FNP - Their Own Clinic - California

thedoc · Dec 8, 2015

I would like to revive this topic of corporate practice of medicine. Can anyone confirm that nurse practitioners can own 100% of their own practice in the State of California? I know PA's can only own up to 49% of the practice.

In Florida anyone can own any medical clinics.

OCRN3 · Jan 7, 2016

I worked for cash only clinic owned by a realtor. We had a supervising MD whom I never saw, and then me who did the work.

Goldenfox · Jan 9, 2016

I would like to revive this topic of corporate practice of medicine. Can anyone confirm that nurse practitioners can own 100% of their own practice in the State of California? I know PA's can only own up to 49% of the practice.
In Florida anyone can own any medical clinics.

The quick and simple answer to your question is yes, but also no. The physicians in California have the screws real tight on independent NP practice, they lobbied heavily to successfully kill the most recent attempt by the NPs last year.

Yes, you can open a business in California as an NP but you would have to incorporate it as a nursing services business, not as a medical services business. If this sounds crazy, that's because it is. But it is based on rules that were put in place by the California board of medicine---rules that were specifically designed to keep the PAs and the NPs out of physician turf. If the business is incorporated as a medical services entity then you, as a nurse practitioner principal, are restricted to owning only up to 49% of it and you must have a physician business partner who owns at least 51% of it. If you set up a nursing services businesses you cannot operate independently as a practitioner in California so you must have a relationship and established protocols with a supervising physician--which again shifts control of your business away from you. Some things you will be able to do on your own, but if the business involves third party payments you are going to run into issues. Most third party payors will reimburse an MD/DO directly, but not you. It really depends on what type of business you are planning to do.

You can make money with your own nursing services business as an NP in California but you're going to be paying a physician a hefty sum of that cash every month for doing next to nothing. And if you're thinking about doing something like a medi-spa then the physician partner will have to be majority owner of the business which means that he/she will be calling the shots and controlling the money even though you will likely be doing most of the work. If you really want to own your own business then I do not recommend doing it in California. You can make money, but probably not as much money as you could make elsewhere (i.e. a truly independent practice state). Unless the laws in California change, of course.

agiboma, BSN, MSN, NP · Jan 12, 2016

and can you name the "truly independent practice states" please thank you

Goldenfox · Jan 13, 2016

Sorry, I don't have a current list of the independent states. Last time I verified it was as follows:

Alaska
Arizona
Colorado
Connecticut
District of Columbia
Hawaii
Idaho
Iowa
Maine
Maryland
Minnesota
Montana
Nebraska
Nevada
New Hampshire
New Mexico
North Dakota
Oregon
Rhode Island
Vermont
Washington
Wyoming

agiboma, BSN, MSN, NP · Jan 14, 2016

thank you goldenfox does anyone know what a typical start up cost would be for an NP run clinic?

Goldenfox · Jan 14, 2016

New York should probably be on the list also, but I left it off because they require a certain number of physician-supervised practice hours before you can be independent there.

thedoc · Jan 16, 2016

Thank you everyone for sharing your knowledge.

I have one more question for requirements. In California, after establishing protocol between the NP and the DO/MD, must we send the protocol or somehow notify to the board of nursing/board of medicine? I could not find anything in the Code of California.

In the code I do see that the physician must be available by tele-communication. I found out that physician proximity is not addressed, and that chart review, co-signatures, physician meeting and onsite supervision is not required.

Goldenfox · Jan 18, 2016

must we send the protocol or somehow notify to the board of nursing/board of medicine?

No. They only require that one exists and that it is kept updated by the NP or the practice administrator.

BarbaraNP · Jan 19, 2016

Agiboma,

Startup cost vary drastically. It depends on things such as location, type of practice you want to start, state rules (how many hoops must you jump through), equipment and more. It's imperative to sit down and do some research on business startup cost in your area as well as ongoing operating expenses.

That said, I have worked with NPs who have started practices for less than $10K to over $250K. It just depends.

agiboma, BSN, MSN, NP · Jan 19, 2016

@Barbara Thank you

@Goldenfox where do you get this information from? I am very interested in NY because its so close to home for me. I just got my NY state RN license. so how do i find out how many hours are needed or do you know off the top of your head?

Goldenfox · Jan 19, 2016

@Barbara Thank you
@Goldenfox where do you get this information from? I am very interested in NY because its so close to home for me. I just got my NY state RN license. so how do i find out how many hours are needed or do you know off the top of your head?

I've also looked into opening up my own business in the not too distant future, and I have licenses in a few states (including the ones being asked about in this thread) so I've researched these topics in most of them. I get information from the boards of nursing themselves, as well as from resource websites for NPs who want to operate their own business. Barbara Phillips (above) has an excellent blog for this, and Carolyn Buppert's stuff is good to review also.

For New York it's 3,600 NP practice hours that you need, then you can opt to practice without physician supervision but they still say that you have to have some type of collaborative relationship with a physician who you can refer to if and when needed.

http://www.op.nysed.gov/prof/nurse/np-prfnp.pdf