Do you ever feel like you’re a contestant on the television program Let’s Make a Deal, in which you tell a patient your price, they tell you your competitor is cheaper, and now you have to decide to play or fold?

Do you hear more often than not, “Hey, this is way too expensive. I can’t afford this. What can you do about this price?”

Since when did aesthetic medicine become a game of who is going to blink first? When did a price you set become the beginning of a negotiation rather than a professional quote that sticks?

Several medical, economic, and societal factors have come about in the past decade that have led us to a point in time when, somehow, it has become fashionable for patients to haggle with plastic surgeons over the bill.


Let’s review the historic events that changed the landscape of aesthetic enhancement. Thanks to the mass media, it has become much more acceptable, socially, for men and women to spend a lot of their money on hiring an aesthetic practitioner to make them look good.

In addition, television programs such as Extreme Makeover encouraged discussions among patients to talk openly about what they had done, who did it, and how much it cost. Societal changes such as divorce, remarriage, midlife job change, and overall longer life expectancy made aesthetic enhancement more attractive to the millions of Baby Boomers in the United States—a huge demographic that will likely drive aesthetics for the next 20 years.

As demand has grown, the number of physicians offering aesthetic services has increased, as they act upon the opportunities to substantially profit from the cash side of medicine.

The tens of thousands of medical spas that have popped up across the nation have had an impact on this consumer drive, with promised medical treatments in a spa setting and featuring impeccable service. The spas competed directly with the medical professional in private practice. The stereotypically bland medical office located in a boring-looking medical building had to give way to a nice, “medspa”-like environment.

Patients are now conditioned to be treated like kings and queens, and to get what they perceive as their money’s worth.

Prior to the recession—and even in the face of ever-increasing competition from medspas, as well as encroaching subspecialists and generalists attempting to break into the aesthetic field—the economic landscape has remained tolerable for many aesthetic physicians. The supply/demand ratio was still profitable for most physicians who gave good service and good results.


As the recession hit, that neatly construed landscape was altered significantly. Credit dried up. Jobs were lost. Homes were foreclosed. Abundance quickly turned to limits—the patients were gone, but the supply of aesthetic choices continued and continues to be vast.

The days of cheap and easy credit appear to be behind us, and with the current economic landscape many patients elect to stay at home and delay surgery until they can save up their pennies and pay cash.

Even so, many patients still want cosmetic surgery and are willing to take out a loan to get it. A handful of financial firms that offer credit to elective surgery patients—such as GE’s Care Credit, Chase Health Advance, and Citi Health Card—usually do so using the physician’s office as a touch point for setting up loans for patients.

These credit companies have followed the lead of most financial institutions during the recession, with increased interest rates and fees, as well as a decreased number of loans made to patients.

In recent months, government regulators and officials have scrutinized health care loan-making firms closely. For example, Attorneys General in New York and Minnesota have called out some companies as possibly conducting illegal or unfair business practices.

From the physician’s perspective, the choice of credit companies has been critical, especially in the recession.

The tough lesson learned: When a patient who wants to look good is spending their own money on aesthetic enhancement, they are in the driver’s seat. They are the consumer, and they know they have choices. They are much more likely to price-shop because they know they can.

There are simple ways to combat this evolution of consumer-centric medicine and the perceived difficulties of obtaining loans for elective surgery.


Not everyone will be able to afford your services like before, so it’s a good strategy to focus on those who are least likely to be affected by changes in the economy.

Here’s the obvious first choice: Target older patients who are more affluent, versus younger patients. Mature patients have more concerns, such as wrinkles, crepe skin, sagging body parts, and sun damage. They are also more likely to have the financial wherewithal to afford your services, such as home equity, good credit, or even an inheritance.

If going after an affluent patient population sounds easy, don’t count on it. In the current economic atmosphere, even the wealthy are prone to haggle over the cost of procedures. Most plastic and cosmetic surgeons rightfully rebel against the haggle system. Partnering with CareCredit or another financial services company is a useful tool to help a prospective client pay for your services, but even these firms admit the current credit crunch means fewer loans to fewer patients.

Whichever approach you take to payment and credit, if you don’t offer your patient an easy way to pay for your services then she is not going to wait until she has the cash. She will go to your competitor to see if they are willing to help her get what she wants now rather than wait. That means you could lose not only that patient and the revenues from that procedure, but future revenues and those of her friends.

