Walk into any modern med spa, and you're likely to find PAs taking a prominent role in patient care—conducting consultations, administering injectables, and ensuring that treatments are both effective and safe. Understandably, many patients and med spa professionals have questions:

• Are PAs qualified to perform aesthetic procedures?
• What kind of training do they have?
• Are treatments performed by PAs safe?

The answer is a resounding yes. PAs are among the most rigorously trained and trusted providers in medical spa settings. This article will explore their role, training, history and why you can feel confident in their care.

Who are physician assistants?

Physician assistants, also known as physician associates, are nationally certified and state-licensed health care professionals. They are educated in the medical model and trained to provide diagnostic, therapeutic, and preventive care as part of a health care team. PAs work in collaboration with physicians and are found in every medical specialty, including dermatology, plastic surgery, and aesthetic medicine.

More than 178,000 PAs are practicing in the United States today, according to the U.S. Bureau of Labor Statistics, with more entering the field each year due to strong demand and proven effectiveness.

The history of the PA profession

The PA profession was born of necessity in the 1960s to address a national physician shortage and growing health inequities. Primary care physicians were in short supply and increasingly moving away from general medicine into specialty areas with the advancement of new medical technology. Meanwhile, thousands of servicemen with medical experience were being discharged every year, 6,000 of whom had extensive medical training, according to The Physician's Assistant—Today and Tomorrow. 

In 1961, AMA trustee Dr. Charles Hudson proposed training experienced former military medics and corpsmen to fill critical care gaps, suggesting a "mid-level" provider work under physician supervision in his address called "Expansion of Medical Professional Services with Nonprofessional Personnel."

Dr. Eugene A. Stead, Jr., of Duke University, designed the first PA program after a fast track training used during World War II to prepare doctors for the military; only eight years earlier, his efforts to establish a similar master's degree program for nurse clinicians, alongside Thelma Ingles, RN, had failed to gain accreditation. This PA program enrolled four ex-Navy hospital corpsmen, who were previously unable to use their considerable medical training without this formal education.

Dr. Richard A. Smith, MPH, developed a collaborative PA program at the University of Washington called MEDEX, named for ME-dicine EX-tenders. Dr. Smith had a special interest in public health after serving overseas in the Peace Corps, recognizing the role of trained non-physician providers to fulfill health needs in underserved areas. The first physician assistants were quickly recognized for their competence and dedication in supporting physicians in medically disadvantaged and rural areas, notably along the Alaska Pipeline.

Credentialing a new health practitioner meant creating a formal structure and curricular model, including: a society of practitioners (American Academy of Physician Assistants — AAPA), an association of educational training programs (Association of Physician Assistant Programs — APAP), an accrediting body (National Board of Medical Examiners — NMBE, then National Commission on Certification of Physician's Assistants — NCCPA), and a process to certify graduates (PANCE).

Significant milestones include:

• 1965: First PA program launches at Duke University.
• 1967: The first class of PAs graduates October 6, marking PA Day.
• 1968: The American Academy of Physician Assistants (AAPA) is founded.
• 1971: The federal Health Manpower Training Act helps institutionalize the profession.
• 1973: The first PANCE exam is administered. AAPA and APAP/PAEA create joint national headquarters.

Different institutions gave the role different names: "physician extender," "extern," "medex," "physician associate," "physician's assistant" and "health associate." By the 1980s, "physician assistant" was formalized and incorporated into state medical practice acts. Eventually, the title physician assistant became the national standard, reinforced by model legislation that amended medical practice acts to allow PAs to practice under physician supervision in what was called "negotiated dependent performance autonomy."

What started as a solution for rural and underserved communities has evolved. Today, PAs practice across medical specialties and excel in fast-paced environments such as medical spas, combining clinical skill with compassion and integrity.

How PAs are trained: Education and clinical preparation

PAs complete rigorous education and training, including:

• A Master’s degree from an accredited PA program (27–36 months)
• More than 2,000 hours of supervised clinical rotations
• Studies in anatomy, pharmacology, diagnosis, procedures, and patient safety
• Successful completion of the Physician Assistant National Certifying Exam (PANCE)

The first PA programs were developed to follow the fast-track medical education used to prepare military doctors. Now there are 308 accredited programs preparing PAs with training to work across a wide range of medical environments, including medical aesthetics.

To maintain certification through the National Commission on Certification of Physician Assistants (NCCPA), PAs must complete:

• 100 hours of Continuing Medical Education (CME) every two years
• A recertification exam every 10 years

These rigorous standards keep PAs up-to-date on advances, safety protocols and best practices in medical aesthetics.

Specializing in aesthetic medicine

Although trained as generalists, many PAs pursue focused education and experience in cosmetic dermatology, plastic surgery and aesthetic medicine. PAs often build their skills in cosmetic medicine through:

• Clinical roles in dermatology or plastic surgery
• CME courses in injectables, lasers, and aesthetic procedures
• Training through aesthetic conferences, workshops, and device vendors
• Mentorships and hands-on proctoring from experienced aesthetic providers

Many PAs who work in medical spas have invested in certifications from industry leaders such as Allergan Aesthetics and Galderma, from CME-accredited aesthetic injector training institutions such as the Academy for Injection Anatomy, and from specialized courses dedicated to safely using aesthetic lasers and energy devices, performing PRP, and more.

