Botox side gig

[Gator7]

There are some CRNAs in our group that are interested in doing Botox in the area and have asked me to be the sponsoring physician.

I’m curious if anyone out there has done this before and what are the pros/cons. What are the risks I’m not thinking of? Do I need separate insurance? I wouldn’t be doing any injections personally but would I need to complete a training course?

Thank you. Doing my own research as well but there always seems to be a wealth of knowledge on here.

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[Status Sciaticus]

There are some CRNAs in our group that are interested in doing Botox in the area and have asked me to be the sponsoring physician.

I’m curious if anyone out there has done this before and what are the pros/cons. What are the risks I’m not thinking of? Do I need separate insurance? I wouldn’t be doing any injections personally but would I need to complete a training course?

Thank you. Doing my own research as well but there always seems to be a wealth of knowledge on here.

Do Botox yourself. Undercut them.

 

[anonperson]

There are some CRNAs in our group that are interested in doing Botox in the area and have asked me to be the sponsoring physician.

I’m curious if anyone out there has done this before and what are the pros/cons. What are the risks I’m not thinking of? Do I need separate insurance? I wouldn’t be doing any injections personally but would I need to complete a training course?

Thank you. Doing my own research as well but there always seems to be a wealth of knowledge on here.

You are the liability sponge when something goes wrong.

CRNA will throw their hands up in the air and point the lawyers in your direction since you will have the deepest pockets.

You will need to talk with your malpractice provider about this arrangement and see if they will cover you.

 

[anaesthetic]

There are some CRNAs in our group that are interested in doing Botox in the area and have asked me to be the sponsoring physician.

I’m curious if anyone out there has done this before and what are the pros/cons. What are the risks I’m not thinking of? Do I need separate insurance? I wouldn’t be doing any injections personally but would I need to complete a training course?

Thank you. Doing my own research as well but there always seems to be a wealth of knowledge on here.

Pros: money. Cons: lawsuits. Not much else to it really. Sounds icky to me.

 

[kidthor]

Do Botox yourself. Undercut them.

Yeah why bother taking on risk for "sponsoring" them instead of just doing them yourself.

 

[Shimmy8]

Make them get an insurance policy where you are covered as well. Your primary insurance co will not want to cover.

 

[likewhatevs]

Pros: The more time CRNAs spend in clinic injecting Botox, the less time they have to provide barely passable OR anesthetics or lobby state legislatures.

 

[nofliesonme]

Plastic Surgeon here....trying to make a good idea out of a bad idea, is a bad idea.

 

[chessknt]

Have you injected Botox before or dealt with complications related to the injections? Have the crnas for that matter?

I don't get how people think that nobody cares what your background is when paying cash for a procedure. Would you let them do a vasectomy on you if it was cheaper than a urologist?

 

[Status Sciaticus]

Plastic Surgeon here....trying to make a good idea out of a bad idea, is a bad idea.

Is this because you dont think anesthesiologists should be doing botox AKA encroaching on the cash pay derm/plastics patients?

 

[Status Sciaticus]

Have you injected Botox before or dealt with complications related to the injections? Have the crnas for that matter?

I don't get how people think that nobody cares what your background is when paying cash for a procedure. Would you let them do a vasectomy on you if it was cheaper than a urologist?

No but I let an MA give me a flu shot instead of a physician.
Lets not pretend injections are the same thing as a surgical procedure.

 

[chessknt]

No but I let an MA give me a flu shot instead of a physician.
Lets not pretend injections are the same thing as a surgical procedure.

A flu shot doesn't cause medium term nerve paralysis and need to be delivered in a somewhat precise location ..

 

[Status Sciaticus]

A flu shot doesn't cause medium term nerve paralysis and need to be delivered in a somewhat precise location ..

I would think as an anesthesiologist, one would know how to inject things in small precise places.

 

[chessknt]

I would think as an anesthesiologist, one would know how to inject things in small precise places.

You routinely inject the face in your practice? Got your facial muscle/nerve anatomy down really good?

You realize your own logic is why crnas think they don't need anesthesiologists right?

 

[Status Sciaticus]

You routinely inject the face in your practice? Got your facial muscle/nerve anatomy down really good?

You realize your own logic is why crnas think they don't need anesthesiologists right?

