How to Negotiate a Killer Compensation Contract with Your Practice

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!

2017-03-06T19:42:28+00:00 By |Contracts|79 Comments

About the Author:

Haley Wood, offers her cosmetic patients a unique combination of experience, knowledge and personal attention. With almost a decade of experience in the field of Aesthetic Nursing, her areas of expertise include non-surgical facial rejuvenation with her distinctive injection technique.


  1. Ben Childers February 10, 2016 at 7:05 pm - Reply

    Hello, I am a plastic surgeon in California. I have a nurse working for me doing fillers, botox, laser etc.
    I provide everything, including staff to help her, I provide my office, I pay for advertising, VISA processing etc.

    What is a good percentage for compensation. I have been paying her 50% after cost of product. I find this to be too much, as my overhead is quite high. What is standard in the industry for this kind of arrangement.


    • Haley Wood February 11, 2016 at 9:57 pm - Reply

      Dr. Childers, great to hear from you! I have emailed you a response. Please reach out with any other questions!

      • agnes sides June 26, 2018 at 2:00 pm - Reply

        Hello I have the same question would you mind explaining it to me as well TIA

        • Haley Wood July 24, 2018 at 12:35 pm - Reply

          Eversion will create the appearance of a fuller lip. You can try Botox in the obic. oris for eversion without volume 🙂

  2. Erin Stratton , NP February 27, 2016 at 10:16 am - Reply

    My employer offered me compensation based on Allergans recommend commission structure. I am a well seasoned injector of 10 years. I a currently due my commission bonus and there is now a discrepancy in the interpretation of Allergans commission between us. Can u please speak to this? I chose a 70 k base salary; if I triple my salary in gross revenue over 6 months I am paid 30 percent on procedures, 15% on product,

    • Haley Wood March 8, 2016 at 7:55 pm - Reply

      Hi Erin, I am not sure I quite understand your compensation question? You are paid $70K/year and then given a bonus based upon gross revenue greater than $210K/year?

  3. SB April 2, 2016 at 12:57 am - Reply

    Hi Haley,
    I was also wondering what the industry standard for compensation is for an experienced RN injector (6 years critical care, 4 years injecting) I recently moved out of state (CA) and I would like more information for bargaining power as the cost of injectables in the new state I’m residing in is comparable with CA even though the cost of living and standard RN wages is lower. Any other information or references would be great. Thank you!

    • Haley Wood April 5, 2016 at 8:33 pm - Reply

      On average, RN pay structure is 25% on the net (price minus cost) without hourly pay of injectables. So, if someone paid $12/unit, the net is around $6 and you would receive 25% of $6. Critical care experience is typically irrelevant in the compensation of RN injectors. Another important factor in compensation is what your annual gross revenue was in your prior office. How do you compare to other RN injectors across the country working the number of hours you worked? If you were in the 75th percentile or higher, you could negotiate 25% with strong evidence! I hope this helps!

  4. Jennifer April 26, 2016 at 10:57 am - Reply

    Hi Haley,
    I am a RN and I am new to the aesthetic field. I did get my certification for injecting. I was offered an opportunity for 27$ hourly pay no commission for Botox, fillers, laser tattoo and hair removal. I will be an employee of the me’s spa so I will not be require to provide my own liability insurance . I feel like that may be on the low end of the scale. I was expecting some commission on top of hourly. Maybe 5-10% to start? What are your thoughts?

    • Jennifer April 26, 2016 at 11:00 am - Reply

      I also have another opportunity that’s offering 30% off net profit but I will have to provide my own liability insurance and they’re wanting a 3 year 100 mile radius no compete clause. I will also be able to work outside the clinic with my own clientele that are not affiliated with the clinic but will still be making 30%.

      • Haley Wood April 27, 2016 at 6:13 pm - Reply

        You can receive liability insurance for less than $2K. This opportunity seems to have more autonomy; however, you have to consider other aspects: culture of the practice, who is your medical director, who will provide you with better training? All these questions are important considerations.

    • Haley Wood April 27, 2016 at 6:11 pm - Reply

      The hourly compensation is not an unfair because there will be costs in training and education. Perhaps, you could negotiate a six month review and your gross revenue. At that time, you can put in a place a percentage on top of your hourly. If you meet goals, then bonuses could be put in place as well. Keep in mind that training a new injector is expensive! Good luck!!!

