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Medical Spa Business Forum > Help, I need a question answered - Medical Spa Start-up

Hello all, I have a few questions I would like to ask you fine folks. I am an esthetician who is planning to open a spa in the next year and am considering turning it into a medispa instead. I have heard different ways of doing it when it comes to adding a doc. Do I pay them? if so whats normal rate? Or do I rent space to them? I keep getting different answers.

Next quetion is what seems to be the average insurance rates with and without a doc? I have talked to several ins. co., they give such a wide range of costs that I believe they are all lying to me. Or do the docs cover themselves?

I would also like to know what you think is the best laser to use to for hair removel, photofacials, acne, and the such? I have worked in several medispas (never got straight answers from these people on any question) and have used many different pieces of equipment and none impressing me so much that I would want them for my own spa.

Any Doc in Florida interested?

I would really appriciate any help that can be offered.

Have great holidays everyone!

Spalady
12.18 | Unregistered Commenterspalady
Hello Spalady,
Please don't take this as a flame of your posting. You're raising some common questions.
However, The fact that you're asking these types of questions demonstrates a lack of the complications that go into this type of operation.

What you're talking about is the practice of medicine. So take this as absolute:
You can not hire a physician.
You can not partner directly with a physician.
You will never control a physician in any meaningful way.
etc.etc.etc.

There are knowlegable people on this site. My personal feeling is that you're not going to get a lot of help with the general questions. It seems as though you're looking for someone to give you easy answers. Good luck.
12.18 | Unregistered CommenterDocsocks
Docsocks,

Thanks for your reply, I have been researching mass amounts of information, but was seeking some overall opinions. Or how other people have handled these situations.

Yes, I posted some rather general questions, hoping to get general answers, but perhaps as you stated, I should ask some direct questions.

I do appreciate your post and look forward to reading each and every bit of information that is newly posted. I have enjoyed this site since becoming aware of it. It is very informative.

Thanks again and I hope you had a great and filling Thanksgiving.
12.18 | Unregistered Commenterspalady
To have your own medical spa you need to form a corporation. The doctor will work for your corporation as an independent contractor, not for "you" directly but for the corporation. That's how it's done.
You do not have to have malpractice insurance in FL. For a start up business it's really a huge financial strain. I've seen quotes of about $26k per year for the MD and the spa.

The fact that your an esthetician means your going to be grossly limited in the medical services you can perform. You won't be able to do any injections or use medical rated microderm equipment or peels with a pH lower than 2.2. You can not touch a laser or IPL in FL unless you are an electrologist and then the MD has to be on site when you use it. MD's, ARNP's, are the only one's in FL allowed to operate any laser devices. ARNP's are the only ones who can use a laser without the MD on site.

Pay rates for the MD vary greatly. It really depends on how much time the MD is going to put into it, etc. I give my MD a base plus a percentage of profits.

In your situation, if you want a medical spa I'd suggest you become an RN or ARNP which will allow you to perform the common medical procedures of a med spa. Being an esthetician will definitly give an excellent background.

I have a spa in FL, I've been through all this....good luck!
About your question if you should rent space to the MD. You can. But be aware that the MD will be renting this space like a hairdresser rents a booth in a salon---for their own business gain, not yours. The services they offer and money they make are 100% theirs. They pay you a rent and that's it. They are not your spa's medical director so you can't call yourself a medical spa. The MD does not work for your business, they just rent space from you.

It might be your best bet to open a day spa and rent space to an MD to come in and perform procedures. You are qualified to run a day spa with your license and you can offer your clients the MD's services. I have seen this done in upscale hair salons and day spa's.

Oh, one last thing. Each MD working in any facility must get an occupational license from the city and the county. If the MD works in 10 locations she needs to have 10 occupational licenses. Make sure they have one before you rent space.
aestheticRN,

Thank you so much for taking the time out to respond to my posting, I really appreciate it. It is funny you say about becoming an RN, I am going to school for it! I had decided to do that a while ago; in the military I ran the ER and there you can do just about anything medically, so I am well trained in giving shots and so forth. Once I became an aesthetician I also decided I needed a higher level license to perform more functions. You are definatly right on this. (my hubby is an RN, I'm trying to convince him to get an aesthetic license as well, so we both can work in our spa, he simply says, I deal with enough women and too many people already think I'm gay -men) As well as setting up as a corp, I have already done this.

