More Med Spas Than McDonald's? 2027 Forecasts say Yes.

Driving down the street in most major US cities, you might have noticed a new fixture popping up in the local strip malls. More and more med spas are opening. According to AmSpa's 2024 industry report, 1,589 medical spas opened in 2023, taking the national total from 8,899 to 10,488. This marked a 17.86% increase, nearly double the 2018 total of 5,431. To put this in perspective, a new med spa opened every 5.5 hours in 2023.

Each of those new medical spas needs licensed clinicians to perform the treatments, typically nurse practitioners and physician assistants, along with registered nurses. However, that workforce is growing much more slowly. According to federal employment estimates, NP and PA employment only grew 6.70% in 2023 in all of healthcare, not just aesthetics.

Skin Clique Academy, an injectable training program for licensed clinicians, wanted to know how the industry's growth compared with the workforce needed to staff it. They pulled together national med spa counts, federal employment data and Certified Aesthetic Nurse Specialists (CANS) certification records to find out.

According to PSNCB's 2024 exam data, 60 nurses passed the CANS exam for the first time in 2023. That's 60 newly certified nurses in a year that added 1,589 med spa clinics.

While there are no sources showing how much of the NP and PA workforce actually works in med spas, these three sources show a stark contrast between the number of med spas opening and the growth of the industry that staffs them.

Why are so many new med spas opening?

Injectables are driving much of the industry's growth. As of 2021, 94% of med spas offered facial injections.

The aesthetics industry isn't just growing in the number of new locations. Revenue, patient volume and the services offered are up. The average med spa had 283 aesthetic patient visits a month in 2022. Average revenue per location reached $1.4 million in 2023, and the same AmSpa report puts the broader medical aesthetics industry's annual revenue at $17 billion.

US med spas are nearing the number of McDonald's locations

A 2026 safety editorial estimates that the United States could have approximately 13,000 med spas by the end of the year. At this pace, the U.S. could soon have nearly as many med spas as McDonald's restaurants.

At a state level, the editorial also reports that the state of Florida already has 2.5 times as many med spas as McDonald's restaurants, highlighting just how far medical aesthetics has moved into the commercial mainstream.

Clinics vs. clinicians

Workforce data was pulled from the Bureau of Labor Statistics Occupational Employment and Wage Statistics program, which estimates wage and salary employment across industries each May.

	2022	2023	Growth
U.S. med spas	8,899	10,488	+17.86%
Nurse practitioners employed	258,230	280,140	+8.48%
Physician assistants employed	140,910	145,740	+3.43%
NPs and PAs combined	399,140	425,880	+6.70%

Note: These numbers count every NP and PA, whether they work in a hospital, a doctor's office, urgent care or a med spa. There's no way to tell how many of them work in aesthetics. Self-employed workers, such as clinicians who own their practices or work as independent contractors, are also not included in the BLS estimates. Also, the med spa counts are from survey data combined with modeling.

More med spas now compete for the healthcare workforce

This difference in growth rate affects the ratio between med spa locations and clinicians. In 2022, the US had 22.3 med spas for every 1,000 clinicians. By 2023, Skin Clique Academy's analysis puts that number at 24.6 med spas for every 1,000 clinicians.

This can be seen at the local level too. A med spa recruiting an NP or PA is hiring from the same pool of regional clinicians as hospitals, physician offices, urgent care centers, dermatology practices and other med spas.

The credential few nurses get

The Certified Aesthetic Nurse Specialist credential, known as CANS, is a certification for registered nurses working in aesthetic medicine. From 2019 through 2023, only 260 nurses passed the CANS exam for the first time, while over 5,000 med spas were added in the U.S. While there is no published data showing the number of med spa injectors, there is a live public tally showing 504 active CANS credential holders across the United States, U.S. territories and Canada.

Year	U.S. med spas	First-time CANS passes
2018	5,431	No exam data published
2019	No count published	70
2020	No count published	0, no exams given
2021	7,430	52
2022	8,899	78
2023	10,488	60

You might assume passing the exam is the bottleneck, but pass rates were 90% in 2022 and 95% in 2023.

The larger issue is that fewer people are taking the exam. The number of exams that have been administered fell 28% from 2022 to 2023. Only 65 exams in total were given in 2023.

According to PSNCB's CANS requirements, two years of experience as a registered nurse in the core specialties is needed to take the exam. Nurses also need at least 1,000 practice hours in those specialties during the previous two years. That means that a new nurse entering aesthetic medicine during the 2023 surge in growth is not even eligible for the exam until 2025, at the earliest.

More importantly, the CANS certification itself is voluntary. Based on their professional licenses and the applicable state rules, physicians, NPs, PAs, and RNs can provide injectable treatments without it.

Med spa locations can grow faster than the workforce behind them

From 2025 to 2035, NP employment is projected to grow 41% and PA employment 21.1%, adding a combined 173,500 new jobs. However, most of this growth is driven by the need for more healthcare professionals in the United States in general, not medical aesthetics.

A med spa clinic can be up and running within a few months. But it takes years to grow the number of new licensed practitioners.