Provider Service: Family Medicine

Christie Joshi, PA-C

Physician Assistant Values Quality Patient Interactions

“It’s a privilege to be part of my patients’ lives.”

Long before she chose a career in healthcare, Christie Joshi witnessed the deep bond between patients and providers. When her father fell ill, her mother—a hospice nurse—became his caregiver. “I understood what it felt like to need comfort and guidance,” Christie recalls. “I saw firsthand how trust and rapport make all the difference.”

That experience led her to become a primary care physician assistant, a role she loves for its variety. “In a single day, I might see patients with respiratory infections, chronic conditions like diabetes or hypertension, or those simply coming in for preventive screenings,” she explains. “No matter the reason for their visit, I want to help them take control of their health.”

Christie joined Vanguard because of its comprehensive, team-based approach to patient care. “The model here is unique,” she says. “We have primary care providers and specialists—cardiology, gastroenterology, sports medicine—all in one place. Plus, having a pharmacist on staff to consult about medications is invaluable. It’s an environment designed for high-quality care.”

Patients describe Christie as approachable, kind, and empathetic. Known for her calming presence and clear explanations, she strives to make every patient feel at ease. “I want them to feel heard and reassured, especially if they’re nervous.”

For Christie, the most rewarding part of her work is being there for patients during difficult times. “When someone is facing a health challenge, you’re reminded of our shared humanity,” she says. “Making a difference in those moments is the greatest service I can provide.”

Outside of work, Christie enjoys walking, playing tennis, and baking gluten-free treats. An avid reader, she loves curling up with a good book alongside her rescue cats.

Rafael Alexandre, PA-C

Physician Assistant Creates Caring Connections with Patients

“When you take the time to understand all the factors in a patient’s life, you get a more complete picture of their health—enabling you to provide more effective care.”

Growing up in a family of healthcare professionals, Rafael always knew he wanted to help people. A self-professed science enthusiast, he found that a career in healthcare perfectly combined his passion and skills. He discovered the physician assistant profession during college while shadowing a PA.

“I was inspired when I first learned about physician assistants—their versatility, integral role in the healthcare system, and ability to work across specialties,” said Rafael. “Shadowing PAs opened my eyes to a dynamic and impactful career, and I knew it was the perfect fit for me.”

While at Rutgers, he volunteered at the HOPE Clinic, providing medical care for the underserved and uninsured in South Plainfield. Not only was he able to make a difference, he honed his skills as a medical professional and solidified his passion for primary care.

“I love the longevity of primary care,” said Rafael. “It allows me to build lasting relationships with my patients, understanding not just their physical health but their mental well-being too. I get to address their concerns, treat their problems, and follow their progress as they grow and navigate through life. It’s incredibly rewarding to be an integral part of their journey.”

Patients like that Rafael takes his time and is attentive to their concerns. “They say I am thorough and that I listen,” he explained. “If I can do anything, it’s to be the listening ear that they need. Plus, you’ll find that often, if you slow down and just listen, patients will share the essential information that helps you to help them.”

When he’s not working, Rafael enjoys spending time with friends, and regularly joins them for jam sessions. Singing and making music is one of his favorite ways to unwind. He also enjoys working out, playing volleyball and video games.

Melissa Ann Eppinger, MD

Family physician sees the person behind the diagnosis

“My goal is to provide compassionate care that acknowledges each patient’s unique story, empowering them through every step of their healthcare journey.”

Melissa Ann Eppinger’s path to medicine seems almost destined. With a father who is a nephrologist and a mother who works as a physician assistant, healthcare was always a central theme in her life. During high school, a volunteer job as a hospital courier, delivering flowers and plants to patients, gave her a firsthand look at the difference a kind gesture can make. However, it was a profound personal experience with a life-changing diagnosis that truly set her on the path to becoming Dr. Melissa Ann Eppinger.

