What a doctor fee (DF) is: the pay models, the withholding tax, and the agreement that stops the monthly argument

01What a doctor fee is, and how it differs from the clinic's service fee

When a patient pays 18,000 baht for a filler treatment, none of that money is wholly the doctor's and none of it is wholly the clinic's. The price bundles at least three things: the product and consumables, which have a real cost; the clinic's service fee, covering the premises, equipment, licence, front desk and assistants; and the doctor fee, which is the compensation of the person who actually performed the work.

DF is broken out as its own line because most doctors in aesthetic clinics are not on a salary alone. Many work at several clinics, work in shifts, and earn in proportion to the work they actually do. The clinic therefore needs a defensible way to say what this doctor did this month and what they are owed. It is also a number the Revenue Department cares about, because it is the doctor's income and the clinic is the payer.

02The four DF models aesthetic clinics actually use

Every model pays about the same in a busy month. The differences appear in a quiet month, in a heavily discounted promotion, and in a month with refunds. Before choosing one, ask a single question: if next month's revenue halves, who feels it? The answer to that is the model you are choosing.

The same month, run through all four models

Take one doctor working 8 shifts a month, and compare two situations: a busy month of 62 cases and 620,000 baht net of discounts, and a quiet month of 26 cases and 208,000 baht net. Every figure below is invented to show the pattern — none of it is a market reference rate.

Read the table across and it shows what a single number cannot. In the busy month all four models land within 111,600 to 125,000 baht — less than 12% apart. In the quiet month the range widens to 31,200 to 64,000 baht, more than double. Arguing about 18% versus 20% is therefore arguing about the wrong thing. What has to be agreed is how the model behaves in an abnormal month.

One more thing that usually goes unnoticed: model B pays more than model A in the quiet month (46,800 against 41,600), because the average price per case that month fell to 8,000 baht — below the 9,000 baht at which a 1,800 baht flat fee equals 20%. If the clinic plans to run high-volume, low-price promotions, the fixed-per-case model becomes more expensive than expected overnight.

03DF and tax: which income category, what rate, which form

The most common mistake is assuming DF has one tax treatment. In fact the form of the relationship between clinic and doctor determines the income category, and the income category determines how tax is withheld and which return is filed. The Revenue Department has answered this in two rulings.

Ruling Kor.Kor. 0811/4394, dated 23 May 2545 (2002), covers two situations at once. In the first, doctors sign a written agreement to use the facility's premises for their practice; the facility collects the fees from patients and pays the doctor the agreed share. The Revenue Department held that the compensation the doctor receives from patients is assessable income "in its entirety under section 40(6)". In the second, outside doctors treat patients occasionally with no such agreement and are paid by the facility for the work done — that is income under section 40(2), income from a post or duty, or from undertaking work for another.

And VAT

Section 81(1)(ญ) of the Revenue Code exempts from VAT "the provision of medical treatment services by a sanatorium under the law on sanatoriums", and (ฌ) exempts "the provision of services of medical practice, auditing, legal practice, or other independent professions". So both the treatment fee the clinic collects and the DF that compensates the doctor's medical practice sit outside the VAT system. But the exemption attaches to the service, not to the clinic as an entity — a clinic with other revenue streams should have its accountant look at those line by line.

04The three things that start a DF argument every month

DF disputes almost never come from the agreed rate. They come from the cases the agreement never mentioned, which both sides then interpret differently and in good faith. The three below account for most of what goes wrong in an aesthetic clinic.

1. DF on discounted prices, promotions and vouchers

A patient buys a 12,000 baht promotion off an 18,000 baht list price, then applies a 1,000 baht voucher. The doctor sees the same work performed and expects DF on 18,000. The clinic sees 11,000 actually received. Both are reasonable and there is no universally correct answer. What is required is one choice made in advance — list price, net of discount, or net of discount and consumable cost — plus one worked example in the agreement that includes both a discount and a voucher.

2. DF on packages consumed over several visits

A patient buys a 10-session package in January and pays in full, then uses it through September. Dr. A performs sessions 1 to 4 and has left the clinic by session 5. If the agreement says DF arises "on sale", Dr. A earned the DF for all 10 sessions in January and the clinic must find someone to perform the remaining 6 with no DF budget left. If it says DF arises "on each session actually delivered", that problem disappears — but you then have to agree how each session is priced: the list price per session, or the package price actually paid divided by the number of sessions. Those two always differ once the package is discounted.

3. DF on refunds, complications and re-treatments

A case whose DF was paid two months ago is now partially refunded, or the patient returns for a correction at no extra charge. Is the DF clawed back? In full, or in proportion to what was refunded? And does the corrective visit count as a new case earning DF again? Most agreements are silent, which turns every instance into a case-by-case negotiation — the fastest way there is to damage the relationship.

