Starting Your NP Practice Changes More Than…

The day you open your practice, you’re not only the NP; you’re also the practice owner.

While this shift is immediate, your mindset takes longer to catch up.

Frequently, NPs who become owners think of it as clinical practice with greater independence.

Now they can:

• make their own decisions
• choose how they care for patients
• and create an environment in line with their values

Clinical aspects are important, but they’re only part of the picture.

Opening a practice comes with additional responsibilities, including the financial, operational, and strategic health of the business.

While you become the legal owner in a single day, with the stroke of a pen, learning to think and act like one is a gradual transition.

Clinical Autonomy Is Not the Same as Practice Ownership

Wanting greater clinical autonomy is why many NPs consider starting a practice.

They want more control over patient care, scheduling, services, and the overall patient experience.

But clinical autonomy and practice ownership are not the same.

• Clinical autonomy gives you greater control over how you practice.
• Practice ownership gives you the responsibility for creating and maintaining the business in which that care occurs.

As a practice owner, you must think about pricing, expenses, cash flow, marketing, patient acquisition, policies, technology, vendors, compliance, staffing, and long-term planning.

You must decide which services to offer, how to deliver them, what they cost, and whether the practice can provide them sustainably.

While you may be comfortable making independent clinical decisions, you may feel unsure about making business decisions.

That’s normal, and to be expected.

And it doesn’t reflect badly on you, nor does it indicate a lack of ability. All it reflects is a lack of training and experience in an area that’s new to you.

Clinical experience prepares you to care for patients, but it doesn’t automatically prepare you to run a business.

Why the Transition Feels Uncomfortable

As an NP, you’ve spent years developing your clinical knowledge and skills.

However, moving into new territory, like practice ownership, can make you feel like a beginner again.

Initially, your new responsibilities will feel unfamiliar and uncomfortable.

Negotiating contracts, evaluating vendors, understanding financial statements, setting fees, marketing your practice, enforcing policies, and making impactful decisions… takes adjustment and a shift in mindset.

While the discomfort can cause some NPs to question whether they’re cut out for owning a practice, it usually just means they are learning new skills and getting used to their new role.

Just as you had to develop your clinical skills through learning and experience, you will, in due time, develop your business skills in much the same way.

You Must See the Whole Picture

As a clinician, you’re trained to focus on the patient in front of you.

As a practice owner, however, you must continue to focus on the patient while also considering how each decision affects the practice as a whole.

Here’s what I mean…

• Waiving a fee may help one patient, but repeatedly making exceptions will weaken the practice’s payment policies and hurt the bottom line.
• Offering extended availability may be convenient for patients, but it may leave you exhausted and frustrated over time.
• Adding a new service may sound promising, but more activity doesn’t necessarily produce more income for the practice.

As the owner, you must consider patients, finances, operations, compliance, staff, and personal capacity… all at the same time.

Owning a practice as a clinician requires a broader perspective and makes for responsible ownership.

Because if the practice struggles financially, becomes difficult to operate, or depends entirely on the owner’s personal sacrifice, it will be unable to serve anyone in the long run.

But when you protect your practice, you also protect the services it provides to the community.

Still Acting Like an Employee?

Starting your own practice will not erase habits shaped by years of employment.

As an employee, you worked with systems created by someone else.

Someone else determined pricing, established policies, negotiated contracts, maintained technology, dealt with finances, and planned for the organization’s future.

But once you become the owner, those responsibilities do not disappear. They transfer…  and become yours.

Sometimes, new practice owners continue to focus almost exclusively on clinical work. It’s where they feel at home; it’s where they feel most competent.

And all too often…

• Administrative tasks are treated as inconvenient interruptions.
• Financial reports are avoided.
• Marketing is postponed.
• Policies, if they exist,  are handled inconsistently.
• Planning is pushed aside by whatever feels most urgent at the moment.

But the practice cannot manage itself while the owner concentrates only on patient care.

If the practice owner is unwilling to pay attention to cash flow, pricing, marketing, workflow, or expenses, someone else has to step into that role.

You don’t have to do everything yourself, but you must ensure that the important work gets done.

Accepting Two Professional Roles

Becoming a practice owner does not require you to abandon your identity as a clinician; it means expanding it.

You now have two legitimate, distinct, and necessary roles.

• As the clinician, you protect the quality and integrity of patient care.
• As the business owner, you protect the viability and direction of the practice.

Sometimes, these roles may seem to be in direct conflict…

For example…

• You may feel uncomfortable discussing money with patients
• Enforcing cancellation or financial policies
• “Firing” a patient from your practice
• Limiting after-hours access
• Discontinuing a service patients appreciate but the practice cannot afford to provide

However, being mindful of revenue, expenses, policies, efficiency, and profitability does not diminish your commitment to patients.

Your practice must stay financially and operationally healthy to stay in business and provide care to the community.

Your clinical mission and business objectives don’t have to be opposing forces.

Remember, it’s the business that makes the mission possible!

Growing Into the Owner Role

The transition to your new role begins when you accept that business knowledge is necessary and must be learned, just as clinical knowledge was.

It begins…

• When you start setting aside time to work on the practice, not only in it.
• When you start reviewing financial and operational information regularly.
• When you create workflows and systems rather than handling everything as a unique event.
• When you take a proactive stance to deal with problems instead of ignoring them.

Don’t shy away from getting professional help when specialized expertise is needed, while recognizing that the final responsibility for the practice remains with you.

At times you will have to make decisions without having all the answers.  Some decisions will work; others will need to be revised.

A poor result does not automatically mean you are a poor decision-maker; oftentimes, you’ll gain insights that help you make the next decision.

Over time, you’ll notice that now you’re anticipating problems instead of reacting to them.

You’ll start asking how a decision will affect the entire practice and become more comfortable reviewing the numbers, enforcing policies, changing ineffective systems, and seeking help before a problem becomes a crisis.

These are signs that you’re developing as a practice and business owner.

In Summary…

Practice Owner… is a role you grow into.

Starting a practice gives you the title of practice owner, but becoming confident in your new role takes time.

There’s no need to stop thinking like a clinician. After all, your clinical expertise and experience are essential to your business.

What is required is expanding your perspective and developing the skills required to operate a business.

Your practice and patients need an outstanding clinician, while your business needs an engaged and capable business owner.

When you learn to care for your business with the same intention you bring to your patients, your business becomes better and stronger.

We want to hear from you; tell us what you think, leave your comment below…

By Johanna Hofmann, MBA, MAc., regular contributor to the NPBusiness blog.