How are you going to get good at it without practicing?
By my logic, CRNAs dont really need anesthesiologists to put in IVs or intubate a run-of-the-mill patient. Unless they screw up. If that happens here, you consult a dermatologist/surgeon. Its a known risk even in deft hands.

 

[chessknt]

How are you going to get good at it without practicing?
By my logic, CRNAs dont really need anesthesiologists to put in IVs or intubate a run-of-the-mill patient. Unless they screw up. If that happens here, you consult a dermatologist/surgeon. Its a known risk even in deft hands.

Who is going to pay you cash so you can practice on them?

Why not train a family med doctor or a pathologist to intubate and put ivs in? They can just call you if it gets ****ed up right?They have as much of a relation to Botox as anesthesia does.

 

[Status Sciaticus]

Who is going to pay you cash so you can practice on them?

Why not train a family med doctor or a pathologist to intubate and put ivs in? They can just call you if it gets ****ed up right?They have as much of a relation to Botox as anesthesia does.

Pretty sure people who want to get botox for cheap will go to docs with less experience. Thats why you see so many on social media and spas advertising "specials". Wouldnt need to discount if skills were top notch with discerning patients.

IDK, I've seen FM docs put IVs in. They also made first year IM residents put in IVs until they got good at it, despite the fact that RNs place IVs in most settings.
By your logic, pain procedures that were previously done by surgeons such as spinal cord stims and kyphos would not be done by pain docs, but they get trained to do it (many after graduating fellowship at a weekend course and get better with practice).

 

[nimbus]

To be fair, Allergan is happy to train anybody and everybody to inject Botox. I would guess that most Botox injectors are not physicians. They just want to sell more Botox. One of my former partners went the aesthetics (Botox/filler) route. He started by doing it himself part-time while still doing full-time anesthesia. That didn’t last long. He just opened his 8th office mostly staffed by RNs and aestheticians.

 

[chessknt]

Pretty sure people who want to get botox for cheap will go to docs with less experience. Thats why you see so many on social media and spas advertising "specials". Wouldnt need to discount if skills were top notch with discerning patients.

IDK, I've seen FM docs put IVs in. They also made first year IM residents put in IVs until they got good at it, despite the fact that RNs place IVs in most settings.
By your logic, pain procedures that were previously done by surgeons such as spinal cord stims and kyphos would not be done by pain docs, but they get trained to do it (many after graduating fellowship at a weekend course and get better with practice).

Yea there is a cardiologist where I work who went to a weekend course to learn how to put ppms in. Impellas too. A few of his patients have died from his butchery. He is still in practice but anyone who has a healthcare connection knows to avoid him at all costs unless you are unlucky enough to get him on emtala call. I suppose you can do whatever you want as long as making money is the only goal. Who knows maybe only a few more will have to be seriously harmed or killed before he gets competent.

 

[nofliesonme]

Is this because you dont think anesthesiologists should be doing botox AKA encroaching on the cash pay derm/plastics patients?

lol....no...you are welcome to inject as many vials of botox as you want, ...your question leads me to believe that you have never injected neurotoxins and/or are unaware of the economics, botox is a great product, but your question and the OPS has to do with making money....as a general rule i dont believe that is the best reason for stretching your armamentarium ..... Botox in most plastic surgery offices is not a big money maker, its a service and retention procedure....if you think you can make more money taking a percentage of a nurse's profits from injecting botox i think you need to re-evalutate your anesthesia practice position....

 

[thinkorswim]

Is this because you dont think anesthesiologists should be doing botox AKA encroaching on the cash pay derm/plastics patients?

Botox doesn’t pay as well as you think it does. The competition is ample and the margins are thin.

 

[2Fast2Des]

I believe many Botox is done by non physicians, including some who kinda just do it at home apparently.. too much work for not much reward it seems, unless you plan on doing medispa as your side money adventure

 

[Tramadeezy]

There are some CRNAs in our group that are interested in doing Botox in the area and have asked me to be the sponsoring physician.

I’m curious if anyone out there has done this before and what are the pros/cons. What are the risks I’m not thinking of? Do I need separate insurance? I wouldn’t be doing any injections personally but would I need to complete a training course?

Thank you. Doing my own research as well but there always seems to be a wealth of knowledge on here.

