Bioidentical hormones and acute NP

Specialties NP

Published

I have a hypothetical question that I would like some opinion on. I'm entering my final year as a student NP in an acute care program. When I graduate I intend to spend some time in an inpatient ICU. However, in the future I would love to open up a small practice dealing in bioidentical hormones. How feasible is this with an acute NP certification? Are there any limits on what I can open a practice in? The clinic would deal mostly in taking and interpreting labs and prescribing bioidentical hormones and implanting hormone pellets for women in menopause. I've not worked in women's health before but I have a big interest in hormonal issues and I've been a nurse for nearly 25 years. Should I try to get a clinical rotation in endocrinology even though it's unlikely they would use or prescribe bioidenticals? I really don't want to have to go back to school to get a post Master's as I'll be 51 by the time I graduate. I only recently discovered this as an option and I was always an ICU nurse which was why I chose the acute program. I don't want to work with pregnant women or babies, just adults. Is there anything to stop me opening a clinic like that? I would obviously attempt to find a bioidentical clinic to work in at first to gain experience, and I'm talking a few years down the road, but I feel it's good to start asking questions now so I can head in the right direction.

Advanced Practice Columnist / Guide

Corey Narry, MSN, RN, NP

8 Articles; 4,361 Posts

Specializes in APRN, Adult Critical Care, Cardiology.

I would preface my post with a statement that I am not an expert in any form of hormone replacement therapy for menopausal women as a male consumer and as a clinician whose practice is limited to adult critical care. However, what I know about BHRT as a field is that it is not well accepted by mainstream medicine and that the practices are still unregulated at this point.

A survey of providers in my home state of California who offer this service come from a variety of fields from DO/MD's who are primary care trained to chiropractors, naturopathic doctors, NP's, and PA's. These hormone preparations are not FDA approved and prescriptions are typically compounded by individual pharmacies. Also, these are fee for service practices not reimbursed by insurances.

I don't see a reason why an AGACNP could not practice in this field in the absence of an approved and widely recognized training program in this modality. If this is an interest of yours, I would try to join the professional organization that espouses BHRT and find out what training programs are available and which practices are willing to have you train under them. You can certainly do this on the side or even as a full time job (if it's lucrative enough which I suspect it is).

Be prepared, however, that the downside of being in an unregulated field is that you have a higher risk of litigation. Unhappy patients can be quick to attack a practitioner for being a quack if they don't see the results they wanted or feel that they were harmed by the treatment. In that situation, you may not have mainstream medicine defending your actions.

smd2521

10 Posts

I work with a lot of BHRT in the family practice I'm currently working with. I am FNP most of my RN experience is in ICU. Remember acute care NP are trained for acute care and then there are primary care certs. If I were you and you plan to do clinic work id get a cert demonstrating training in PC. Even though you probably do fine, I'm just saying for CYA. Just like if I went to work in the ICU I think I could fly but I should get ACNP first.

Goldenfox

303 Posts

I am curious to see the responses you get to your question. I have always wondered about BHRT but too lazy to actually research it. The champions of this technology insist that bioidenticals are the same (or at least close enough in chemical composition) to true biogenic hormones to effect the wanted changes. I wonder about this because the bioidentical stuff is neither approved nor regulated by the FDA, yet I've watched the FDA jump all over certain other types of 'naturaceuticals' and forced them off the market in the past. I had noticed that the FDA has been quick to soft-knock bioidenticals---probably because the bioidenticals do not come from traditional Big Pharma that pays billions to affect the outcomes of 'scientific research' that promotes their outrageously expensive drugs? Who knows?

I would guess that your ability to open such a clinic might depend on the state you're in. Some states with practice restrictions do not permit NPs to prescribe certain types of hormones. Where bioidenticals fit in on the spectrum is a question that would probably be best directed at the BON. Another consideration is whether you will be able to get insurance coverage as an NP owner of such a business---since the substances that you would be treating with are unregulated, and there are no standards/protocols for the treatments or guaranteed successful outcomes there is probably a higher risk of being sued by clients who are dissatisfied with their results. I would look into that as well.

Aromatic

352 Posts

id get insurance quotes. usually thats the best way to see how likely one is to get sued. insurance companies have high end actuaries that figure this stuff out.

Specializes in Reproductive & Public Health.

There's no data to support the idea that "bioidentical hormones" are any safer than synthetic ones- nor are they actually more "identical" than synthetically produced hormones.

I don't see a problem in specializing in hormone replacement therapy, per se. I do a lot of it in my practice, and as long as you are adequately trained it is well within NP scope, barring local regulatory silliness. I do, however, feel a little bit alarmed whenever I hear NPs espouse pseudoscientific health beliefs, especially ones that actually have potential for harm. Bioidentical hormones are largely produced by an industry that is just as profit driven and susceptible to corruption as Big Pharma, and who also benefit from a lack of outside oversight. Actual amounts of hormone in a pill can vary widely from company to company, and even batch to batch.

SnipImage-480x242.jpg.1bca04278c7cb07da6f1adbf0668d8ba.jpg

Specializes in Critical Care and ED.

Thanks for all your reponses. I hesitate to get into a debate about the efficacy of BHRT, as I have done a lot of reading and have formulated my own opinion on it, which is a conversation for another time. Suffice to say, that some BHRT is FDA approved, and it is only the compunded BHRT that is not. I speak from a patient's perspective as I was ill for a long time and was unable to tolerate synthetic hormones which made me terribly sick. I am now on BHRT and feel amazing...no side effects or negatives so far. In fact, the very first week I felt incredibly better after years of suffering. As you can imagine, I am a true believer. Yes, absolutely there needs to be more studies, but if the funding isn't there it won't happen. Menopausal women are not deemed as important as men of a similar age with erectile dysfunction I guess. Whatever the reason, I'm grateful that BHRT exists and I want to help other women feel better having such a deep understanding of how devastating hormonal imbalance can be.

That said, how would I go about finding out if there is some kind of organization for the use of BHRT? I've searched and not found one. I know of one company that offer training but currently it's only available to MDs. My own BHRT practice is run by just two doctors, and I know of one other in Maine run solely by APRNs. Also, how would one go about getting a malpractice quote? I know nothing at this stage of the practicalities of running this type of business so I'm not sure what kind of questions a company would ask, or even what company I would approach. This is a real maze and I feel I will be doing a lot of research in the coming months. I will definitely approach the BON also, so thanks for that suggestion.

Psychcns

2 Articles; 859 Posts

Specializes in Psychiatric Nursing.

Good for you looking into this! You could call insurance companies and ask about quotes. How about talking to malpractice attorneys for how you could protect your license and assets if sued? Have you tried calling the place that offers training to only MD's to seen what it would take to let you in. Maybe a letter of reference for example. Also

Ask Your BON. You might also check if OK with your state board of medicine and what kind of extra training is recommended. Or other professional organizations. Best wishes.

Specializes in Critical Care and ED.
Good for you looking into this! You could call insurance companies and ask about quotes. How about talking to malpractice attorneys for how you could protect your license and assets if sued? Have you tried calling the place that offers training to only MD's to seen what it would take to let you in. Maybe a letter of reference for example. Also

Ask Your BON. You might also check if OK with your state board of medicine and what kind of extra training is recommended. Or other professional organizations. Best wishes.

Thank you...great suggestions! I will definitely follow up.

+ Add a Comment