NP in.....fitness and wellness?

sauce · Nov 21, 2015

I own a gym on the side, doesn't make as much money as practice (i work in er) does but its pretty easy. would be difficult in an urban area since gyms are usually multimillion dollar facilities but it might work in a rural area where i live. but then again most people in rural areas don't work out. unfortunately all of these great ideas usually are more difficult than they sound. Gyms are not a very profitable business and the most profitable ones make their money off of long term contracts and the hopes people sign up for 2 years and don't lift at all.

Sounds like this is far out since you are waiting for your husband to finish school but you could always just buy a few bikes and treadmills and throw them in the clinic and start with that. starting a clinic is the hard part though, you prolly wouldn't want to start the gym section until the clinic is up and running and profitable, so i would probably (if i where you) focus on that first.

Most patients aren't interested in getting in better shape and usually when told to exercise they snort and finish their cheeseburger, but there may be hope for some.

Just don't count on it bringing in mega bucks. its very difficult to couple a clinic with some other sort of facility, unless its an attached pill mill. lol.

Also, I wouldn't get a PT license yourself unless you are HARD set on training people. I mean... trainers cost like 15-20 bucks an hour and are a dime a dozen. It may work better to just hire somebody to train them. As a provider who can bill for hundreds of dollars per hour do you really want to train people when that can be delegated to somebody with a trainer Cert. (training certs are usually pretty easy to obtain you basically pay some money and pass a first grade A and P test and your certified to teach people to move around and burn calories)

greygooseuria · Nov 21, 2015

Thanks sauce! I know of two endocrinologists I follow on facebook (both are bodybuilders) and they had mentioned adding a gym to their practice. They are definitely in the "lifestyle is medicine" group but only used evidence based practice and I admire them a lot, so I thought that more practices like that must exist but perhaps they're the anomaly.

sauce · Nov 21, 2015

They might I just haven't seen many in the southeast. But we are the laziest section of the country also so i mean probably not completely representative of the whole (gosh I hope not)

Gym equipment is pretty expensive new, I would get used (commercial grade) equipment. I mean a new treadmill for commercial use is like 5k for a good one but you can get used for 1-2k

Same thing with weights and machines, the markup is very high, but there are so many gyms that go out of business with a little time it is not too difficult to find good deals on used stuff.

You can also lease equipment, I forgot to put that in there.

But if i owned a practice and had some extra space and there wasn't a hospital based gym around or a Y or something of that sort for soft-core lifters I would probably just buy 1 tread 1 bike 1 elliptical, some light dumbbells and one good multipurpose station. you can get all of that for around 5k if you look closely. New it would cost around 10k but again new is not the way to go, unless your practice is bringing in like 500k a year or something insane.

Ggraf · Nov 22, 2015

The NP I see personally has a gym in her offices. She practices from a wellness perspective. I actually see the need for her to add a nutritionalist to her practice because people need allot of practical help making eating plans.

You might look for practices that focus on Functional Medicine. The national professional organization advertises for openings in the type of practices you're describing.

xenogenetic · Nov 22, 2015

I second what Sauce stated. I used to have my PT certification (NSCA CSCS). The issue that I envision you running into is that you and your husband are not easily replicated, and in morphing any business into a big success usually requires you replicaing what you created in your local area with you in other areas. Very hard to create another *you*. The only other business angles would be to teach and sell others (as franchisees) your system for a fee and ongoing royalties. Lastly, you could escalate your fees where you do private coaching and seminars (like an Anthony Robbins does) for very, very wealthy customers, but you would have to really be a one in a million guru. Bottom line is to always use your time, which is finite, to the highest and best use. And if setting up a practice with your husband and becoming certified in PT revs your engine, then that may be the best use for you because you derive inherent joy from that...but might not be the most profitable in terms of dollars and cents. Which is ok, just don't delude yourself. But, always remember the old saying that usually people on their deathbed rarely regret not working more or earning more money, they regret not having more of the experiences with their friends and family, and more days of good health. Good luck to you!

FolksBtrippin, BSN, RN · Nov 22, 2015

I'm a yoga teacher in school to be an RN and eventually NP. Sauce has given you some good advice. Getting a personal trainer certification is unnecessary for an NP. It's even unnecessary for me, a yoga teacher.

I am coming to the same place you are from the other direction. I ran my own yoga business successfully but I want to do more.

I think the way to start this, is to find a personal trainer and a registered dietitian that you trust. I would also find a good yoga teacher, who knows how to teach many populations. Start by writing scripts; eg. weight training 2x per week, 150 minutes moderate cardio per week, consult with dietitian, hatha style yoga 2x per week. If someone doesn't know where to go do this, you refer. They refer people to you as well. My clients ask me to recommend providers to them all the time.

Eventually, you can rent out space in your office to those people you trust. Or you can hire them, but I personally wouldn't go that route.

If you have an urge to participate in the personal training aspect somehow (it is fun) I recommend you do it as a health promotional event.

Best wishes

sauce · Nov 22, 2015

Or if your feeling extra spicy make a moderate sized facility and let a PT (not personal trainer, an actual physical therapist) use it for his or her clients while collecting a fee from the PT.

BeachsideRN, ASN · Nov 22, 2015

Also check your state laws regarding nutrition counseling some states are very specific and that scope is for RDs only

carachel2 · Nov 23, 2015

Just to add a few thoughts to the great advice you've already received:

-insurance companies provide very little reimbursement if any at all. Most people won't even do much needed physical therapy if it isn't covered, yet less join a wellness program. Co-pays for PT are sometimes sky high and after 2-3 sessions most stop going.

-The winds of change are blowing for cardiac rehabilitation and the Medicare requirement that a physician be present at the cardiac rehab facility are starting to be pushed down. Have you ever spent any time in a cardiac rehab facility? You may find that it combines your passion for exercise and wellness with the clinical side of the career you are pursuing. I have a degree in clinical exercise physiology and am also an RN/FNP. I worked for years in cardiac rehabilitation and found it was a great combination of roles.

-you can integrate your passion for fitness into your primary care role. While you won't be directly reimbursed for the wellness counseling, if you are passionate and personal with your care you will find yourself with a panel of patients who don't want to be on meds and who WILL respond to active change guidance.

Good luck!

Nacki, MSN, NP · Nov 24, 2015

My new job does just what you describe minus the chronic disease management and gym. We see corporate employees who want to come in for either general health and wellness or weight loss, so no walk-ins. All patients are out-of-network so no insurance to deal with. We get paid by the corporate contracts I'm assuming.

Our team consists of a MD, NP, nutritionist, allergist (for allergy testing), nutritionist, NCV and ultrasound tech. We do not have a gym onsite, but do refer them to local partnerships we have. In addition, we will be starting up a program for those who want to go for a walk at the local mall during our clinic hours since we are open on Saturdays.

Patients can come and see us in the office or go to our mobile clinic (mobile bus) location which is generally twice a month. Like I said, we strictly see patients that work with specific employers we have contracts with and we do not do insurance verification since we are out-of-network.

I specifically sought something "out-of-the-box" for my NP career because I despised throwing pills at patients who truly didn't want to care for themselves and just wanted a quick fix with medication. My per-diem job is also in wellness. At that job I just consult patients on Metabolic Syndrome and how to avoid or reverse the condition.

In the future I envision doing something similar to what you want to do, (opening a wellness clinic with a fitness studio connected) but I need to get all the details ironed out and save enough money to do so. I'm thinking 5 years. Good luck on your endeavor!

carachel2 · Nov 24, 2015

Designer NP...I would love both of your gigs! I would be interested in hearing more. How did you find out about these opportunities?