  5. annie June 3, 2016 at 9:58 am - Reply

    Hello Haley,
    What is the standard rate (salary/ commission/ per hour) for NP injectors?

    I am a newly licensed NP but I have 5 years of cosmetic surgery and cosmetic injectable experience. The jobs I am applying for want the NP to sign off on procedures, provide cosmetic injectables, and possibly provide medical services ( BHRT and weight loss management ) while working only part-time till a clientele is built.

    I am unable to find any salaries or standards of payment for NP Injectors. I am unsure how to negotiate a fair salary.

    Thank you, Annie

    • Haley Wood June 21, 2016 at 8:46 pm - Reply

      Hi Annie,
      NPs tend to earn more base salary. If commission is a consideration in your position, NPs will garner 35% of net profit and RNs should expect 25% of net profit. It can take a while to build your business but typically a year should be adequate! If you love aesthetics, I would work park time if you think there is potential in that position! Good luck!!!

  6. Fiona July 31, 2016 at 1:35 am - Reply

    This is very helpful, thank you.. I’m bringing in about 52,000 monthly and making peanuts so really needed a sounding board. Thank you!!!!!!

  7. Fiona July 31, 2016 at 1:39 am - Reply

    Also I was just reading the comments. Be wary of those non compete clauses. I have been burned. Make sure they are offering something really solid if they are cutting off your options.

  8. Michelle August 9, 2016 at 10:38 am - Reply

    Hi there

    Do you recommend commission being calculated on sales of skin care products pre or post sales tax? I always thought pre tax, but want to hear what you think.


    • Haley Wood August 10, 2016 at 1:55 pm - Reply

      Typically, commission is taken on pretax retail price. For example, if a product is sold for $20, the 10% commission is taken on the gross, rather than the net. Therefore, the commission would be $2 for a $20 product. Does this help?

  9. Angel Sarfo-Darko August 28, 2016 at 8:43 am - Reply

    Hello Haley!

    I am a Certified Registered Nurse Anesthetist and have interest in obtaining a certification.. I’m trying to figure if it is worth my while. What does the salary range from (I know it depends on location, experience, etc.) For an advanced practice nurse? I think it would be amazing to provide anesthesia, as well as perform injections, etc ; ). I work in a hospital currently, so I could continue that and then injections, etc. in a plastic surgery office part time.

    • Haley Wood August 30, 2016 at 2:28 pm - Reply

      Hi Angel, Great to hear from you. There are many variables in compensation but starting out, you could make an hourly of $35/hour. As a seasoned injector with a substantial following, it’s not unheard of to make greater than $300K. The average NP in aesthetics working on a profit sharing/commission type of compensation probably brings in around $100K-$150K full time. I hope this helps!

  10. Catie October 14, 2016 at 6:12 pm - Reply

    Hi Haley!

    I am a Nurse Practitioner in California and have been injecting for 6 years. I have been with my current employer for 3 years and have acquired a good patient following for both Botox and dermal fillers. It is a very small business and I also perform laser hair removal and Vbeam laser treatments. I started out at $45/hr and now at $65/hr. I am getting busier and busier and wondering if I should renegotiate and ask for a commission on injectables. At my current hourly rate would you suggest a smaller commission rate like 10% or go for the more standard 25-35% commission rate?

    • Haley Wood October 15, 2016 at 2:07 pm - Reply

      Hi Catie,
      I may be mistaken, but I thought I heard where commission based pay in California is illegal…so check into that. However, maybe a profit sharing opportunity or bonus structure could work?

  11. Bea November 13, 2016 at 9:07 pm - Reply

    Hi Haley,

    I own a spa in Texas and have an opportunity for a NP to come in
    to do dermal fillers and Botox.
    She works out of several other spas, she will purchase all supplies, has own insurance
    and a medical director.
    What is the acceptable percentage range for a spa owner providing facility at no charge and all clientele?

    Thank you!

    • Haley Wood March 28, 2017 at 1:36 pm - Reply

      Hi Bea,
      Gosh, I have never been asked this question so I don’t have an exact answer for you. It sounds like she would be renting space from you basically? Have you thought about a room rental fee?

  12. Jen November 21, 2016 at 7:02 pm - Reply

    Hi Haley!

