The authority of a nurse practitioner varies widely from state to state. Some states are considered “restrictive”, meaning they require NPs to practice medicine under the guidance of a physician. Others are “independent”, and allow nurse practitioners to operate freely without a physician collaborator. Practicing in an independent state offers a plethora of benefits, and can help NPs provide top-notch care without conforming to excessive regulation and navigating bureaucracy.

The challenges of practicing in restrictive states

According to a report published in the Journal of Nursing Regulation, “practice and licensure laws [of certain states] restrict the ability of NPs to engage in at least one element of NP practice. Some state law requires career-long supervision, delegation, or team management by another health provider in order for the NP to provide care”.

Some NPs and health care administrators argue that these regulations can harm patients and hinder NPs from providing the best care possible. Others argue that because NPs have a less advanced degree than an MD, there should be restrictions on the scope of their practice. In addition to poorer patient outcomes, it can be more expensive and logistically complicated to establish a clinic in a restrictive state.

About half of all U.S. states are considered “full practice”, while the remaining states enforce full or partial restriction on an NP’s business and clinical operations. However, there seems to be an upward trend of states loosening restrictions, and some NPs are relocating in order to begin practicing in independent states.

Is it better to practice in an independent state?

It can be simpler and less costly to practice medicine in an independent state. NPs with businesses in independent states do not have to hire a physician collaborator, boosting the practice’s bottom line and removing the stress of finding an MD that fits your business model. However, many Full Practice Authority (FPA) states are rural areas with less demand for niche services. This may effect the profit potential of a clinic, especially in places where the typical household income is lower than the national average. It is up to you to decide whether relocation is worth it, both financially and socially.

How can NPs navigate state-enforced restrictions?

While it may be a challenge to achieve independence in restrictive states, there are ways to operate efficiently in any area of the country. NPs can take the traditional route and hire a physician collaborator, or they can establish a telemedicine business in an FPA.

Physician collaborators

Obtaining a physician collaborator can be difficult for many if they do not have a relationship with a qualified physician. Many NPs have strong professional networks, but others will find this as a barrier to their success. These NPs either must pay for a collaborator, or go into business with a physician. Both of those options can lead to poor economic outcomes, but many NPs find this route necessary. Elite NP recommends hiring a physician collaborator rather than starting a business with one as a partner. Read up on the average cost of a physician collaborator here.

Telemedicine

The other option for the nurse practitioner wanting to start a medical practice is to open a telemedicine practice. This may be the best option if you want to practice independently. As mentioned in the Elite NP telemedicine course, an NP can practice independently in a state like Montana (FPA) while residing in a restrictive state like South Carolina. A telemedicine clinic can be a great way to work around restrictions that may be hindering your true potential. If you are a skilled, responsible, and competent medical professional, it is safe to operate a practice independently.

However, there are telemedicine restrictions in certain states. Most states have more relaxed telemedicine laws, but there are a few (like North Dakota) where things can get murky. Some states also have restrictions with NP practice via telemedicine, but most do not. Regulations may change in the coming years, but this is not guaranteed. Therefore, if you must live in a restricted state but want to practice in an FPA state, telemedicine can be a great niche side practice and the perfect way to start your own business.

Benefits of FPAs

When practicing in an independent state, you can assess, diagnose, and treat patients 100% independently. Elite NP founder Justin Allan describes the professional and clinical climate after relocating from a restrictive region to an FPA: “When I moved from a restricted state to an FPA, I was blown away with the autonomy afforded me by law,” Allan says. “I picked up a shift in the ER and NPs were inserting chest tubes, putting central lines in, and seeing patients independently. It was like I landed on a different planet. This is when I realized the power I had with FPA. I jumped right in and started a practice.”

Perks of relocation

Practicing in an independence state can allow NPs to build multiple businesses, get out of debt, and travel down the road to financial freedom. Dozens of practice owners in the Elite NP community have gained financial and professional success by relocating to more NP-friendly areas.