If its really about pt safety, than our efforts should be to fight against people like this.
http://www.wired.com/wiredscience/2009/10/botox-without-prescription/ This woman is neither an MD/NP and she is able to purchase botox legally and developed a youtube video for women on how to administer themselves.
I really don't see what the big deal is about this spa. Here in NY there are tons of places that call themselves medi-spas, that have no doctor or even nurse on premises or affiliated with them at all. An MD is paid a fee to come in and give botox when requested if that spa offers it, but he/she is not overseeing what is going on there. Having some practitioner on premises I think is safer than having none at all. I would be more against calling a place a "medi"-spa with no real MD or NP in charge than at the very least having a licensed NP there.
If the fight against NP's is partially based on the belief that they are forming their own organizations to become "board certified" and confuse the public, than I think it would be hypocritical to fight them and not fight this:
http://www.bewiseaboutbeauty.org/learn/myth.html#m1
Optho, ENT and dermatology performing advanced plastics procedures. This patient info site along with others says that members of the American Academy of Cosmetic Surgery are trained specifically to perform cosmetic surgery and Plastic's board certif. MD's are trained in correcting congenital deformities and such. AACS is a perfect example of a group forming their own way of becoming "board certified". I'm sure the MDs that spent years in plastic surgery residency would disagree with the AACS.
Again, I think the fight against NP's who are looking to replace MD' is legitimate. Those few NP's are attempting to do so in primary care, not specialty areas. However, the more I look into these specialty training programs, the more I understand the purpose for which they are designed. The specialty ones are designed to further train the NP in the specialty they are want, so they will gain skills in order to work in those area in collaboration with MD's. It would be out of the scope of practice and illegal for any of these NP's trained in specialty areas to open a practice alone. PA's have been doing "residencies" for years, this is nothing new.
I copied this quote from the previous post on this thread. I see how you can be taking it the wrong way. From what I have been reading, these practices the NP's are setting up are not intended to replace MD's. "In addition to being top-notch healthcare providers, NPs deliver a unique blend of nursing and medical care. They provide comprehensive, personalized health education and counseling. NPs assist patients in making better lifestyle and health decisions"
I'll give you an example of what this means, and if you still disagree with it that's OK.
An NP with a fellowship in diabetes care opens up an independent practice. This practice may be in rented space w/in an MD office or may have a free standing office. The endocrinologists/cardiologist/internal medicine MD's refer the patients there, so even though the NP is practicing alone, he/she is still working with the MD's. The care the patient is getting from the NP is focused on lifestyle changes related to diabetes, not primary management of the patient. MD's do not have the time to spend on this type of care with the patient as it is. I don't see how this type of care given by both the NP and MD is dangerous for the patient.
Other fellowships such as critical care, emergency medicine are just extra training to help them work in these areas. We already have plenty of PA's and NP's working ER as it stands, especially in non-teaching hospitals. The relationship b/t the MD's and midlevels we have now has been working out well, and I don't see that changing.
Very slippery. 
