Greetings my nurse practitioner sisters and brothers,
This is the 6th installment of our “Interviews with Elite NPs” series where I will interview various nurse practitioners who have utilized Elite Nurse Practitioner content to help build a life where they live on THEIR terms. The goal of the articles in this series is to enlighten many of you that might be on the fence about diving into nurse practitioner entrepreneurship on how possible it really is.
The nurse practitioners interviewed in this series are REAL and have started their practice in just the last 1-2 years. It has been my honor to have assisted these fine nurse practitioners who took the appropriate steps to start their own business and most importantly, had the courage to take ACTION instead of suffering from analysis paralysis.
The 6th nurse practitioner interviewed is Erin Jolene, FNP, out of Colorado. Erin is both a CNM and FNP and has been in the advanced nursing role for over 6 years. She used to be a slave to “the system” like many of us, but decided to break free and go out on her own. She started a successful HRT practice about 2 years ago and has seen steady growth ever since. She started this practice as a part-time practice and has since focused all of her efforts on this and is now 100% self-employed! She has replaced her previous salary, is only working 20-25 hours a week, and is now living the good life that every nurse practitioner can achieve, with the right plan! Her practices website can be found at www.hormonehealthinverness.com. Now, to the interview:
1. Tell us a little bit about yourself: How long have you been an NP? What has been your background as an NP? Where do you practice? Where are you at in life in terms of your age, financial goals, or anything else you would like to share with The Elite NP readership to help them understand more about yourself.
I’m a dual certified CNM/FNP practicing 20 minutes south of Denver, Colorado. To understand why I’ve taken the route I have and why my goals are different than many other NPs, I think it’s necessary to understand my life leading up to entrepreneurship. I’ve been an RN for 13 years, a CNM for 6 years and an FNP for 4 months. As an RN, I did mainly multispecialty clinic and labor & delivery. I knew since nursing school that I wanted to catch babies so midwifery school was the next step. I honestly never could have guessed how much midwifery would affect my ability to have a life. I worked for a physician as a sole CNM and was on call 24/7. These were not normal births in the slightest. I was delivering breech babies, twins, and other high risk pregnancies. I was paid $60,000/year with no benefits. I was taken advantage of due to the fact that midwives are bleeding hearts who will sacrifice themselves to be with their patients at a birth. The hospital system was also terrible to private practice providers, especially non-physician providers and that only added to the stress. Ultimately, I left that job and joined a big OB/GYN practice and had only 4 days a week clinic and 10 days a month of hospital call. But the damage was done. I was burnt out, cynical, and craved freedom from call and hospital politics.
2. What made you shift your mindset from “employee” to “entrepreneur”? Basically, why did you want to start your own practice?
I finally accepted that as long as I was catching babies, I’d always be a slave to the call life and hospital politics. I just didn’t want that for the rest of my life and started my practice as a side gig to allow me to leave midwife life. I’m blessed to work in a full practice state so I started thinking about how I could use my skills to have a practice with no call. Originally, I planned a GYN practice but quickly realized that I didn’t want to deal with insurance. Menopause care was an interest area for me, so I decided to go that route and focus on hormones. And more importantly, there are no hormone emergencies, no weekends, holidays, or call. To be perfectly honest, I have very little interest in primary care. The FNP degree I did solely for the purpose of expanding my practice to include TRT for men and it has been well worth the time and expense.
3. What type of practice did you start and why did you pick the niche service line you chose?
My practice is a BHRT practice, and I do mostly pellets. There are several reasons I chose to focus on pellets. First and foremost, I believe in them. They have worked wonders for me and many of my friends and family members. Of course, there are many other modalities that work great as well, but I wanted to do one thing and do it well. Doing pellets keeps me from having to deal with superbills and insurance prior authorization attempts because insurance simply does not cover them. Pellets also require very few clinic visits once established. These things give me the ability to work very few direct patient care or administrative hours. If a patient really prefers another route, I’ll do it for them obviously, but the majority of my patients are pretty happy once their dose is dialed in. On occasion, I will manage a primary care issue for uninsured patients, but in general I send everything outside of hormone management back to primary care. This has allowed me a ton of freedom.
4. How long have you been open?
I saw my first patient in June 2019. I saw patients 1 afternoon a week, then ultimately quit my CNM job 13 months ago to focus on FNP clinicals and building the business,
5. How successful has your practice been so far? If you don’t mind, please share with us some average revenue and expense numbers.
