How a nurse anesthetist transitioned from hospital care to running her own aesthetics spa with Jane.
Story by Jack Murphy
Suzanne Jagger is the owner and lead injector at Aura Aesthetics Medical Spa. She is also the creator of Aura Injecting Academy, which provides training to other advanced practice providers on aesthetic injectables as well as coaching on how to start their businesses.
Tell us a little bit about your background.
I received my bachelor’s degree from the University of Oregon. Then I decided that I wanted to go into nursing school because the prospect of heading to medical school I knew I wouldn’t have the patience for the length of the program. Instead, I headed to Baltimore to do the Johns Hopkins accelerated second-degree nursing program.
Funny enough, the very first week in nursing school I was told by my clinical instructor that “this nursing thing is not for you” and if I was going to stay, I better think about becoming a nurse anesthesiologist. That planted a seed to consider for the future, but upon graduating nursing school, I took a position with a boutique consulting firm, doing healthcare management consulting. I travelled across the country and had the opportunity to learn how hospitals run, which was just so fascinating.
After a couple of years of that, I went to work in the ICU using my nursing degree, while also enrolling in anesthesia school at Samuel Merritt University in Oakland, CA. After 15 years in anesthesia, first practicing in San Francisco’s Bay Area and then in Portland, Oregon, I began the transition into starting my own aesthetics practice. I also went on to complete my doctorate at the University of Alabama. Teaching has always been a passion of mine and I wanted the credential so that I had the option to pursue that avenue as well.
That’s a fascinating journey. How did you decide that medical aesthetics was what you wanted to do?
I think a lot of entrepreneurs coming from the medical field would agree, especially if they are from the US, that there is a lot of politics to navigate in the workplace. It didn’t help that my job as a nurse anesthesiologist had the same scope of practice in the level of care as a physician anesthesiologist. Any profession where there are two qualified people vying for that one decision-making position - it’s like the saying, ‘you can’t have two chefs in the kitchen’, is really applicable in this case.
While I loved providing anesthesia I just couldn’t imagine navigating that work culture any longer. I thought about other areas of interest to me and I asked myself, what if I did botox instead? That’s where it started for me.
I think that your decision resonates with a lot of Jane users. They want work-life balance and a sense of professional autonomy, and starting their own business can be the first step toward that.
Sure, starting your own business will be a huge undertaking and you don’t know what you don’t know until you have to deal with things, but it is so rewarding.
When you’re offering amazing service and quality care, you can create a happy, and profitable business. I often hear from clinicians and new businesses that I work with that they’re made to feel that it’s shameful to want to be profitable because we are so accustomed to the sick-care, hospital-based model.
But, in the private sector of concierge medicine, this point of view is too limiting. Really open your mind to the thought that with all the years of education and expertise, we are providing an in-demand service for our clients that deserves proper compensation.
Can you tell us what your initial steps were toward opening up your practice?
First of all, it was wrapping my head around the idea that I was actually going to do it. It was getting into a place of feeling capable to take those first steps toward opening my business. That truly is a hard hurdle to overcome. You have feelings of self-doubt or have been made to feel that you can’t do this, or that you’re not good enough. I had several people tell me “everyone is doing that, who do you think you are?”. It took believing that I could do it. As simple as that sounds, I had to believe why couldn’t it be me…
Once I overcame that thought process, I needed to decide what my scope of practice would be. I dusted off my 1997 notes from the Business 101 class that I took in college and got to work.
Can you go a little into the nuts and bolts of finding a space to practice?
I started mobile because I didn’t know where to go and because there was no one to ask. So I started on the road, piecing together a semblance of a career. You know, I would go to Costco and do my groceries, and then travel to someone’s house and do a botox appointment. That would be my days, going from one place to the next.
Then as I began doing dermal fillers, which is a much more intensive procedure, I would rent a room at the beauty school for maybe two to four hours a week.
That’s the thing about business, it can and probably will start slow as you build your foundations. As I began to network, I was put in contact with someone that had this little place in a cute part of town who had an extra room free next to her. It was there that I opened my first place, which was 100 square feet that I shared with the esthetician. I got started with very, very low overhead. This is key when you get started, you want to keep your costs down.
I think there is a misconception that you’ve got to spend a lot of money to get started. Would you agree with that?
You’ve got to hustle and don’t overspend! Watch your numbers and slowly work up to what you want your final place to be. It doesn’t need to be the end game from the start. As you’re starting, it’s better to be bad in relative obscurity while you’re learning and growing your business, than underperforming from day one because you’re dealing with the learning curve of owning a business.
I spent about $2000 remodelling the single room I started in because I was trying to keep my overhead as low as possible.
As my business grew, I moved into something slightly larger with three rooms, but still on the outskirts of town, because I was still figuring stuff out. It’s those incremental steps I needed to take to get to where I’m now.
For those wondering, how long did it take you to move from offering mobile service to opening your own clinic?
I started my mobile practice in 2016. I opened my first space in 2017. Then moved into the larger space in 2018, and I spent three years there until I opened my current space in 2021. I want people to know that nothing happens overnight.
I know it can feel like a slow journey. Especially because it’s difficult to learn what the correct path is to take to hit those business milestones. No one in my area was going to train me because I was their competition, I had to figure it out as I went.
How did you know when it was the time that you could afford to hire someone to join your clinic?
This is something I coach on with my consulting clients all the time. There are some great benchmarks you should probably follow to be in the correct financial position to expand your team. One of those is that the new hire should generate roughly five times their hourly wage to afford to bring them on.
That’s a great little rule of thumb. If you know that you have enough patients to accommodate that, then great, bring someone on. Especially as you decide to expand into offering other treatments.
