Entrepreneurship as the Doctoral PA: Educate. Empower. Serve.

Dr Joni Collins DMS PAC CAC

Twelve Twenty Eight Precision Aesthetic and Regenerative Medicine

For approximately 25 years, medicine has been the classroom in which I have learned, served, questioned, and grown. More than 20 of those years have been spent in clinical practice, caring for patients across very different specialties and settings.

I did not begin that journey with a master plan to become an entrepreneur.

I certainly did not begin with a plan to build a business, develop educational programs, or

create new models of care. Those things evolved gradually, through experiences with

patients, conversations with colleagues, moments of frustration, and a growing awareness of

the gaps that exist within healthcare.

Over time, I kept returning to one question:

How can I use everything I have learned to educate, empower, and serve?

Those three words have become more than a professional philosophy. They have become a

way of discerning what belongs in my next chapter.

A Career Built Across Clinical Silos

My clinical path has taken me through neonatal intensive care, reproductive endocrinology,

hospital and trauma medicine, interventional cardiology, facial plastics and head and neck

medicine, internal medicine, psychology, aesthetics, regenerative medicine, and precision

medicine.

Each area taught me something different. More importantly, each one shaped how I see the

patient.

A newborn in intensive care cannot be separated from the family surrounding that child. A

patient experiencing trauma is not only a collection of injuries. A person seeking aesthetic

care may also be navigating hormonal changes, metabolic concerns, inflammation, grief,

stress, or a changing relationship with their own identity.

Working across specialties made it increasingly difficult for me to see patients as isolated

body systems. A patient is not a diagnosis, a procedure, an injection, a laboratory value, or a

single visible concern. Those may be components of the clinical picture, but they are not the

whole person.

Aesthetic medicine helped crystallize this belief for me. I began to understand that aesthetics could be approached as much more than performing a procedure. The way a person ages, heals, and responds to treatment may be influenced by vascular health, hormonal health, Twelve Twenty Eight | 1228wellness.com metabolic health, genetics, inflammation, lifestyle, emotional well-being, tissue quality, and

regenerative capacity.

That does not mean every aesthetic concern requires an extensive medical workup, nor does

it mean emerging therapies should be presented as proven solutions for every condition. It

does mean we have a responsibility to ask better questions before we recommend treatment.

This thinking eventually contributed to my philosophy of Precision Aesthetic and

Regenerative Medicine: a personalized, consult-first approach that attempts to understand

the patient before treating the visible concern.

At Twelve Twenty Eight, I have been fortunate to continue exploring that approach while

collaborating with our Medical Director, Dr. Ray Bennett. Our work is grounded in the

understanding that responsible care begins with listening, clinical evaluation, appropriate

evidence, and the humility to recognize when a treatment is not indicated.

What the Doctoral Degree Changed

Earning my Doctor of Medical Science was not simply a matter of adding another credential

after my name. It changed the questions I was willing to ask.

Clinical training teaches us how to evaluate and care for individual patients. Doctoral

education challenged me to think more broadly about leadership, evidence, systems of care,

research, education, innovation, and the responsibility clinicians have to improve healthcare,

not merely function within it.

For a long time, many of us learn to ask:

What am I allowed to do within this system?

That is an important question. Scope of practice, competency, collaboration, regulation, and

patient safety matter deeply. But doctoral education encouraged me to ask a second

question:

What can I responsibly help build that improves the system?

That shift is not about rejecting employment or assuming that traditional healthcare is

inherently wrong. Hospitals, clinics, academic institutions, and corporate practices need

excellent Physician Associates. They need clinicians who can care for patients, lead teams,

teach, advocate, conduct research, and improve quality.

The doctoral PA can contribute in all of those spaces.

Advanced education should bring increased responsibility, not simply increased recognition.

A doctoral degree should deepen our commitment to evidence, ethical leadership, lifelong

learning, and service. It should make us more thoughtful about the consequences of our

decisions and more willing to participate in the difficult work of improving care.

Entrepreneurship Was Not the Original Destination

My entrepreneurial journey began with problems, not a business plan.

I saw clinicians who wanted to practice differently but did not know where to begin. I saw

patients who needed more time, more context, and more individualized attention. I saw

promising ideas introduced without adequate education, systems, or safeguards.

Eventually, I realized that some of the solutions I was searching for would not come from

waiting for an existing system to change. They might require building something new.

That realization was both exciting and frightening.

Leaving familiar structures, or even stepping partially outside them, comes with uncertainty.

There is financial risk. There is responsibility for employees, patients, providers, operations,

compliance, and decisions that cannot always be reversed. There is self-doubt. There are

nights when the numbers do not make sense and mornings when the next step feels unclear.

Medical training prepared me to assess patients and make clinical decisions. It did not teach

me everything I needed to know about accounting, operations, contracts, marketing, human

resources, technology, or business strategy. I had to learn those things while continuing to

protect the clinical purpose behind the work.

I also had to accept that being an excellent clinician does not automatically make someone

an excellent entrepreneur.

I have made mistakes. I have moved too quickly at times and too cautiously at others. I have

trusted the wrong assumptions, underestimated the complexity of certain decisions, and

learned that good intentions are not a substitute for good systems.

Entrepreneurship is not a perfect success story. It is an ongoing process of learning, adapting, failing forward, seeking mentorship, remaining teachable, and returning again and again to one question:

Does what I am building ultimately serve patients and providers?

If the answer becomes no, then growth is not success.

