Is there a niche for evening/night time practices?

  1. --Didn't know which forum to post this in. Moderators please move to most appropriate place if necessary --

    I'm only now in nursing school, but I tend to play the long term game often in my head. I ran this by my primary doctor who I've known forever and she thought it was a good idea.

    I plan to nurse at night (as an RN), standard night owl etc. etc. Most likely in psych, but we will see. Then after a few years get NP.

    My question is (because I've never seen and always wondered why it doesn't seem to exist):
    Once 5 p.m. hits and everyone is shutting down and leaving work..outside of a trip to the ER or cities that have the urgent care type minute clinics, where do people go if they want to be seen for general sickness-- or more particularly in my case perhaps outpatient psychiatric therapy/med management? It seems most people have to sacrifice a day of work, use vacation or take sick days that they could have not used IF there were evening practices.

    I would love to ideally go NP (via msn or dnp whichever will hold more leverage/autonomy in the future) and open a private practice that filled the void that exists AFTER people are getting off work on "off" hours. Perhaps open in the afternoon and keep hours until 8,9,10 at night. Make sure 1 of the days I'm open is a Sat. or Sunday for even more flexibility. Find other evening preferred providers to staff, set up decent proximity to 24 hour pharmacies, make arrangements for labs/referrals and contacts with day practices during afternoon hours the next day.

    I know I always have been frustrated either getting off work or school and it being 5-6 p.m. and everything is closed. My primary, the dentists, many psychology practices etc. That or whenever I get sick it's Friday afternoon and the only way to see someone is an expensive minute clinic that may or may not take my insurance, and always requires a higher co-pay for being "off" hours.

    So just your opinion(s), do you think there would be interest/need for this type of setup in the future? Standard evening private practice (not minute type clinic) for either FNP or PMHNP. Also given a need, what are the major hurdles? Also, assume this would be in a state where NP are independent without need for physician supervision/collaboration. I just think it's something I'd be good at if it has a place that needs filling!

    TLDR: Is there a need for Evening/night time practices and would it be logistically possible to create?

    Thanks for input, guys!
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  2. 10 Comments

  3. by   adammRN
    I think once you get more experience in medicine you will see the answer. I have been perplexed as to why we do certain things (like throw away the majority of a vial of pain medication after using a small portion of it) and it is because of the economics behind it, not necessarily because it "makes sense." I am sure the reason this doesn't exist already is there is not enough demand for it.

    Here are the two primary instances of needing to see some sort of provider;

    1) IF you are in need of EMERGENT care, then you drive to the nearest emergency room or you call 911. Those services are 24 hours already as you pointed out.

    2) If it's not an emergency, and you need to get seen, you request sick absence from whatever it is you are doing during the day to go get seen. For example - In the government/military, we have convalescent leave - you get time away from w/e you do during the day to go get the issue checked out.

    With those two options, there is not much need of a 3rd. That's not to say it would be impossible to make a business out of it.
    Last edit by adammRN on May 15
  4. by   Riburn3
    I actually disagree with the poster above.

    Even in larger cities where some off hours clinics exist, there is definitely a need for other options. One of the reasons ER's are bombarded with stupid walk in patients with no emergent issues is because there is a lack of options for patients to be seen during off hours. Even if you have a PCP, sometimes it takes days or weeks for an appointment, and this is why urgent care is so popular.

    In my area there are a couple of pediatric night clinics open from just 1800-0000, that make a killing because they fill this role.
  5. by   Lanntis
    Quote from Riburn3
    I actually disagree with the poster above.

    Even in larger cities where some off hours clinics exist, there is definitely a need for other options. One of the reasons ER's are bombarded with stupid walk in patients with no emergent issues is because there is a lack of options for patients to be seen during off hours. Even if you have a PCP, sometimes it takes days or weeks for an appointment, and this is why urgent care is so popular.

    In my area there are a couple of pediatric night clinics open from just 1800-0000, that make a killing because they fill this role.
    Riburn3, YES that's exactly what I saw in a nearby shopping village the other day. An evening clinic that seemed to operate like a normal day clinic but only for pediatrics. It reinforced my belief that there HAS to be a need for things like psychiatry and maybe even other "mundane" specialties like dermatology. Why take that day off work (which may not be paid for by your employer) to have that mole removed, to manage your psych meds, get some therapy or get an antibiotic for a throat infection--which might mean a large co-pay at the Emergency room etc. if you could just go after "9-5" work hours. It seems like a win/win for people like myself that are 2nd/3rd shift oriented biologically and for the busy morning people all over.

    My PCP is amazing, but she is ALWAYS booked for 2 weeks. So by the time you can get in, you've already suffered through whatever problem you had usually, and thus I end up in a CentraCare paying a larger co-pay. That's definitely why emergent care places stay running...it's certainly not for their stellar care (not where I'm located anyway..)