“I understand what it’s like to be on the other side of the examination table,” she said, “feeling the fear and worry. My goal is to ensure my patients know that I’m here for them, seeing them as more than just their medical conditions.”

Dr. Eppinger ultimately pursued her medical education with a focus on family medicine. Her formative experiences included internships in surgery and pediatric neurosurgery, where she conducted and published research in areas such as breast oncology, hypertension, pediatric neurosurgery, and neurology.

Returning to New Jersey, where she considers home, she said “I feel a strong connection to the community that helped shape who I am today.” Dr. Eppinger chose Vanguard for its comprehensive resources and patient-centered approach.

Dr. Eppinger values the diversity of her patients, from newborns to the elderly and everyone in between. “I could be seeing a sick appointment, and then seeing a baby, and after that treating someone with a chronic medical condition,” she said. “They are so much more than their chronic medical conditions, hypertension, anxiety, depression, and diabetes, so much more than their blood pressure value, hemoglobin count or A1C value. They are also mothers and fathers, chefs and firefighters and marathon runners, and that’s how I think we should be treating our patients. We need to take a step back and truly get to know who our patients are to really be effective clinicians.”

She has a particular passion for women’s health, engaging in meaningful conversations about issues that many women are hesitant to discuss. “I aim to empower women and emphasize the importance of healthcare screenings. I also provide services like pap smears, birth control implants, and intrauterine device insertions.”

Her patients appreciate her personable and compassionate approach, noting her dedication to listening and understanding their concerns. “It’s incredibly rewarding to be a part of my patients’ lives, helping them through both the big and small challenges,” she said.

Outside of work, Dr. Eppinger enjoys traveling, staying fit through cardio kickboxing, and dancing competitively in jazz, contemporary, and ballet.

Amanda Start, FNP

Family Nurse Practitioner Shares Passion for Health and Wellness

“When you know your patient, you are able to customize care just for them.”

For as long as she can remember, Amanda Start wanted to work in healthcare. She sought to make a meaningful difference in the lives of others. Amanda ultimately decided on nursing, and began her career in a hospital setting, gaining experience in everything from cardiac care and emergency medicine to orthopedics and neurology. However, her RN degree could take her only so far.

“I saw the care that advanced practitioners were providing, and I wanted to be a part of that,” she said. “I wanted to play a larger role in my patients’ health and be able to help them a little more.” That’s when she decided to enroll in a family nurse practitioner program.

After working in the Intensive Care Unit as a charge nurse, she pursued travel nursing, filling roles in regional medical centers. Once she earned her advanced degree, Amanda joined Vanguard Medical Group. It was important to her to work in a physician-owned and operated practice that put patients first. She is thrilled to be able to put her experience to work in the Teleheath division.

“After years of working in critical care units, I have developed a strong understanding of chronic illness and the disease process,” she said. “With Telehealth, I’ll be more focused on acute care, but I’ll also share strategies for preventive measures. After all, I’m passionate about health and wellness.”

Patients say that they like Amanda’s empathy and appreciate the care that she takes in discussing their health. She is equally as comfortable with patients in an online setting as in the office. She works hard to make patients feel comfortable so that they can talk to her openly.

“For patients to feel their best, their care must be tailored to them,” explained Amanda. “We want them to comfortably be able to take the steps needed to improve their health.”

When she’s not working, Amanda is a self-professed fan of summer. She enjoys going to the beach and paddleboarding, among other warm weather activities.

Pamela Macirowski, FNP

Family Nurse Practitioner Values Patient Relationships

“You get to know your patients and grow with them. That’s how you provide personalized care.”

Inspired by the compassionate care her grandfather received from a hospice team, Pam Macirowski found her calling in medicine. She honed her skills as an EMT and phlebotomist before landing a position as a medical assistant in a bustling primary care office. It was there that she crossed paths with several nurse practitioners, igniting her determination to further her education and ultimately become one herself.

