By Adam Reinebach, Chief Executive Officer, American Med Spa Association (AmSpa)

Since stepping into the CEO role at AmSpa, I’ve spent a lot of time listening to med spa operators. One pattern keeps emerging: when growth stalls, it’s rarely because of demand, marketing, or access to capital. More often, the real limitation is the ability to hire and retain the right people — and keep them engaged as the business grows.

People, by themselves, are not the constraint. Med spas are full of talented clinicians and committed staff. The challenge is finding injectors and team members who can grow with the practice — and then creating the conditions that make them want to stay. In medical aesthetics, that challenge shows up earlier and more acutely than in most service businesses.

I’ve seen similar dynamics across other fragmented, founder-led industries I’ve worked in. But in aesthetics, the stakes are higher. The work is more personal, the training curve is steeper, and the relationship between provider and patient is often the asset. When talent decisions go wrong, the impact isn’t abstract — it’s immediate and measurable.

One of the simplest — and most underused — tools I’ve seen strong operators deploy is also one of the hardest: regularly checking in with key team members about whether the work still fits.

Not “Are you happy here?”
Not “Everything good?”

I’m referring to a real check-in: Are you still enjoying the work? Does this role still energize you? Do you see yourself growing here?

As owners and operators, it’s easy to assume that competitive pay, stability, or long-standing loyalty will be enough to keep strong performers engaged. We tell ourselves that if the business is doing well and compensation is fair, satisfaction will take care of itself. In reality, disengagement tends to surface quietly. By the time it shows up as turnover — especially among top performers — the cost is already significant.

That risk is magnified in medical aesthetics. Losing a head of sales or a CFO is disruptive, but typically solvable. Customers rarely leave overnight because of leadership turnover. Losing a key injector is different. You’re not just losing capacity — you’re risking patient relationships that may have taken years to build. That dynamic makes hiring, development, and retention decisions far more consequential than in most other service businesses.

That reality is also shaping how we think about AmSpa’s role going forward — with a growing focus on helping members approach hiring, development, and retention not as HR tasks, but as core growth disciplines.

This is why retention isn’t about keeping people “happy.” It’s about designing roles and career paths that remain compelling as the practice evolves. What excites someone in a smaller, early-stage environment may not be what motivates them as the organization grows. Without regular, intentional conversations, misalignment doesn’t announce itself — it compounds quietly.

The second lesson I’ve learned is that learning and development play a larger role in retention than many owners expect, especially as teams mature.

Yes, attending industry events is valuable, and we strongly believe in the power of community and shared learning. But growth-oriented practices also invest in deeper, more structured development — training that sharpens clinical judgment, leadership capability, and decision-making. Across every market I’ve worked in, high performers don’t leave only for more money. They leave when they stop growing.

The most resilient organizations share a common mindset: they treat talent management as an ongoing discipline, not a one-time decision. Hiring well matters. Paying competitively matters. But the real work happens after that — through role clarity, honest feedback, periodic recalibration, and the willingness to address small issues early rather than large problems later.

As AmSpa looks ahead, one of my goals is to support members not just as clinicians or entrepreneurs, but as leaders navigating one of the most people-intensive businesses out there. The operators who succeed over the long term aren’t the ones with the flashiest marketing or the newest technology — they’re the ones who build teams that can grow with them.

And they don’t assume their best people are still engaged.

They ask.