Driving down the street in most major U.S. cities, you might have noticed a new fixture popping up in the local strip malls. More and more med spas are opening. According to AmSpa's 2024 industry report, 1,589 medical spas opened in 2023, taking the national total from 8,899 to 10,488. This marked a 17.86% increase, nearly double the 2018 total of 5,431. To put this in perspective, a new med spa opened every 5.5 hours in 2023.
Each of those new medical spas needs licensed clinicians to perform the treatments, typically nurse practitioners and physician assistants, along with registered nurses. However, that workforce is growing much more slowly. According to federal employment estimates, NP and PA employment only grew 6.70% in 2023 in all of healthcare, not just aesthetics.
Skin Clique Academy, an injectable training program for licensed clinicians, analyzed how the industry's growth compared with the workforce needed to staff it. The analysis pulled together national med spa counts, federal employment data and Certified Aesthetic Nurse Specialists (CANS) certification records.
According to PSNCB's 2024 exam data, 60 nurses passed the CANS exam for the first time in 2023. That's 60 newly certified nurses in a year that added 1,589 med spa clinics.
While there are no sources showing how much of the NP and PA workforce actually works in med spas, these three sources show a stark contrast between the number of med spas opening and the growth of the industry that staffs them.
Why are so many new med spas opening?
Injectables are driving much of the industry's growth. As of 2021, 94% of med spas offered facial injections.
The aesthetics industry isn’t just growing the number of new locations. Revenue, patient volume and the services offered are also up. The average med spa had 283 aesthetic patient visits a month in 2022. Average revenue per location reached $1.4 million in 2023, and the same AmSpa report puts the broader medical aesthetics industry’s annual revenue at $17 billion.
US med spas are nearing the number of McDonald’s locations
A 2026 Aesthetic Surgery Journal report estimates that the United States could have approximately 13,000 med spas by the end of the year. At this pace, the U.S. could soon have nearly as many med spas as McDonald's restaurants.
At a state level, the ASJ also reports that the state of Florida already has 2.5 times as many med spas as McDonald’s restaurants, highlighting just how far medical aesthetics has moved into the commercial mainstream.
Clinics vs. Clinicians
Workforce data was pulled from the Bureau of Labor Statistics Occupational Employment and Wage Statistics program, which estimates wage and salary employment across industries each May.
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More Med Spas Now Compete for the Healthcare Workforce
This difference in growth rate affects the ratio between med spa locations and clinicians. In 2022, the U.S. had 22.3 med spas for every 1,000 clinicians. By 2023, Skin Clique Academy’s analysis puts that number at 24.6 med spas for every 1,000 clinicians.
This can be seen at the local level too. A med spa recruiting an NP or PA is hiring from the same pool of regional clinicians as hospitals, physician offices, urgent care centers, dermatology practices and other med spas.
The Credential Few Nurses Get
The Certified Aesthetic Nurse Specialist credential, known as CANS, is a certification for registered nurses working in aesthetic medicine. From 2019 through 2023, only 260 nurses passed the CANS exam for the first time, while over 5,000 med spas were added in the U.S. While there is no published data showing the number of med spa injectors, there is a live public tally that shows showing 504 active CANS credential holders across the United States, U.S. territories and Canada.
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You might assume passing the exam is the bottleneck, but pass rates were 90% in 2022 and 95% in 2023.
The larger issue is that fewer people are taking the exam. The number of exams that have been administered fell 28% from 2022 to 2023. Only 65 exams in total were given in 2023.
According to PSNCB's CANS requirements, two years of experience as a registered nurse in the core specialties is needed to take the exam. Nurses also need at least 1,000 practice hours in those specialties during the previous two years. That means that a new nurse entering aesthetic medicine during the 2023 surge in growth is not even eligible for the exam until 2025, at the earliest.
More importantly, the CANS certification itself is voluntary. Based on their professional licenses and the applicable state rules, physicians, NPs, PAs, and RNs can provide injectable treatments without it.
Med Spa locations can grow faster than the workforce behind them
From 2025 to 2035, NP employment is projected to grow 41% and PA employment 21.1%, adding a combined 173,500 new jobs. However, most of this growth is driven by the need for more healthcare professionals in the United States in general, not medical aesthetics.
A med spa clinic can be up and running within a few months. But it takes years to grow the number of new licensed practitioners.
This story was produced by Skin Clique Academy and reviewed and distributed by Stacker.