When you offer financial alternatives, it can completely change the patient’s mind-set. She is now thinking about how to move forward rather than asking herself, “Should I move forward?”

This could be just the competitive edge you need if your competitors don’t offer financing plans because they believe it’s a hassle or it bites into their profits.

Word of caution: If you don’t offer easy-pay plans for your patients because the finance company charges you a fee, you are getting 100% of nothing!

• Don’t judge.

It’s important to not project your assumptions on your patients—don’t spend their money for them. You never know a person’s financial status by just looking at them, so keep your options open.

An aesthetic patient may have the cash but may not want to use it, especially during uncertain times. They may, for instance, not have the total amount due in cash and may need an easy-pay alternative.

• Avoid sticker shock.

You never want to shock the patient with your pricing. This is a tricky point, given the number of people who surf the Internet and find Web sites that appear to be practically giving away aesthetic services.

When presenting prices to a patient, you should start with the total amount needed to realize their goals but then talk about an easy-pay plan option. Today’s consumer is very familiar with paying for services and products incrementally. In this way, your patient will think it is perfectly normal to visualize their monthly cost rather than the total cost.

• Use financing as a patient-attraction tool.

If it is not clear already, in the current economy some aesthetic patients still want what they want when they want it, but may not have the money for it. Financing may be more important than the actual price of the procedure. Be sure every prospective and current patient knows you offer easy-pay plans.

Mention it in your ads, add it to your on-hold message, display it in your in-house signage, and include it in your welcome packet.

Add a patient-finance calculator and online application to your Web site—as well as your blog, Facebook page, or on Twitter—so the prospective patient will spend more time on your Web site to, hopefully, call you or send e-mail to you.

• Use financing as a qualifier.

Here is a good way to find out how serious a patient is about moving forward: Your staff should be scripted to set expectations and get a feel for the patient so you don’t waste time. For example, when a prospective patient calls asking about liposuction, your receptionist should gauge their interest by asking, “Sally, depending on the areas to be treated, it could be from $2,500 to $6,000; or, with our easy payments plan, you can start at $150 per month. Will you be interested in looking into our easy-pay finance program, or will you be using your own credit card?”

When they answer that question, they are more likely to move forward to the next step.

• Use financing as a negotiation tool.

You have patients who will say yes to the physician who helps them get what they want. Add the words “What if” when you are negotiating with a patient (or when they are forcing the negotiation). For example, your patient care coordinator can ask a simple question to determine how serious the patient is about moving forward. For example, “Sara, what if I can find an easy-pay plan for you at only $150 per month. Would that do it?”

At this point, you are not talking about the total price of the procedure. You are only concentrating on a smaller monthly monetary commitment, and that might be just what the patient needs to move forward.

• Use financing as a closing tool.

When the patient has walked through your door, met your staff, met you, been given the quote, and now they are hemming and hawing, you need to find out why. An easy way to find out is to ask a strategic question to flesh out the real reason. Most often than not, it’s the price—but you never know, so be prepared.

For example, “Karen, I can see you’re hesitant. Please share your thoughts with me. Is it the price? If it is, wouldn’t it make sense we look into an easy-pay plan option for you?” The patient will now be more open to agreeing it was the price or more comfortable telling you the real reason.

• Use financing as a follow-up tool.

Have you ever noticed how resistant your staff is to following up with patients who left your office but didn’t book? The main reason for their hesitation is because they feel like a sales person “pushing” a prospective patient to make a decision and that, in turn, makes her feel pressured. All this pressure brings on a sense of discomfort.

When following up, a better approach is to call the prospective patient in order to provide additional information about your practice or procedure. In essence, you’re not calling to follow up, per se; you are calling to reveal an important update.

On The Web!

See also “Your Recession Recovery Plan” by Michael J. Wiley, DHBC, and Lawrence B. Keller, DFP, in the June 2009 issue of PSP.

For example, “Hi, Barb. It’s Carla from Dr Smith’s office. I thought you might be interested to know we just introduced a 12-month, no-interest plan so you could have that surgery for only $285 per month. How does that sound?”

What a great way to find out where the patient is in their decision-making process, and what a great way for your staff to feel comfortable making the call.


Financing is a way of life in the aesthetic industry. Embrace it, use it strategically, and reap the benefits you are now losing out on if you’re not seeing the bigger picture.

Catherine Maley, MBA, is president of Cosmetic Image Marketing, a Sausalito, Calif-based firm that specializes in helping aesthetic practices grow. She can be reached at