Educating Clinicians Before Building Businesses

Over the years, I have taught and trained more than 1,200 medical providers. Through that

work, I began to recognize a recurring pattern.

Many of the PAs and clinicians I met were highly capable. They had excellent clinical instincts

and substantial experience. Yet they also felt exhausted, constrained, undervalued, or

uncertain about how to create something of their own.

Some wanted greater autonomy. Some wanted more time with patients. Some wanted to

leave hospital-based medicine. Others wanted to enter aesthetics or regenerative medicine

but did not know how to do so safely and ethically.

I also met clinicians who had already purchased devices, products, or courses but still lacked

the clinical reasoning, consultation skills, systems, mentorship, and confidence needed to

integrate those tools responsibly.

That experience gave me a deeper calling:

Help clinicians build the knowledge before they build the business.

Healthcare entrepreneurship must begin with education. Before we discuss revenue,

expansion, or branding, we should discuss competency, patient safety, ethics, evidence-

informed decision-making, scope of practice, collaboration, documentation, and regulatory

boundaries.

Opening a practice should never be only about escaping the hospital or generating income.

It should be about creating a better way to serve.

Moving Beyond Procedure-Centered Care

Precision Aesthetic and Regenerative Medicine is one example of how clinicians can

challenge conventional silos.

Instead of beginning with, “What procedure do you want?”

we can begin with:

What is happening with this patient, what are their goals, and what

factors may be influencing how they are aging, healing, and functioning?

That question can lead to a more complete conversation about skin health, structural aging,

vascular and metabolic health, hormonal considerations, genetics, lifestyle, sleep, stress,

tissue quality, and overall wellness.

These areas intersect, but they are not interchangeable. Aesthetic procedures have specific

indications, risks, limitations, and evidence bases. Some regenerative therapies are

supported for particular clinical uses, while others remain emerging or investigational.

Precision medicine optimization can help us organize information and personalize care, but it should never be used to overstate what science has proven.

Responsible clinicians must be willing to communicate uncertainty. We must know when to treat, when to wait, when to refer, and when to say no.

Building a Training Pathway Around Clinical Reasoning

This is why I ultimately felt called to develop a structured training pathway for PAs and other

qualified clinicians interested in this evolving field.

The goal was never simply to teach someone how to perform a procedure. A procedure is a

technical skill. Responsible care requires much more.

Clinicians need to understand:

• How to conduct a comprehensive consultation.

• How to think about the whole patient rather than an isolated treatment.

• How to recognize when not to treat.

• How to develop appropriate, individualized plans.

• How anatomy, physiology, aging, vascular health, and tissue biology intersect.

• How to evaluate emerging technologies and therapies critically.

• How to practice within appropriate scope-of-practice and regulatory requirements.

• How to build ethical clinical systems.

• How to communicate uncertainty and obtain meaningful informed consent.

• How to create financial sustainability without allowing revenue to supersede patient care.

• How to know when to refer, collaborate, or say no.

  
  

The business model matters, but it should follow the clinical model: not replace it.

For Physician Associates considering entrepreneurship, legal structure, liability coverage,

payer requirements, state regulations, and physician collaboration must be addressed

thoughtfully. Scope of practice is shaped by education, experience, state law, practice-level

policies, and the needs of the patients being served. These details are not administrative

obstacles to work around; they are part of building a safe practice.

A Message to the PA Who Feels Stuck

If you are reading this from a hospital, clinic, or corporate healthcare environment and

wondering, Is this really what the rest of my career has to look like?: I want you to know that

the question itself may be meaningful.

But I do not believe every PA should leave traditional medicine. Our healthcare systems

desperately need excellent Physician Associates. Entrepreneurship is not the right pathway

for everyone, and remaining employed can be a deeply fulfilling and important form of

service.

Your PA education can grow into many different careers. You can remain in clinical practice.

You can teach, conduct research, lead, consult, advocate, mentor, or help design better

systems within an existing organization.

And, with appropriate preparation, legal structure, clinical competency, collaboration, and

humility, you may also become an entrepreneur.

Just do not run away from something. Build toward something.

Let purpose: not frustration alone: guide your next step.

The Responsibility of the Doctoral PA Entrepreneur

Healthcare entrepreneurship is different from many other forms of entrepreneurship because

patients are vulnerable, and clinicians hold an inherent position of trust.

Growth cannot be our only metric of success.

We must ask:

• Are patients safer because of what we created?

• Are clinicians better educated?

• Are we practicing within appropriate evidence and regulatory boundaries?

• Are we honest about what is known and what remains uncertain?

• Are we improving access, or simply creating more consumption?

• Are we building something sustainable enough to continue serving people well?

  
  

These questions are not meant to diminish ambition. They are meant to anchor it.

After decades in medicine, I am increasingly aware that my purpose is not simply to count

how many patients I can personally treat. My next chapter is also about multiplying impact:

educating clinicians, empowering PAs to recognize the possibilities available to them, and

helping create models of care that place thoughtful clinical evaluation back at the center.

Educate. Empower. Serve.

That is the work.

The doctoral degree did not mark the end of my education. For me, it expanded my

responsibility to use that education: to question, to build, to teach, and above all, to serve.

References

• American Academy of Physician Associates: Innovating Healthcare and the Quintuple Aim

• American Academy of Physician Associates: PA Practice Modernization and Scope of

Practice Resources

• Review of Post-Professional Doctoral Education for the Physician Associate

• Twelve Twenty Eight Precision Aesthetic and Regenerative Medicine