Primary Care Experience Should Be the Foundation of Aesthetic Practice, NP Argues

As medical aesthetics continues to attract clinicians from increasingly diverse backgrounds, one nurse practitioner is arguing that technical training alone is not enough. In a brief report published in the Journal of Clinical and Aesthetic Dermatology, Lori J. Robertson, MSN, PHN, APRN, FNP-C, Clinical Director at Skin Perfect Medical/The Aesthetic Immersion in Brea, California, contends that primary or acute care experience should be considered a foundational prerequisite before clinicians enter aesthetic medicine.¹

Robertson argues that while courses on injectables, lasers, and anatomy have become widely available, the specialty lacks standardized expectations for broader clinical competency. Without experience evaluating complex medical conditions, she writes, aesthetic providers may overlook signs of systemic disease that become apparent during cosmetic consultations.¹

Cosmetic Visits Can Reveal More Than Cosmetic Concerns

Unlike many other specialties, aesthetic medicine often provides extended face-to-face time with otherwise healthy patients. Robertson suggests these visits create opportunities to identify underlying medical conditions that might otherwise go unnoticed.¹

She describes providers with backgrounds in primary or acute care as bringing transferable skills developed through years of comprehensive patient assessment, differential diagnosis, and clinical decision-making under pressure. Those skills, she argues, remain valuable even when the patient's primary reason for seeking care is cosmetic.¹

Two Cases That Changed the Conversation

Robertson illustrates her argument with 2 patient cases from clinical practice.

• A 46-year-old man presented for neuromodulator treatment and casually mentioned taking antibiotics during his medical history. Further questioning uncovered a neck mass that was ultimately diagnosed as adenocarcinoma of the jugulodigastric gland. The patient was referred the same day for imaging and otolaryngology evaluation.¹

• In another case, a 52-year-old woman seeking treatment for facial volume loss was noted to have asymmetric globe prominence. Robertson referred the patient for endocrinology evaluation, where laboratory testing confirmed hyperthyroidism with findings consistent with thyroid eye disease.¹

She also notes that aesthetic consultations may uncover signs of thyroid disease, cardiovascular disorders, autoimmune conditions, neurologic disease, psychiatric illness, and skin cancer when providers perform thorough medical assessments rather than focusing exclusively on cosmetic concerns.¹

An Ethical Argument for Broader Clinical Training

Robertson frames the discussion around the ethical principles of beneficence and nonmaleficence. According to the report, providers must be equipped to recognize when a cosmetic concern may actually represent an underlying medical issue or when treatment should be delayed because of an undiagnosed condition.¹

She also highlights body dysmorphic disorder as an example of a condition that may present during aesthetic consultations, requiring careful clinical judgment before proceeding with elective treatment.¹

A Call for National Credentialing

Beyond recommending prior primary or acute care experience, Robertson proposes creating a national certifying body for aesthetic medicine.¹

According to the report, no single US organization currently verifies the foundational medical competency of clinicians entering aesthetics across nursing, physician associate, and physician pathways. Robertson suggests a standardized certification process that would evaluate both previous clinical experience and current aesthetic knowledge while requiring ongoing recertification.¹

Rather than replacing existing specialty certifications, she envisions a national credential serving as a baseline standard for entry into aesthetic practice.¹

What This Means for NPs and PAs

Robertson's proposal is likely to generate discussion among clinicians entering aesthetics through different career paths. As demand for cosmetic procedures continues to grow, questions surrounding standardized training, patient safety, and minimum clinical experience remain unresolved.

For nurse practitioners and physician associates considering aesthetic practice, the report raises a broader question: Should competency in aesthetics be defined primarily by procedural training, or should it also require a foundation in comprehensive medical assessment?

A robust background in primary or acute care should be a recognized prerequisite, - Lori J. Robertson, MSN, PHN, APRN, FNP-C

References

1. Robertson LJ. The non-negotiable prerequisite: Why primary or acute care experience is foundational for aesthetic providers. J Clin Aesthet Dermatol. 2026;19(5-6 Suppl 1):S24-S26.
2. Singh H, Taber DG, Schiff GD, et al. Types and origins of diagnostic errors in primary care settings. JAMA Intern Med. 2013;173(6):418-425