?
It takes some soul searching to know what you really want out of life, your day and your time. For me personally, I absolutely love what I do.
I love teaching, I love injecting, I love being creative, but I hate the little bitty things like social security tax, payroll, paying bills, laser malfunction etc. Yes, I could hire that out but again, at the end of the day, I don’t worry about those tasks, who is doing them or if they are being done correctly.
At the end of my day, I go home to my family and take on the tasks of mom and wife, which, let’s be honest, requires a WHOLE new set of negotiating skills!