We know aesthetics is a highly dynamic and fast-paced specialty, driven by innovation, new science and an ever-growing patient demand. Once, it was the exclusive domain of a specialised few – primarily surgeons1 – but the last few decades have seen a wider variety of medical practitioners entering the field, including nurses, dentists, dermatologists and GPs to name but a few.
Whilst I heartily believe that aesthetics should only be practised by medical professionals, I have grown concerned about the training, support and expertise of many of the new entrants coming into the specialty. My own observations as a trainer and interaction with delegates at conferences indicate there is an increasing number of medical practitioners jumping almost directly from their foundation qualifications straight into aesthetics – virtually bypassing the NHS to fast-track towards what they see as the promise of a lucrative cash-pay business. My question is whether, without a solid foundation of practical, clinical experiences, are these ‘fast-track’ industry entrants going to end up putting patient safety at risk?
The ‘shiny’ world of aesthetics
With the public sector pay cap of 1% a year having been implemented in 2013, following pay freezes for the two years prior to this,2 it is understandable why so many practitioners are leaving the NHS in search of more financially-rewarding careers. The current strains placed on healthcare professionals within the NHS also continue to grow. For many, the booming aesthetics specialty offers a way to utilise clinical skills and provide patient care within what can be a highly lucrative and in-demand cash-pay business model. Whilst this move is obviously a free choice, my belief is that individuals who are switching into aesthetics very early in their careers are missing a host of invaluable skills for patient management and care, which can only be achieved having spent a few years undertaking hands-on clinical practice. The ability, for example, to recognise and manage complications, I believe, comes with clinical exposure and time.
Don’t get me wrong – I’m not against younger practitioners entering the aesthetic specialty; in fact, youth often brings a new way of thinking and practising. However, there’s a lot to be said for the hands-on experience and independent skills that are acquired in clinical practice, which help ground the success of business endeavours. I’m talking about that connection, ability to listen and get a feel for what your patient is all about. These skills simply cannot be encapsulated in a two-day course, after which a practitioner is directly responsible for patient outcomes.
Training and mentoring
My career began in the NHS more than 18 years ago, when I studied medical surgery at St George’s Hospital Medical School before specialising in colorectal surgery. When I decided to make the transition into aesthetics, I undertook extensive training with Cosmetic Courses at Aurora Clinics, as this was the only UK training academy led by a plastic surgeon at the time. This was important to me as I felt a surgeon could best help me understand and respect tissue layers of the skin to achieve optimum aesthetic results. Yet, even after this training and with all my years of surgical training and clinical experience, I still felt completely out of my depth and pursued several other courses alongside one-to-one training and mentoring before truly starting my business. The rigorous training, constant reviews and check-ups and a clear hierarchy of teachers and mentors you receive in medicine is not as clear-cut in aesthetics – there is nobody ‘checking up on you’ in the early days and I feel this is a potential danger zone, particularly with the increased number of new aesthetic practitioners who only have minimal NHS experience under their belts. Conversely, I’m not advocating for a ‘nannying’ approach in aesthetics, just consideration of a supportive way to help new practitioners find their feet and learn how to manage patients (and complications) on their own, but have the option of senior support when they need it. When I was a house officer, I remember my senior house officer saying, “Please don’t phone me until you get the patient as far as you can get them.” This really stretched my capabilities, but rather than phoning at the first hurdle, I built my confidence and capabilities with that lifeline still available. I feel this kind of approach is currently lacking in aesthetics.
This absence of a ‘foundation’ of clinical experience can manifest in some new practitioners feeling very nervous and unsure about putting their aesthetic training into practice. As with surgery, in aesthetics there is an element of learning by doing – yet often I see practitioners on my training courses who feel unable to treat patients despite several sessions of training. Often, they are looking for ‘fool proof’ and absolute textbook methodologies for patient assessment and treatment, and struggle to grasp the concept that you can’t adopt the exact same approach with every patient, or even with the same patients at different time-points. The lack of on-the-job mentoring for many aesthetics practitioners can leave them feeling unable to trust their own skills – or worse, to treat patients without feeling fully confident or able to review and manage any complications.
Rather than being quite so damning about this new generation of aesthetic practitioner, I think other experienced aesthetic professionals should support them. As long as the NHS is allowing their vital staff to leave in droves, we will need to put in place something to support these medical professionals. The old adage of ‘see one, do one, teach one’ is something that I think could be adopted to a degree in aesthetics. I would propose a mentoring system whereby new practitioners are allocated a mentor to refer and report to. Maybe something for the myriad of new training courses to adopt to make them more discerning? Some voluntary associations, bodies and training academies are taking the lead on this; for example, the British Association of Cosmetic Nurses offer a mentoring programme,3 while the British College of Aesthetic Medicine have just launched an Academy which aims to mentor and train its members.4 The Joint Council for Cosmetic Practitioners meanwhile have adopted the role of a ‘supervisor’, who has oversight and is accountable for their delegated practitioner.5 I think every patient should be an opportunity to assess, analyse, reflect and learn from. This is ongoing and we must remember ‘train hard, fight easy’ to ensure that our patients, and indeed us as a profession, stay safe.
The immense strain on our NHS is unlikely to resolve in the next few years, and with the aesthetics specialty continuing to demonstrate significant growth this will represent a highly attractive alternative for many newly-qualified medical practitioners. With no mandatory training and qualification pathway in aesthetics, it is primarily up to the individual to decide how rigorously to pursue training and support before engaging with patients. I believe this offers significant scope for future concerns on patient safety and care, and there should be a greater focus on training and mentorship within the industry. This could help support new practitioners and give them the tools and confidence to deliver the best possible experience for their patients.