While many nurse practitioners (NPs) dream of working on their own, those who have done it know it takes a driving passion both for the profession and for owning your own business.
"You have to want this enough to really work for it," says Carol Dalton, a women's nurse practitioner who has started three practices. Currently, Dalton has a complementary health practice within a family practitioner's office at Helios Integrated Medicine in Boulder.
Consider these 10 steps to see if going solo is right for you.
Step 1: Research the Law
State laws governing nurse practitioners vary widely, so learn what kind of practice entity your state allows. Are NPs required to have a collaborating physician, a supervising physician or a limited-liability company, for example? Contact the board of nursing for the state in which you'll be practicing. Carefully review your state's Nurse Practice Act, and look for any relevant advisory letters, documents that clarify an NP's role on certain procedures or hot topics such as giving BOTOX injections. With a wealth of free information, this is a great place to start your research.
Read up on starting your own practice. As a practicing attorney, nurse practitioner Melanie Balestra of Laguna Beach, California, counsels NPs on launching their own practices. Her favorite book on the topic: Nurse Practitioner's Business Practice and Legal Guide by Carolyn Buppert, a lawyer and certified registered NP.
Step 2: Consider the Cash Flow
If you'll be accepting Medicare and Medicaid patients, contact your state Medicaid office to gain a solid understanding of state laws. Fee-for-service plans and HMOs are easier to deal with, says Balestra, who has been a practicing pediatric NP for more than 20 years. Also, since expenses are likely to outweigh income for six months to a year or more, have supplemental income lined up. Some nurses ease into their practice by working part-time elsewhere.
Step 3: Choose a Niche
Dalton's holistic-medicine practice offers alternative treatments to OB/GYN patients who prefer nonsurgical options. Martha Klay, MSN, APRN, in Great Barrington, Massachusetts, chose a niche in continence management -- a growing but underserved patient group. Both receive referrals from physicians who don't feel threatened by their NP practices.
Step 4: Plan and Protect
Develop a business plan, and protect yourself with malpractice insurance. Balestra uses the Nurses Service Organization.
Step 5: Be Official
Check city and county laws governing businesses and licensing of medical professionals. Also, be sure you're in compliance with state and federal licensing laws and certification requirements.
Step 6: Line Up the Logistics
Most NPs will need office space, furniture, an office assistant, a Web site, stationery and startup financing. Possible financing sources include a small-business, equity or bank loan, Balestra says. Dalton kept her startup costs to a minimum, beginning each of her practices using a few thousand dollars of her own money.
Step 7: Build an Infrastructure
To get your business in order, you'll need a competent medical biller, accountant and attorney -- preferably professionals who understand what a nurse practitioner is and have worked with one before. Depending on state laws, you may need a supervising or collaborating physician.
Step 8: Find a Mentor
Klay's mentor, an out-of-state NP also specializing in continence management, has explained business matters and helped her avoid pitfalls. "My mentor is just amazing, just inspiring," says Klay, who gladly compensates her mentor monetarily for her valuable counsel.
Step 9: Ride Out the Rough Spots
Starting a new business is no easy task, especially since the whole concept of an NP is poorly understood by many patients, physicians, insurers, medical-billing companies and attorneys. But don't let obstacles get you down. "Every nurse practitioner I've spoken to is so happy that they have gotten through those barriers," Balestra says.
Step 10: Determine Your Own Destiny
Dalton loves working for herself and can't imagine ever working for someone else. "I get to determine my own schedule, my own income, how much to charge each patient and how much time to spend with each patient," she says. "Starting your business is determining your own destiny. But, you have to be willing to do the work to make that happen."