She joined Vanguard Medical Group because it aligned with her own beliefs of patient-focused primary care. “It felt like that close knit family practice where providers are able to form longstanding relationships with patients,” she said. “I like those connections. You get to see the happy moments in their lives as well as the sad moments. You get to be there to support them through all of it.”

Patients like that Pam takes the time to listen to them and their concerns. She partners with them on their health, and they make decisions together. “I love being able to make a positive difference in their lives. It’s incredibly rewarding.”

When she’s not working, Pam loves to travel. The beach is her favorite place in the world. She also enjoys spending time with her husband and kids.

Debra Palmer, PA-C

Physician Assistant enjoys making connections with patients

“The more you know about your patients, the better you can guide them toward good health.”

Debra Palmer first discovered her passion for medicine in the U.S. Air Force. Her role, as a medical technician, was the inspiration for her future career. She put herself through school, earning an undergraduate degree in physics, then worked as a teacher while raising a family. When her youngest graduated high school, she enrolled in the Yale School of Medicine’s Physician Assistant Online Program. “It was time to pursue my dream,” she said.

She chose primary care because of the opportunity to build a rapport and relationship with her patients. “I love the idea that the Farmingdale office has been here for a very long time,” she said. “It has that family and community feel that was important to me. I wanted to work in a warm, welcoming place.”

Patients appreciate that she takes the time to get to know them and listen to their concerns. “I want my patients to feel comfortable, so that they can tell me anything,” she said. “Building relationships is part of building that trust.” She also is known for her thorough explanations. “I am proud of my teaching background, and I think it helps me understand people and how they learn. I think that makes me a better provider.”

She’s also noticed that her varied background helps her connect with so many people. “I’m a military veteran, a teacher, a cancer survivor, and a mom,” she said. “I have aging parents. I understand what my patients might be experiencing, and that along with my medical training, helps me to guide them.”

When she’s not working, Debra enjoys DIY construction and woodworking. She and her husband have renovated several houses including their current home.

Alyssa Townsend, PA-C

Physician Assistant Provides Positive Patient Experience

“As family medicine providers, we are the gatekeepers of our patients’ health.”

From a young age, Alyssa Townsend was drawn to a career in healthcare. Inspired by her mother’s dedication as a radiation therapist, she too wanted to make a difference. In high school, she had the opportunity to shadow her primary care provider, who happened to be a physician assistant at Vanguard Medical Group. “It was during this experience that I truly fell in love with the PA profession,” Alyssa recalled.

She worked as an EMT to get patient care experience before beginning her studies. In her PA program, she completed an additional rotation in women’s health. She also enjoyed the fast pace of working in emergency medicine and urgent care. “When I was looking for family medicine jobs, I saw that Vanguard had an opening,” she said. “I was excited to join the practice that had inspired my career.”

Patients say that they appreciate that Alyssa takes the time to really listen to them. “I want to hear their story,” she said. “I want to know their concerns. Then, we can determine the next steps together.” In her role as a family medicine provider, she perceives herself as the custodian of her patients’ well-being, steering them through essential preventive measures like screenings and vaccinations, while also addressing urgent matters and seamlessly coordinating referrals to specialists when necessary.

She wants her patients to have a positive experience so that they are more likely to return when they need care. “I don’t want them to be hesitant to go to the doctor’s,” she said. “I want them to be inspired to keep up with their health. That’s my biggest motivation.”

When she’s not working, Alyssa loves to read and spend time with friends and family. She also enjoys hiking at the many picturesque parks in New Jersey.

Daniel Khan, MD

Physician Meets Patients Where They Are

“I want to make sure my patients feel heard and empowered.”

A stay in the hospital during his teen years inspired Daniel Khan to become a doctor. He was still in high school, but he knew he wanted to help others the way the physicians had helped him. He became an EMT, shadowed doctors, and went on to complete years of rigorous training. Now as a family physician, Dr. Daniel Khan is doing what he was meant to do.

“I really love being a doctor,” he said. “I love being able to use the knowledge that I’ve accumulated over 13 years of training to help my patients.”

