Creating a Low Overhead Practice

If your goal is to have a part time-high profit practice, this article is for you. We will not be discussing how to create a large volume practice in some Taj Mahal office. That requires a ridiculous amount of capital, resources, employees and ultimately stress.

Creating a practice can be very costly. Before you know it, you can be out $20,000 and have nothing to show for it. It sucks. Trust me, I have been there.

The main goal with any type of business is to make money. Sure, helping people as a medical provider is a plus, but you must make money to keep the doors open and to provide yourself a nice lifestyle. If that is not your goal, then you need to stop reading and just continue with your normal day job. Why take the risk and nights of lost sleep starting a business if it does not benefit you?

So, for a practice to be successful and ultimately profitable, you must learn how to keep expenses low and revenue high. Especially if you follow the Elite Nurse Practitioner Model. This is a very hard practice to actually follow and stick with, but it can be done.

I have a side practice where I make a healthy 6-figure side income and it is a one man show. If I hired a receptionist or an assistant, that number would be cut down dramatically. You must pay them their salary as well as taxes, workmans comp insurance, etc… Not only that, but you must deal with the bullshit having an employee brings: drama, call ins, theft, and apathy towards your business for example.


Before we begin talking about specifics. This all assumes you are starting a CASH practice. I do not advocate using insurance. Relying on a 3rd party to pay and dictate your practice is a recipe for unhappiness and unnecessary stress in your life.

So the first thing you need to figure out is this: what can be your practice niche that can be done 100% solo. A difficult task indeed and requires creativity. Concierge services are easy to set up. As are telemedicine practices. I know a guy who does nothing but prescribe erectile dysfunction medications from his house via telemedicine. He makes $100,000 a year working 6 hours a day!

The second item is keeping operating expenses low e.g. medical supplies, rent, utilities, insurance, etc… There are some practice expenses that are inevitable such as malpractice, but this can be attained fairly cheaply at $1-1.5k a year for an occurrence policy. You could forgo malpractice if your practice is low risk and you know how to protect your assets.

These are basically the big-ticket items of a practice: staffing and operating expenses. You must keep these two things low or non-existent to have a high profit practice. Therefore, what are the absolute essentials for operating a solo business?

  1. Cell phone. Everyone has one, so this is not an issue. But now you are using it for business purposes! Ah, the beauty about business expenses. Tax free savings!
  2. Website and Social Media Page. You must market your service through the internet. The best way to do so is to have a website and get your google ranking to the top. You also should have a substantial social media following.
  3. Marketing. You need to have a modest marketing budget. You would be amazed what $250-$500 a month could do for you.
  4. Computer. You cannot operate a business optimally on a tablet or a cell phone. Get yourself a computer or laptop. If your budget does not call for it, then get a keyboard for your tablet. I have seen people operate a business off their phone. They constantly have issues. A computer is far more productive.

That is it! Those are the essentials to starting a solo cash practice. You are probably scratching your head thinking “That’s all you need? Really?.” Yes! Of course, depending on what type of practice you open up could require additional expenses such as rent. But even that can be found cheaply. There are plenty of small offices you can find for less than $500 a month. You don’t need a big fancy building on a high traffic road.

I have 2 side businesses that operate on the above, nothing more… It is simple and brings in a health 6-figure income a year.

Thus, a low overhead and high revenue cash practice requires:

  1. Little to no employees. You as a nurse practitioner should be able to handle the vast majority of the work in the initial startup phase. Only hire someone if you can justify the cost and having this employee becomes a vital function of the business.
  2. Low expenses. Keep your expenses as low as humanly possible. Be a cheap ass. If you have a physical location, buy the furniture off Craigslist or at a garage sale. Seriously. To this day I have used the same office furniture I purchased off Craigslist 3 years ago when I started. My patients don’t care. They are there for the service, not to sit in luxury.
  3. Basic supplies. As listed above.

In addition, you must not be risk averse. The money you put into this business needs to be an amount that you are okay with loosing. If this is going to put a large financial strain on you, then keep saving and just hold off. DO NOT TAKE A BUSINESS LOAN OUT. It is beyond the scope of this article but stay debt free. Debt = Slavery.

