While the majority of physician associates (PAs) initially plan to work in primary care or urgent care settings, many advanced practice providers today are stepping into niche areas of care as entrepreneurs.
Whether it’s IV hydration, ketamine therapy or highly specific women’s health, the demand for niche healthcare is growing.
“Providers are burning out of traditional roles in primary care and urgent care, so they’re trying to redefine their identity slightly as a PA,” says Phoebe Gutierrez, a consultant at Single Aim.
The niche care areas driving growth
In her work supporting a clinician marketplace where PAs and NPs can access consulting services and operational support, Gutierrez sees several popular niche care areas. “It’s not just one area of wellness because the businesses are very specific depending on local needs,” says Gutierrez.
The following are some common niche health businesses among PAs:
- Longevity and wellness clinics: IV hydration and broader wellness-focused services are growing businesses in most states, especially in metropolitan areas.
- Hormone specialties: Many PAs are building businesses in the hormone space, offering targeted care for menopause, erectile dysfunction and hair loss.
- Ketamine clinics: Ketamine therapy is increasingly common. According to a 2023 PubMed editorial, there’s been “a significant recent trend toward offering ketamine therapies for a multitude of medical and mental health diagnoses.”
These services fill critical care gaps, especially as health systems retreat from certain service lines in rural areas, leaving communities underserved. “I have one PA partnering with NPs in Tennessee and Alabama to treat opioid use disorder because there was no provider within 200 miles,” says Gutierrez.
PAs have a competitive advantage over online brands
PAs entering niche markets can even compete with large health tech brands like Hims & Hers or Midi by offering hyper-local, personalized care.
One PA Gutierrez supports now works in a rural area where he’s the only provider. “That kind of community engagement is where PAs can shine,” says Gutierrez.
Opportunities abound for PAs willing to serve rural areas. “Big companies don’t want to tackle rural markets because they’re harder to operationalize. But for smaller clinics, it’s manageable, and you can quickly capture market share,” says Gutierrez.
High-touch care can also set smaller clinics apart. “A lot of PAs are experimenting with concierge models, bundling services together to make it more advantageous for patients. The personalized nature of their care is a huge selling point over big-box virtual providers,” says Gutierrez.
Learning the business of medicine is critical to success
Clinical expertise alone isn’t enough to build a successful niche healthcare business. Underestimating the business requirements or overlooking key compliance factors are key reasons Gutierrez sees businesses fail early.
“People jump in thinking they just need a collaborative practice agreement to set up a business. They forget about the marketing and compliance side,” she says.
Compliance
It’s not unusual for Gutierrez to see PAs come to Single Aim last when they’re ready to launch a business. They’re seeking a collaborating physician, and she has to tell them their state doesn’t even allow PAs to practice that way or has some really strict rules that would almost make it impossible to operate solo.
Marketing
Marketing mistakes are another common pitfall. Some spend too much on outsourcing it all, while others ignore marketing altogether. “You’ve got to have a website, a Google Business profile and a Healthgrades account. Every company needs marketing because being local isn’t enough, you really have to establish your brand.”
Tackle legal & compliance first
Understanding your state’s legal landscape is a non-negotiable first step to starting a niche health business. “If you’re in South Carolina, for example, it’s nearly impossible for a PA to work independently because of the tough supervision laws that require you to practice together with your physician for at least six months,” says Gutierrez.
Always research your state’s specific regulations, DEA requirements and scope of practice rules before moving forward.
Choosing your niche
Picking the right niche is about more than market size and needs. It’s also about aligning your passions with your community’s needs. Gutierrez recommends the following steps to pick the right niche care business for you:
- Pick a service that resonates. For example, if you’re passionate about women’s health because you’ve experienced menopause yourself, that’s a natural fit.
- Determine if it’s financially viable. Viability will depend on whether you’re cash-pay or insurance-reimbursable.
- Talk to people. Ask friends, family and community members about what healthcare services they feel are missing.
Common mistakes to avoid
Gutierrez sees a lot of PAs make the mistake of thinking that starting a niche health business will be simple. “You have to leave yourself enough time to effectively pick the right EHR, implement your systems and establish the right framework to document and store everything,” she says.
The following are the most common mistakes Gutierrez says to avoid:
- Skipping compliance research: “Do your homework upfront. I’ve seen people build a clinic and realize later that their business isn’t even legal in their state.”
- Rushing the launch: “Be realistic about timelines. It can take six months to get fully up and running.”
- Ignoring marketing: “Some overspend; others neglect it entirely. You need a balanced approach to digital presence and community outreach.”
Breaking into a niche healthcare requires more than clinical skill. It means mastering the business side of healthcare. “It’s complex, but if PAs have a strong plan, the right support system and the willingness to learn from others, they can absolutely succeed,” says Gutierrez.
For PAs looking to redefine their careers and fill critical care gaps, niche clinics offer both meaningful work and sustainable business models. “If there’s something you’re super passionate about and in an area where you’re experienced, plus there’s nothing that precludes you in your state regulation, go for it,” says Gutierrez.
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