I worked and basically ran Physician Skin Care for about 3 years. I learned alot about general dermatology while there including treating atypical moles, skin cancer, acne, warts, as well as cosmetic procedures such as Botox, cosmetic fillers, chemical peels, microderm abrasions, and scar revisions. I went to a conference in Kansas City where I was trained on allergy skin testing and treatment. More importantly, I learned how to run a clinic. I learned how to take care of patients, but I also learned how to make money from patients and milk them and their insurance for everything they are worth. I appreciated the good things I learned about medicine, but I did not like making the business side more important than patient care. As I became more frustrated with the pressure I felt to make the business more profitable, I was actually looking at options to start non-medical businesses that I could run efficiently on the side and still take care of patients at my current employment at that time. Then an interesting, fateful thing occurred. My uncle Terry Bagley calls me and wants to meet for lunch. While eating at BurgerKing in Idaho Falls, he tells me he is building a professional building in Rexburg and he wants to know if the doctor I was working for wanted to open a satellite clinic in Rexburg. I felt like this was an answer to my prayers, I told him I wanted to open a clinic in Rexburg. Keep in mind, in addition to my desire to do something else, Rexburg was exploding in population and opportunity because to the change from Ricks College to 4 year BYU-Idaho. This was when I started to look into the laws in Idaho regarding Physician Assistant ownership, and talking to the few PAs that were already doing it. The State Board of Medicine told me as long as I had a supervising physician and followed all the rules of the Delegation of Services Agreement, than it did not matter who the clinic was owned by. I would have to go to battle with the Board of Medicine in a couple years as some physicians started complained that Physician Assistants were supposed to’ assist the physician’ and not to try to do things in a different and better way while chasing the American Dream. I felt prepared that I could open my practice, follow all the rules, and yet offer a service that took care of the medical, especially the dermatology needs of patients, at reasonable rates and without having to wait for months to see a dermatologist. I wrote letters to and met with some of the dermatologists in the area explaining my intentions and how I would help make dermatologic treatment more accessible and yet refer those patients that needed more specialized treatment. This went positively with some of them and negatively with others. Doing things differently and outside of the established box is always met with resistance. I will continue the story in the next blog.