In many states, Nurse Practitioners (NPs) can open their own practices. But just because you can doesn’t mean you should. Here’s how to decide and, if you choose to, the types of actions you’ll need to take.
When Scharmaine Lawson, FNP-BC, FAANP, FAAN, had been a nurse for 15 years, she had worked in many different specialties. One of her favorites was home care. In fact, it was her passion.
“I wanted to help my community, and a physician approached me about starting my own clinic/housecall service. It was a ‘right time/right place’ moment,” she recalls.
Lawson ended up founding a VIP housecall practice, Advanced Clinical Consultants in Louisiana, which has been successful for the last 15 years. She also penned Amazon’s number one house call book, Housecalls 101: The Only Book You’ll Need to Start Your Housecall Practice. Finally, she’s designed a course called Housecalls 101, in which she teaches other clinicians how to start and maintain a successful home visit program. Since 2008, Lawson says she has trained more than 600 nurses on how to do this themselves.
“When the opportunity presented itself, it was a natural fit in an environment I felt comfortable operating in,” says Lawson. “Plus, I saw the community need and felt I could best be a servant leader. At the end of the day, the ability to serve is my superpower. It’s an honor that I don’t take lightly.”
Should You Open a Practice?
As Lawson says—and as do our other sources—first, you need to find your passion. You also need to decide if this is something you really can do. “Opening your own practice takes guts, time, and dedication. If you’re missing any of those, it’s not worth it,” says Graig Straus, DNP(c), APRN, CEN, FF-NREMT, founder and owner of Rockland Urgent Care Family Health NP in New York. “I always knew that I wanted to be my own boss, make my own rules, and care for my patients on my own terms. Having that desire really drove me to the point of wanting to open my own business.”
While fulfilling, opening and running your own business isn’t easy. “Nurse practitioners should only open their own practices if they want all the things that go along with owning any business: bookkeeping, marketing, networking, hiring/firing, social media, etc.,” says Bradley A. Bigford, MSN, APRN, NP-C, CCHP, founder and owner of Table Rock Mobile Medicine, PLLC in Idaho. “If they like working 9-5 jobs, owning their own businesses likely isn’t for them. They have to put in long days and nights, weekends, and holidays.”
If you’re up to the task, the next step is to determine what kind of impact you want to have on your community and profession, while making sure that what you want to do matches up with a need in the area you want to serve. “It was a simple decision for me,” says Maurice D. Graham, DNP(c), MSN, APRN, FNP-BC, CEO of Graham Medical Group, a concierge medical practice in Maryland. “As an African American male, [I know that] we are often undertreated for health care issues, accompanied with the fact that African American men do not seek routine screenings and prevention.”
Ask yourself tough, but important, questions. Melanie Balestra, JD, NP, MN, of the Law Offices of Melanie Balestra, is a lawyer and an NP and has been working with other NPs in a legal capacity to help them set up their own practices for more than 25 years. She says you should ask yourself some of the following questions:
- What are the goals of opening your own practice?
- Where will it be located?
- What will be the focus of it?
- Will you take insurances or be cash based?
- Will you need support help?
- Will you be taking out a loan? If so, where will you apply for one?
- Will you be able to function in the red for at least a year?
“The biggest challenge is that it does not happen overnight,” says Balestra. “The NP needs patience and be able to evaluate what might not be going right in the practice. This is why location is important. Collections can be a nightmare, so it’s important to have a good billing and collection service. The biggest mistake is expecting overnight success, and then when it does not happen, giving up.”
What to Do First
The first thing you need to do if you plan to open your own practice is to develop a business plan, says Balestra. “If you are in a state that requires a supervising physician, make sure you have him/her on board. When this is done, hire an attorney who has experience with setting up NP businesses and understands the laws of your state. Hire an accountant to work with the lawyer on setting up the best entity for you legally and tax wise,” she explains. Have several office spaces in mind and make sure they are zoned for medical practices. If you need a loan to start business, it may be a personal loan but a note can be written so that the business pays back the loan.”
Do your research. “Nobody should just open a practice for the sake of opening one without any research into their idea or doing market analysis,” says Lawson. “This is a disaster waiting to happen.”
Bigford stresses that you also need to talk with your family. “It takes a buy-in from everyone because of the significant work it takes from everyone involved and their loved ones to pick up their slack,” he says.
As for how long it will take—for our sources, it took anywhere from four months to two years before they opened their practices.