    @AdammRN I do see your point too though that perhaps if you are taken care of by military or your job allows for many paid sick days, you might as well use them and thus depending on the location and state perhaps the need for such a dynamic might be less useful. It's definitely something I think I want to explore though as I start my career.

    Thank you both for your opinions, and I welcome more and a discussion if others have anything to offer!
    Last edit by Lanntis on May 15
  6. by   adammRN
    I did a quick search after seeing these posts; there are tons of urgent care clinics around my city that are open till 8 or 11 pm but a lot of them have bad reviews. Seems like what you want already exists!
  7. by   adventure_rn
    I'm guessing most offices aren't open in the evenings because people generally don't like to work in the evenings (providers or office staff). To be honest, I think that many people go to NP school to have normal daytime hours and move away from the crazy 24/7, weekends and holidays nature of floor nursing.

    I've seen several dental practices that advertise the fact that they're open until 8 PM; they stay open late specifically to capture that subset of customers. I wonder if you could join a standard daytime psych practice where you could offer after-hours services and just stay late. You might need an office person to stay late and do the intake paperwork (or do it yourself), I have no idea about the logistics of that.
  8. by   Lanntis
    Quote from adventure_rn
    I'm guessing most offices aren't open in the evenings because people generally don't like to work in the evenings (providers or office staff). To be honest, I think that many people go to NP school to have normal daytime hours and move away from the crazy 24/7, weekends and holidays nature of floor nursing.

    I've seen several dental practices that advertise the fact that they're open until 8 PM; they stay open late specifically to capture that subset of customers. I wonder if you could join a standard daytime psych practice where you could offer after-hours services and just stay late. You might need an office person to stay late and do the intake paperwork (or do it yourself), I have no idea about the logistics of that.
    I was talking to nursing faculty in my program today and they were absolutely in agreement that is an amazing niche to be filled and like you said , the reason they think it isn't common yet is that 1.) our healthcare system is broken and things that seems obvious often go overlooked and 2.) Finding other people that enjoy the same type of schedule I do. As such, I was encouraged to go be a trail blazer in this area. So we shall see in the future I guess! Thanks for your input!
  9. by   caliotter3
    Most of the practices that I have seen that advertise evening hours only have the late hours for one day out of the week, and for that matter, they are not even very "late" hours. Most of us can not make it to a clinic by 6:30 pm if we can't get there by 4:30 pm to begin with, so a 7 pm closing time is not beneficial.
  10. by   klblank
    I think an evening/night time primary care provider is an excellent idea. I don't mean urgent care but actual primary care with regularly scheduled visits such as annual physicals and medication refill visits. With the FDA tightening up on prescriptions most people are forced to Visit their physician face to face for refills on their antihypertensives. Currently they have to miss work once a month or go without the required medication s. I say be a Trail Blazer, imo it's needed.
  11. by   Lanntis
    Quote from klblank
    I think an evening/night time primary care provider is an excellent idea. I don't mean urgent care but actual primary care with regularly scheduled visits such as annual physicals and medication refill visits. With the FDA tightening up on prescriptions most people are forced to Visit their physician face to face for refills on their antihypertensives. Currently they have to miss work once a month or go without the required medication s. I say be a Trail Blazer, imo it's needed.
    @Calilotter3 Exactly, the "late" hours are often 6-7 p.m. max. There's not a single normal primary doctor in my metro that stays past 5 p.m. Monday-Friday. Same thing for psychiatry practices. There are some mental health counselors that realized the benefits for patients to have evening appointments available a long time ago. However, those are generally just for therapy and they can't help with the medications part.

    @klblank I hadn't even thought of that fact on the FDA tightening everything so even the common hypertensives are getting more difficult to simply refill without an appointment. You're fleshing my ideas out even more. A family practice that also has an in-house psych department (featuring myself!) and then find similar FNP's to take care of the day to day problems. Everyone wins. A cozy place to go after 5 p.m., no urgent care co-pays, no ER visits for general illnesses-- there's lots of complaints in the hospitals near me who are swamped with people that have no major issues they just need basic care but have nowhere else to go when it's 10 p.m. on Friday and will spend a weekend without a needed antibiotic.

    Thanks for the input guys! In some years, I hope I'll be providing this type of service/environment to my community wherever I end up.
  12. by   WKShadowRN
    Recently I had an ortho need and they had an after hours clinic. My urgent need was met. However, the follow up appt could only be during regular hours. I felt that was a missed opportunity because I'd either have to come up on my day off or miss work.

    I cancelled my follow up because the problem was mostly resolved. But if it hadn't I would have missed plans I had with my family.

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