    I am a RN with my BSN and interested in obtaining certification to work as a nurse injector under either a board certified MD. So my questions are:
    First, where should I obtain my injection certification from? (I live in Philadelphia, PA) There are many online that I have seen but which is the gold standard in injectable practice? Should I do more than one certification?
    Second, how should I get experience and hands on training?
    Third, how do I find a mentor to train me?
    Lastly, is it realistic for me to stop bedside nursing in the icu to pursue this with the expectation of being compensated closely to what I get paid now?
    Any guidance you offer is greatly appreciated.

    • Sarah Baldoni March 21, 2017 at 2:12 pm - Reply

      I’m curious how you decided to move forward as I’ve got the same background but now work in a private plastic surgeon’s office who does injectables. I’d like to break into the field for the extra cash and I’ll be completing an NP degree in two years. What did you find out? Any good advice?

      • Haley Wood March 28, 2017 at 1:30 pm - Reply

        Hi Sarah,
        Starting in a plastic surgeon’s office (or derm’s) is truly the best way to go. If the plastic surgeon is agreeable to allowing you to train on injectables, under his supervision, that is the perfect way to start. Once you grow a nice clientele, perhaps 100 patients or so, you can negotiate a pay structure that works for you both! Always check with your state licensure board as well to ensure injectables are within your scope of practice! Good luck!

    • Haley Wood March 28, 2017 at 1:46 pm - Reply

      Hi Jen,
      Great to hear from you! I would suggest calling the PA board of nursing and inquiring about your scope of practice. The state may have specific certification courses, much like Mississippi. Start there.
      If they don’t have specific courses, I would try AAI or Palette Workshops. Both offer a robust fundamental training. I am not sure I would invest the money into these programs until you have a job secured and all your ducks in a row with state regulation.

  13. Tani December 12, 2016 at 4:08 pm - Reply

    Hi Haley,

    I currently hold 2 years of pediatric nursing experience in the hospital setting and am 26 years old. I am eagerly excited to merge into the aesthetic field and after reading your “10 reasons why being a nurse injector is right for you” I’ve never felt more like “It’s for me!” However, I don’t know where to start, where to go or who to net-work with to gain a position as a nurse injector and be given the opportunity to flourish. Also, I don’t know if I should go straight for my MSN or if that would place me in a better state in regards to a job in the aesthetic field? Any guidance or advise would be greatly appreciated!

    • Haley Wood March 28, 2017 at 1:57 pm - Reply

      Hi Tani,

      Great to hear from you. Let me tell you, pediatric nurses make the best injection-ists! First, I would check with your state board to see what your scope of practice says about injecting. That’s the first place to start b/c every state is different. You may want to look for positions in derm or plastics b/c these settings allow for great growth and mentorship 🙂

  14. Bryan December 16, 2016 at 2:34 pm - Reply

    Hello Haley,

    I am a plastic surgeon on the other side of most of the above comments. I have hired an experienced (5yrs) RN injector recently at an hourly rate with commission on gross sales. Commission is 10% initially until target/goal is met and then it is 15% of gross sales. She is a great addition to the practice and is rapidly increasing business, though the practice (me) is paying for all of the advertising, facility, product etc (overhead). I am not opposed to her making a large amount of money, however, I did not really factor in overhead costs in our initial negotiations. I have seen several recommendations on calculating commissions on “net sales”. There is very little info online about this topic and how to figure out exactly what the profit to the practice is. Do you have a standard formula or several options of formulas to determine what is the actual cost to the practice for the Nurse Injector to more easily determine the profit/loss to the practice that can be compared to her compensation? Any insight will be appreciated. Thank you.

    • Haley Wood March 28, 2017 at 1:54 pm - Reply

      Hi Bryan,
      Owning a practice myself now, I completely understand overhead…gulp.

      However, commission on net sales is how most practices compensate RN injectors. For a RN, 25% of net is typically the commission structure; NPs are awarded 35%. You just have to be very savvy to understanding what your filler and botox costs are, with which your industry reps can help. I don’t know your overhead….marketing, rent, supply costs, malpractice, it all adds up. It’s hard to say what you will exactly make on each unit of Botox or syringe of filler not knowing this info. I hope this helps 🙂

  15. Desiree January 5, 2017 at 10:12 pm - Reply


    Thank you for the informative article! I am an Aesthetic NP in Florida and I bring over $600,000 of gross annual revenue to the practice. What do you think is a fair base salary rate with and without commission? Right now I’m getting a flat $55/hr salary rate.