You bring up some great thoughts, I was not aware about doc's having to have seperate occupational licenses, - awesome. Is your spa in central florida?

Again, thanks so much for taking the time out to offer help. It's very kind. Hope to repay sometime.

Spalady
12.18 | Unregistered Commenterspalady
This is not meant to be mean or rude statement.

It seems that everybody in the Spa industry wants to do medical procedures. They just don't want to put in the time to become doctors.

It's like the guy who looks at Microsoft and say, I wish I had a billion dollars, I want that. Then, he looks around and finds out that he has to work countless hours to get there.

The next logical step would be to find a shortcut. That is whats happening now.

I agree with the first post in here.

If you want to do doctor procedures, then become a doctor. I don't mean this to be harsh, but even if you look at the european model. The aestetisians go to school for 4 years. Here, someone goes for like 6 months and now they want to grab a laser and zap away.

Lasers and IPL devices are getting easier to use, but I believe that there has to be a physician on site at all times when they are done. Legistators tend to be favoring this as well.

If you want to open a Day Spa go for it. If you want a spa that has medical equipment that needs doctor you have two choices:

Become a doctor or work for one.

Good luck with everything.
12.18 | Unregistered CommenterMD
I wish I had it as good as my MD has. I do all the leg work, set up a posh office for him, advertise, do the build out, hire staff, payroll, etc, he has ZERO out of pocket expenses, he only does the procedures he enjoys--one day a week--returns to his regular MD job the rest of the week and just like that adds six figures to his income. He deals with none of the business related stress. The MDs are still making out like bandits and still have all the control on what's done and how it's done.

To maximize your expertise, education and skill as an MD you need to be smart about where and how you spend your time. Forget the fact that your working for a corporation owned by a non-MD. If you let pride/prejudice get in the way it will be very difficult to make money in this business.

For example;
A plastic surgeon now has to sit there and do laser hair removal (under current FL law) or vs. perform high cost surgery for that hour. Well he can't be in two places at once so train the nurse and maximize the profit for that hour. Not only that but if you have a good nurse she/he will sell the surgery to the non surgical patients. I have actually bonded with a local PS and cases that I can't treat with non surgical methods I refer to him. Likewise, he refers the Botox and Restylane business to me. I advertise like crazy, he does none. He gets to take advantage of time I spend talking to a client about how HIS surgical procedures will give them the best results. The pt. calls him and books it. They are sold by me. He did not generate the business nor spend time selling it. This alliance is awesome becuase we both profit (him just 1,000x more than me...).

In my situation my MD and I both profit from each other. It's working great for us. It's not a short cut in any way. I still perform my RN only duties and he his MD duties. If a question comes up I call him. If I'm interested in performing a new procedure we look into it together. He makes the final call. I do nothing without his consent.

I wish more MDs would open up to this concept as it profits all involved.
SpaLady;

No, my place is in south florida. You may also want to invest some time in taking some business related classes or read books. Setting up a business, especially a med spa, is a very involved process. Medical people are not taught about business, marketing, etc. but you will need to learn the basic skills. It greatly helps the financial decision making process if you have a business person helping you. I would have spent money on things not needed that at the time I thought were great investments had it not been for a seasoned business person that had the knowledge of the long term effects each decision could have on the business. A few silly mistakes and your deep into debt, kiss your dreams of a med spa goodbye!

