If you run or manage a med spa, you’ve probably wrestled with the commission question.
On one hand, it’s easy to see the appeal: offering commission-based incentives can boost motivation, increase bookings, and reward high-performing team members.
On the other hand, it’s a legal and operational minefield, full of compliance concerns, fairness questions, and the fear of compromising client care.
This blog is here to help.
We’ll cut through the confusion, offering practical, balanced guidance to help you decide if (and how) paying commissions should be part of your med spa’s compensation strategy.
Why this question matters to med spa owners and managers
You’ve got a lot on your plate — long hours, packed schedules, and the constant challenge of balancing exceptional client care with running a profitable business. And that’s just the start.
Staff turnover, unclear compensation structures, and burnout only add to the pressure.
Which brings us to the looming fear: losing top talent because your medical spa staff pay isn’t competitive.
So, when someone brings up commissions, it’s tempting.
You want your team motivated. You want to reward top performers.
And the numbers support it: 44% of employees say commissions or bonuses boost job satisfaction, and 43% say it increases engagement.
But commissions aren’t a silver bullet. They can trigger legal issues or create a cutthroat vibe in a space meant to heal and relax.
That same survey shows the flip side: 18% say it makes them feel less engaged, and 22% report it makes them anxious about meeting goals.
It’s a tough call, and you’re not alone in facing it.
So, when med spa owners ask themselves, “Should med spas pay commission?”, they’re often balancing med spa team motivation against the legal risks of commissions.
The pressure to incentivize performance
You want your team to care about results, to treat your medical spa like it’s their own.
Whether it’s filling the appointment book, upselling skincare packages, or delivering consistently exceptional client experiences, the question lingers: Is a commission structure the key? After all, shouldn’t people be rewarded for bringing in revenue?
The fear of doing it wrong
But then comes the hesitation: Is this legal? Am I violating fee-splitting laws?
Could it create resentment among staff or encourage overly aggressive sales tactics?
What starts as a good idea can quickly spiral into anxiety, confusion, risk, and team tension if it’s not handled carefully.
The legal landscape of commission in medical aesthetics
Here’s where things get tricky.
Because of their medical nature, medical spas follow a different set of rules. Many owners are surprised to learn that what works in a traditional spa could actually lead to legal trouble in a medl spa, especially when licensed medical professionals are involved.
That’s why commission-based compensation structures in this industry face more scrutiny. If you’re not careful, a well-intentioned decision could result in fines, audits, or worse.
Fee splitting and anti-kickback laws
At the core of the legal concerns are “fee splitting” and “anti-kickback” laws.
👉 Fee-splitting generally refers to the illegal practice of sharing medical fees between licensed and unlicensed individuals, or between healthcare providers when it’s not explicitly allowed by law.
👉 Anti-kickback laws, on the other hand, prohibit offering or receiving anything of value in exchange for patient referrals or generating business for a healthcare service.
Ignoring these laws can lead to serious penalties. In states like California, non-compliant med spa employee incentives may result in fines up to $50,000 and could even prompt criminal investigations.
And the business owner isn’t solely responsible — employees can be affected too. That’s why it’s essential to ensure any compensation model aligns with state regulations.
While the specifics vary by state, the underlying principle is that compensation models should not incentivize medical decisions or compromise patient care for financial gain.
Bottom line: If your staff includes nurse practitioners, physician assistants, or other licensed providers, commission pay tied to medical services could get you into serious trouble.
What you can incentivize legally
Don’t get discouraged — all is not lost. You can still reward performance, it just has to be done the right way.
Commissions or bonuses are often legally allowed for:
- Non-medical services (e.g., certain aesthetic treatments that don’t involve injections, medical diagnoses, or prescriptions)
- Retail product sales (e.g., skincare products like serums, moisturizers, cleansers, skin spatulas, derma rollers, and even skincare pillows)
Furthermore, alternatives like productivity bonuses or goal incentives are generally safer and more flexible ways to reward your team without running afoul of fee-splitting laws.
Pros and cons of commission-based pay in a med spa
Before deciding if commission-based compensation is right for your medical practice, it’s important to weigh both the benefits and the potential risks.
Commissions in med spas can be a double-edged sword — boosting performance in some cases, while creating challenges in others.
Below is a clear, at-a-glance look at the key pros and cons to consider before implementing or adjusting your commission model.
The benefits
When done right, commission-based pay can be a powerful motivator. It gives your team a clear reason to go the extra mile and helps align their success with the success of your medical spa.
Here’s what commissions can achieve:
✅ Motivating staff: Commissions incentivize team members by linking performance to earnings.
✅ Rewarding high performers: Recognizes and retains high achievers with fair compensation.
✅ Potentially boosting revenue: A motivated team can drive more bookings, upsells, and overall growth.
With the right safeguards, a commission model can support a culture of accountability and support sustainable business growth.
The risks
Commissions are not without downsides. Without careful planning and legal oversight, a well-meaning pay structure can unintentionally create problems that impact your team, clients, and business.
