What prevents a NP from opening up shop?

  1. In my state, Arizona, NPs can practice independently of physicians. Not that any good healthcare provider doesn't consult with their colleagues, but the law as I understand it, allows NPs to be sole providers.

    What prevents NPs from opening up 'Arizona Family Medical Center' (theri own practice..)? Do insurance panels not cover them? I am trying to understand such dynamics. It's no secret that family physicians and GPs are on the decline in serious numbers which will/is introduce a serious deficiency in primary care.

    I believe NP (and PA) will ultimately become THE primary care providers and insurance panels and state/fed laws will be revised to allow people access to mid level practitioners as a whole.
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    About revolution

    Joined: Sep '08; Posts: 42; Likes: 1

    4 Comments

  3. by   core0
    Quote from revolution
    In my state, Arizona, NPs can practice independently of physicians. Not that any good healthcare provider doesn't consult with their colleagues, but the law as I understand it, allows NPs to be sole providers.

    What prevents NPs from opening up 'Arizona Family Medical Center' (theri own practice..)? Do insurance panels not cover them? I am trying to understand such dynamics. It's no secret that family physicians and GPs are on the decline in serious numbers which will/is introduce a serious deficiency in primary care.

    I believe NP (and PA) will ultimately become THE primary care providers and insurance panels and state/fed laws will be revised to allow people access to mid level practitioners as a whole.
    There is nothing to prevent an NP to open their own practice. However, running a medical practice is incredibly difficult in todays practice environment. NPs face additional hurdles including difficulty getting on insurance panels, lack of ability to follow their own patients in the hospital and public perception.

    All of these can be overcome, and individually they don't present insurmountable challenges, collectively they are very difficult to overcome.

    That being said the number one reason that businesses fail is they are insufficiently capitalized. Are you willing to put up the money for the months necessary to open the practice. Even if you manage to open the practice can you get a decent mix of payors to make money. The reason that physicians are leaving primary care is that reimbursement is strongly skewed towards procedure driven specialties.

    Finally if you think that you can open a practice without physician involvement, you would have to give up on Medicare which requires a collaborating physician.

    Take a look at advance for NPs. There are lots of stories about successful NP owned practices, but also note the struggles they went through:
    http://nurse-practitioners.advancewe...repreneur.aspx

    http://nurse-practitioners.advancewe...ent-Model.aspx

    http://nurse-practitioners.advancewe...n.aspx?RPID=35

    David Carpenter, PA-C
  4. by   Dr. Tammy, FNP/GNP-C
    Quote from revolution
    What prevents NPs from opening up 'Arizona Family Medical Center' (theri own practice..)?
    If it's a solo practice or a practice concerning only NP's, I'm not sure how the term "medical" would figure in the title. Remember, NP's are not licensed by medical boards as a physician and surgeon, hence NP's are not licensed to practice medicine, hence NP's holding themselves out as practicing medicine may find themselves in both administrative (license) and criminal (misdemeanor) hotwater for holding out as practicing medicine to the public.

    Perhaps repalce the term "medical" with the term "nursing" or "health" or "primary care" or another term that does not advertise that the organization is providing medical-model based care.
  5. by   KatieRN04
    There are NP's in AZ with their own practice since the scope of practice doesnt require a MD be present in the same facility. There are a few other states like this also. There are even some NP's who run their own speciality clinics such as cardiology. However, that being said, even though there is not an MD present, there is a collaboration with MD's as colleagues, if advice or a second opinion is needed. Even in the government run facilities, like the VA, many of the primary care clinics (including speciality areas) are run by NP's with referrals to MD's if the case is to complicated. Although from what I am aware after talking to a few of the NP's in these positions, you are expected to have the knowledge, and many of them spent hours of studying after graduation, to get up to the pace, they were expected to be capable of.
    This advancement in the NP world has accomplished many feats, but not without battle from the AMA who would like to dictate the scope of practice for NP's similiar to how the PA's are practicing. Hence, one of the many reasons, for the proposed DNP as entry level to practice. This is an entirely different topic though, and like many will probably say, there are many threads on the DNP already in existance.
  6. by   ANPFNPGNP
    Quote from revolution
    In my state, Arizona, NPs can practice independently of physicians. Not that any good healthcare provider doesn't consult with their colleagues, but the law as I understand it, allows NPs to be sole providers.

    What prevents NPs from opening up 'Arizona Family Medical Center' (theri own practice..)? Do insurance panels not cover them? I am trying to understand such dynamics. It's no secret that family physicians and GPs are on the decline in serious numbers which will/is introduce a serious deficiency in primary care.

    I believe NP (and PA) will ultimately become THE primary care providers and insurance panels and state/fed laws will be revised to allow people access to mid level practitioners as a whole.
    I didn't realize that NP's in Arizona were completely independent...I thought they had to have a "collaborative" agreeement with a physician the way we do in TX.

    It is very difficult to set up a practice b/c I've been trying to do it for the past 2 years. I have a friend who has her own clinic and it has taken her over 1 year to even get listed as a primary care provider with insurance carriers. Up until now, she only accepted cash. Fortunately, she had about 100K to keep her afloat...not many people have that much cash. She has to pay a physician $1,000 a month to be her collaborative physician. She has her daughter and mother help her in the office...for free.

    I know a number of physicians who have tried to establish a practice and it's just too expensive. Several of them have gone to work in the ER where they're paid well and don't have any overhead. So, it's not just NP's who aren't willing to go out on their own.

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