3 Surprising Things I Love About Working in Aesthetics as a Physician Associate (PA)

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Tracy Bingaman

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I'm a PA who burned out, big time, and now I teach PAs to negotiate effectively because every PA deserves a paycheck they are proud of and to feel valued at work. I love leopard print, skiing, and my morning routine. My mission? To help PAs stop feeling overworked, underpaid and overwhelmed and start feeling valued and earning what they deserve.

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I’m three years into my specialty change working as an aesthetics PA. These days, the majority of my day is neuromodulator and filler patients. As an aesthetics PA, I do everything from consulting with new patients and creating a comprehensive treatment plan to treating with botox, hyaluronic fillers and biostimulant injectables.

Working in a space that is cash-pay, cosmetic and aesthetic as a PA… read the majority of what I do is completely elective procedures… is a night-and-day difference between the insurance based medically necessary surgery that I’ve done in the past.

Here’s what you can expect to hear on this episode of The PA Is In: three surprising things that I love about working in aesthetics. 

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1 – My relationship with my aesthetics patients.

Aesthetic injection is a little bit like therapy. Hear me out here. You know the relationship that you have with your hairdresser? That you tell them things that you wouldn’t tell some of your pretty good friends? 

This is the type of relationship that I get to cultivate with my patients.

I see many of my patients on a quarterly basis for neuromodulator injections every 3 months. 

This is going to surprise many of you BUT from when I was in high school shadowing and deciding to become a PA all the way through until the last year of PA school while I was on rotations… I wanted to do primary care.

I KNOW! I can hardly believe it myself.

Me – the surgery PA through and through – the provider who LOVES the OR, procedures, holding a needle or a scalpel or suture in my hand – the person who would love nothing more than to clamp a renal artery for a complicated partial nephrectomy at this very moment – primary care.

Let me explain.

When I was in high school I did some job shadowing. I ended up in the primary care office where I was a patient shadowing a Primary Care PA – Sarah. I got to spend a few days with Sarah.

Even back then I remember the wide range of ages and patient complaints that were on Sarah’s schedule that day. I also remember the charting burden and how much she had to know about so many different aspects of medicine.

My favorite part about primary care was the longevity of her relationships with patients. She got to see them over time. She saw them through childhood and into adulthood. In fact, she saw ME through childhood and into adulthood. She saw babies and moms. She treated families. She navigated the health of her geriatric patients as they approached their last years of life. She treated young kiddos and their grandparents. 

And she KNEW them. Truly knew patients and had deep conversations with them.

That shadowing experience led me to think that primary care was the place for me.

Then I stepped into the OR on rotation about halfway through my clinical rotations and the rest was history – I loved the OR and surgery. I adored the fact that we got to fix something, help solve an acute problem, excise a patients cancer, and in short order help patients to feel better.

In both general surgery and my position in Urology, I didn’t get the chance to cultivate that long-term relationship… It was acute care, inpatient rounds, or solving problems that were acute in nature.

My only patients that I saw over time in Gen Surgery were my cancer patients and I adored getting to know them over time. Others we would treat their acute problem and away they’d go.

With aesthetics I have the pleasure of seeing my patients sometimes as often as every 3 months! 

These ongoing relationships are one of my favorite things about practicing cosmetics and aesthetics. People come in for treatment before big occasions – weddings, graduations, travel and trips – and I get to hear what they are up to and looking forward to and then, when I see them next I get to find out how it went. 

People share things with their injectors just like their hair stylists and therapists. We often joke that it’s part therapy and part treatment when we are injecting, particularly for a longer visit because we get into it.

My patients and I talk about societal definitions of beauty and what it feels like to raise children in this world and everything in between. It’s an honor every time a patient trusts me with their safety and the aesthetics of their face. 

2 – The community of aesthetic PA injectors. 

Honestly, with as competitive as it is to break into the aesthetics industry it’s very surprising how collaborative and encouraging the community of injectors is.

Part of this is the amount of injectors that have an online presence. It opens a door to both follow and connect with other people in this space.

Despite the relative competition the community is powerful. It’s interesting to see the collaboration that exists within the providers in this space.