He chose a family medicine focus because it encompassed everything in primary care. “It was what I originally envisioned when I wanted to be a doctor, treating patients of all ages,” he said. “During our clinical studies, no other rotation could even compare with family medicine.”

Dr. Khan joined Vanguard because of its patient-first focus. He chose the Jersey City location because of its diversity. “I come from a diverse background myself,” he said. “I appreciate racial diversity, multilingual diversity, sexual orientations, and other differences. I want to meet patients where they are on their health journeys and help them feel their best.”

Patients like that Dr. Khan takes the time to talk with them. “I explain things and then I listen. I want to make sure that they feel heard and empowered in their healthcare. That’s what I want as a patient myself. I want my doctor to hear my concerns and address them.”

When he’s not working, Dr. Khan enjoys playing soccer and cheering for his favorite teams, the New York Red Bulls and England’s Liverpool. He and his wife have a newborn son.

Urvi Patel, PA-C

Physician assistant helps patients take control of their health

“I think of primary care as the headquarters for a patient’s health.”

When Urvi Patel was in high school, her grandfather had a heart attack. That’s when she realized that no one in her family was equipped to deal with a medical emergency.  “I had this opportunity as a first-generation college student to pursue whatever career I wanted, and that’s when I decided on medicine,” she said.

Urvi ultimately chose a career as a physician assistant, and during her schooling, she gravitated toward pediatrics, women’s health, and family medicine. Vanguard Medical Group was a natural fit because the primary care practice incorporates all three, and more. “Vanguard’s team-based care approach creates a supportive environment where everyone is helping each other,” she said. “That not only helps me as a provider, but in turn it benefits our patients.”

She takes the time to really listen to her patients and address their concerns. “It’s so important to listen with an unbiased, nonjudgmental ear,” she said. “That way, you can get to know your patients and get a full picture of their health. The better that you understand the whole person, the better you will be able to provide recommendations for treatment or preventive care.”

Urvi feels the impact that she makes every single day. “I like being able to go home, knowing that I made a difference in someone’s life. That is very fulfilling for me. Helping people is what drew me to medicine in the first place.”

When she’s not working, Urvi loves to read, bake, and spend time with family. “I have a huge family,” she said, “and we see each other lot.”

Ruth Dominguez Enriquez, PA-C

Physician assistant treats patients like family

“Communication is so important. There should never be a language barrier in medical care.”

Ruth Dominguez Enriquez vividly remembers the confusion in her mother’s eyes as the pediatrician tried to consult with her. As a native Spanish-speaker, her mother struggled due to the language barrier. That was the moment that young Ruth decided on a career in healthcare. As a dual-language speaker, she knew she could help.

“Medicine is complicated enough,” said Ruth. “Speaking the same language is necessary so that patients fully understand their health needs. It also is comforting to hear the explanation in your native language. It’s much easier to ask questions and patients are more likely to follow guidance.”

She considered various careers in medicine, and ultimately selected the Physician Assistant. Before she even started her graduate studies, she found Vanguard Medical Group. “I worked as a medical scribe, and I loved this practice so much that I knew I would find my way back here if I could.”

Ruth initially began her PA career in urgent care, waiting for an opening at Vanguard. Now that she’s here, she enjoys the depth and breadth that primary care brings. “With urgent care, you get a snapshot of one moment in time, but with primary care, you get the complete picture,” she explained. “It’s a continuous relationship with the patient that includes preventive care and wellness, but also understanding the various stresses and challenges in a patient’s life that could affect their health. Getting to know them helps me with the best way to give them the care that they need and deserve.”

“I think that patients really appreciate my kindness,” said Ruth, “and that I’m a great listener. I try to provide them comfort when they need it the most, and speaking their language is just the start. I treat my patients that way that I would want my loved ones to be treated.”

When she’s not working, Ruth enjoys indoor cycling, cooking, and baking.