    • Haley Wood March 28, 2017 at 1:50 pm - Reply

      Hi Desiree,
      Congratulations on your well done gross annual revenue numbers! Very nice! You are well above the 50th percentile!

      I probably won’t be too popular when I say this but it’s time to negotiate…but I say that with caution. I don’t know your benefit package currently. You could always suggest a small profit sharing on your quarterly sales 🙂 You are a value to that practice, obviously, and I would think, an employee that is highly valued 🙂

  16. Sandra April 4, 2017 at 8:37 pm - Reply


    I am an NP who is new to injecting. The practice I work for is opening a medical spa, where I will be injecting and also doing laser vaginal rejuvenation and ablative face treatments. They are currently paying their nurse injector 10% of gross sales. What would be your recommendation for my reimbursement? My current salary is $110,000 with the practice, but I will be shifting time to the spa so that will decrease. My goal (and theirs) is that I don’t make less that what I am earning now but none of us knows how to go about figuring a starting point! The spa will be located in Salt Lake City.

    • Haley Wood April 30, 2017 at 2:07 pm - Reply

      Great to hear from you. Congratulations on your new position. Until you have an idea of what your volume will be, it will be difficult assessing if you can continue to earn $110K/annually. Perhaps, the first year, you could take a combination salary and commission compensation plan. At 40 hours per week, you are currently making $57.29/hour. If you could take a small cut in hourly and a smaller commission, say 7% of gross, then your pay may equal out in the end. This transition is difficult. In the end, it’s typically best to be commission based in a growing practice, so if you can handle the fluctuation in pay for the next year, it will be worth it in the end.

  17. Rae April 13, 2017 at 2:43 am - Reply

    I am an experienced RN injector with a MSN, but not NP. I am in my early 40s & have more than 10 years of experience in the aesthetics arena and 20 in nursing. I currently work for a large plastic surgery practice in California and have been with the same physician group for 10’years. I am content at my current practice, but I am aware of coming internal changes to our management structure using an outside agency. I have full autonomy over the med spa operations. I was told that my schedule and time I allow for procedures would not be affected, however, as with any large corporation managing a practice I am not so certain that holds true. Hospital and large corporate business entities can decimate the existing team dynamic. This has left me re-evaluating my next 20 year plan. I have a 2 month wait list to see me and I supervise 2 other full-time injectors and 4 estheticians. My individual gross revenue production last year was over 1.125 million (I brought in more than one of the surgeons) and net was higher than most practices based on our pricing tiers. My financial compensation package is around 200k/yr. Knowing this info.
    My question is 2 fold: I am considering relocating back to one of the southern states to be closer to my family. I know that annual income in the south is less relative to the cost of living. Do you know states offer the most opportunity for nurse injectors? From a compensatory and legal perspective? California has many restrictions regarding RNs and MedSpas. I would ultimately like to stay within a well recognized group/single practice without taking on my own business expenses. I never explored other options, so the prospect of starting from scratch is a little terrifying. I don’t really know how my current practice value translates across country.
    Thanks for taking the time to respond,

    • Haley Wood April 30, 2017 at 2:21 pm - Reply

      Well girl…you have a lot of options…and a lot to offer! If you are bringing in that type of gross revenue, any plastic surgeon would be fool not to take you. Tennessee and Kentucky are fairly great states to practice aesthetics. In Alabama, RNs cannot inject, nor can NPs or PAs. In Mississippi, you must be a NP and even at that many physicians won’t take one on. In Georgia, RNs can inject but I am uncertain as to their authority. My opinion would be to stay in your current position for 6-12 months to see how the waters go. Who knows, you may be able to function just as you are now without any hiccups. Being from the South myself, I can tell you that Tennessee doesn’t have an income tax….yes, that’s right. Our sales tax is high, however, your cost of living would be less of course.
      You are in a tremendous position.
      If you decide to move, I would contact your reps who can get you in touch with local reps in the area in which you want to move. They can start the connection process for you! Good luck!

