Tuesday, January 11, 2011

Private Practice

There is an interesting trend that I'm observing and don't necessarily see how this is going to turn out. I'm seeing more and more nurse practitioner's opening their own autonomous practices. Many of these offices set out to offer care that is personalized, covered under insurance, and of course high-quality. I'm also seeing more NP specialty/sub-specialty practices such as house calls, incontinence, and women's health.

This is in a time when more physician practices are joining together in these conglomerations that aren't necessarily tied to hospitals. You'd be hard pressed to find a solo primary care physician these days yet nurse practitioner solo practices are popping up. The talk about the formation of accountable care organizations can be attributed to health care reform and the spurring of large multi-physician practices.

What to make of this? I honestly don't know. Many people and patients have said to me "you should start your own practice." Right now, that is not something that sounds very appealing to me. In my mind, I know how I would envision my own practice, patient flow, focus, etc. However, I hear the insurance company barriers, the paperwork hassles, the initial start-up costs, finding a new collaborating physician and see solo physician colleagues joining large practices and think that is not what I want to do right now.

What are your thoughts? Will you be starting your own practice? If you are a patient, would you go to an NP practice? For those NPs interested in starting your own NP practice, I highly encourage you to check out fellow blogger and NP practice owner, Barbara Phillips' website at http://www.nursepractitionerbusinessowner.com/. She offers tips and networking opportunities to give you the best chances for success.


NP Odyssey said...

I see two main factors to this movement.
First Md's are not going into primary care when they can specialize and double their money, thus creating a shortage of small primary clinics. Second is the big business of health care, and everybody has opinions on that.

A private practice is intriguing to me and maybe in conjunction with some other practitioners, and they don't have to be NP's.

I remember an article about Belgium or Holland and how they still have the family doctors on just about every block. Sometimes their business and homes were in the same big old house or building.
Maybe it was too idealistic that your patients were also your neighbors, but it sounded appealing and what I remember as a kid.
They also said these practices were good filters for the Emergency departments and hospitals.
Here at 8pm a child with an earache is taken to the ED, but there your primary care neighbor can get you a script for ear drops and not tie up the hospital staff.

Is this the past or future of American medicine?

Candi said...

Ultimately my plan is to go solo. Not all the way solo, probably with another NP to split the overhead costs, but my main goal from the very beginning has been NP & then solo/joint practice, it's the reason I want to be a NP, to have my own clinic.

Mrs. Hall said...

not sure how it works in your neck of the woods, over here, um, by where Fargo was made, NPs need to collaborate with MDs.

we can prescribe independently, but no practicing as such. Also, that being said, going solo, hmm.

I like the benefits of pension, health insurance and boko vacation time.

huh. well. there ya ago.

BarbaraC. Phillips, NP said...

Thanks for the mention Stephen.

I am hearing from more and more NPs going into to business for themselves. One reasons I hear is that NPs want to practice as NPs - in their own way, where they focus on the whole of the patient.

For those that are interested, they will get access to lots of info at our blog or by following our facebook page. (NPBO is a private page, but all are free to sign up for our ezine).

Barbara C. Phillips, NP
Blog: www.NPBusiness.ORG
FB: www.Facebook.com/NursePractitionerBusiness

Van V Family said...

I have had my own practice for 8 years in Washington State. Wouldn't go back for anything. It has been a challenge at times, lots of questioning if I was on the right track, making very little money in the beginning, the ongoing task of learning about business operations. It is working out very nicely. Not making scads of money but I tend to be more of a socialist when it comes to medical practice.

I have recently taken on a new grad to be part of my practice. She is scared to death but fun to teach her the ropes and reassure her that she is doing the right thing.

In Washington State 30% of primary care is being done by NPs. Do you have independent practice in NY State? Makes all the difference.

Stephen Ferrara, NP said...

Unfortunately, no independent practice in NY yet. We are working on that one.

Anonymous said...

I think more and more NP's should be allowed to practice on there own; however the amount of push back from physicians is amazing regarding this. Do they not think if something is out of the NP's league that the NP wouldn't refer to an appropriate colleague? What it boils down to is money IMHO and not what is best for the patient as usual. Reading “Not What The Doctor Ordered” by Jeffery Bauer as really opened by eyes to the business of medicine and the control physicians have over it.

Litton Resource Group said...

Not being an NP I can't comment on going solo but I think there is a place in the medical world for NPs in private practice; convenience, potential cost savings to name a few..

Nancy Onyett, FNP-C said...