Begin with step one. Figure out what service line you will provide. Think outside the box, let the world tell you what they want. You would be surprised how much cash people will drop on services that seem so elementary to a skilled nurse practitioner.

13 Responses

  1. I feel motivated for the first time in a long time. I haven’t been this excited about an independent gig since NP school! That was before my dreams were crushed by the weighty realities of an actual NP career versus the long line of BS served up by graduate school recruiters. Thanks Justin!

    1. Graduate schools are the bane to the NP profession. They continue to crank out vast numbers of graduates saturating the market. Dentists, optometrists, doctors, etc… know what they are doing, keeping the numbers down thus keeping the demand high. The only way you are going to make it as a NP in the long term is to venture out on your own.

  2. I am currently an accountant at a nonprofit that focuses on drug treatment. I’m going back to school to become a who’ll eventually to become an Np. I have a few friends who convinced me to go to medical school and it’s not viable since I am a 32 yo man. I am ready to work in a clinical setting and start making a difference in people lives while making this schmoney. What pointers do you have for someone like me who will be new in the field?

    1. Wow an accountant? Going back to NP school? How much time do you have before you become a NP? Are you sure this is a financially sound move? My best advice is to learn as much as you possibly can during school. Take full advantage of any learning situation you can get and really HIT THE BOOKS HARD. The best NPs are the self taught ones who spent more time at study. The ones that slide by are the “meh” providers who really have to rely working for someone because they lack the confidence to be on their own.

      1. I’m entering an adn program by spring and will be done in two years. After that I am planning to get at least 2-3 solid intense years before entering a Np. I will be an rn by 34 and an Np by 40. My best friend is a hospitalist np and my other friend is a psychiatrist and told me np is the way to go. I am an accountant, but I do not enjoy it and it has never been fulfilling and doesn’t pay well whatsoever.

        1. Very interesting. Well you have a stepping stone being an accountant. Starting your own business should be much easier for you! I wish you the best of luck. Again, hit it hard and learn as much as you possibly can!

  3. Thanks for the insight. I enjoyed reading your posts. I have recently completed NP program be and planning to work to get some experience and savings before venturing into my business. It really concerns me to see the trajectory of the NP profession; low pay, oversaturation and so forth. I have thought of two directions I could take to be able to reach my financial goals but not 100% sure which way to go. However, reading your post was motivational. The plan I had in my head were..
    1. NP business
    2. Go back to CRNA school. This plan however will put me more in debt and also I’m past my 30’s

    It’s good to hear successful stories of NPs doing well in business such as yours

    1. Hi Jay,

      Thanks for reading. Congrats on finishing NP school. Yes, that trajectory is scary… NP academia is doing us no favors.

      1. You must start a NP business if you want to mitigate the future risks. It is the only way you will outpace inflation and make a really good living as a NP. Otherwise salaries will continue to stay flat or even decrease like in some areas.

      2. CRNA school??? Dude, why did you even waste your time with NP school? I would advise against this. That is 2 years of lost income not to mention the debt and time.

      Make some money and save it. Start a business. You would be surprised what you can do with just $5-10k.

  4. Thank you for sending me the link to your website! it’s motivated me to move forward with starting a housecalls/concierge business. Do I just hire someone to do the billing coding for me or learn and do it myself?

    1. You need to think real hard on if you want to take cash or insurance. Taking insurance introduces an entirely new headache and overhead to your practice. Read my article about insurance. If you decide to go with insurance, hire a biller during your initial start up phase. You need to focus on marketing.

  5. Thank you so much for introducing me to your page! very encouraging! now am motivated to go ahead and do away with the fear and start a housecall/concierge business!!

  6. Great information- I am reading your blog articles and it’s very informative. I am an NP with 7 years experience in Primary Care and am considering a Post Masters Cert in Psych /Mental Health because there is still quite a demand in this area.
    Upon completion, I would love to have my own practice, but I would need a Collaborative physician because I am in NC. How do find a collaborative physician for this purpose and how much money do you have the pay the collaborative physician for their oversight?

    1. The best way to get a collaborating physician is to ask ones you know. If you do not have a relationship with any then I would advise working on that while you are doing your psych rotations. There are services where you can pay physicians to do it but it can be expensive. In my opinion, I believe a collaborating physician shouldn’t cost you more than $1000 a month.

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