I will say that finding your location will be the biggest challenge. It took me 11 months of consistent looking. It's because the day spa's and most MD's don't want you next to their place. I've been turned away time and time again because of "non compete clauses" and big spas having the money power to say to the building owner, don't rent to her. Like wise for medical condo's, if a dermatologist or plastics occupies space there they will throw a tantrum so you won't move in. Many MD's are very resentful of non MD's opening med spa's. However, the smart MD will invite your spa to move in next door. Moving in next to a Plastics or derm will do wonders for both business. If you find a space next to one of those MDs go in and talk to them about your plan and how you can both benefit before you sign a lease. You don't want to move in next to one and have a constant war going on. If your going next to a day spa be careful, they are the least "open" to the idea of another spa next door. Although this can be a great alliance as well.

You also have to make sure the retail space is zoned for medical use. Realtors won't tell you this normally b/c they just want the sale. Then when you go to get your city licenses your told no way. So you wasted time, money, etc.

There's so much more to opening a spa, I could write a book! If this is something you enjoy doing and are passionate about, nothing will hold you back and you'll learn from mistakes and move on.

Good Luck!
aestheticRN,

You're awesome!

You are correct that there is alot of information out there to read over. I have been planning this spa for the last year and have been reading plenty of books and articles, especially those on the business side of the industry. It has just been recently that I have started looking indepth into a medispa, although that is where most of my experience is.

I am thankful that my past experience is in management and the ER while in the military. I believe it has and will continue to help me in the finacial aspects of the spa and in working with doctors and other medical professionals. I also agree with your post that two professionals can have a healthy relationship. There is no reason for any type of business be parasitic. Although, I firmly agree that doctors that work with aestheticians make-out well above the rest and get-over on doing any other form of work on the most part. I worked with some pretty cool docs in the Army.

There of course no reason for an aesthetician to become a doctor. Although, I believe training for the profession could be longer and more indepth. I found the training to be rather surface and lacking any real form of acadamia. There should more information on the workings of peels; from what are the chemical make-ups of solutions to how peels interact with the skin and what facilitates that interaction.

I did consider the advanced school of aesthetics, but decided against it, deciding instead to continueing my master's and become an Rn. This was also the most financialy sound decision and only leaves me devoting about an extra six months more. And certainly allows me more professional options than not.

Funny you mention opening a spa next to another spa; I was just debating that same topic with my husband, who just doesn't "get it". I have no problem with it. And if their down with exploring possiblities together, I am too.

I enjoy your posts and that you are so willing to share your knowledge, I have found people are very insecure about sharing knowledge - as if one candle loses something in lighting another. Thank you.

Spalady
12.18 | Unregistered Commenterspalady
I am a ParaMedical Aesthetician in Western Ky. I attended a 1 year program in TN for my Aesthetics and later graduated from the National Laser Insitute in Scottsdale, Arizona where I recieved my training for Laser Hair Reduction, Tattoo Removal and Photpfacial as well as Botox and Restylane training. I have medical exprerience being employed by a large Medical Spa/ Dermatology Clinic performing said dutues as EST and Laser Tech.
I am also interested in taking advantage of the open market in this area and in search of a MD who has mutual desires. I do not pretend to have all of the answers and believe education is on going and can be obtained by experience and eagerness to obtain knowlege. I am currently researching the market and creating a business plan. The problem that I am encountering is that this paticuliar geographical area has a limited number of Dermatologist and I am not sure how to approach potential MD's with my ideas. I currently commute an hour and fifteen minutes one way and as valueable as my time is. I know that my current employers hve far less time to become involved in new ventures so far away. I have a passion for this field and a drive for success. As MD's how would you like to be approached with a pitch such as this?
12.29 | Unregistered CommenterMichelle
Someone posted in here that "they wish they had it as good as their doctor, something about how they just show up and do the procedures.

You know what, you can have it as good as your doctor,

Let me tell you how.

GO TO MEDICAL SHCOOL FOR FOUR YEAR AFTER YOU FINISH FOUR YEARS OF UNDERGRADUATE SCHOOL, THEN DO ANOTHER 3 TO 7 YEARS OF RESIDENCY AND YOU WILL BE ABLE TO DO THAT.

Oh yeah, I forgot the medical and undergraduate student loans. I guess I did make an investment.