Straus says that after you incorporate, you should also get a group NPI number—this is different from the personal one you would have gotten when you initially began practicing. “This establishes your company as an organization capable of being recognized by CMS,” he says. He then went and spoke with his local Industrial Development Agency to determine what tax breaks and industry connections he could get. “This will help to reduce costs and potentially hasten any permits needed to build a practice. These are quasi-governmental agencies who have the ability to lessen the tax burden placed on you in the initial stages of opening a business. The goal of these agencies is to promote sustainable businesses and help support local communities.”
You’ll also need insurance—for yourself and your business. “Insurance is a necessity prior to your business opening,” says Emily Keller Rockwell, RN, MSN, CRNP, owner and founder of The Montchanin Center for Facial Aesthetics in Delaware. “Without question, have a detailed meeting with your insurance agent, discussing your business in detail—making sure they understand all aspects of your business and will provide the adequate coverage and limits to protect you and your business.” A few kinds of insurance to discuss, she says, are property, liability, errors and omissions coverage, umbrella, and disability, among others.
Some of our sources didn’t hire staff—at least for the first year. “Staffing depends on the volume of business being generated,” says Graham. “My first year, I didn’t hire anyone. I did all my administration duties and cared for my patients. My goal was to keep my overhead as low as possible without lowering the level of care given to my patients. This worked out well for me.”
Rockwell also waited a year to hire an assistant. Now she has three and a full-time publicist. “I am able to do speaking engagements, conduct trainings, and attend training events to further my professional knowledge,” she says.
If your type of practice requires that you have staff from the beginning, Balestra says to know what you’re looking for in attitude, skill level, and personality.
Bigford says that “Hiring non-revenue generating staff should be kept at a minimum.” When you hire anyone, he suggests that you find people who have a good work ethic. “Someone personable, easy going, and friendly is important,” says Straus.
Once you’ve determined your business, you may need to find a place. (Obviously, if you choose to have a house call business, you don’t need a brick-and-mortar office.)
“Think about the services you want to offer and the space you need to do it in,” says Straus. His urgent care facility needed a lot more resources than a primary care office. “I specifically met with architects who specialize in medical offices to help determine the size and capabilities of the space, based on my needs.”
Graham had one large room that included his own personal desk as well as all the equipment he needed to conduct assessments and provide routine care to his patients.
Rockwell says that when designing your space, keep your clients’ need in mind. “Design a warm, comfortable waiting area to keep patients relaxed,” she says.
All our sources say that you must have a website. Even if it doesn’t bring clients in directly, they will want to look at it to get information about you and the kinds of services you offer.
Don’t discount word of mouth. This can be one of your best marketing tools.
Social media is your friend. Learn how to use it. If you don’t know how, hire someone who does.
When using social media, decide which is best for you. For Rockwell, Instagram has brought her the most clients. Bigford says to go where your core consumers are. His are on Facebook and Instagram. “Post every single day. Go to Facebook groups. Facebook and Instagram ads work really well for me to build trust,” he says.
Straus suggests having “coming soon” ads before you actually open to build up curiosity. “Ads in local papers that cater to your community could be beneficial,” he says. He adds that advertising in church newsletters, school calendars, and through the police athletic leagues—any organization that involves your community—can be beneficial to your business.
Our sources also stress getting patients/clients to give you reviews on Yelp, Google, and Facebook. High ratings attract new consumers.
Before you start your own business, there’s still more to know. “Get experience elsewhere first,” says Bigford. “If you’re trying to learn to be an NP and start your own business, you’re going to struggle at both.” He also suggests that you get traction with patients. It took Bigford about a year to get a steady stream of patients and referrals. “If you have a high overhead in the beginning, you can go out of business before you even see your first patient,” he cautions.
Be sure that you know how to properly manage your time. That was Rockwell’s biggest challenge. “I wanted to see and help every patient who inquired,” she recalls. “I quickly found out that I needed to manage my work time and personal time equally. As with anything in life, you need to reboot or you will burn out. Schedule yourself into your schedule!”
Look for a mentor. “NPs should look for a mentor or someone who has already established a clinic, and pick their brain. That’s what I did,” says Graham.
Have enough money to get you through. “In jobs that rely on insurance, payments are delayed. You do not simply offer a service and get paid the exact moment of exchange. A claim has to be made, filed, and processed. Then payment is issued per contracts,” says Straus. “A solid 4-6 months of cash on hand to cover expenses is needed while you establish your practice, build clientele, and await the beginning of insurance reimbursements.”
Despite all the hard work and sacrifice needed to run your own practice, our sources wouldn’t have it any other way.
Lawson’s biggest reward in having her own practice? “Complete autonomy,” she says. “It is the biggest entrepreneurial superpower.”
Disclaimer: This story is meant to give general advice. For specific individual advice on starting your own business, be sure to consult a lawyer, an accountant, and other professionals.