09/01/2026
3 years as a licensed Physician Assistant in Texas! 🩺✨Even though I graduated from Yale in May 2023, it took several months to finish my credentialing exam & get officially licensed in Texas.
August 30th was the big day it became official thru the state of Texas & on September 1st, I began working with Rife Pediatrics and Family Care. I am ever so grateful to Dr. Rife, my supervising physicians, and the entire team who showed me the ropes and helped me grow into the PA I am today. I still refer to them often because they are truly excellent providers.
From 2023 to 2025, I poured my heart into earning my doctorate while steadily building my patient panel. My journey took me from practicing in Living Holistic in The Woodlands to caring for patients right out of my home in Magnolia. Navigating the steep learning curve of a new PA while wrestling with imposter syndrome wasn't easy, but finding my passion in holistic care completely transformed my confidence. That said, staying on my toes is a daily requirement… today’s patients are so plugged into the latest health trends that they occasionally know about them before I do, which keeps me constantly learning, researching, & catching up right alongside them!
Then led by prayer in October of 2025, my husband Matt (my partner in this journey), my supervising physicians, & I took a leap of faith to launch this new practice.
I quickly began seeing patients in the Magnolia Landmark building. A space that feels like a second home… I am so thankful for such a comfortable & safe place to serve our community. Right below me is an amazing ER, Houston Methodist Magnolia is there when needed. And everyone knows & loves Magnolia Pharmacy, also on the 1st floor, …. because their team is stellar not only in customer service but in likeminded education & resources. I run down there quite often to grab my own supplements or show a new patient around, it really is the perfect setup.
Reflecting on these past three years, I thought I would share 🔟 things I’ve learned along the way (even tho there are dozens of things learned 😅):
1️⃣ Know your network. I’ve learned knowing who, what, where, when, why and how to refer patients for additional support is soooo important. From ENTs to urology to imaging to labs… ♻️ My referral list is intentionally short because I refuse to send patients anywhere it doesn't meet the standards I’ve set. We still face the occasional disappointment when a referral falls short of expectations, so while I’ve learned this lesson, it’s still a work in progress. It is why I ask, you my patient, how did the specialist visit go?
2️⃣ Along the same lines, I cannot fix everyone 😭 … I wish I could! But sometimes the most responsible thing I can say is, "This is out of my scope," "I don't know," or "Someone else could do this better for you." It can be upsetting for patients to hear, & that’s hard to sit with.
3️⃣ I am not pizza, tacos, or ice cream… not everyone will like me. 🍕🌮🍦 As a people-pleaser, a giver, & a classic Enneagram 2 (say hi 👋 in the comments), I used to get sooo easily hurt, defensive, or offended if someone didn't like me, the clinic, or the environment… Thankfully, I’m getting much better at not staying in those emotions… because now as a business owner, ya just cant, ya gotta move on, change has to happen whether we want it or not. So instead, I focus on proactive solutions so our clinic stays sustainable and true to the mission: “unapologetically changing the way healthcare is done’’..
4️⃣ Buttt… "Unapologetic" still involves a whole lot of apologizing (LOL). Who knew? 🤣There’s a razor-thin line between staying humble, making waves, and championing a vision… and as it turns out, I’m just one human being, not a Transformer, so I physically cannot do all. the. things. all at once. Whether it's looking a patient in the eye and saying, "I'm so sorry I dropped the ball—I'm a one-woman show and I get sick too," explaining why I have to protect my limited clinic days, apologizing to my kids when patient needs conflict with a school event, or gently sharing that I temporarily can't take on new patients... I deeply hope my apologies are always received as sincerely as I intend them. But hear me on this: I will never apologize for pushing back against a broken healthcare system that has failed so many. I intend to be so different, and so deeply intentional, that I don't fail my patients when they need me most.
5️⃣ Butttt we still fail ….. & thankfully failure is a powerful teacher. I’ve learned so much from watching the broader system fail people: postpartum moms having their physical & emotional needs dismissed, cancer patients begging for integrative care, people needing trauma-informed primary care, & parents just wanting to feel heard, respected, and un-judged in their choices for their children. 💪What I NO longer have to witness: watching patients get stuck in a "one-size-fits-all" model that treats symptoms instead of finding the root cause; coaching families forced to choose between standard protocols that don't fit their values or going at it entirely alone; witnessing how quickly the traditional system rushes people through 7-minute visits without ever asking why their body is hurting; seeing chronic illness labeled as "normal" just because it's common, leaving people without real answers or hope; watching entire families get shuffled through insurance red tape instead of getting the personalized, compassionate care they actually deserve. Ok, that was a long one!
6️⃣ Hurt people, hurt people. I have learned that there is so much more than medical hurt, there is: church hurt, family hurt, work hurt, marriage hurt, adult kid hurt….etc. & the body keeps the score (read the book)… so unforgiveness and/or unaddressed trauma make people physically sick. I can’t help facilitate real healing unless I ask the tough questions…even when it's uncomfortable for patients, even when they only came in for diabetes. Truth be told, one of the hardest struggles, is hearing the stories that can be mentally & spiritually draining for me. That’s not a complaint it’s a call to action…. For prayer.
7️⃣ Prayer is non-negotiable for me. Praying for my patients… before, during (with patient permission) & after appointments…is essential. HE is the Great Physician; I am simply a vessel. I cannot do this on my own. It takes willing hands, as Karen on our team, reminded me this week with a new tee that has Proverbs 31:13 on it!
8️⃣ Not just willing hands, but well managed hands. I am learning that family time requires intentional planning & also needs to be put on the schedule. Because this work is heavy, I have to get better at scheduling true downtime for me with my family. I never want to leave my patients hanging, but too often my family gets what’s left of me. I'm actively working on balancing this, including seriously looking to hire trusted, like-minded help that our practice needs, and that someone needs to be someone that our patients will love. Why?…
9️⃣ Because my patients are simply the BEST. My patients are informed, self-aware, gracious, kind, & overwhelmingly generous. They’ve rallied together to feed and clothe each other, covered the cost of medications for neighbors in need, & prayed over me and one another. They walk through our doors sick, tired, & burdened, yet they still smile, respect our space, & come ready to learn & share. I have learned that I immensely blessed by the people I get to spend my days with. Many I consider dear friends; none are strangers. THANK YOU! 💕
🔟It truly takes a village … not just to raise kids, but to survive school, & run a thriving clinic without losing your sanity! My study buddies in PA school were a God-send & I couldn't have made it without them. Same now…Behind every healthy patient, every smooth clinic day, & every milestone reached is a team of incredible people holding up the structure. My clinic staff & my personal circle are the quiet backbone of this entire operation. From stepping in when I’m stretched thin, to managing the endless behind-the-scenes chaos, to loving my patients with the exact same heart & standard of care that I carry, I could never do this solo. God knew I needed a team & He gave me absolute gold. THANK YOU! 🫶
Here’s to every hand that built this, every heart that keeps it running, & to growing this village together for many years to come!
❤️Kindly,
Dr Nicole Hoff, DMS, PA-C
Physician Assistant
Ps. Speaking of #8 I still need to learn how to take a vacation... help! 🚢 Alaskan cruise pros, drop your best tips below! I did a clinical rotation in Alaska back in 2022 and I am eager for my family to see how majestic it is. I want to plan a year in advance to celebrate 4 years in practice next year. I need all the recommendations on where & how to book…
PLUS advice from you, my patients, on how to keep you completely cared for (happy) while truly unplugging for 7-10 days away… what’s your expectation when I need some time off to get refreshed + renewed?☕️