I don't have any problems with non-MD's opening day spas. Those are great. I'll even invite them in. I do have issues with non-MD's trying to capitalize in medical industry with medical procedures.

06.16 | Unregistered CommenterMD
I get so many calls by health spa people trying to use my medical license to make money doing laser. Any MDs in this field beware your malpractice isn't worth few hundred bucks a month. Your license is your life not simply a fast buck.
06.20 | Unregistered CommenterPccMD
I would like to ask you guys if anybody knows who is legally allowed to perform mesotherapy in the state of Florida?
Is it only MDs?
Or ARNPs?
Or Nurses?
Thank you
07.5 | Unregistered CommenterCosette
Who is legally allowed to do mesotherapy?

That is a good question. I know who has a good answer.

IT WOULD BE THE STATE MEDICAL BOARD OF EACH STATE.

That would be the first place I would call.

As a general rule however, Mesotherapy is considered both holistic medicine and alopathic.

That does not mean that some guy in his basement can treat someone. Unless he has a license to practice medicine and his practice happens to be in his basement.

You need a Medical license to practice medicine independently. Independently, that is the key word. If you have to be surpevised, then you have to work for a doctor who can supervise you.

In some states RN's can work under the direct supervison of a doctor and since an RN license allows him/her to give injections, they can give mesotherapy injections if trained properly. But they can't open their own clinic or give it on the side in their home or any of that.

Nurse practitioners in some states can practice independent of supervision. So, that means that they should be able to perform mesotherapy.

By the way when I say license I mean Medical license. Not a business license. Aestetcian and day spa owner have a business license.
08.2 | Unregistered CommenterMD
Anyone have any insight on how the laws in the District of Columbia work with regards to DR and spa relationship? Do they have to form a sub-contracting agreement?
08.10 | Unregistered Commenterheidi
Why high capital equipment cost (Expensive medical equipment)? Could higher profits be produced with procedures that require minimal gross cost? Why not specialize? Imagine the bottom line on being the Botox and dermal filler specialist in your area?

Am I wrong?
Yeah. You're wrong.

Botox and fillers are high cost. Better to be the hair removal specialist where your costs are fixed.
12.2 | Unregistered CommenterBurnedMD
I started working with an esthetician in her day spa providing Botox, fillers and IPL/laser (my equipment). I have never been prejudiced in working with non-MDs but my recent working experience made is so that I will NEVER, EVER work WITH a non-MD other than in a employer-employee situation and I will strongly advise any MD not to consider it, it is not worth it. Non-MDs, although can be very good in their field of work, have no understanding of the complexities of medicine and the consequences of malpractice problems. All they see is the money the MD makes and how the non-MD works very hard while the MD reaps off the benefits. Think twice before considering anything else other than employing a non-MD.

I am both an American and Canadian RN, BSN currently working in Canada's Northwest Territories (near Alaska for those of us Americans that need a geography lesson) and I have been working as a labor and delivery/OR nurse for over 5 years. Owning my own business has always been a passion of mine, and as of recent, I've become VERY interested in the idea of co-owning a medispa with an MD. Although not an MD, I couldn't agree more with the MDs on this site who have noted that if you want all the glory and money of a doc, then go to school for it! This isn't rocket science people! And that goes for everything else in life too. Since I have no direct experience in medispa services, I am starting training in February of this year (2014) at the National Laser Institute in Phoenix. I have heard mixed reviews on spending the money on these courses, but with my lack of experience, I'm willing to drop the money on a well recognized program and at least get my feet wet with medical spa tools. Here in Northern Canada there is zero opportunity to get any hands on experience in this field. I am more excited to take this course than I have ever been with anything related to my career in the past and would love for my career to take me to medical spa work/ownership. If anyone has any advice for me, or thinks I'm out of my mind, please set me straight--cause I know there's someone on this thread that would love to do so, as evidenced by past responses to posts! haha.

This is a question. I am an LPN and due to an car accident and botched surgery can no longer be on my feet for 12 or 8 hour shifts. I would like to open a alternative procedure office, doing procedures not needing a license for ex: the foot detox. Are there any other procedures you can think of that I could do. Can I do microdermabrason, tens unit treatments ?