• The calculation base — state whether it is the list price, the price net of discounts and vouchers, or the price net of consumable cost, with one worked example containing both a discount and a voucher.
• When DF arises — on payment, or on service delivery; and state it separately again for packages.
• Per-session pricing for packages — list price per session, or the price actually paid averaged per session. Pick one and write the formula down.
• Refunds and cancellations — DF is reversed in proportion to the amount refunded and deducted from the next period; say what happens if the doctor has already left.
• Corrections and complications — state that a correction within a defined number of days is part of the original case (no new DF), and that anything later is a new case.
• Cases with more than one doctor — how the consulting doctor and the performing doctor split the DF, and who decides when they disagree.
• The period-close, statement and payment dates — plus the window in which the doctor may query the statement, e.g. so many days after receiving it.
• The withholding-tax rate that will be applied and the return the clinic will file — so the first month's net transfer is not a surprise.

05What a monthly DF statement should show

A good statement lets the doctor check it without asking anyone, and reconciles back to the point-of-sale system. The principle is to start from what was collected from patients and walk down, line by line, to the amount transferred — not to hand over a single net figure. The example below numbers each line so it can be referred to.

You reconcile it by comparing line 2 against the point-of-sale revenue report for the same period, filtered to bills where this doctor is the performer. If they match, any problem is in the rate or the base. If they do not, the problem is in how doctors are linked to sale lines, which can be fixed at source immediately. Separating those two cases is what turns a half-day reconciliation into a ten-minute check. Line 8 must always be itemised case by case in the attachment, because it is the line that gets queried most.

06Setting up a DF scheme that does not need a monthly argument

1. 1

   Choose one calculation base for the whole clinic

   List price, net of discount, or net of discount and consumable cost. Pick one and apply it to every doctor. If someone has an exception, make it a written exception rather than a difference of understanding.

2. 2

   Build a rate table per doctor and per procedure, not one clinic-wide rate

   Procedures that demand different skill should carry different rates, and so should doctors with different experience. The table is built once and edited when it is renegotiated — not recalculated every month.

3. 3

   Decide when DF arises, and have the system lock the amount at that moment

   On full payment, or on completion of the service — one choice per type of work. What matters is that once locked, the rate used is stored with the entry. If the rate changes next month, past entries must not move with it.

4. 4

   Write the package rules separately

   Packages cause the most disputes because the money and the work land in different months. State when DF arises, the per-session pricing formula, and what happens to the remaining sessions when a doctor leaves.

5. 5

   Make reversals automatic rather than negotiated

   When money is refunded, the DF should reverse in proportion as a visible negative line, not by deleting the original. A month where an amount simply vanishes without a trace is a month where trust vanishes with it.

6. 6

   Fix the period-close, statement and payment dates, and keep to them

   For example: close at month end, statement on the 5th, queries until the 10th, transfer on the 15th. A fixed calendar removes every "when do I get paid" question and gives queries somewhere to go.

7. 7

   Let doctors see their running total during the month

   When the number moves daily, discrepancies get raised while the cause is still easy to find, instead of arriving as 148 lines queried at once on closing day.

8. 8

   Review rates on a calendar, not on a mood

   Set a review cycle — every six months, say, or whenever the price list changes. Knowing a review is coming means nobody has to open the subject mid-month.

07Common mistakes

• Agreeing a percentage without saying a percentage of what — the number one dispute, and one that a single sentence on day one prevents.
• Calculating DF from the bills but transferring a remembered figure — after two or three months where the transfer does not match the statement, the doctor stops reading the statement, and real errors stop being caught at all.
• Not storing the rate used with the entry — change the rate and every historical report changes with it, and nobody can prove what was agreed last month.
• Applying the same withholding rate to every doctor regardless of the relationship — an employed doctor and a doctor on a facility-use agreement sit under different sections and are filed on different returns.
• Showing only the net transfer on the statement — a doctor with section 40(6) income needs the amount collected from patients for their own return. If the statement omits it, they will have to ask for it every year.
• Leaving unconsumed packages without an owner — the remaining sessions of a package sold by a doctor who has since left become work with no DF budget behind it, unless the rule was written first.
• Running it on a spreadsheet several people can edit — the problem is not a broken formula, it is that nobody can say who changed what and when, which is the only question that matters when the numbers disagree.

08Checklist before signing or revising a DF agreement

Use this when talking to a new doctor, or when revisiting an existing agreement. Anything you cannot tick is the item that will become a dispute in a few months.

• The calculation base is stated — list price, net of discount, or net of consumable cost
• A worked example including both a discount and a voucher is in the document
• Rates are stated per procedure or per procedure group, not as one floating number
• When DF arises is stated — on payment, or on service delivery
• There is a package clause: which session triggers DF, how each session is priced, and who owns the remaining sessions if the doctor leaves
• There is a refund and cancellation clause, with the reversal method and the period it is deducted from
• There is a correction and complication clause defining what counts as part of the original case
• There is a clause for cases involving more than one doctor
• The income category, the withholding rate to be applied, and the return the clinic will file are stated
• The calendar is stated — period close, statement date, query window, transfer date
• The rate review cycle is stated, along with what triggers an early review
• Doctors can see their own running total during the month without waiting for the statement