Traveling Down Multiple Revenue Streams

Guest post by Dr. Nancy Dirrubo, DNP, FNP and travel health expert. More about Nancy below:

Few businesses thrive without more than one revenue stream. Primary care practices add cash only services such as cosmetic dermatology. Some practices sublet space to other providers and collect rental income and benefit from increased exposure. As an NP business owner who owns a travel clinic, I also offer hard to find travel products and provide continuing education with a new twist. Travel.

Photos credit flippinyank (Creative Commons)

Photos credit flippinyank (Creative Commons)

Imagine getting CEU’s for a unique educational experience where you will rarely see a power point slide. Where you get to observe, discuss, question, and interact and come out thinking in new ways about some big problems. “Health Care in Cuba” is an international, intercultural program where a small group of us will see how Cuba went from sugar plantations, playboy playgrounds, rebels and revolutions to an emerging small island country with health outcomes that are equal to or surpass industrialized countries (as measured by the World Health Organization).

cuba clinicHow do they accomplish this? Over 40 years ago they figured out that investing in primary care was the biggest bang for their dollar. With very tight financial constraints, their solutions to health care problems was to fix the system. They set up primary care teams of physicians and nurses working together in communities of up to 130 families. Individuals are patients seen within families, within communities that are part of the districts and the country. And all of this stems from the primary care physician and nurse team. So, the community itself is also their patient. They observe public health issues and watch for patterns of communicable diseases. When a public health problem is identified, a plan to intervene for that community is put in place.

The physician/nurse team has a clinic in the community. They make house calls. They are required to live in their neighborhoods, too. Secondary care is provided at the regional polyclinics where lab, imaging, PT, OT, dentistry and complementary medicine such as acupuncture are available. Complimentary medicine is included in the medical and nursing school curricula. If tertiary care is needed it is provided in the larger cities and includes surgery and specialty care. ON this trip we will and meet with Cuban health officials, nurses, urban planners and visit community clinics, a maternity home, elder care facility, a CAM clinic and talk with gay rights advocates. We will experience Cuban culture, art, cuisine, and music.

So what can we learn from a country that spends 96% less on health care than we do? “Health Care in Cuba” November 6-13, 2015 registration ends July 31. Where should we travel next?

NancyDirubbo, DNP, FNPDr. Nancy Dirubbo, family nurse practitioner is an avid traveler and the founder of Travel Health of New Hampshire. In addition to traveling and working with travelers, she speaks and teaches other healthcare providers about travel health and how they can add travel health services to their practice, or indeed create a travel health business of their own. You can learn more at


Comments 6

  1. Post
  2. Nancy:
    I have been an Adult NP for 15 years with a total of RN 30+ years. I am now trying to find the right place for me in this everchanging world of healthcare. I recently moved to Rio Rancho, NM a suburb of Albuquerque. I have been working at doing Health Risk Assessments for the Medicare Advantage programs. I needed a break from the Nursing Homes and being on call that took most of my life for those 15 years. This was very refreshing and I enjoyed it tremendously, but there isn’t any job security since it is so seasonal for production.

    I am interested in the trip to Cuba. But, most of all I am curious about your Travel Business. How can I find out more about what a Travel Business entails? Are you talking about Locum Tenem? I think it is wonderful that you are so involved and learning what other cultures and countries do!!

    Our nation, needs some help, especially the state of New Mexico, as they have poor health care from what I have seen. Healthcare here has become all about production and not so much quality. There are not enough healthcare providers, that want to work in a Medicare Advantage Program. The Medicare system keeps decreasing the reimbursement and the influx of baby boomer population on Medicare have caused a different attitude about healthcare. Providers here have to see 30 patients per day and have their face in a computer, not really caring for the patient or giving them much eye contact. Most of these changes are the result of the restraints and low reimbursement the providers have to contend with. I am sure there are other places in the US that have the same problem. I am not ready to give up, unlike so many other health professionals have done, due to all the frustrations mentioned above, but then the additional frustrations of ever changing software programs of EMR. This is a big learning curve for most of the senior tenured, experienced providers. Most have just gave in and retired, as young as 50 years old! Thank you for any information you can give me on the Travel Healthcare Business you own and how it works.

    High Regards,
    Carri Laws, ARNP-BC

    High Regards,

  3. What a great opportunity to travel, share your knowledge, educate patients and be educated by the locals. This is a win-win opportunity.

  4. Carri,
    Thanks for your comments. Many people confuse travel health with travel nursing or locum tenem. A travel clinic prepares clients for safe international travel by immunizations, Rx and advice and counseling. So in my clinic the patient travels not me. But separately, I am an avid traveler and love to teach. So I expanded my practice to include both of these as well. I had my own primary care clinic for 30 years and last March closed it. I like to say I have rewired not retired. In this uncertain health care environment we all have to find what works for us and our clients. If you look at my web site www. you can learn more about how a travel clinic runs. Best to you!

  5. Helo,

    I Have done some travel counseling in the past and really enjoy it. The agreement was ended between me and my collaborating Physician when the hospital closed the practice. I would love to get started again . Where can I get the continuing education I would need to practice? I keep up to date with the yellow book and CDC. Is there any other resources I can use, especially for medication alerts etc.

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