Susanne S. Warfield is the leading expert on the business, legal and liability issues that affect physician and esthetician relationships working in a medical or spa setting. Warfield is a 27-year Licensed Esthetician and is NCEA Certified. Her career started as an Esthetics Instructor at Sheridan College in Oakville, Ontario, Canada, where she taught the 2nd year of a two-year degree Esthetics Program. When she moved to the United States, her advanced training was put into use and she spent almost 14 years working with a dermatologist in New York City. See Susanne S. Warfield’s profile on the Beauty School Lounge.
Today’s esthetician enjoys a broad range of esthetics career options in the traditional salon/spa setting, theatrical makeup for stage, or the film industry. Cosmetics companies offer numerous opportunities, from sales and training to management and executive positions. All of these, however, lie outside the scope of this article, which is devoted to career options for estheticians in medical settings.
Two questions should come to mind when considering working as an esthetician in a medical setting: would I like it and would I be good at it? The answers may not be as obvious as you think. Physicians and estheticians may not be that different. The reasons for choosing careers in esthetics or medicine differ in many respects, but they also overlap in more ways than you might think, which makes combining the two a natural choice.
People pursue esthetics careers for various reasons. Obviously, one of the essentials is the enjoyment of working with people. There’s really no room in the profession for people who don’t genuinely enjoy dealing with others and helping them be their best. It takes real skill to put people at ease to the point where they trust others to keep their interests at heart. Often, the esthetician has to learn to listen between the words to find out what the client really wants, and also develop sophisticated psychological skills.
Respecting our clients’ privacy is important: remember the hair coloring commercial that posed the question “Does she or doesn’t she [today it could well be does he or doesn’t he]? Only her hairdresser knows for sure!” The ad may sound old-fashioned but the concept of respecting the trust people place is not.
The esthetician enjoys work that centers on esthetic sensibility, and quality esthetics training refines that sensibility 
and focuses it on helping people look their best. In a sense, estheticians are one of the so-called helping professions, and as such, it has quite a bit in common with the other helping professions: part of the professional satisfaction comes from the knowledge that when a job is well done, the esthetician has helped other people in a wide variety of ways.
Estheticians also like to work independently. That is, the esthetician is personally and directly responsible for the job he or she does. That’s true of just about any job, but some work, like that of an esthetician, allows the person performing it to assume complete responsibility for the end results. If done well, the results are obvious, but their effects may be more subtle, revealing themselves in a patients’ increased self-confidence. If done poorly, the results are equally obvious and the effects for the patient are genuinely painful.
And let’s not forget that we do it to be profitable.
What I said about estheticians is equally true of physicians in many ways. The clinician (the physician actually engaged in patient care as opposed to research physicians and certain specialties that often involve very little actual patient contact) must enjoy dealing with people. Physicians need to be able to put people at ease and win their trust. The Hippocratic oath that all physicians take when they get their medical degrees demands that the physician put the interests of his or her patient first and that the physician be governed by what is best for the patient, even when his or her own interests must be sacrificed. And the good physician respects his or her patients, always guarding their privacy and the confidential nature of the relationship.
In comparing the esthetician with the physician, I don’t mean to equate the two. In terms of education and training, there’s simply no comparison. The physician generally spends a minimum of eight years beyond college, and frequently longer, training for his work. Physicians continue their formal education throughout their working lives and spend countless hours on their own reading journals, attending conferences, watching technical videos and generally keeping abreast of developments in medicine and in their specialties in particular. Estheticians also need to keep abreast of the field and continue esthetics education on a national basis, such as becoming NCEA Certified. The Society of Dermatology SkinCare Specialists recognized early that if an esthetician is working with a physician, one needs to be at the top of their game and that is why all SDSS members we urged to become certified.
It’s also important for estheticians considering working with physicians to understand that establishing professional limits and understanding their scope of practice as defined their state regulatory board is sometimes difficult but absolutely necessary. The trained, licensed esthetician brings to the medical practice an expertise in the knowledge of skin care that the physician may not necessarily have and this expertise can play a vital role in the physician’s practice, especially in specialties such as dermatology and plastic reconstructive surgery. At the same time, it’s important to understand that egos – yours and the physician’s – are involved in any working relationship.
I bring it up because when examining your career options as an esthetician and deciding whether you really want to work in a medical context, you need to consider whether you’re the kind of person who needs to be dominant in all situations. While the esthetician working in a medical setting is the expert in his or her sphere, that sphere is secondary to medical/physician issues, and ultimately the doctor is the boss. How much independence you achieve in a medical practice will depend on the relationship you work out with the physician(s) you work with, but in the final analysis you’ll never have the kind of ultimate authority in a medical setting you would enjoy in your own facility. As usual, the first step in making a career decision is taking a good, honest look at yourself.
