Hello, I currently am a practice manager for a well established Plastic Surgeon in the West. I have been working as an Asthetic Nurse Specialist for over 10 years, it is extreamly competitive. New grads are unlikely to be hired for a plastics or high end derm with out a patient base as these docs are looking to drive injectable patients into their surgery practice. There is a misconception that people working in this area have it easy with high salaries. That may have been true even 3 years ago for highly experienced RN's, when fewer businesses like this were in the market. Many larger metro areas are saturated with med-spas.
Patients are paying out of pocket for these treatments as nothing is covered by insurance. In fact, insurance companies have made it very difficult to get a breast reduction covered. The reality in this economy is that an RN with no experience, and no patient following is going to make an average of $25 to $30 p/hour if they can get in. People receiving the treatments want someone with years of injecting experience, an excellent aesthetic eye and a more mature person delivering their treatments. Generally speaking women do not want to take anti-aging advice from someone in their 20's who has not experienced any aging issues? A large part of the Aesthetic Nurse is managing patient expectations.
Med-spas unless owned or medically managed by a Plastic surgeon or a Derm are lower paying as they do not have the surgeon dollars to keep the business stable. In our practice, the skin care and injectables break even and are there as a convience for the surgical patients. I find that Gen practitioners, OB's Dentists etc. have no idea what they are getting into when they open a med-spa and usually don't make it in this business for more than a year or do the injections themselves. They are also unable to back you up as they have no real practical experience in managing complications in this area. The injectable products are expensive, lasers 100k and monthly payments are factored into the cost of the treatments. Overhead is high, this is a business and bottom line, aesthetic procedure profit margin for the practice or doctor is very tight and the doctor is going to make the money not the staff.
In some states Plastic Surgeons and Dermatologist are pursuing legislation to regulate who, how and where treatments can be administered. This is a valid issue as it is still a medical procedure and things can go wrong quickly. I have expereinced full blown grand mal sezure of a patient during a "simple Botox treatment".
Recently, the Doc I work for sent me to a demo for a laser assisted liposuction device, there was not one plastic surgeon in the room! I had more experience using this device than the pain management MD, or the Internal medicine MD etc, at the demo. These doctors are not Board Certified in Plastic Surgery and only one had surgical experience as a semi-retired OB. You put yourself at risk assisting these docs.
On another note, some states have no regulation on estheticians doing Botox, these tecs have no science, no anatomy and no idea where facial nerves are etc. I am unsure how they can be covered under malpractic insurance?
I may be painting a bleak picture, but having been in this arena for awhile I've seen the trends.