A Twenty-Year Clinical Foundation
Buchi Neita, PA-C, and Shanna Miranti, PA-C, open the conversation with their guest Robert Higham, PA-C, a dermatology PA who spent more than 20 years in clinical practice before moving into the pharmaceutical industry. Higham did his undergrad and PA training at USC and came to PA school as a self-described 'later student' after a successful career as a paramedic in emergency medicine.
Higham explains that he originally assumed he'd return to emergency medicine, but realized he left to find a quieter life — so he chose 'the complete opposite of that,' dermatology. He also credits his leadership work with the Society of Dermatology PAs (SDPA), where he rose from a board member to past president. That role, he tells the hosts, gave him 'a wealth of leadership skills,' and taught him something clinicians don't always get to practice: managing people is very different from managing patients. On a board, he notes, once a decision is made, everyone has to move in that direction — that's what makes a board work.
Why He Made the Jump
Higham describes hitting his early 50s after two decades of near full-time patient care and feeling 'a little trapped.' Increasing pressure to see more patients just to keep pace with lifestyle and pay — especially in an expensive state like California — made his plan to cut back unworkable. Having collaborated with industry through the SDPA for a decade, he started wondering what else was out there.
The hosts press him on the emotional reality of that last day in clinic. Higham is candid: it was 'really weird,' and he even peeled his nameplate off the door to take it with him. He gave patients roughly six to eight weeks of notice rather than a two-week departure, in part because his staff — including a medical assistant of 17 years — was devastated. He describes going all in with a 'cannonball,' as Miranti puts it, rather than dipping a toe. His safety net, he says, was simple: 'If it doesn't work out, I can always go back and start seeing patients. Everybody needs a DermPA.'
What Clinical Skills Actually Transfer
Higham's core message to APPs is that their biggest asset is knowing how to be a dermatology PA. Clinicians bring a science-based medical background that a PhD scientist or PharmD who doesn't see patients has — plus the ability to advocate and carry the patient's share of voice into industry conversations. He believes companies are 'waking up' to how valuable that perspective is on a diverse team.
In his view, that clinical skill set is best utilized on the medical side of the business rather than the commercial side, though he notes marketing may benefit from a provider perspective too. He points APPs toward medical affairs roles — medical science liaison (MSL) work, publications, medical inquiries — and, to some extent, clinical development.
One PA's Progression Through Industry
Higham has now been at Arcutis for over six years and walks the hosts through his path. He joined as executive director of clinical development in a two-person shop alongside Dr. David Burke, writing protocols and eventually juggling what he estimates was 17 or 18 clinical trials. That work produced four marketed products with multiple indications — a run he calls 'lightning in a bottle' and acknowledges is highly unusual in drug development.
As the pipeline had a gap and the clinical development team shrank, Higham filled a vacant MSL role for the Pacific Northwest for roughly eight to nine months, satisfying his curiosity about field medical work. He then moved into his current role as head of global advocacy, a natural fit given his SDPA background. In advocacy, he explains, he works with large organizations like the NPF, NEA, and AAD; tackles policy issues such as step therapy and access to medication; and supports Arcutis's Canadian business and partnerships in Asia. As he puts it, it's wonderful that new biologics, topicals, and orals exist — 'but if none of our patients can get it, that's a problem.'
How to Start Your Own Journey
For APPs curious about industry, Higham's number one piece of advice is blunt: 'talk to everybody, network, network, network.' He notes it's hard to jump into industry with zero prior history, so you usually get in by expanding your network and proving what you bring to the table. He encourages getting familiar with LinkedIn, connecting with colleagues at conferences like Elevate, and simply asking your local sales reps and MSLs whether they have PAs or NPs on their team — they'll be thrilled to talk. Miranti adds that identifying a disease state, company, or product you're genuinely passionate about is a strong place to begin.
Higham also warns against selling yourself out just to land a job: you want your first industry experience to be a good one, so make sure it's the right fit. For those not ready to leave patient care entirely, he offers reassurance — at Arcutis, several active clinicians still see patients, and the company encourages them to keep their skills up, including through volunteering in free clinics. Higham himself hasn't seen patients in six and a half years, but figures 'in 20 years, I saw enough patients.' He closes on optimism, calling this a 'Renaissance period in dermatology' with a very bright future.