Part 1: How to Address your Fears and Start Your Business
Updated: Oct 30, 2022
A Guide for the Family Nurse Practitioner's Financial Freedom and Practice
Most healthcare providers are wonderful at their trade, but do not want to or know how to create a business. Even though it seems daunting, as I look back on how I started my private practice, it became clear that the steps weren't actually complicated, getting over my fear of doing it by myself was the hardest part.
Nobody told me I could make more money working less hours.
I quit my job to figure it out, but you don't have to. I did the legwork and now I can guide you to take some small steps towards your own private practice where you can make more money working less hours. There were so many things school did not teach us, but you can still learn and implement it!
Let's be real, starting a business is not easy. All the logistics can seem overwhelming, you're learning a new language of business, you can feel alone, not knowing if you truly understand what you're doing let alone people may critique or judge you. Once you accept that you may not feel competent all of the time, that certain ideas may not work out as you thought, but knowing that you are capable, and can set up your own private practice regardless, it makes waking up and working extremely satisfying.
You need to know your worth! Your schooling, time and effort is money, and this is an investment. You are an investment. It's important for you to understand your strengths and weakness, create short and long term goals and be your own boss. It doesn't have to be full-time, but in creating your own business, you get to set an expectation of your own services and value.
When I was working in a federally qualified healthcare system, the chief executive officer, chief medical officer, and clinic managers were my bosses. They held me accountable to produce positive patient outcomes, see certain amounts of patients per day, hit government quality measures, and bring the company income. That's how businesses operate and most are not truly motivated to help you feel satisfied in life because the goal of any company, regardless of whether it's a nonprofit or not-for-profit is to make money. If you have a wonderful boss, they can help you feel more confident in the workplace, but at the end of the day, you are working within a capitalistic system meant to generate as much income as possible. In return, they offer you stability in terms of a salary and benefits.
However, you can be your own boss, which may be the most difficult aspect of a transition because many of us can't hold ourselves accountable to ourselves as easily as we can to someone else. I personally decided there's a "Boss Nancy" and "Employee Nancy." "Boss Nancy" is a great boss that supports her employees well-being. She is mission-driven, firm, creates structure, expects results, and wants her employees to feel understood and heard. "Employee Nancy" is the health care provider. She is dedicated to learning medicine and therapy, has lots of great ideas, she's a hard-worker, determined to succeed, but also gets absorbed in her insecurities about not achieving enough. How do I balance these two parts of myself? We communicate to each other openly and the needs are discussed in depth. However, you may want to enlist a friend or a coach to help you achieve your goals. Pick people who you know care about your wellbeing and can offer honest and kind feedback because we already know you're already going to be very tough on yourself.
Before I quit my community health job, I wrote a business plan. If you haven't had business experience or know how to write proposals, it can feel a little daunting, but the concept is simple.
What's your mission?
What are your values?
Who are your audience?
Don't think too hard, just jot down your grand visions. I made an easy one-page template you can download below.
When you get the big picture out of the way, go for a walk, drink some water and come back to start working on the SMART details. If you can break down the details, it will feel more tangible to create goals you can reach.
Specific (simple, sensible, significant).
Measurable (meaningful, motivating).
Achievable (agreed, attainable).
Relevant (reasonable, realistic and resourced, results-based).
Time bound (time-based, time limited, time/cost limited, timely, time-sensitive).
What steps are you going to take to get to your mission?
3 month goals?
6 month goals?
1 year goals?
Remember, SMART goals!
Break down your 3 month goal, working backwards.
What are the most important to-do's and dates in those 3 months? For example, I knew I wanted to have my reach in Oregon because of the NP Payment Parity Bill. In the first three months, I needed to apply for my RN and NP license in that state. I heard it didn't take as long as California, but it was going to still take a few months.
One really important thing about starting early is that if you want to take insurance, then it can take up to 6 months to get credentialed (the insurance company reviews your whole career and become a provider under their panel if you're approved). What school and companies didn't teach you and probably made you believe was that if you did private practice you would be paid poorly. If you take commercial insurance you can make at least $100-200 hourly. You would have to check for the rates of Medicaid and Medicare, but even in Utah, the reimbursement is $93 for a 99214. You can always do self-pay, but it would take much more effort to recruit patients.
What goal do you hope to reach in 6 months? By this time, you'll probably already be licensed and/or credentialed. At this point, how do you plan to get patients?
What goal would you like to reach in 1 year? Is this a financial goal and/or how many patients you can obtain?
Now we create structure. Let's focus on this current month: Are there any important dates or to-dos this month? What would you like your week to look like? Create a rough guideline, knowing that it may change as you start.
Break it down even further. What does your ideal work day entail? This is a balance of self-care and productivity. For me, the most important parts were meditating, exercise, and being able to enjoy my meals. You may accidentally add too many things in, but don't be too hard on yourself as you adjust as needed. This isn't you being lazy, this is you maximizing your creativity and conserving your energy so you can do this for the long run.
As you're brainstorming, remember that everything takes more time when you're beginning. It takes a little practice getting those creative muscles in shape.
What services do you want to offer? I recommend starting off with specializing in something and practicing telemedicine. Full-scope practice is expensive due to overhead, supplies, and staff. For those who want to do full-scope, an option is joining a co-op that rents the medical equipment and share office costs.
Let's talk about money! Good-doers like us hate thinking about money, but it's important. Remember, you are your own investment and your creativity is valuable.
What are the start-up costs?
Licensing can vary in each state.
DEA license: almost $1000 at this point
Malpractice license: $1,000-$2,000 per year depending on part time or full-time status
Business license: Usually around $100 for the state you work in. You can start an LLC, Professional LLC, or S-Corp if you're running your own business
Domain names? As easy as signing up for GoDaddy and getting it for $20. Think of whether you want your name or make it a group name.
Website servers? Although you won't need to have lots of social media, it would be beneficial to have a website to book patients. This is an upfront cost of a few hundred dollars for a few years.
EMR cost vary: FNPs would benefit from a system like CharmHealth, which is low cost and you can access all of the ICD10 codes unlike those specifically for therapists.
Office space (can be in your home), but you can sublease as well if you want to see patients face to face.
This is a lot for one post. Follow my website for the second part! If you would like to consult with me, please visit My Offerings.
Even though it's a pain, the planning is going to pay off. Allow your creativity to shine!
With structure and discipline, and support, you can create even when you don't feel like it. That's how you succeed and you CAN succeed in creating your own private practice.