Like many physician associates (PAs) who open a private practice, Christina Davis, MSPAS, PA-C, fell into her specialty when she wanted to address a significant unmet community need. At a school-based Federally Qualified Health Clinic (FQHC), Davis found that a growing number of kids needed as much behavioral health support as well-child and sick visits.
“I started noticing a lot of children were falling behind because of behavioral issues. They weren’t getting services like OT because parents couldn’t get them to those areas, so I was diagnosing ADHD and treating those behaviors and even helping with skills like handwriting,” she says.
Davis even made time to sit in on classrooms and talk with those teachers. “That’s when teachers and I noticed a change because of what I was doing within the clinic. I was able to change medications and really get a care plan that was suitable for the child,” she says.
The experience didn’t just change how she practiced. It changed what she built next. She recently opened All Hands In, supporting neurodiverse development and is the only developmental and behavioral pediatric specialist (DBP) practicing in Pensacola, Florida.
Why Reimbursement Models Are Failing Developmental and Behavioral Pediatric Patients
Across pediatrics, demand for developmental and behavioral services is rising. But reimbursement models haven’t kept pace in the specialty that requires time, coordination and a more holistic approach.
For Davis, that gap was an opportunity. “My practice started because there was no other care like mine within the Florida Panhandle.”
Rather than trying to fit her care model into existing reimbursement constraints, Davis decided to build a model around what patients actually needed.
The result was a cash-pay practice designed to be a more sustainable way to deliver high-value care. She pairs her clinical services with educational consulting, supporting more families and building her reputation.
How to Build a Cash-Based PA Practice in an Underserved Pediatric Specialty
With a background in primary care and pediatrics, Davis pursued a DBP fellowship for advanced practice providers to gain additional experience diagnosing and treating behavioral disorders. Her goal is to address the fragmented care for children with ADHD, autism, dyslexia and other neurodevelopmental conditions.
Traditional pathways often required:
- A diagnosis before access to services
- Multiple referrals across disconnected providers
- Limited coordination between clinicians, schools and families
Davis hopes to change that pathway in the Florida Panhandle by offering a cash-based, hybrid model of care that allows more time and accessibility for patients and families. By offering her services on a cash basis, she can spend as much time with patients and families as needed. She built a practice that:
- Combines evaluation, whole-person care planning and ongoing support
- Integrates insights from parents, teachers and clinical diagnosis
- Looks beyond diagnosis to identify root causes, such as behavioral, developmental or even nutritional
How Community Education Drives Patient Growth for This Cash-Pay PA Practice
Because DBP care is rare in her area, Davis faces the challenge of raising awareness of her specialty. She started her business by offering education consulting on behavioral and developmental pediatrics. With that side hustle in place, she was able to work on setting up her clinical practice.
Davis hosted community sessions, worked directly with parents, connected with local providers and even consulted on a DBP app, the DevBeh Provider Hub.
That coaching business helped inform prospective families and referral sources about her services. Since opening in January 2026, she’s gradually gained new patients.
How to Separate Clinical and Educational Services in a Multi-Service PA Practice
Maintaining clear boundaries is critical with multiple service lines of clinical care, education, coaching and digital tools.
Davis’s model separates:
Clinical services: Diagnosis, lab interpretation, treatment and monitoring
Education services: Coaching, skill-building and behavioral guidance
Clinical insights may inform her educational support, but medical decision-making stays within the clinical setting.
4 Lessons for PAs Starting a Cash-Pay Practice Outside Traditional Insurance Models
After a few months into launching her practice, Davis’s most important advice for PAs considering a cash-based practice is, “Make your plan, but be flexible when you have to pivot.”
She also suggests the following:
- Start with a real care gap: Build around unmet patient needs in your community.
- Don’t wait for perfection: “If you’re like me and try to control everything, know that it’s not always like that when you own your own practice.” Instead, Davis recommends learning as you go.
- Align your financial model with your clinical values: If a cash-based business is better for your patients and your practice success, Davis recommends going for it. You can always change your mind and accept insurance later.
- Get help from professionals: There’s a lot to learn when starting a new PA practice. Davis recommends seeking expert help on everything from compliance to malpractice insurance.
For more information on medical malpractice built with PA practice owners in mind, click here. Learn more about IPAC, a collective by and for women PA entrepreneurs, that Davis joined to help launch her practice.