  18. Katie April 19, 2017 at 6:03 pm - Reply


    I am an aesthetic Registered Nurse Injector with 10 years experience in the aesthetics field. I’ve helped launch a very popular body sculpting laser, training physicians and nurses from coast to coast, have worked with most all laser wavelengths, and injectables. My background is in dermatology and facial plastics. I have been offered a position with a wellness center and have only been offered $10/hour with 5% commissions on injectables and 40% on MedSpa facial services. I have built a following and this practice is wanting me to introduce aesthetic lasers and injectables into their practice. So I will be training them as well on some of the procedures. I’m not sure that 5% commission and $10/hour is enough for my experience and expectations. I also have to factor in that I’m starting with this practice from the ground up with injectables and lasers, as they have never done them. Any help or advise on negotiating would be very appreciated. Thank You!

    • Haley Wood April 30, 2017 at 2:25 pm - Reply

      As I read this, I am thinking…run!!! Run!!! 5% on gross or net profit is not great. It sounds like you have a great gig training and I would suggest holding out on this offer. Not every offer is a great offer.
      If your 5% is on gross revenue…you would be $30 on a $600 syringe of Juvederm. If you did one per hour, which usually isn’t the case in most medpsas, you would make $35/hour. But, remember, that’s gross. If it’s 5% on net….I would tell you to run for sure!

      • Katie May 2, 2017 at 11:13 pm - Reply

        Hi Haley,

        Do you have an email address I can email you with further questions? Thank you!

  19. Nancy April 24, 2017 at 7:59 am - Reply

    Hi Haley,

    I am a Physician Assistant currently working for a dermatology practice doing general derm, lasers and microneedling. I am paid a flat hourly rate of $60/hr. working part-time. They do not pay me any extra for selling products or for the laser or microneedling. We have only been doing the laser and microneedling for 6 months but I perform about 5-6 a week. Now I’m about to get certified in botox and fillers and want to add this to the procedures I am already doing. Because I am part-time, they do not pay for any training or benefits, only malpractice insurance. Can you give me advice on what is fair compensation?


    • Haley Wood April 30, 2017 at 2:32 pm - Reply

      Hi Nancy,
      As a part time worker, $60/hour may be fair but the only way to truly gauge your worth is to ask your practice manager for an annual revenue report on your work. You should be able to see how much you are bringing in for each procedure you perform. If you were in a commission based practice, mid levels typically earn 35% of net profit of the procedure. So, if a laser procedure is $1000, and your costs ( disposables, laser payment, etc) are $200, then the net is $800. Your commission is 35% of $800 which is $280.
      It’s hard to say if this is fair b/c I don’t know how productive you are during the time you are there. I hope this helps!

  20. Trudi Ramsey April 26, 2017 at 10:38 am - Reply

    Haley, I have been an RN for 18 years, however primarily in the hospital setting. I have obtained training/certificates in advanced Botox/ Dysport, dermal fillers and PRP. I have also been training in a dermatologist clinic for laser hair removal. I am wanting to start my own business and work within the clinic of a physician. What are the medical director fees that you recommend for those starting out. Please feel free to email me.

    • Haley Wood April 30, 2017 at 2:37 pm - Reply

      Hi Trudi,
      Ahhh, medical director fees! Fee schedules go many ways: flat fee, percentage, the number of charts signed. The most common fee structure I hear about is flat fee, which is anywhere from $1500 to $3500/month, typically. Some physicians ask for a fee for the number of charts they have to sign on a monthly basis, but no matter the arrangement, I believe the average is around $2K/month. Hope this helps!

  21. SD April 27, 2017 at 1:10 pm - Reply

    Hi Haley!

    I am so happy to have found your site and this post!

    I am a new graduate PA looking to build my niche in the aesthetic industry earlier rather than later in my career because it is what I enjoy and am passionate about. After being told I lack the experience a couple dozen of times, I’ve finally found a place that is willing to give me a chance. With where I am at, I felt it was most important for me to get my foot in the door and worry about my compensation (as long as I can have some money coming in) when I feel I have something to offer the clinic in return. Their previous RN injector only performed Botox and so the expectation for me is to do what I feel comfortable with. I am scheduled to take a training course next week and wish to implement my learning right away as far as the neurotoxins and fillers go.

