FNP - Their Own Clinic - California

agiboma, BSN, MSN, NP · Jan 20, 2016

@Goldenfox and Barbara thanks again. I am truly looking to open my own clinic in the Western New York area in the coming years. I think after all this money and time spent on NP education it will be the best thing for me and my family. I will continue to research this topic as I continue to work on the required hours for New York state.

Goldenfox · Jan 20, 2016

@Goldenfox and Barbara thanks again. I am truly looking to open my own clinic in the Western New York area in the coming years. I think after all this money and time spent on NP education it will be the best thing for me and my family. I will continue to research this topic as I continue to work on the required hours for New York state.

Remember though that it's NP practice hours that they count, not RN hours.

Good luck!

BarbaraNP · Jan 20, 2016

NYS has a lot of NP owned practices. I know in their conferences (state and regional) they address these issues as well, so make sure you get involved.

Best wishes!

~ Barbara

RichFNP · Jan 28, 2018

Goldenfox is mostly correct. In CA, the medical corporation may only be up to 49% owned by the NP, but the other 51% does not have to be held by a single physician--it may be divided among as many as you like. Using this strategy as an example, employ 5 physicians as part time collaborators, each sharing some call for availability by telephonic consultation as required by law. This way, each one owns only 10.2% of the corporation and the NP retains the majority share. The only time this would become a major problem is if 4 of the physicians all "sell" their share to the final remaining physician. Also, the consultation fees can be structured for physician collaboration, so that they retain a retainer as a fixed amount, or may be negotiated on a per patient encounter basis. When examining patient throughput and flow as a marker of revenue (especially in a patient payer, not insurance payer model), it may be of benefit to put a physician in another room creating increased patient volume. I think much of this depends on the collegial and collaborative spin you put on this to the physicians.

FullGlass, BSN, MSN, NP · Jan 29, 2018

There are NP-owned practices in California. There is one in the San Diego/Inland Empire area that often recruits and they also pay very well. In addition, I have seen RN-owned medispa facilities - there is one in La Jolla.

Since most salaried NPs in California make over $100K per year, a clinic owner should be able to do very well, once the practice is built up.

Best wishes to you.

crazyarin · Oct 9, 2020

On 1/9/2016 at 11:01 AM, Goldenfox said:

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.

Hi there, an old thread but it’s very true in CA NP can only be 49% and MD would have to be 51% and some insurances are pita because they will only contract with md do only.... I know I have my own clinic and had to deal with all the politics and hurdles it’s a true pain. BUT my main question is, since the California bill AB-890 passed for NP independent practice... does anyone know if this will allow for NPs to own and operate their own 100% medical clinic without having to pad the md pockets and corporations could be 100% NP and NOT 49/51%

Grande_latte04 · Dec 8, 2020

I know this comment is late to the game, but as on Oct 05 2020 NP can practice independently by January 2023 in California

BarbaraNP · Dec 9, 2020

When I last had a conversation with Melanie Balestra, NP, JD in California about this (recorded and is available on Youtube), the rules were still in the process of being written. It's definitely not FPA in terms of no physician involvement, but is a step, hopefully in the right direction.

NPs in California will still have hoops to jump through, but it is doable.

crazyarin · Dec 9, 2020

Thank you guys and gals for the replies. California hopefully will have changes so that NPs can have some more freedeom and the MD lobbies will relax a little. There is such a shortage in all medical personnel accross the board and sadly also almost any indioensong business specially healthcare related is a nightmare in California to start and operate. From insurnace companies constantly trying to deny claims, even when you have contracts with their groups they still deny. Haha our clinic has paid claims of pennies, .55 and 76 cent claims and we had to dispute it. If your are trying to do your own clinic I think Arizona NV and many other states are more flexible and less restrictive to start. Here it is not worth the headache, unless the NP has a brother/sister or a significant other that has a md or do license that you can use to get through. Even when talking to the California medical board or lawyers one pointed me to the other for bylaws and the legalities! None of them knew nor wanted to give any information about how to go about this.

crazyarin · Dec 9, 2020

I think this is the video link Barbara was talking about at the 22minute mark Melanie Balestra talks about some great points on the AB 890 bill And also some eye opening talks also about the BRN being the interferer that slows NP progress and that we truly need our own board not just a committee the PA have their own board and it helps them advance more effectively.

BarbaraNP · Dec 9, 2020

There are two videos that NPs in CA might be interested in on my channel. One in which Melanie talks about Independent Contracting in California, and one in which we talk about this new law. I'll try to post the links here.

The other is also of note for those who are forming businesses as Independent Contractors.

It's really important to understand the laws in each of our states, and also support our NP organizations.