10.29 | Unregistered Commenterlee

P.S. I forgot to mention I live in Texas. Thanks Lee

10.29 | Unregistered Commenterlee

I have worked with an MD at a wellness center for quite sometime. We have talked about opening a med spa together. I am a licensed aesthetician and licensed massage therapist for 14 years. I am in the process of doing a business proposal. I know that he has many years of expertise and schooling and will be the one using the lasers etc. I would like advice in what percentage would be fair for both of us on services rendered.

01.11 | Unregistered CommenterMicaela

regarding Michelle 12:29
I hate to tell you but those laser certifications are useless unless your license allows you to perform the procedure, The paramedical aesthe. is a new term , I guess the newer term of medical aesthetician which also carried no medical credibility is out already.
The injection of Botox and fillers is the direct practice of medicine and you are not legally allowed to inject anybody. This entire field has become corrupt and just as one MD stated everyone wants to do it fast and skip the 8 years of pre/medical training and at leas 3 years of residency.
I suggest you cease the injections before you and your surgeon get legal sanctions on your licenses

01.13 | Unregistered CommenterMYMED

Injections are not practicing medicine, I am an RN and in MY state if an MD delegates to me to give Botox and I have advanced documented injection training I can.. It is 100% a state by state call so no whomever is telling you as an RN you cannot inject Botox they obviously do not live in my state and many others.. Practicing medicine in a med spa is when you initiate the patient-Doctor relationship, assess the patient and make a diagnosis.. Get your delegation facts please-read your medical boards definitions of such-NOT rocket science.

06.3 | Unregistered CommenterJZ

JZ
The letter from MYMED was regarding a post from michelle 12;29 that person has no medical training , is not considered a medical professional, can not self purchase medical lasers in most states and can not inject any persons with botox or fillers.

I don't think that post was talking about RN's in which you are correct, the RN is a medical professional and can indeed inject botox and fillers.

Also injections do constitute the practice of medicine in every state

06.5 | Unregistered CommenterGM

Yes- you CAN either hire a physician, PA, or NP at your medspa. You can also 1099 them

11.11 | Unregistered CommenterJe

We have a Med/Spa my husband is a PLASTIC SURGEON and I am an RN, we have 2 NP's on staff as 1099 contractors. You MUST contact these folks in Chicago-they have classes for exactly the question's you are asking AND they have attorney's on staff who oversee it so they will advise you specifically on your state laws and opening. Cost is about 2k but you are crazy NOT to do their program www.americanmedspa.org. If you feel confident after meeting with this team to open then go for it-if not you will save yourself massive amounts of time and legal malpractice potentials and lose your license-this is a BIG deal, get it right or your state boards (Florida is very strict), will be all over you and chew up your life and time... They have represented people that opened their business incorrectly and it hasn't gone well-you will learn all about this. They have a fabulous insurance team there as well and they are our carrier and AMAZING people our rates are $1200-$2500 a year because we NEVER will touch a laser in our facility-your rates will skyrocket and as our MD sais -that should tell you alone not to use lasers-plenty of other ways to make $$-Microblading is an awesome venue... You have to have excellent insurance or you are a sitting duck in this business... Opening a franchise would be a great route for you with a hair removal company, etc. so you'd have the business help and training already done. Opening a brick and mortar has taken us 4 years of preparation before we ever opened our doors-MASSIVE commitment-make sure you really understand this... Best wishes to your adventures that lay ahead!

11.11 | Unregistered CommenterJz

Would you be willing to email me
About you and your husbands practice. I am a FNP and have been working for. Board cdsrtified plastic surgeon . He is at the age where I don’t think he want to add on a medical spa to our practice. Just wanted to get your opinion about cost of set up, investors :size of building I may need etc. I love in lake St. Louis missouri

Thank you

11.25 | Unregistered CommenterTracy

Yes, I would be happy too! Send me your contact info. and I will chat you up~

11.25 | Unregistered CommenterJZ

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