    My current compensation model we have set up is $2.50/unit of Botox I inject per person (the clinic charges the patient $13/unit). We didn’t discuss fillers at the time because neither of us were sure I was going to offer the service. If and when I feel comfortable to offer it, I was wondering what a fair compensation model would be for it. There was no room for negotiation for the Botox and I really wanted a chance. When I bring up the filler though I want to have done the research. As a little background, this clinic doesn’t have a large volume so initially I anticipate working maybe 1 day a week for 3 hours and just a handful of patients. I understand filler isn’t calculate by units and rather syringe so do you have a recommendation that would be in line with the Botox compensation and fair representation of my being new to the field?

    Thank you so much Haley! 🙂

    • Haley Wood April 30, 2017 at 2:43 pm - Reply

      Well, $2.50/unit is not a bad deal what so ever… feel good about that!!!

      Yes, you are correct, syringes are sold by the syringe typically. For a midlevel, the average amount one will make per syringe is $60-$100. Sometimes more, sometimes less.

      Once your practice grows, you will be able to cross market to all those Botox patients that you offer filler services. Your patients will trust you and it will be a nice transition. I always say that if you grow your Botox practice strong, your filler practice will grow just as well when you are ready!

  22. Tammy Ryan July 3, 2017 at 3:38 am - Reply

    Hi Haley,
    I am a new NP but I have 13 years of aesthetic experience with plastics and aesthetics. I am negotiating my first NP salary job in North Carolina. I have no idea what to ask for ?? The average salary is $110,000. How do I negotiate services rendered to be calculated into base salary?
    Thank you

    • Haley Wood July 15, 2017 at 7:15 pm - Reply

      There are typically three pay structures in aesthetics: base salary only (the average I have seen is $50-75/hour), small base salary with smaller commission ($20/hour with 5% on gross) or full commission (25% for RNs on net revenue, 35% for NPs on net revenue).

  23. Sharon August 1, 2017 at 2:02 pm - Reply

    Hi! I’m a newly certified nurse injector in Scottsdale, AZ. Most of the physicians offering to be a medial director charge from $500 a month to $1000 a month to nurses under them.

    For a person that just wants to do friends and family until I get some stronger skills, that isn’t very affordable. I was thinking perhaps of partnering with one or two more RNs to see if we could possible create a proposal for a medical director that would give us a little time to practice, like 3 months of each just paying $200 a month then after we are ready to see patients it could go up in monthly cost. Do you know if that is something that may work? If so, I need help figuring out a contract or proposal between RNs and the MD acting as medical director.

    • Haley Wood August 2, 2017 at 4:44 pm - Reply

      Hi Sharon,
      Each physician calculates their liability as medical director in different ways. Some may see your “practicing” as an increased liability even though you may not be seeing many patients, whereas another physician may calculate their liability in a reduced manner. I would recommend connecting with a physician who knows your skill level as a RN. If they have faith in your nursing knowledge and expertise, they may be more willing to work with you on a fair arrangement.

  24. Tom Cunniff April 9, 2018 at 4:30 pm - Reply

    Dear Haley,

    I have been a nurse injector for 15 years. I am employed at a very busy Plastic Surgeons office in Illinois. Last year with salary and commissions, I was paid $110k. The gross revenue I produced for the practice was $600k.

    Based upon my experience, and the amount of revenue produced, do you think I am being adequately compensated?

    Thank you for your response.

    Kind Regards,


    • Haley Wood May 16, 2018 at 12:11 pm - Reply

      Yes, I do believe your compensation is in line with your production! Great job!

  25. Elizabeth April 12, 2018 at 10:09 am - Reply

    Hey Haley!
    I have been a PA now for almost 10 years with a busy Aesthetic practice.
    I receive $70,000 base salary and 18% of gross sales (injectables) over that base.

    I bring in roughly $1,000,000 yearly gross.

    Do you think this if fair with my experience or is it time to negotiate?

    Thank you

    • Haley Wood May 16, 2018 at 11:54 am - Reply

      Yes, I think this is a very fair compensation plan 😉

  26. Cherice April 14, 2018 at 10:56 am - Reply

    Hi, Im a newly certified nurse injector in Arizona. This is my first position after course completion, and my medical director is asking that I pay out of pocket for my own botox and filler until fully trained. He also feels I need to provide my own patients, so I dont “upset” any of his current patients (which I totally understand). So essentially I need to provide my own supplies and patients (under his supervision) until he is satisfied with my work. Does this sound like a fair agreement? What kind of hands-on training do most have when starting? What kind of agreements are made between director and nurse while she is still ‘learning’? Im just having a really hard time figuring out whats commonly done for a new practicing injector nurse.

