(Pulse Check #56) Understanding Scope of Practice

Waist up portrait of smiling female nurse and doctor posing looking at camera while standing with arms crossed in modern clinic, copy space

Healthcare Boss,

It's been a while since we've talked about scope of practice, so I thought it would be worth revisiting.

It's the number one question we get, and it's not as daunting as it appears.

Physicians, this is important for you to understand when you're looking to hire clinicians that are not Physicians, it can also be an income-earning opportunity, so don't skip this.

The first thing we need to make absolutely clear, you need to speak to a local attorney about the specifics of how scope of practice impacts your business model.

This is too important to simply look up your nurse practice act or trust someone who isn't an attorney, even if they have the same license as you, even if they own a clinic in your state. They could be being operating out of scope and not even know it.

Laws and regulations are notoriously difficult to read and understand. It's kind of like trusting someone off the street to insert an IV. They might get the concept, but there's a good chance they won't be able to do it right. The same goes for scope of practice. The best attorneys have experience and training in this area.

But that doesn't mean you should walk into an attorney's office and ask them if you can open a clinic. Attorney's will be more than happy to bill you by the hour as they do all the research to answer every detail of your questions. That can get expensive quickly!

Instead, read your practice act first. For nurses, it is called the nurse practice act. Each license type has its own and a link is usually found on your respective licensing board's website. Get very familiar with it, take notes, highlight parts that apply to your license, and mark the areas you don't understand.

Once you've done that, collect your notes and schedule an appointment with an attorney. Be very specific about what you need to know and how you plan to structure your business.

The main questions: With my license type (in my state) can I practice independently? Do I need a physician to collaborate with or supervise me?

Here's where a lot of nurses give up too soon. Many believe that if they live in a restrictive state, they can't open a clinic.

You can still open and own your clinic in just about every case. The way you structure your clinic is the only thing that will change. CA and NY are certainly the most challenging though.

Hiring a physician to collaborate/supervise should be considered a normal cost of doing business in states that require it, just like paying the electrical bill or spending money on advertising. Depending on your state and the level of involvement required will determine how much you should pay them. Typically a hands-off collaborating physician fee is around $750-$1500 a month.

You do not need to give them ownership in your business unless your state explicitly requires it, those states are called CPOM (corporate practice of medicine) states. You do not have to pay them a percent of your profits either, in some states that is illegal if it is structured wrong. If someone is insisting on that, look elsewhere unless you know them well and are truly looking for a partnership.

The truth is, being a collaborating physician for a private clinic doesn't take up that much time and can be a great little side income for someone. In fact, I know some physicians who supervise or collaborate with dozens of clinics across multiple states and they earn an extra $20-$30k a month for this easy PRN roll. So look around, many are eager to earn the extra income. Find a salary you're both happy with and pay them a fair rate for the role, it is a joint effort and a win-win for both parties in those restrictive states.

I've talked to many healthcare professionals who are afraid to say no to a potential medical director's demands because they think that is the only physician they could possibly find. Trust me, make a job post on indeed and you will likely have dozens of applications within a few days.

There are even companies that help match collaborating physicians with clinic owners, but they WILL take a fee for that service. I recommend you start asking people in your network. First, there's an excellent chance you probably already know someone who would be interested. If not, post the position online.

I can't emphasize enough that needing a physician supervisor and finding one is not a big deal.

In NM I had to hire an independent Nurse Practitioner when I started my clinic since the CRNA scope of practice is so limited in the outpatient world. It ended up being one of the best things that could have happened.

The main point I want to emphasize is that there is always, a solution to every “problem” or obstacle. A key trait you need to develop to be a successful clinic owner is to focus on solutions, not problems.

Stop asking IF you can do it and start asking yourself HOW you can do it. That tiny reframe in your thinking will change your life.

If you'd like a more in-depth look at understanding rules and regulations, you're in luck. We just added the full rules and regulations lesson from our Academy programs into the free trial.

As we've been looking at new ways to help healthcare professionals decide if opening a clinic is right for them, we thought making this lesson available for free before enrolling in any of our Academy programs was a no-brainer.

If you'd like to get a free 14-day preview of either course and check out the full Rules and Regulations lessons, click one of the links below.

IV Therapy Academy Free Preview

Ketamine Academy Free Preview

Cheers,
Jason Duprat, MBA, MSA, CRNA, APRN

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