A good blog. When I decided to go into practice, I wanted to eliminate insurance altogether and focus Age Management Medicine. When the economy spiraled down I found it difficult to practice without plans. The trick is time getting credentialed on plans and keeping overhead to a minimum. Surprisingly, insurance is paying for hormone therapy with appropriate codes. Now, the only big cuts are wellness exams for adults so has to be billed differently.Appropriate coding and billing makes all the difference. It is harder here in AZ. as this is a large managed care state.

portlandgal said...

More and more NPs will continue to go into private practice hopefully the FTC will be successful in helping to remove the states that restrict NP practice as this really is restraint of trade.

for those of you already in private practice or thinking of going into private practice I encourage you to go

we are trying to get a national group going.

also, email me at teribunker@bridgecitymedical.com

Teri Bunker

Cornerstone Medical Recruiting said...

Nurse Practitioners are a God send to the world of healthcare. Because there is currently such a shortage of primary care physicians practicing, and not enough new MDs coming out of college, Nurse Practitioners are VITAL to the healthcare industry.

I am the co-owner of Cornerstone Medical Recruiting, based in St. Louis, Missouri. Cornerstone Medical Recruiting works nationwide, and specializes exclusively in the permanent placement of Nurse Practitioners,Physician Assistants, and Certified Registered Nurse Anesthetists.

Feel free to check out our website at www.cmrmedcareers.com

Kimmie said...

Hello; I've been a Nurse for 14 years and an FNP for 2 years. I have a strong zeal to open my own practice here in NC; can any one give me an idea of how much NP experience one should hae before going solo? Kim

Kimmie said...

Hello everyone; I have been a nurse for 14 years and an FNP for 2years. I have a strong, strong zeal to open my own clinic,in NC; can anyone tell me how much NP experience I should have before going solo? or does it matter?


Kimmie said...

Hello everyone; you all may see this message more than once because I'm not seeing it posted. Nevertheless; I've been a nurse for 14 yrs and an FNP for 2 years. Yet, I have a strong strong zeal to open my own clinic; my question is, can anyone tell me how much experience I should have before going solo? or does it matter?


Stephen Ferrara, DNP, RN, NP said...

Hi Kimmie,

I really don't think there is a magic number of years before starting out on your own. As long as you have strong clinical skills and adequate resources of referral/collaboration, I would imagine that you are ready!

Check out Barbara Phillips website, http://www.nursepractitionerbusinessowner.com/ for great tips and advice for starting a practice.

Good luck!

Anonymous said...

so about how much can a nurse practitioner earn yearly if they own their own practice?

Katy said...

I support nurse practitioners opening their own practices after they have some experience. Research articles have shown that patients are often more satisfied with care from a nurse practitioner than a physician (http://www.midlevelu.com/blog/nurse-practitioners-top-physicians-patient-satisfaction). If you know when to refer a patient to a physician and are familiar with your scope of practice, I say go for it!

Anonymous said...

The Sisters Upper Room
"Second time around"
I have been a NP for twenty years and a Nurse for thirty, in 2005 I started my own practice in New York called the "Sisters Upper Room" it focused on Women's Health. I learned as much or more then I would have if I had went to school for an MBA. I invested all my money and time. It didn't last long and I had to return to a 9-5.
Seven years have passed and I have the opportunity again, this time I'll practice smarter and go slower , however the passion and zeal to create my own practice is still there.

Cara Cipriano, Licensed Massage Therapist said...

I enjoyed reading your posts. I am a Medical Massage Therapist and I am looking to open a space in Stony Brook, New York with a Nurse Practitioner. Is there any interest from anyone who posts here? Please feel free to email me directly at caracip@yahoo.com

I have an established base of clients who are active participants in their healthcare and are looking for a perfect fit of western and complimentary medicine.

Cara Cipriano, Licensed Massage Therapist

Anonymous said...

Don't call it the Sister's Upper Room.... sounds like a lot of things, but a clinic is not one of them....would make your marketing harder...sisters clinic....sisters primary care...

Anonymous said...

I worked for NP owned walk in clinic in 2012 where she cleared $650,000 in 2012 just from insurance reimbursements. She had 4 NPs working part time and full time and saw 50-80 patients a day, 5 days a week - much like the minute clinics all over the country. Those are owned by doctors or huge corporations and they are making a fortune with this "retail clinic" idea - all staffed by NPs. I opened my own clinic with an integrative med twist but also with acute care as my bread and butter. Doing ok, 7 months into it...