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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Barriers to Success

We have all been there. Every single one of us. Working that awful job with some asshole physician “supervising” you:

Telling you to go see that vaginal discharge because they don’t want to.

Telling you to pick up more patients because they are trading stocks on their tablet.

Telling you you shouldn’t prescribe that antibiotic.

Telling you that you didn’t treat that patient right. And on and on it goes.

We have all experienced it.

Some of us have been fortunate to be “supervised” from a physician across town. Sure they are signing off on your charts but you have never met this person. I practiced at an urgent care for almost 2 years and NEVER met my supervising physician. I contacted her 2 times in 2 years for advice. You know how much they were paying her to “supervise” me? $4000 a month! Ya that’s right, $4000 bucks. That is $4000 that should have been going into my pocket!

Many of us also live in very restrictive states. There are some states that don’t allow NP’s to prescribe schedule 2 drugs. Some don’t allow NP’s to prescribe suboxone. Others require direct in house supervision.

The list goes on… There are a multitude of barriers to your success, all thanks to medical association lobbyists. So how do we get around these barriers? There are a few ways. Some are tough but the risk is well worth the reward.

  1. Move the hell out of that restrictive state. I am dead serious. I left the slavery southeast and moved out west. BEST DECISION I EVER MADE FOR MY CAREER. There are 22 states with full NP practice authority. Many of which are fantastic places to live.
  2. Consider telemedicine. You can practice in any of those 22 states independently via telemedicine while living in the most restrictive state. So you could see patients independently in Washington state over video chat or even the phone while sitting in your supervising physicians chair after he has left. Hah, that’s an idea!
  3. Partner with a physician in the restrictive state you live in and open a side hustle. Make sure its 50/50. The physician has the same amount of skin in the game as you and acts as your “supervisor.” This sounds great in theory, but I suspect in practice you would be hard pressed to find a physician willing to do this unless you have a relationship with them.
  4. Start a side business outside of NP practice. Many have done legal consulting but this has been overdone and lets face it, a jury is going to look more highly on the MD than the lowly NP during a malpractice trial. Perception is reality. Others do continuing education, teaching, etc… I suggest a business completely outside of medicine. More to come about that in future posts.

These are the top 4 interventions you can implement in your life to get past the barrier to your professional growth. As long as you work under a physician in a restrictive state, you will never reach professional actualization or true freedom. Being supervised is modern day slavery. Just like student loans. You will never be truly happy if your a career and goal driven individual if you live in a restrictive state. Plain and simple.

I have worked with multiple NP’s who have worked their entire careers in a restrictive state. As they reach the latter end of their career they develop an inferiority complex. Or the opposite, they know they are equal to a MD yet can do nothing more with their career. They become bitter and are stuck with no upward momentum.

Do you want to end up that way? Hell no, neither do I. That is why I changed the trajectory of my life. So can you!

I urge each and everyone one of you to look at your salary. Do you believe you are being compensated fairly?

Look at your current job and the future outlook with it. Do see yourself doing the same old shit, day in and day out over many years? Or do you see your career growing year after year? I suspect when you look at the reality of it, there is little growth.

Most professionals see yearly raises and promotions. Do most NP’s? NO. It is the same job and position year after year. You are lucky if your salary continues to grow with inflation. The only growth a lot of us will see is more work load.

These barriers can be overcome. Many have broke past them. You can too with the appropriate due diligence, planning, and risk.

8 Responses

  1. Interesting, I totally never considered doing Telemedicine and seeing patients in a non-restrictive state while living in Califonia!!

    1. Absolutely. But be aware that finding a telemedicine job might be difficult. So think about a niche that you could capitalize on and start your own telemedicine practice. The overhead is very very low. The biggest expense is marketing.

      1. Please share more on how to start one. I am interested but dont know where to start. Can one do that without doing Primary care?

        1. Yes you can start any practice you want whenever you want. It is not difficult starting a practice. If you need a consultation I can help you get something up and running. Otherwise do you have a particular question?

  2. Finally. Someone “says” what we (NPs) have been thinking. I’ve been wanting to do telemedicine for patients in Hawaii while I’m in Texas. I’m licensed in both states. My problem is where to start, and let’s face it..when living in Texas you have a general fear of prosecution (along with persecution) just for being an NP, add to that being a woman, and thoughts of being burned at the stake come to mind. Great blog, and great advice. Thank you Justin!

    1. Hi Leslie,

      You need to put those fears out of your mind. If you practice medicine in Hawaii telemedicine, you cannot be prosecuted in Texas. Its totally different laws. The BON or the BOM cannot do anything about it. You are practicing within your scope in another state. Go for it. Start by looking at what services are in HI and try to find a niche need. Starting a telemedicine practice is simple. I will be posting more details on that in the future. Let me know if I can help.

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