My wife and I have this setup. She runs the practice and im the supervising doc. I would get a membership with AMSPA, they have a bunch of resources on what you need to setup a practice. I would also talk with a law firm specializing in med spas, each state has different requirements and they will be able to walk you through all of the compliance issues. In some states, only a doc or NP/PA can do the initial patient eval. Not sure how a CRNA would factor into this.
The biggest thing is making sure the CRNAs do everything by the book as far as compliance, procedural protocols, practice setup goes. You guys should all do training/CMEs in aesthetics. If the medical board gets a patient complaint and looks into the practice, you dont want it too look like youre just nurses/doc trained in anesthesia doing botox on the side. Youll definitely need your own malpractice too.

 

[Status Sciaticus]

Yea there is a cardiologist where I work who went to a weekend course to learn how to put ppms in. Impellas too. A few of his patients have died from his butchery. He is still in practice but anyone who has a healthcare connection knows to avoid him at all costs unless you are unlucky enough to get him on emtala call. I suppose you can do whatever you want as long as making money is the only goal. Who knows maybe only a few more will have to be seriously harmed or killed before he gets competent.

So i guess CT surgeons should be the only ones doing surgical procedures as it pertains to the heart? Better tell those cardiologists that they cant do TAVRs and mitraclips anymore.

lol....no...you are welcome to inject as many vials of botox as you want, ...your question leads me to believe that you have never injected neurotoxins and/or are unaware of the economics, botox is a great product, but your question and the OPS has to do with making money....as a general rule i dont believe that is the best reason for stretching your armamentarium ..... Botox in most plastic surgery offices is not a big money maker, its a service and retention procedure....if you think you can make more money taking a percentage of a nurse's profits from injecting botox i think you need to re-evalutate your anesthesia practice position....

I have not looked into the P/L of directly providing botox to patients, but I agree that it can be used as an adjunct service, specifically in cash pay med spas. Dont really think that I am taking a nurse's profits. Not sure why opening a side business would make me "re-evaluate my anesthesia practice position". I dont think theres an equivalent anesthesia procedure that pays money in a similar fashion to that of Botox.

 

[chessknt]

So i guess CT surgeons should be the only ones doing surgical procedures as it pertains to the heart? Better tell those cardiologists that they cant do TAVRs and mitraclips anymore.

Or you know, actually be qualified to do the procedure instead of winging it on a weekend course.

Or go do a weekend course in TAVR then start popping those in because what could go wrong? The CT surgeons can step in and fix it if you screw up. I guarantee those will make way more money than botox.

 

[Status Sciaticus]

Or you know, actually be qualified to do the procedure instead of winging it on a weekend course.

Or go do a weekend course in TAVR then start popping those in because what could go wrong? The CT surgeons can step in and fix it if you screw up. I guarantee those will make way more money than botox.

If the maker of the drug deemed it adequate for non-physicians to be able to do the procedures, then why bar physicians from doing it. Im sure they are making more, but the mortality/morbidity risk is also proportionally higher. However, we are discussing scope of practice of a given procedure, not comparing which procedure is more profitable.

 

[BobBarker]

Botox doesn’t make any money. It is around $1250 for 200 units. Some people charge as little as $8/unit. Do the math.

It is ok in a plastics office as it can be done on a post op follow up and turn a no pay visit into a tiny profit.

Plastics in general is not as lucrative as you think. A breast aug is $5000 here including the anesthesia. 1 hour consult, multiple post op visits, paying for the implants, supplies, anesthesia. There isn’t much anything left after overhead.

 

[IMGASMD]

Hello, I think finding good specialists is very important because the Botox process is a very complicated field.

You’ve come to the correct corner of the internet to find us.

 

[amyl]

I took a long weekend course and am certified in Botox/filler and have an account with allergen. The courses are basic and just money makers for the teacher/institute . I went to the best with live models you did not have to provide. After the weekend, I was barely competent… I needed much more experience and practice. The courses teach you basic drug reconstituting and basic techniques… not advanced.
That said, the profit margin on Botox is terrible. Most successful Medical-spas use Botox and filler specials to get you in the door to use lasers and peels etc and sell you products- as that’s where the profit margin is.