Whether in person support or training with other injectors to long-distance mentorship, the PAs in the injectables space are incredibly supportive. 

Take my friend Maryellen Bishop. She was a guest back on Episode 107 [iTunes & YouTube]. She’s states away and one of the best PAs in this space in the entire country. We found each other through the PA Moms Group and I am continually amazed by her work. 

Maryellen is a trainer for one of the largest companies in the aesthetics space and she’s one message away – for encouragement or inspiration – for advice and what would you do with these patient or situation types of questions. 

Speaking of trainings – aesthetics is a space where trainings are readily available. Whether in person conferences, having a trainer come to your office or following other injectors on patreon, trainings abound in the aesthetics space.

At first I felt on the outside of this community, but after leaning in to cultivating relationships with others in this space, it feels great to have people near and far to bounce ideas off, collaborate and commiserate with. 

3 – The challenge, complications and cosmetic aspects of working as an aesthetic PA.

The third thing that I love about working in the aesthetics space is the technical challenge and the artistic nature of the cosmetic aspect of what I do.

When I first started I was cocky about my surgical training and background and… although that prepared me well for the technical aspect of using my hands when I’m injecting…  I underestimated the importance of safety, anatomy, keeping up with best practices, and the challenge that comes along with each unique person’s anatomy.

Not only is everyone’s anatomy unique but their face, aesthetic treatment goals and budgets are different. 

The hardest and most challenging part is doing a full facial assessment and forming a plan for treatment that is going to work for the patient and help them meet their goals.

A common misconception about botox and filler treatments is that you will look fake, overfilled and artificial. There is absolutely a way to utilize these tools to increase balance in a face, to highlight positive features and minimize things that bother people about the way that they look. 

I adore being able to help boost my patients confidence by balancing their face. I also take pride in being able to take care of patients in a way that is safe, moderate and effective.

Oftentimes this leads to me saying no to patients requests and educating them about their anatomy and why what they are requesting is contraindicated.

There is a lot of misinformation floating around on the internet about aesthetic treatments and people come in asking for tons of things. It’s my pleasure to educate them on things like on and off label uses of the medications in our repertoire, their safety profile, indications and potential complications.

Injectables are just like any other procedure, medication or treatment – we review informed consent and share risks, benefits and alternatives to procedures before we treat them.

The aesthetics space is interesting because everything is elective so weighing the pros and cons of treatment, expected results, and patient investments.

The hardest part of my job is each unique full facial assessment and sharing with patients what would be best given their age, skin, anatomy, favorite and least favorite features.

We also try to share with patients that the two halves of their faces are are sisters and not twins – we can improve asymmetries of faces but they cannot be exact matches.

I try to be diligent about identifying these asymmetries prior to treatment and establish that they are there before we treat patients. 

The Bottom Line as an Aesthetics PA

Bringing safety and ethical treatment of patients, reviewing a true and complete informed consent and educating patients are all aspects of working in aesthetics that I love. 

It’s a unique space and it includes a strange balance between procedures, medicine and sales. In the past my informed consents were for life-saving, urgent, emergent and necessary procedures – stent placement for obstructing stones in a patient with bacteremia… lap chole for acute cholecystitis – aesthetic procedures are elective without a true and specific medical indication. 

Working as an aesthetics PA has been a big adjustment for me. I’m three years in and learning to embrace this space and enjoy it’s unique benefits and challenges.

It’s a crazy, cool combination of medicine and art, cultivating relationships, helping patients embrace their confidence and doing so in a way that is safe, honoring patients goals and reasonable with their budget. 

Love this episode? Check out this one where I walk you through a day in the life of the aesthetics PA.

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I'm Tracy Bingaman

It's so nice to meet you... I’m a PA Mom life coach, self-care promoter, curly haired achiever, mom and dog mom, and a margarita drinking badass.

I burned out working as a PA... BIG TIME. I quit my job, doubled my hourly income earned, work half as much and learned to build a life around the things that I value instead of a schedule set by someone else and now I get to share all that I've learned with you. 

oh hey!

Now I teach PAs to do the same.

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