Hollistically Oriented Independent NPas PCP? New - need help!

zenman · Sep 19, 2010

Hi all,
So I have recently had a dramatic change of interest and careers. I graduated from college 3 years ago with a BA. Since then I found massage therapy - and the first time I sat in on my anatomy and physiology course I was blown away with how interesting it all was - and applying it through manual medicine was fantastic. I like massage therapy a lot, but I know I'll never be satisfied at that level.
My dream recently has been to open a comprehensive care clinic that offers insurance-based western medicine as well as accupuncture, massage, botanical remedies, etc.
For a bit I have been thinking that Naturopathy was the way to go here - I love the hollistic approach and philosophy of naturopathic medicine (to respect and aid the body's innate ability to heal itself). However, the field of Naturopathy is so new and unrecognized and difficult - hard to make any money in it and schooling is similar to med school in time/money commitment.
So I wallowed for a bit about how I'd never be able to find the career that would let me do what I wanted: be a doctor that focused on holistic remedies (lifestyle changes, nutrition, botanical remedies, physical medicine/exercise, etc) while also having the ability to use allopathic medicine when necessary, as well as have financial viability, work independently, and not go through the trauma/time of med school. phew!
Then someone said: what about being an NP? I started looking into it and it seems like this field might be perfect.
I have some questions that I would REALLY appreciate being answered:
1) I can't seem to find a cohesive list of states that let you work independently of MDs - is there one?

Yes, look up "Pearson Report."

2) I read that in 2015 NP's will have to have a PhD? But that if you get your masters and become an NP prior to 2015 you don't? A) is that true, and if I were to begin in January on my coursework (I think I'd have at least 1 semester of pre req and then a direct entry masters program) would I be OK? and B) are there DE doctoral programs? what additional schooling is a doctorate on top of a masters?

They are requiring the DNP...which might actually happen 50 years from the planned time. You can check out DNP programs at nursing school sites.

3) My main interest is to work as an independent NP. My goal is to create my own comprehensive care clinic that offers all doctor services, but has a hollistic tilt and works alongside accupuncturists, massage therapists, provides botanical supplements, etc. I would like to set this up and be the governing NP of the operation able to cover any and all medical situations that come in (referring, of course, when necessary). Is this possible? To work totally independently and render all services a PCP could and accept insurance for it?

I heard a few days ago that acupuncturists are hurting. I know many who got out of school and made $30k a year. Massage therapists mostly are private pay which should be a good clue to deal with insurance as little as possible.

I've just answered a few of your questions...

Advanced Practice Columnist / Guide · Sep 20, 2010

I have no idea how you can get medical insurance companies to cover services that fall within alternative therapies. However, there surely are "independently practicing NP's" and in some cases, they do so despite a lack of legislation allowing full independent NP practice in their state because the feredal requirement for physician collaboration does not call for 100% physical presence of a physician. I think your best bet is to go to experts on indpendent NP practice or NP business owners. If you Google "NP business owners" you would find many links to independently practicing NP's though I do recall a few who regularly post in this forum.

thenewguy8 · Sep 20, 2010

Since I wrote this post I've learned lots by reading more into this forum and other resources.

My goal is to create this clinic that offers lots of services, but of course as an NP I could only bill insurance for this services they covered. I would, as a primary care provider, like to work with my patients as hollistically as possible including counseling on nutrition and supplement usage and then referring them to other services my clinic provided (outside of their insurance) such as pilates or accupuncture (though some insurance does cover that and massage therapy if referred from a PCP, I hear).

Basically I want to run an independent multi-service collaborative clinic, acting as the NP that sees patients and refers to the alternative healing modalities when appropriate (and the other providers could refer their patients to me when they needed western medical consulting since they would know I was a medical professional that valued alternative medicine as well). As an NP I could also do prescriptions when necessary and counseling on lifestyle and nutrition.

I want to create a space that combines alternative and 'mainstream' medicine to work with clients and achieve the most effective, least-invasive and non-toxic solutions possible to their problems - whether that means drugs, nutrition changes, accupuncture, massage, hospital admittance, etc.

I thought going the NP route would allow me to create this space with the legitimacy of an insurance-backed medical background, making it more financially viable and accessible to folks who don't have lots of throw-around income.

zahryia, LPN · Sep 21, 2010

Of course it's possible, check out this lady's profile:

Cathlene Scoblionko MSN, RN, ANP-BC

Trauma Columnist · Sep 21, 2010

She also works in a large clinic with many providers, including MDs.

zahryia, LPN · Sep 27, 2010

She also works in a large clinic with many providers, including MDs.

It's not a clinic. It's a private practice where she works independently. She has her own patient load and gets paid directly from them.

thinksyouareawesome · Oct 21, 2010

Hi thenewguy8,

I think you raise some good questions. It's hard to figure those out without either being in school to become an NP or practicing as one. I'll start where zenman left off.

You asked:

4) I heard NPs are recieving only 60-70% reimbursement from insurance companies? is this true?

Practicing NPs can answer this more specifically. To get you closer to the ballpark (and that's all I'm doing) for *Medicare* billing, it's more like 100% when it is "incident to" a physician's care, and 85% when an NP bills under his or her own name. From what I understand, each private insurance company decides what percentage they will use for reimbursement of NPs.

You asked:

5) With someone that has a BA, what is the most direct route to get the NP license? Direct Entry MSN? It seems like that takes 3 years after pre reqs? Are there lists of the best schools? For what I want to do I'm especially interested in making sure my education is top notch. I have a good non Pre req GPA - 3.7, if that matters.

Yep, direct entry MS in Nursing. Are you planning on working with adults only? If so, look here. If no, look here and click on your favorite specialty. Most of these schools have some kind of feeder direct-entry program that will get you into the master's degree program. I'm sure you understand that one has to see this as the start of doing fine-toothed-comb research on schools, though, not the end.

You said:

I want to create a space that combines alternative and 'mainstream' medicine to work with clients and achieve the most effective, least-invasive and non-toxic solutions possible to their problems - whether that means drugs, nutrition changes, accupuncture, massage, hospital admittance, etc.

You sound like are talking about developing a nurse-run integrative clinic. At my school, they used to offer a cool NP program specifically focused on complementary care, but not any more. They may still be out there, though. Do look.

I just want to add a little bit to your thought that becoming an NP might be a good fit. Nursing has a special outlook on health that I think may mesh with yours. Without using these words, it kind of looks at the feng shui of health. Compare the basic concept of feng shui, managing the flow of wind-water around a space that people use, with Florence Nightingale's Notes on Nursing, which is largely about managing the air, water, fire/heat, and space around a sick person to help them get better. If you look at all-things-nursing, these are themes you will see repeated over and over again, from the most practical and concrete nursing actions to the most abstract (seriously bordering on mystical). If you go to school to become an RN and then an NP, you'll find you study ten thousand different things, but - in my opinion - they really boil down to these basic concepts.

Best of luck, and take care!