I am seriously considering opening a practice of my own in Washington state, but have some real qualms about it! I am not sure how much overhead I can afford based on the revenue I will be able to generate. How much rent/lease/mortgage payment is reasonable for an NP practice (primary care)? How well do your books balance at the end of the month and how long did it take you to get “balanced”? Also, how much space are you finding that you need — how many exam rooms per provider, etc?

Thanks for your input!

Susan Vendeland

Today, the Editor of the local newspaper interviewed me for a feature article on my opening practice in Wilsonville, Oregon. He stopped by last night and asked if he could. I was working until 3pm at my other job today, and so did not get much time to prepare. But I quickly called my soon to be “assistant” and asked her if she would “pose” as a practice patient, and she did not hesitate to help out. I was happy to be asked, and included in the interview was the always asked question “what exactly is a nurse practitioner?” I think we still need to include this information in all our brochures, websites, and articles. The cultural climate is changing but slowly, and there are still the commercials that say “call your doctor” and the images of Marcus Welby…. We now are seeing new images from the large medical groups, with very artistic commercials about doctors expressing caring about “the whole person”, and health prevention, and integrative medicine. Medicine is a business, and NPs need to keep up.

I just feel privileged to have the opportunity to open a practice. My biggest issue right now is financial, as I did not have an ideal job set up that met my financial needs prior to starting the practice. Finding space in this neighborhood was difficult, and when the office came up with the right price, I grabbed it.

I have decided initially to go full bore into the practice, with aggressive marketing in the yellow pages, the chamber of commerce as a “gold member”, letters to merchants and the pharmacies, and soon will have an open house. If the finances takes longer, I may need to reduce hours, keeping some evenings and weekends open, and take a second job. But until I get credentialed, I am going to market the uninsured, and also assist those that need to get help with prescriptions. Every drug manufacturer has a program called “patient assistance program, and while not all, a good many of their pharmaceuticals are on this program. If the patient needs the medication, and has the income that matches the criteria, they can get their medications free of charge in their own labeled bottles, (not as samples) and they come in 3 month amounts. But they do need to be picked up at a provider office, so this is another way to assist patients, while also marketing your practice. I believe these patients will pay it forward by speaking positively about the practice to those they meet.

In regards to Joe’s comments, I think it is awesome that he is able to lease space as a psychiatric NP for his own practice from a psychiatrist. I still fully believe that all health care providers can work together in our current healthcare environment, rather than against each other, and that there is enough healthcare out there for all sorts of providers. Each patient is unique and will have unique provider needs. It is a matter of choice. Regards, Carla Anderson

One year ago I made the decision to open an independent psychiatric NP practice in a local community. In an effort to minimize my risks and lessen the amount of footwork that would be required I accepted a position as a psych NP in a nearby hospital. This helped me get to know the lay of the land as well as some added perks. The hospital has a credentialing person who gets the clinicians on all the insurances. This was helpful because I didn’t have to take all the time filling out the paperwork or returning phone calls ect to get on them. Secondly, when I was ready to step out on my own I simply had to write letters to each asking to add another office/practice. Quite simple to do.

Also, the hospital reimbursed me for getting my licenses in the state as well as for my DEA number (all of which went with me into the private practice).

My arrangement is fairly simple and psychiatry (as you might imagine) has low overhead costs. I lease a space from a psychiatrist. I pay her for office space, collaboration, billing and other incidental expenses. I had the expense of purchasing all of my own office equipment such as desk, computer ect… I set my own hours and use my own forms/paperwork.

At this point I am working both my private practice as well as my full-time position. (Private on Weds evening as well as 2 Saturdays a month). By the end of summer I will be able to go 50% full-time at the hospital. This helps me with health insurance costs, although I’ll be paying more than I am now, it is still significantly cheaper than footing the bill by myself.

I am hoping that next spring I will be into my private practice full-time.

I would be happy to share information on the dynamics of my practice if anyone is interested. Working Weds evening for 3 hours and two Saturdays a month for 4-5 hours each day has now built into about $2200 net each month. That is take home after paying expenses (not taxes though).

Joe Reis NP