From Clinician to Executive: Entrepreneurship as the Doctoral PA

By Joni Collins, DMS, PAC, CAC

I did not leave clinical medicine when I became an entrepreneur. I brought it with me, and discovered,

gradually, that I had taken on another role as well: executive.

Nobody warned me that this would be a different kind of work. The clinical habits I had built

years (attention to detail, weighing a differential, making decisions when the picture is incomplete)were valuable. But they could not answer every question that began appearing on my desk as anowner.

Clinical excellence helps you care for the person in front of you. Executive leadership asks

systems, people, resources, and decisions around that person make good care possible.

That shift can feel disorienting. I knew how to assess a patient. I was learning how to build

zation that could serve patients well without depending on my personal presence at every turn.

A wider view of medicine

I have spent about 25 years in medicine, more than 20 of them in clinical practice. My work

me through neonatal intensive care, reproductive endocrinology, hospital and trauma

terventional cardiology, facial plastics and head and neck medicine, internal medicine,

aesthetics, regenerative medicine, and precision medicine.

Moving across those specialties showed me how differently care can be organized, and how

each model depends on the people and structures behind it. I began to see the patient and

tem together: not just what was happening in the exam room, but what had made that

sible or difficult.

Serving on professional boards and spending years educating other providers also shaped

time, I did not think of those commitments as preparation for executive work. Looking back,

were early apprenticeships in governance, advocacy, communication, and teaching.

learned, can begin long before anyone gives you a title.

Building an independent practice and a training organization extended that learning. The

meaningful, but it was not a smooth ascent. I was learning in real time how to steward

ey, risk, and trust, not simply how to deliver care.

The work beyond the exam room

The American Academy of Physician Associates’ 2023 competencies for PAs in healthcare

tion describe domains including leadership, interprofessional communication, the

ment, business skills, and education. I recognize those domains not as abstract headings,

of the lived work.

Hiring and developing people, for example, asks more of a leader than finding the right

role. People are not procedures to optimize. They bring judgment, hopes, obligations, and

ways of seeing a problem. I had to learn to listen well, set clear expectations, offer

back, and make room for others to grow.

Delegation was another lesson. Trusting someone with clinical or operational responsibility

mean stepping away from accountability. It means establishing the right support, clarity, and

through so that responsibility is shared without patient care or staff being left to guess.

Then there is the quiet, necessary work of systems. If a practice runs only because its owner

bers every detail, works every extra hour, and rescues every missed handoff, that is not

dependence on personal heroics. Policies, workflows, training, and governance may not feel

diate as a clinical decision, but they can shape the experience and safety of everyone who

through the door.

Image: A blank notebook on a conference table, a reminder that leadership begins with

thoughtful planning.

Financial stewardship was a humbling part of the transition. Reading a profit-and-loss

derstanding margin, forecasting expenses, and making payroll were not skills my clinical

been designed to teach me. I learned them the unglamorous way: by asking questions,

ance, and accepting that I had more to learn.

Financial health matters because it helps sustain the work and the people doing it. But

byproduct of serving well, not the mission itself. A healthy organization needs resources; it

the judgment to decide how those resources support care.

That same judgment is required in strategy. Entrepreneurship can bring a steady stream of

ties, and it is tempting to treat every opportunity as a door you should open. I have learned

ership often means choosing what not to do. A thoughtful no can protect time, attention,

tegrity of the work.

Risk and compliance belong in the executive’s daily thinking, too. They are not tasks to hand

forget. In healthcare, decisions about scope, documentation, privacy, safety, and regulation

up with trust. Leaders need to ask questions early, invite appropriate expertise, and build

that help people do the right thing consistently.

And the tone a leader sets matters. Patients may never see a staffing decision or hear a

sation, but they can feel the culture those things create. Staff feel it, too. Whether a team

concern, ask for help, or admit uncertainty is part of the environment in which care happens.

Earning my Doctor of Medical Science reshaped the questions I brought to work. I found

ing from What am I allowed to do within this system? toward What can I responsibly help

improves the system?

Doctoral education strengthened the way I think across disciplines: how I appraise evidence,

quality improvement, engage with policy and education, and examine organizational

kind of systems thinking is useful to an executive because decisions rarely stay in one lane. A

change, a new workflow, or a training decision can affect care, morale, access, and

once.

But the degree did not teach me how to run a business. It helped me think more

leadership and responsibility. The business skills came through a humbler process: mistakes,

ship, careful study, and a willingness to be teachable.

Image: A small inter-professional team listens and works through a shared challenge in a meeting room.

Lessons I had to earn

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

ecutive. The strengths overlap, but the work is different.

Early on, I overextended myself. I under-delegated. I sometimes confused being busy with

strategic. I gave away some of my most valuable work without pausing to ask whether I was

appropriately. And at times, I built on effort and determination when I should have been

system.

I do not share those lessons as a formula for success. They are reminders that growth can be

fortable and that good intentions do not replace good structure. Mentors, honest feedback,

ple willing to tell me what I could not yet see have mattered. So has the discipline of staying

dent.

There is one question I return to when a decision feels complicated: Does what I am

Ultimately serve patients and providers, and are patients safer because of it?

That question keeps ambition in proportion. It encourages me to think beyond whether an

grow and toward whether it should, what it asks of the people involved, and what its effects may be.

Leadership as a duty of care

Healthcare entrepreneurship is different from entrepreneurship in many other settings

tients can be vulnerable and clinicians hold a position of trust. Growth alone cannot tell us

we are doing the right thing.

I try to ask: Are patients safer because of what we built? Are clinicians better educated and

burned out? Are we acting within evidence and regulatory boundaries? Are we honest

known and what remains uncertain? Are we improving access, or simply creating more consumption?

The clinician’s first duty, to do no harm, does not disappear when we become executives. It expands.

We must consider not only what happens in one interaction, but what our systems make

er, safer, or less safe for many people.

Continuity matters here, too. Building something that can outlast its founder means sharing

edge, developing others, and making decisions with a future team in mind. The goal is not

yourself indispensable. It is to help create conditions in which good work can continue.

Image: A clinician walks through a quiet hospital corridor toward the daylight, suggesting

and perspective.

There is more than one way to lead

If you are a doctoral PA, or a PA student, wondering whether leadership is for you, I would

you that you need to become an entrepreneur. Our traditional healthcare systems

excellent PAs, and executive leadership happens within them every day: leading a service

ing a department, chairing a committee, precepting, or serving on a board.

Entrepreneurship is one pathway to executive leadership, not a superior one. The deeper

to notice that your clinical training already contains its seeds. You learned to think through a

tial, triage under uncertainty, communicate in high-stakes moments, and stay calm when

needs help. Those skills can serve patients directly, and they can help you lead the teams

around them.

You do not have to run away from clinical work to lead. You can build toward a wider

the setting that fits your values and your life.

My personal philosophy has long been Educate. Empower. Serve. I return to it when the

complex, because leadership is not separate from service. It is one way of practicing it.

The doctoral degree did not mark the end of my education; it expanded my responsibility to use it.

Leadership is not a title I was given. It is a trust I have to keep earning, in the clinic, in the

and in the systems I help build.