Practicing in Independent States


To many nurse practitioners live and practice in a restrictive state. I was one of them… They have no idea what true professional freedom is. What those nurse practitioners also don’t realize is that life is so much better in a full practice authority (FPA) state. Life is not only better professionally, but also financially and personally. I can’t tell you how much my life improved once I started practicing and living in an FPA state. It is a night and day difference. Luckily for everyone, more and more states are moving towards independent practice! I honestly was surprised with Virginia and Florida’s recent independent practice laws.

How many states have full practice authority as of April 2020? 25. That is half the country! Another 16 states have reduced practice and the rest are totally restricted.  So, there are 25 states, plus a few others, where NPs can practice without a physician collaborator in most settings. This is awesome for the nurse practitioner entrepreneur. You can open a practice, 100% independently, in half the country. That is huge.

The issue comes down to where you are located though. A lot of the states that have FPA are rural western states with lower populations. Therefore, it is safe to assume that over half of all practicing NPs live in restrictive states. If you are an NP living in one of those restrictive states, what can you do if you want to start your own practice?

  1. Obtain a physician collaborator.
  2. Practice telemedicine in an FPA state.

Those are your only options unless you start a business outside of medicine, which really is not a bad idea if you practice the concept of redundancy and follow The Elite Nurse Practitioner Model.

Regardless, if you want to open a medical practice, those are your only options.

Obtaining a physician collaborator can be difficult for many if they do not have a relationship with some physicians. Luckily, many NPs are friends with some, therefore finding a collaborator is not difficult. Others will find this as a barrier to their success though. These NPs either must pay for a collaborator or go into business with a physician. Both of those options are not ideal, but you have to do what you have to do. I would recommend just hiring one vs going into business with one. I advise not going into business with anyone. It adds complexity and drama to your business life. I talk about how much a collaborator should cost here.

The other option for the nurse practitioner wanting to start a medical practice is to open a telemedicine practice. This really is the best option if you want to practice independently. Like I mention in the telemedicine course, you can practice independently in Montana (FPA) and live in South Carolina (restricted). It is a great way to work around these bullshit restrictions that are in place to keep you from reaching your true potential. The physician lobby does not want nurse practitioner independent practice, it is a direct threat against their monopoly on delivering patient care. It has little to do with patient safety, but everything to do with money.

Either way, opening a telemedicine practice can be very freeing for the nurse practitioner. Imagine logging into your telemedicine practices EMR and begin seeing patients without having to worry about physician supervision? If you are competent, this should excite you significantly. This is not a fairy tale folks, this is completely legal and doable in most FPA states. It is vital you understand the laws in each state you want to practice in before jumping into this though.

There are restrictions with telemedicine in some states. Most states have liberal telemedicine laws but there are a few like North Dakota where it is a pain in the rear. Some states also have restrictions with NP practice via telemedicine, but most do not. One thing you need to remember here though, is that with the advent of the COVID pandemic, many of these laws will change and telemedicine will gain significant traction in the NEAR future. I guarantee it. Therefore, living in a restricted state and wanting to practice via telemedicine in an FPA state will be a great niche side practice in the upcoming year for those nurse practitioners interested in starting their own business.

When you practice in an FPA state, you can assess, diagnose, and treat patients 100% independently. It is fantastic. When I moved from a hell hole restricted state to an FPA one, I was blown away with the autonomy afforded me by law. 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.

By doing this, it has allowed me to build multiple businesses, get out of debt, and it put me on the road to financial freedom. It was truly life changing. I am not the only NP who has experienced this either, there are dozens of NP practice owners I know that have a financially and professionally rewarding career. The difference in demeanor NPs have in FPA states vs restricted ones is like comparing apples to rocks. It’s totally different!

Listen, you do not need to be walked all over and held down in a restricted state. You can break free from the shackles placed around your wrists. The best way to do this is by opening your own business and/or practice. If you cannot move to an FPA state, then consider telemedicine if you want to open a medical practice. If you do not want to practice via telemedicine, then you need to seriously consider opening a business up outside of medicine. Be aware though, that practicing in one of these 25 states will reinvigorate your advanced practice to another level that you simply cannot fathom until you have experienced it.

The “How to Start a Telemedicine Practice” course is still on sale for $197 until 4/13/20 at 11:59 EST. After this the price will go up to $247 indefinitely. This course will teach you how to open a telemedicine practice in one of these FPA states. I guarantee it. Check out the course HERE if you are interested in taking that next step to financial and professional freedom.

12 Responses

  1. I love your gusto for moving forward and finding ways for us to practice to our full licensure and education, but I would like to see you really encourage people to practice within their formal education and professional certification. I currently live and practice in Texas, and I cannot tell you how many NP’s I have seen in trouble for working outside their certification and licensure! I would like to see a little “pay attention” to the professional and national guidance to the types of patients NP’s are caring for. Every day, I see primary care NP’s working in ER’s thinking they can put in chest tubes and central lines when it is not within their professional scope of practice and they are losing their licenses! Again, I love your entrepreneurship, but I want everyone taking part in your information to do it correctly! Until NP’s become experts in their licenses and certifications, we are putting our licenses on the line, and even more scary- people’s lives at stake when doing things we weren’t formally trained for or licensed to do! Remember, we can’t “train ourselves” above our licensure and certification!

    1. I agree with you. Do not do things outside of your scope of practice, but you can easily provide a multitude of services via telemedicine within your scope of practice!

  2. God, I couldn’t agree more with this! I used to live in GA and moved to CO a few years ago. Holy hell what a difference it made. I never thought about telemedicine though, that is brilliant!

  3. I never thought about doing this. I am so sick of having a MD supervisor… I have been practicing for 14 years now as a FNP but I do not have the luxury of moving to a FPA state. I am going to look into obtaining licenses elsewhere. Thank you for what you are doing for the NP community! We needed this.

    1. Tiffany,

      Anything you want… Literally whatever you want to do. I am focusing on short term rental properties. It has NOTHING to do with being an NP. My suggestion is to focus on things outside of medicine. The world outside of medicine is sooooo much better… No regulation… No significant liabilities… No headaches…

  4. I’m am very interested in telemedicine because I live in a restricted state. My question is what do you do when a patient is in one of the restricted states and you can’t provide care? Do you tell them, sorry, I can only see patients in these 25 full practice authority states and you don’t live in one of those?


    1. Yep, just tell them sorry basically… You should only be seeing patients in the states you are located in anyways because that is where you are marketing

  5. I like the idea of practicing telemedicine in a FPA state. If one lives in a restricted state but want to open up a telemedicine practice in a FPA state (that one is also licensed in). In your experience is the process of registering solely a telemedicine company (say an LLC) as a NP in a FPA the same as registering a brick and mortar practice/company? or does one have to register the business under a special category?

  6. Thank you SO much Justin for sharing all of your wisdom and experiences with us! Do you happen to know where is the best place to actually find telemedicine laws specific to our state? I am closer each day to starting a telehealth business, but I need to find my states laws to review. More specifically, I want to determine if any in-person visits are required before managing a patient over telehealth.

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