Look at what your capacity is. You’re at full capacity if you’re at 70 to 80% booked because you need to factor in breaks and lunch during your hours.
You always want to pay attention to those benchmarks. Are you generating enough to pay for yourself with a margin, to cover inventory, how much are your overhead, personnel, or otherwise?
I knew that I should not be doing facials as you want the right qualified personnel offering the right level of service. I can inject and should inject as that’s using my full scope of skills. An aesthetician does facials and other skin treatments and they should use their full skill capacity.
Initially, I brought an advanced aesthetician on for two days a week. You know, five hours to start to make sure their time was fully booked, and then I could grow the position from there.
How would you recommend new aestheticians approach pricing their services?
Aesthetics is tough because our cost of goods is so high, especially in the US. Where I think people go wrong is they initially have a certain idea of what their pricing should be when starting their business. They think since I’m new I have to charge the lowest in town to entice people to come through the door. This is a patently wrong strategy!
Knowing your financial numbers you will calculate your overhead; what are our cost of goods, payroll costs, and insurance costs? You want to decide what you need your profit margins to be to sustain this business. After all that, then you can assess the marketplace and price according to what the market will bear. Patients who are only financially motivated will not stay with you. Price for the client you want to have long-term, not the one-time visit.
Once you figure all that out, then you can set your price. If the price you come up with is way too high for clients, then you don’t have a sustainable business model. This can be where it gets really difficult for people in some industries where they don’t have a high-cost service because their margins are slim.
The best advice I ever heard from a consultant was you want to be the second most expensive place in town. There is that consumer mindset of what they consider premium. People value what they put their money towards. One of my mentors candidly put forward, if you’re going to get a $10,000 procedure and a $15,000 procedure, which one are you going brag more about? Probably the more expensive one. This is a mindset to consider if you are working in the beauty business.
Tell me a little about your other business, Aura Academy.
I was a clinical instructor in anesthesia, and so teaching was something I wanted to continue doing. Early on, I started teaching the basics of aesthetics, going over the fundamentals of injecting and the fundamentals of business, too.
I currently teach all credentialed providers from registered nurses to medical physicians, but really specialize in helping advance practice providers, like nurse practitioners, start their own practices.
A critical element of launching a practice is a solid business model that is going to sustain them, and not get them into large amounts of debt.
I go over what I see as three kinds of business models: a mobile business, a brick-and-mortar space, or a large businesses.
I always talk with my clients about how they want to work and what they are hoping to do. Is this a side hustle business? Is this something you want to grow and become your full-time job?
Now I travel around teaching and I also invite people to come to my spa here in Portland to spend the day with us learning how to do botox and dermal fillers. We also do general health and wellness business consulting because the fundamentals are the same whether you’re a naturopath, chiropractor, or aesthetics practitioner.
I’m also super excited to announce our injector conference taking place in sunny Orlando, Florida next year, from April 28th through the 30th. We’re going to be getting into the nitty-gritty of how to learn, grow, with your aesthetics tribe. The first day will all about how to inject botox, followed by two days of talks with experts on how to start a successful botox business.
Tell us why you decided to use Jane for your business.
I had tried two other aesthetic platforms before coming to Jane. There is something to be said for the internet because I found Jane App by googling what is the best software to run my practice.
From there I started looking more into into Jane, testing out the platform in your demo clinic and playing with it to see if it could do everything we wanted.
We decided as a company that we are patient-driven and that the customer experience is the number one thing that was important to us. Jane fit that bill perfectly for both us and our customers. For everything that Jane offers the price was unbeatable, and transitioning from our old platform to Jane was a breeze.
What Jane features are your favourite?
The best thing about Jane is how easy it is for patients to schedule. They can easily see exactly who they’re scheduling with and what they’re scheduling. Like most businesses, patient experience is paramount for us. They can log in through their browser on any device. Book an appointment on their phone without the need for another app. The experience is really second to none because of Jane’s ease of use. We see more customers actually making bookings with us because of Jane.
It’s the same for our staff. It is quick and easy to schedule with Jane. That goes for sharing their charts and aftercare instructions, too. We always have access to do all that because Jane is all online, which is so important. We use a lot of different devices, and Jane runs perfectly on all of them without us needing to download any extra add-ons.
The other thing we loved about Jane is just the cleanness of the software. We can look at our schedule and the assignment and everything is neatly displayed for us. And then, just as easily, we can process a payment using Jane Payments, Jane’s integrated payment system.
🗣 Jane Team shoutout: Jane offers fully integrated payment processing where you can store customer cards on their profile, accept online booking pre-payments online, and send e-invoices to customers for outstanding balances. Learn more about Jane Payments here.
- Want to watch the Jane Team explain how Jane Payments can help you get paid? Check out one of our Summer School Sessions on the topic right here.
Before we say goodbye, have you got any advice you would like to share with other providers?
I want everyone to know that we all feel imposter syndrome, and that’s okay. I have a good friend that runs a multimillion-dollar company, he’s doing something correctly, but he still has impostor syndrome. It’s a feeling that none of us will be free of, especially when we need to be the ones making all the decisions in our businesses.
There’s a great TED talk about making hard decisions. If it’s a hard decision, then that means that there’s no right answer. For example, if you use stealing a car, that’s not a hard decision. I’m not going to steal a car.
But if you’ve got to choose between pink or purple balloons at the party, the choice can be debilitating. The reason for that is that it doesn’t matter, right? Both are fine.
Once I acknowledged that it just made life so much simpler. I apply that thought process to everything I do in life and business now, and it’s been a game changer.
Resources from Suzanne
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