Independent Clinic as NP

core0 · Sep 21, 2009

I have heard that NPs are allowed to open their own clinic with an MD overseeing, but not necessarily there all the time dependant on states. I would like to know if NPs are usually expected work under a doctor full time for some time, prior to starting their own clinic? Or can an NP start a clinic immediately amoung licensure? Also how can I find out what states allow NPs to work independently? Anyone with experience?
CC

In most states you can probably legally open your own clinic as an NP but the question is should you? The first few years in practice will be formative to learning about medicine. The NPs and PAs that I know that have opened their own practice have a number of years of experience. Also consider that a medical practice is a very specialized type of small business. While owning your own practice may seem interesting it entails a whole different set of problems that you don't have as an employee or partner.

There is a section on advance for NPs that talks about NP owned practices:

http://nurse-practitioners.advanceweb.com/editorial/content/articlelistalpha.aspx?ctiid=1552&rpid=35

The Pearson report contains information about the different state practice acts for NPs:

http://webnp.net/ajnp08.html

David Carpenter, PA-C

Trauma Columnist · Sep 22, 2009

Opening a practice is a business which is something few of us learn in school. If this is the direction you want to pursue, I would recommend doing a combo MSN/MBA program.

coco3299 · Sep 23, 2009

Actually I have an MBA and have owned my own business with some degree of success. So I am aware of the varying complications that accompany the tast- more focused on nursing regulation. :yeah:

Editorial Team / Admin · Sep 23, 2009

Review the links core0 provided as to what your BON requires regarding independent practice. It will depend upon your state.

Good luck.

maziemoo22 · Sep 23, 2009

I'm curious to know whether an independent practice brings in more revenue than working for somebody else? Specifically, a psych practice.

core0 · Sep 23, 2009

I'm curious to know whether an independent practice brings in more revenue than working for somebody else? Specifically, a psych practice.

According to advance for NP they do. Third in fact behind ED and Neonatal:

http://nurse-practitioners.advanceweb.com/article/2007-salary-survey-results-a-decade-of-growth-3.aspx?CP=2

The practices aren't broken down by practice. The 2009 survey may contain more information on this. There is at least on person on here that has their own psych practice they might chime in or you can look through the psych NP posts on the last two pages or so.

David Carpenter, PA-C

maziemoo22 · Sep 23, 2009

Thanks David, I've seen you post on here before and you are always so helpful. Thanks again!

coco3299 · Sep 23, 2009

Im not an NP, but as a business owner I know that many people don't consider the costs of owning a business listed below. I don't know your level of business ownership knowledge (I hate when people assume I don't, eh ehm), but it would depend on your state, the type of reimbursement that you would receive and your population. For example Medicare reimburses for elderly, and Medicaid for younger adults. However adults seem to fall by the wayside often times on the insurance end, then you would be forced to seek government reimbursement that may or may not come through. Some places (from what I hear) such as inner cities pay less, because the demand is lower for NP's, but Suburban areas pay more. With that said consider the cost of leasing a place, insurance (general, professional, liability) administrative costs (secretary type stuff), taxes possibly as a partner or worse as a professional corporation, getting started (equipment), and how you will fund yourself for the first 6 months to a year before the reimbursements become steady. Just a few thoughts.

CC

core0 · Sep 23, 2009

Im not an NP, but as a business owner I know that many people don't consider the costs of owning a business listed below. I don't know your level of business ownership knowledge (I hate when people assume I don't, eh ehm), but it would depend on your state, the type of reimbursement that you would receive and your population. For example Medicare reimburses for elderly, and Medicaid for younger adults. However adults seem to fall by the wayside often times on the insurance end, then you would be forced to seek government reimbursement that may or may not come through. Some places (from what I hear) such as inner cities pay less, because the demand is lower for NP's, but Suburban areas pay more. With that said consider the cost of leasing a place, insurance (general, professional, liability) administrative costs (secretary type stuff), taxes possibly as a partner or worse as a professional corporation, getting started (equipment), and how you will fund yourself for the first 6 months to a year before the reimbursements become steady. Just a few thoughts.
CC

Actually depending on your outlook psych may be the exception to this. Many private practice psych practices that I am aware of operate on a cash basis. They require the patient to pay the fee then collect reimbursement from the insurance company. This decreases expenses considerably. One psychiatrist that I knew in Denver even used self scheduling software. The only overhead was an office. No billing, no insurance contracts no employees. Whether this model would work for an NP will depend on the practice environment. If insurance reimbursement is the norm or their is a surplus of psych providers then it would be tough. Most areas though, have a deficit of psych providers. One of the great joys of working in academia is not having to negotiate with various providers to get my patients seen.

David Carpenter, PA-C

al dente · Sep 25, 2009

I have my own independent psych practice and practice very similarly to the way core0 described. My state allows for autonomous NP practice and the only physician involvement I have is when I ask one of my psychiatrist friends for their input - but there are no legal requirements for any physician collaboration or supervision.

I work with insurance on an out-of-network basis only. My patients pay at the time of service or monthly, and I provide them with the documentation needed to submit a claim. I used to file the claim as a courtesy to the patient, but I have recently stopped doing this (it was taking too much time). The demand for psychiatric services is huge and this is the case in almost all areas of the country. I have over 600 patients in my practice and my phone rings constantly with new referrals. Increasingly, more of my time is spent trying to farm out these referrals as there are nowhere near enough providers.

My overhead/practice expenses run about $27,000/year including my malpractice insurance and a full-time office manager/secretary who I share with 3 other clinicians. My income is greater that what I could earn in a salaried position and the freedom from institutional administrative and bureaucratic BS is what I enjoy most.

coco3299 · Sep 27, 2009

I have worked at a psych facility in the past and the aging population usually are paid for through Medicare which requires billing. Also, I am not sure how insurance coverage would be waived just because there was no billing. Insurance would not only be for employees as general, liability and professional are needed, even for one. I am also confused as to what this psychs basis for practice was with an office and no employees. Was he like an independent that saw one patient an hour type thing? If so,then I sort of see this, but is this likely for a Psych NP?