. It is easy to do the basic Botox techniques and you have to be an idiot to mess it up if you are taught correctly - which takes an hour to learn but longer to practice… (it’s an art and a science - and you need to develop a “feel” like you do for how the ligament “feels” when placing a lumbar epidural,)
However the advanced techniques - like getting the inner corner of the eye superficial enough to block muscle (whole muscle not just the lateral part) without getting the tear duct is a very advanced technique. Probably only 5-10% of injectors know how to do it right. Most patients, though, have no clue and just want cheap Botox.
I’ve been asked by crnas to train them in Botox, and to be their medical director. I don’t have time for the former and there is not enough money in the later to be worth my time or liability.
You are wasting your time… for now at least, where anesthesiologists make the most money is in the OR. It’s not a fun fact people like to hear but it’s the truth.
If you have time on your hands pick up and extra shift or get an MBA…. There’s no money in Botox

 

[Ubba]

Odds of making a good hustle out of cosmetics may be better by opening up a sleazy FUE transplant clinic.

 

[epidural man]

To be fair, Allergan is happy to train anybody and everybody to inject Botox. I would guess that most Botox injectors are not physicians. They just want to sell more Botox. One of my former partners went the aesthetics (Botox/filler) route. He started by doing it himself part-time while still doing full-time anesthesia. That didn’t last long. He just opened his 8th office mostly staffed by RNs and aestheticians.

I wonder if we know the same guy. He is killing it.

 

[epidural man]

Plastic Surgeon here....trying to make a good idea out of a bad idea, is a bad idea.

I needed you as a wing man during my dating years.

 

[epidural man]

..... Botox in most plastic surgery offices is not a big money maker, its a service and retention procedure....

If you use Xeomin, it costs less and works just as well - with some theoretical and real (like not having to refrigerate) advantages. People say it doesn't last as long. I don't buy it. I think that is a built in bias from it costing less.

I'm surprised that it isn't much of a money maker because of all the fillers, and peels, and lotions, etc - botulinum toxin works VERY WELL to do what it is supposed to do. It actually is a pretty phenomenal product (as you mentioned).

 

[amyl]

There’s a new Botox out that lasts 6 months - daxxify. Thankfully I bought some RVNC a few months ago and got the 20% plus bounce when it hit the market the other day.

 

[nimbus]

I wonder if we know the same guy. He is killing it.

I wonder if we know the same guy. He is killing it.

Very possible. We’re in the same area. Just PM’d you.

 

[nimbus]

There’s a new Botox out that lasts 6 months - daxxify.

That could be good or bad depending on your interests.

 

[amyl]

Good for me - my stock went up and I’d like my Botox to last longer

 

[nimbus]

I didn’t know you needed to be a doctor to do Botox. There are so many people who call themselves Botox professionals even though they know nothing about medicine and just do something they learned from some online classes.
Sometimes I think it’s better to get surgery for more sustainable and visible results, like eyelid surgery Cincinnati. It lasts for way longer than 3-4 months, and the results are much better. It’s an invasive surgery, but the risks are rather low, especially considering that you can develop an allergy to Botox and get an adverse body reaction to it.

I dunno. I’ve seen a few really f’d up eyelids from bad eyelid surgeries.

 

[shawnmorones]

In the US, the business of Botox and dermal fillers is not regulated at all, and recently there was an interesting article on this topic on medscape (Botox Training: Shortcut to Cash or Risky Business?). In short, in fact, to start doing Botox, you need to take 2-3 day courses (Botox Training & Certification Courses | Empire Medical Training), after which you will receive a certificate for the procedures and, most importantly, permission to buy Botox and other fillers(https://fillercloud.com/product/botox/). In fact, people who have just completed a two-day training a few days ago can inject Botox.

 

[IMGASMD]

In the US, the business of Botox and dermal fillers is not regulated at all, and recently there was an interesting article on this topic on medscape (Botox Training: Shortcut to Cash or Risky Business?). In short, in fact, to start doing Botox, you need to take 2-3 day courses (Botox Training & Certification Courses | Empire Medical Training), after which you will receive a certificate for the procedures and, most importantly, permission to buy Botox and other fillers(https://fillercloud.com/product/botox/). In fact, people who have just completed a two-day training a few days ago can inject Botox.

Isn’t it a loss leader, just to get people in the door for something more expensive?

There are a few injection parties where the CRNAs or the individuals who would give injection for cost to drum up business.