    • Haley Wood May 16, 2018 at 11:53 am - Reply

      In all honesty, this doesn’t sound like a place you want to build a practice. I would look elsewhere to start your aesthetic career.

  27. Armine Harutyunyan May 2, 2018 at 12:14 am - Reply

    Hi Haley,

    I am wondering if you provide injection hands on training?

    Thank You!

    • Haley Wood May 16, 2018 at 11:50 am - Reply

      Currently, I am not providing trainings in my office for out of state practitioners.

  28. Hannah May 19, 2018 at 12:01 pm - Reply

    Hi Haley,

    I am new going into the aesthetic field. I have been hired at a med spa that I have been to a couple of time and enjoyed my experience there. Now that I have been hired-I haven’t started yet, but I started looking further into all the legal aspects of this field that I need to know…and I became slightly concerned. So I live in Texas and from what I’ve been told a mid-level doesn’t need to be on-site when a RN is working just reachable BUT they have to (NP/PA/MD) do the initial assessment on each new patient… Well I never saw a mid-level when I went for the first time I was just treated by the Nurse..who was very knowledgeable and this didn’t bother me but now that I’m supposed to be working there with my RN license I’m like😶. Also, one thing that drew me to this spa as a client is they sell filler by unit, they get the initial syringe the filler is in and inject into another syringe in the amount the client buys, they are super busy so I’m sure these half used syringes only sit for a day or two. Are there legal loopholes for these concerns that you know of? I feel like there has to be because they have been open and thriving for years in multiple locations. And of course I will be having this discussion with the hiring manager when I am sent my paper offer. Unfortunately, I didn’t learn about the mid-level having to assess each new client until after the interview, and I totally forgot to ask about them selling filler by the units and the legal backing behind that. In the mean time, I’m freaking out because besides these concerns this would be an awesome job for me in all aspects so I thought I’d get your opinion!

    Thank you!

    • Haley Wood July 24, 2018 at 12:43 pm - Reply

      Call your Board of Nursing to understand what your scope entails.

  29. Missy June 21, 2018 at 3:51 am - Reply

    Hi Haley,

    This blog is very insightful. I am an RN in a very busy practice in the northeast with 4+ years of injection experience. I am getting 18% on the net profit which factors in tier discounts, app rebates and free goods with our orders. I bring in roughly 1,000,000 in net profit, which means that I am being paid 180k. Do you think that this is fair considering that I am full time and have additional responsibilities (light surgical patient care when needed, ordering,etc). In addition to 18%, I have paid vaca, benefits.

    Do you think this is fair?

    Do most practices factor in discounts, rebates and free goods into what determines the net profit?

    Thank you!!!

    • Haley Wood July 24, 2018 at 12:39 pm - Reply

      Your compensation plan appears fair 🙂 I would ask your office manager how you are getting to $1mill as your net profit. This will help you understand how your practice calculates your income.

  30. Kae July 16, 2018 at 8:38 pm - Reply

    Hi Haley!

    I love your site! such great tips and professional advice for those who are both new and seasoned in the industry.
    I have been working as an aesthetic RN for 2 years in the bay area, California.
    I get paid $40/hr with 10% on products and 4% gross on all services (coolsculpting, prp, lasers, injectables).
    I am projected to bring in around $700,000 gross this year.
    I understand that I am fairly new (2 years) and additionally receive ongoing education and training to increase my skills in the office by my employer.

    Does this sound appropriate to you?


    • Haley Wood July 24, 2018 at 12:33 pm - Reply

      As your gross revenue increases, perhaps you can create a bonus structure with your employer 🙂

  31. Sunny July 31, 2018 at 3:44 pm - Reply

    I am a Family Nurse Practitioner for 3 1/2 years and have been an operating room nurse for over 12 years. I currently work at a medical weight loss and hormone center for the past two years. I am trained in PRP services and microneedling with stem but not formally trained with Botox or fillers.

    I have been offered a job at a medical spa that performs every aesthetic service that I know of. Fillers, neuromodulators, Halo, BBL, sculpsure, laser hair removal, microneedling, threading, O shot, P shot, and vaginal rejuvenation, and BioTE hormone replacement.

    I am offered 10% commission on my gross for all procedures and 30% for BioTE. Paid liability insurance but no other benefits. Also, classified as an independent contractor. The company will pay for all my training and advanced training.

