The Interconnected Journey of a PA: From Rejection to Innovation in Primary Care

“PAs are uniquely positioned to take on leadership roles and drive meaningful change in the evolving healthcare landscape.”

November 19, 2024

By James L. Ali, PA-C, DMSc, MBA, DFAAPA

My journey to becoming a physician associate/physician assistant (PA) and choosing primary care as a career has been marked by unexpected turns and significant experiences. After graduating from New York University in 1980, I relocated to Phoenix with aspirations of entering medical school. Unfortunately, I was not accepted, an event that turned out to be a pivotal moment in my career. This initial setback was the first thread in the interconnected tapestry that led me to the PA profession.

The move to Arizona shifted my perspective from viewing my medical school rejection as a failure to considering alternative ways to contribute to healthcare. My first job was selling allergenic extracts on behalf of Hollister-Steir. This role gave me a sense of pride and a broader understanding of the healthcare industry. Over the next 12 years, I gained valuable experience working in various sectors of corporate medicine, including hospitals and home health, while earning an MBA.

Eventually, burnout from the corporate world compelled me to explore new avenues. I started a small business and began teaching science, anatomy, and physiology at a community college. My passion for education and helping others flourished as I took on leadership roles at a medical vocational school. My certifications in biological science, behavioral science, and business management further enriched my academic career.

My Path to Becoming a PA
A transformative moment occurred when the chairperson of the community college biology department approached me to develop a curriculum for students interested in PA school. Intrigued by the PA profession and its growing prominence in healthcare, I realized that becoming a PA aligned perfectly with my background and experiences. My wife, a nurse at Mayo Clinic who worked closely with PAs, supported my decision to return to school, and we navigated the financial transition through our small business.

I immersed myself in research about the PA profession, took the GRE, and applied to PA programs. At 50, I was accepted into A.T. Still University’s PA program and graduated in 2003. Despite being one of the older students, my experience in business leadership and teaching allowed me to excel. I was elected president of my class, marking the beginning of my leadership journey in the PA field.

Commitment to Primary Care
Volunteering at an underserved clinic was my first exposure to primary care, and it solidified my commitment to the field. In 2007, I opened my primary care clinic in a Hispanic community where many patients had no insurance or Medicaid. Navigating the clinic’s financial and operational challenges, particularly with Medicaid reimbursement, required creative solutions. My background in corporate medicine and connections in the healthcare community proved invaluable in overcoming these hurdles. Among the most significant challenges was finding adequate provider staff. We applied for loan repayment through the National Health Service Corps, which became an effective recruiting tool and attracted many providers who remained with the practice. Despite these efforts, we faced additional limitations, such as the restricted number of PAs a physician could supervise, misconceptions about PAs taking patients from physicians, and concerns regarding PAs education and competency levels

The financial crash of 2008 introduced new challenges but also opportunities. By working with severely mentally ill (SMI) clinic patients and collaborating with Medicaid and other health plans, we reduced hospital admissions by 79% and significantly increased our practice’s patient volume. Our success led to the transition to a Patient-Centered-Medical Home (PCMH) model, which provided additional financial support and recognition.

Leading the Future of Primary Care
Throughout my career as a PA, I faced challenges including limited awareness of the PA role, legislative barriers, and competition from specialty practices. While many PAs are drawn to specialty care for (perceived) higher income and prestige, I believe that primary care deserves greater recognition and respect. It is the vanguard of the healthcare system, providing essential services and building lasting patient relationships. The intrinsic rewards, potential financial incentives in value-based care models, and student loan repayment options make primary care a fulfilling and financially attractive career choice.

PAs are uniquely positioned to step into leadership roles and drive meaningful change in the evolving healthcare landscape. The rise of value-based care (VBC) highlights the potential for PAs to become pivotal players in the future of healthcare, whether by joining leadership teams within larger organizations or by establishing their practices under the VBC model. This transition period is an ideal opportunity for newer colleagues to forge ahead and thrive in the 21^st century health paradigm. By stepping into primary care roles, we can address significant gaps present in the field and help strengthen our nation’s healthcare system.

Value-based care emphasizes outcomes and efficiency over volume, aligning well with the strengths of PAs who are adept at patient-centered care and holistic management. By becoming experts in VBC, PAs can harness opportunities to lead initiatives that enhance patient care, reduce costs, and improve overall health system performance.

Leadership in healthcare carries inherent risks but also offers substantial rewards. I became involved in leadership within our profession to help shape the future of the PA profession – not just for myself and my colleagues, but for future generations. This could be your call to leadership as well.

As PAs, we have the power to influence our profession’s trajectory, impact healthcare policy, and drive innovations that make a tangible difference in our communities. This leadership can lead to increased income potential, entrepreneurial opportunities, and the satisfaction of profoundly impacting patient lives and the broader healthcare system.

I also urge all PAs to engage with their state organizations. Staying informed about local events and advocating for resources that benefit our practice and profession can create valuable partnerships. A successful collaboration is built on mutual benefit, so actively shaping these relationships will support your professional growth and the advancement of the PA field.

Together, we can lead healthcare transformation, ensuring that PAs remain at the forefront of delivering high-quality, patient-centered care. Let’s embrace this opportunity to lead, innovate, and make a lasting impact.

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