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For many nurse practitioners (NPs), starting their own practice is less a question of if and more a question of when. But how does one gauge if the time is right to open a business, and what barriers can one expect to encounter when they make that decision?
To answer these questions the American Association of Nurse Practitioners® (AANP) spoke to Entrepreneur AANP Community co-chair Erin Athey, DNP, FNP-BC, RN, FAANP, about her experience opening a private practice, developing business skills and leveraging the support of her NP community.
Erin Athey: I've been an NP for 18 years. During that time, I became motivated by the fact that I really didn't like the model of care that was being delivered to patients. I've always worked in under-resourced areas of Washington, D.C. Sitting in a clinic and waiting for patients to come to a typical office setting, 9-to-5, Monday through Friday, when many have issues with transportation, childcare and needing to go to work is incredibly inconvenient — but we just keep forcing that model on people.
I was inspired to set up a clinic that was very different than what I was used to practicing in. The way my practice is set up is that we are embedding primary care clinics directly in public housing in D.C. People that live in those neighborhoods just need to walk down the hall or across the street to get to our clinic.
In doing so, we're really trying to improve access to care and make it as easy and convenient for people as possible. We’re also using community health workers to help build trust, and bridge people back into care that have been out of it for a while. I felt like I had to do this— this is how I want to practice, and I couldn't find a model like this elsewhere.
Athey: When I won the award, it was just an idea, truly. Now it's all about implementation. Since that time, we have set up clinics — one fully established primary care and various mobile vaccination clinics. So, it's really kind of coming to life right now, but it took a while.
If I had to give any advice to NPs, it would be to understand that this process takes time. I think that was one thing that was a surprise to me. I thought, “Ok, I'm going to open up shop and get it going.” But credentialing, contracting and all those things took almost a year to complete for some of the managed care organizations that I'm working with. We are now fully up and running — onboarding some new NPs, hiring a nurse and onboarding some community health workers. It’s really starting to take life right now.
Athey: Get a couple of years of experience under your belt. My experience as an NP has shown me that the first few years of practice have a steep learning curve depending on the environment. I've taught NPs for many years, and I think it's always good to start off in a setting where you're well supported and have resources and folks you can go to if you have questions.
I also think some business acumen is vital. Whether it’s through membership to a professional organization or enrollment in a basic business course, taking something beyond just the clinical component is important because that's the part — unless you have a business background — that’s so completely new and different than being a clinician.
Athey: It’s about culture. I've worked in enough spots where the culture hasn't been right — it's been negative, a bit unprofessional or simply not the most enjoyable place to work. So, for me, the key is finding likeminded folks that are mutually interested in community health and are passionate about working with under-resourced communities.
Getting things up and running is a lot of hard work — there's all sorts of processes and protocols to put in place — but I think if you have folks around you with the same passion and end goal, then you're going to be in a good spot. We might have personal issues or differences in opinions, but we can always go back to the vision and the mission of the company, and I think that keeps us aligned.
That's really what I'm trying to do right now: find folks with this shared passion. It's not for everyone, but there are colleagues that want to work in this space, and I want them to come along and help us grow. I really want to build something that has that kind of positive culture and the passion to serve these communities.
Athey: When I won the Johnson & Johnson award, it provided me with some funding to get started. That was incredibly helpful, but it wasn’t enough to get everything up and running. I ended up connecting with a lot of different folks — through professional organizations, conferences and the NP entrepreneurial events — to help bridge knowledge gaps and receive support.
I had this clear vision of putting clinics in public housing, and I’d tell other NPs to consider where you are going to put your clinic and what type of practice it is. Once you determine if it is home-based or clinic-based, you can find out all the legalities and what type of insurance you need to get started. Insurance is a big thing that I was totally unaware of — it’s not just the insurance that you need as a practicing NP, but the general policies, umbrella policies and coverage for the type of practice you want to have. It may help to find a service provider that can handle things like billing, credentialing and web services to help get your practice off the ground.
I think my biggest piece of advice is to find someone who's done it because they're going to be your best go-to. This experience can be overwhelming, but the AANP Entrepreneur Community really helps NPs start their own practice by allowing them to connect with others that have done it and get their assistance in setting things up for the very first time.
Athey: Our model of care is what we love, right? What really makes us so unique is that we have this very patient-centered model. We want to spend time listening and supporting our patients instead of talking down to them and telling them what to do. That’s our greatest strength.
Then, I think about how to actualize that given the current regulations, insurance barriers and restrictions to NP care. Sometimes you have to act like the circle in the square peg to accomplish your goals. So, how can you be creative with that? In order to do this, you must ask yourself how you can use your nursing background and the nursing model of care to make this system work for you, and help you provide the best patient care possible.
If we can get more NPs out there starting their own practices and partnering with one another, we can build more networking and resources. As we continue to grow, it’ll become easier for NPs both new and old to establish their own practices. I think that movement is happening — in the next 10 years, I'm sure there'll be way more NP run practices out there, and that’s exciting.
Starting and maintaining your own practice can be difficult, but the Entrepreneur AANP Community provides a network of NP support and expertise. Offering a unique opportunity to interactively collaborate with entrepreneurial NPs, join this community today to come learn, share and help progress development of theory and practice.
Designed to support discussion, document sharing, collaboration and networking, each of the 28 AANP Communities maintains a dedicated online forum where you can instantly connect with like-minded NP colleagues and share information.