    I feel like this offer is really low. Any advice?

    Lastly, the company eventually will want me to bring in my medical weight loss knowledge and hormone management to add to their menu.

    • Haley Wood August 7, 2018 at 9:21 pm - Reply

      Ask for 20% gross, and see where you get!

  32. Sunny July 31, 2018 at 3:52 pm - Reply

    I feel like this a great opportunity but I would like to believe that I am worth a little more than 10% commission. The company has had a complete turnover of staff and they admittedly report they uncertain of the retention of current clients.

    • Haley Wood August 7, 2018 at 9:18 pm - Reply

      Shoot for the moon! It never hurts to ask for what you really want!

  33. katie August 1, 2018 at 3:14 am - Reply

    Hi Haley,

    Thank you so much for writing this article and for all of your responses in the comments section. I read everything! I feel a little awkward asking for your advice, as I’m still in nursing school, but I’m in awe of your knowledge on this subject and I can’t help myself!

    Before nursing school I was an esthetician, which I really enjoyed but I really felt a calling (cheesy but true😉) to go into nursing. So far, I love the OR, and I can’t wait to get into the ER and ICU. I also can’t get the idea of aesthetic nursing out of my head. I really think I would love it!

    Is it ridiculous to think that I could get hired as a new grad with a plastic surgeon? What can I do now, or when I’m finished with school to make myself a more attractive hire? Would I be a better fit for aesthetic nursing after I have more experience in the hospital setting, like in the operating room? Is there anything that you wish you had known or anything you would do differently if you had pursued aesthetic nursing straight out of school?

    Thank you again for this article and all of your time, and please forgive me for asking so many questions! I will be grateful for any information and advice you are able to throw my way.



    • Haley Wood August 7, 2018 at 9:17 pm - Reply

      Hi Katie 🙂 Best of luck to you in your pursuit of a nursing degree. Operating room experience where plastic surgeons rotate will give you great experience. Often times, plastic surgeons will ask skilled OR nurses to come work for them in their independent practices. You can always look for jobs in cosmetic surgery centers, as well!

  34. Sunny August 18, 2018 at 8:18 pm - Reply

    Thank you Haley for your advice!

  35. Jen August 20, 2018 at 10:37 pm - Reply

    Hi Haley! You taught my CANS course in Chicago I think it was over four years ago now! 😁 Anyway, I am glad I found this thread. I have been making 35% as an RN-CANS in a plastic surgery office in Chicago for the past four years with 6 years of injecting experience and an additional 10 in medical aesthetics. My concern is that now I recently became the NP and Aesthetic director for the practice (grad school was brutal lol). I am negotiating more compensation since I am transitioning roles but I don’t want to seem greedy. I am extremely happy where I work and since I was making 35 of net already what is fair now that I am An NP and aesthetic director ? Thanks so much and I hope all is well! I will probably see you at the meeting in October here. Jen

    • Haley Wood October 20, 2018 at 4:29 pm - Reply

      I didn’t attend the ISPAN Chicago meeting…sorry I missed you! It sounds like formulating a bonus structure might be in your best interest. Perhaps a monthly or quarterly bonus based off of total gross revenue generated could be an option for you!

  36. Mary September 1, 2018 at 10:21 am - Reply

    I live in Texas and I have been approached by an aesthetic office (RN and aesthetician, with a plastic surgeon overseeing off sight). What specialty is required as a Nurse Practitioner to do the initial assessments on the clients?

    • Haley Wood October 20, 2018 at 4:36 pm - Reply

      Check with your state nursing board. Some states require MDs, PAs, and NPs to do the initial consultation prior to treatment.

  37. Danielle September 18, 2018 at 1:09 pm - Reply

    Hi Haley, I absolutely love you blogs- so much great advice! I’m going to to be starting a soon an independent contractor at a plastic surgeon’s office in Colorado and wondering what you think as far as indemnity insurance. They believe I am covered under theirs so wouldn’t need to take out my own. Is this common practice with contracted RN’s? I’m an RN (BSN) with 4 years of injecting experience but have only worked as an employee in the past. Thank you in advance!

    • Haley Wood October 20, 2018 at 4:39 pm - Reply

      Reach out to Amber at MedPro and she can guide you on the correct coverage!

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