I would guess the majority of nurse practitioners start a practice to make money, but my motives were very different. I just wanted a life. I am 35 and feel like I’ve worked enough for a lifetime. So, success probably looks a bit different for me. Financially, I obviously wanted to pay my bills. But I would live in a cardboard box if it meant I’d get to sleep at night and take a vacation. The income has definitely grown steadily though, and I now make as much as I did as an employed CNM. Pellets have a great profit margin (if you use the right pharmacy and avoid the training companies with huge management fees). I bill about $12,000 per month and my expenses are about $3000 per month. I rent a room to another FNP who also does pellets which cuts my clinic costs in half. I am only utilizing half of my practices capacity and at the rate I’m growing, I’ll have a full practice in 12 months. My salary at that point should be about $230,000/year and patient contact and admin hours should total 20-25 per week. A true “part-time” practice as Justin calls it!
6. What speedbumps did you come across as you started your practice?
I think the biggest speedbump was competing with the huge local practices. There are a ton of pellet practices near me and the biggest training practice for the most well-known pellet company is right down the street from me. I couldn’t outspend them on SEO or marketing. I had to be different. I’ve been successful in taking patients from the big practices because my patients get 30-60 minute visits and my cell phone number. They wanted the individualized treatment and relationship with a provider that they couldn’t get with a big practice. (Providing VALUE to the patient!).
7. What was the biggest personal fear you had to overcome to get started?
Failure. Everyone is afraid of failure, but I think I put more pressure on myself than the majority of people. My family and friends thought I was nuts to leave a very stable job to start my own practice and I just didn’t want them to see me fail. It motivated me to succeed though. Of course, there was always the fear that I wouldn’t make enough money to pay my bills, but ultimately in a practice like this it only grows over time. It’s just about being patient and doing the work to allow it to grow.
8. Tell us what surprised you the most about diving into the world of nurse practitioner entrepreneurism?
I think the thing that surprised me the most about starting my own practice was the actual cost of business and the amount the administrators had been making off of my work. When working in the general medical establishment, I accepted that the cost was exorbitant because supplies and medications were just so expensive. I learned as a business owner that this is in no way true. In my opinion, it is just a way to justify screwing providers into a pittance of a salary while making the CEOs big money. I used to make $30 for an annual exam and now I can make 10 times that for way less work and do a better job for my patient. I think we are conditioned to think that we need the hospital system, administrators, or insurance contracts to make money. It’s just not true!
9. Did you use any of The Elite Nurse Practitioner content or courses? If so, how did it benefit you?
I’ve taken the men’s health course and plan to take a few more after that. I think it’s so important to keep learning not only about your own specialty, but also others so you can speak confidently to your patients. I wish that I would have known about the Elite NP courses sooner. I am pretty sure they would have made starting a practice exponentially easier. I lecture on starting a business for a local University’s NP program and I highly suggest to the students that they take any and all Elite NP courses that are applicable to their interests!
10. What are your future plans for your practice? What steps are you taking to accomplish those goals?
My future plans are pretty simple. I plan to grow to a panel of 200-250 BHRT patients and maintain at that level. I don’t want to grow above that since my ultimate goal is a healthy work life balance with zero employees. In my area, the best way to grow has been word of mouth. A successful business owner friend of mine once said that if you just talk about how much you love what you do everywhere you go, you’ll always find new clients. I’ve found that to be true. I’m a very social person and tend to find new patients in the local networking events, live music venues, and bars. The love for what I do shows, and people want to see what it’s all about!
Thank you so much for participating in The Elite NP Interview series Erin! Erin is absolutely killing it and is following the principles described on The Elite Nurse Practitioner website. She is operating a part-time practice, minimizing her expenses, providing a simple and specialized NICHE service, and living below her means. She was able to build all of this in less than 2 years by focused work and staying patient. If Erin, myself, and the hundreds of other nurse practitioner entrepreneurs can do it, so can you! You do not need to be a pawn in the modern healthcare system being fed the scraps from your hard work after all the SHARKS take their cuts. You can earn what you are worth by following proven practice models and by overcoming the fear and limiting beliefs that might be holding you back. Stay tuned for more interviews as more nurse practitioners SUCCEED!
If you or someone you know has started their own business and would like to be a part of this series, please email me at firstname.lastname@example.org! Thank you for reading! I hope this article helped spark the fire of motivation in some of you to get started 🙂