⚠️ Legal exposure: Poorly structured commissions can violate fee-splitting or anti-kickback laws.
⚠️ Inconsistent service quality: Staff may rush treatments to boost earnings, affecting client care.
⚠️ Prioritizing upsells over client care: Overemphasis on upselling can erode trust and professionalism.
⚠️Team friction: Heavy commission models may create unhealthy competition and resentment among staff members.
That’s why commission plans should never be universal. They require a deep understanding of your team’s dynamics.
Smarter alternatives to commission
If commission feels risky or hasn’t worked before, you need to know that there are safer, smarter ways to motivate and reward your team without stepping into gray areas.
Alternatives like performance bonuses, team-based incentives, and goal-oriented rewards allow you to recognize hard work without crossing legal boundaries.
Productivity bonuses (not commissions)
Unlike traditional commissions that tie pay directly to specific services or sales, productivity-based compensation plans focus on metrics like:
- Number of treatments performed: Bonus opportunities for exceeding a set number of medical procedures in a given period.
- Client retention rates: Incentives for providers who consistently rebook and retain clients.
- Utilized hours: Bonuses for maintaining a high percentage of scheduled time actively booked.
The key difference is that productivity bonuses are typically tied to volume or efficiency, rather than a percentage of the revenue generated from a specific medical service, thus mitigating fee-splitting concerns.
Goal-based incentives for non-providers
Your administrative staff, front desk, and support team are also crucial to your med spa’s success.
You can motivate them with goal-based incentives, such as:
- Bonuses for completed consults: Rewarding the front desk for successfully scheduling and ensuring attendance at new client consultations.
- Positive review targets: Incentivizing the team for achieving a certain number of positive online reviews.
- New client acquisition: Bonuses for staff who contribute to bringing in new clients through referrals or marketing efforts.
These types of incentives help non-clinical team members feel seen, valued, and directly connected to the med spa’s growth.
Rewarding the whole team
Team-based bonuses (including medical directors, registered nurses, nurse practitioners, physician assistants, aestheticians, and non-physicians) are a great way to build collaboration and strengthen your workplace culture.
These incentives can be tied to practice-wide metrics like:
📲 Overall rebooking rates
💌 Growth in loyalty program sign-ups
📈 Hitting monthly or quarterly revenue goals as a team
When everyone works toward the same benchmarks and shares in the rewards, it builds a more united, motivated team that’s fully invested in your medical practice’s success.
How to choose the right compensation model for your team
There’s no one-size-fits-all solution — but there is a right fit for your unique med spa.
The key is to approach this decision with both empathy for your team and a clear understanding of your business goals.
The best model will come from thoughtfully weighing your team dynamics, legal requirements, and your med spa’s long-term growth strategy.
Considerations that matter
Ask yourself:
❓ What’s the size of your practice, and what services do you offer?
A smaller med spa with fewer providers may benefit from a simpler structure, while a larger, multi-specialty practice might need more tiers or customized compensation plans for different roles.
❓ Are roles clearly defined, and are your providers licensed appropriately?
Compensation must reflect the scope of practice. For example, RNs and estheticians can’t always be incentivized the same way due to legal restrictions.
❓Can your compensation model support your financial targets, including gross margins?
Your pay model should drive performance without cutting too deeply into profits or disrupting cash flow.
❓ How will it affect your team culture, motivation, and morale?
A good med spa compensation structure supports trust and collaboration, rather than creating unhealthy competition or resentment.
The bottom line is that your compensation model should foster an environment where both your team and your business can grow and thrive together.
Should you pay commission at your med spa?
There’s no blanket answer, but here’s the truth:
You can reward performance and stay compliant.
You can motivate your team without compromising client care.
With the right structure and tools, you can create a pay model that’s fair, effective, and stress-free.
So, should you pay commission?
That’s entirely up to you. But you can let Pabau, our all-in-one practice management software, to help you manage your team, track their performance, and stay compliant at all times.
How Pabau supports smarter, simpler compensation tracking
Hopefully, this blog helped you decide whether paying commission is right for your med spa.
At Pabau, we know how hard it is to juggle legal compliance, performance tracking, and fair pay, all while keeping your clients happy and your team motivated. We are right there with you.
That’s exactly why we built Pabau: an all-in-one practice management software designed specifically for med spa operations.
Here’s what you can count on:
👤 Create unique staff profiles and track performance in real time.
🎯 Set custom staff goals based on roles and permissions.
💰 Build smart commission plans directly in Pabau based on performance — no spreadsheets or guesswork.
🔄 Automate bonus calculations.
💸 Create custom commission structures based on services, packages, memberships, gift vouchers, and products.
💳 Eliminate payment errors with built-in timesheets and wage tracking for clock-ins, clock-outs, pay rates, and overtime.
⌛ Save admin time and maintain clear, transparent reporting.
At the end of the day, your focus should be on growing your business and caring for clients, not wrestling with compensation and compliance.
Let Pabau take the complexity off your plate so you can lead your team with confidence.
Ready to see it in action? Book a demo today.