Safe, reputable med spas vet and verify each provider’s credentials and training before allowing them to perform cosmetic procedures. Even if a newly hired provider has previous experience at another practice, the med spa's medical director or supervising physician will assess their skills in each procedure before they can treat patients.

Licensure and scope of practice

PAs are licensed by state medical boards. Their scope of practice is defined by state-specific laws and regulations, medical board rules, their supervising or collaborating physician, practice-level protocols and delegation agreements.

Generally, PAs can:

• Take medical histories and perform physical exams
• Diagnose and manage conditions
• Prescribe medications
• Perform procedures, including minor surgery and injectables
• Supervise clinical staff and ensure compliance

The scope of what a PA can do in a med spa may vary by state, but their authority is always grounded in licensed medical practice.

Roles PAs perform in medical aesthetics

In medical spas, PAs are responsible for a wide range of clinical duties:

• Initial consultations and patient assessments ("good faith exam")
• Developing and overseeing individualized treatment plans
• Administering Botox, dermal fillers, and biostimulators
• Performing advanced procedures such as laser therapy, microneedling, and PRP
• Managing complications and providing follow-up care

Generally, PAs can perform medical aesthetic treatments (such as botulinum toxin, hyaluronic acid fillers, lasers, PDO threads, and more) provided a particular treatment is within their scope of practice in that state, the PA has documented training in the procedure and is working pursuant to written guidelines with a supervising physician. PAs may also supervise nurses and other team members. They can prescribe treatment and delegate that treatment to appropriately licensed, trained and supervised providers. 

In states with collaborative practice for PAs, they work under the supervision of a physician or following protocols of a written and signed collaborative agreement. In recent years, more states have proposed and adopted legislation that grants PAs reduced physician oversight and allows more autonomy. This trend toward independent practice usually includes provisions that a PA must work under supervision for a specified number of years or hours of supervised practice (ex: at least three years, 4,600 hours). Once a PA meets those state requirements, they can apply for greater autonomy. 

Are PAs safe aesthetic providers?

Yes. Research consistently shows that PAs provide care that is safe, effective, and comparable to physician-led treatment.

• A 2019 review of 25 international studies found no significant difference in patient satisfaction between PAs and physicians.
• A multicenter hospital study found PAs provided safe, high-quality inpatient care with better patient experience outcomes.
• In emergency departments, PAs were associated with reduced wait times and no increase in complications or readmissions.
• A 2021 review of 33 studies found that PAs delivered equal or superior care at lower cost in many settings.

Government agencies such as the Agency for Healthcare Research and Quality (AHRQ) and the Department of Veterans Affairs recognize PAs as essential providers in both general and specialty care.

What patients should know about PAs in med spas

Patients should feel comfortable asking providers about their qualifications. Here are helpful questions to ask before a treatment:

• What is your background and training in aesthetic medicine?
• Are you board-certified by the NCCPA?
• How long have you been performing this procedure?
• Who is the medical director of this facility?
• What training have you completed for this device or injectable?

Here are some things you can look for in a safe med spa:

• Licensure and certifications displayed openly;
• A clean, professional setting;
• Transparent consultation and informed consent process; and
• Clear answers to questions about training and oversight.

Well-run med spas feature clear supervision, credentialed providers, and continual staff education. Check out these resources for further insights from trusted aesthetic professionals:

A Patient's Guide to Medical Spas

What to Look for in a Safe Med Spa Visit

How Safe Are the Top Med Spa Treatments

Safe med spas build strong health care teams

A high-quality medical spa should include:

• A licensed, active and accessible medical director
• Qualified providers (PA, NP, RN) with up-to-date training
• Supervision and delegation protocols that follow state law
• Safe equipment and procedures for emergencies
• Clear documentation, informed consent, and follow-up care

Safety is not just about who performs the procedure—it’s about the systems, supervision, and structure supporting the clinical team.

Why med spas trust PAs

Med spa owners choose PAs because they offer:

• Strong clinical training and decision-making
• Ability to perform a wide range of procedures
• Leadership in staff supervision and clinical protocol
• High patient satisfaction and trust
• Compliance with state regulatory frameworks

Whether a med spa is just opening or expanding services, a PA is often the key to delivering safe, effective, and consistent care.

PAs are qualified aesthetic providers

Physician Assistants are thoroughly trained and licensed to provide care in medical settings, including aesthetics. Their presence in medical spas reflects their professionalism, competence and commitment to patient outcomes.

For patients, knowing your provider is a PA should give you confidence. With proper credentials, training, and oversight, PAs offer safe, skilled, and compassionate care in medical aesthetics.

Resources and References

• Human Resources for Health: Patient satisfaction with PA care
• PLOS ONE: Cost-effectiveness of PAs
• National Library of Medicine: History of the PA profession
• NCSL: PA scope of practice determination
• AAPA: Becoming a PA
• AHRQ Reports: Patient safety evidence

• Sadler AM Jr, Sadler BL, Bliss AA. (1975). The Physician's Assistant—Today and Tomorrow (2nd ed.) New Haven, CT: Yale University Press.

• Mayo Clinic: PA Specialties