It may be unusual for NPs to open their own retail healthcare clinics, but it’s not impossible. In November of 2006, I opened my first convenient care clinic, Express Care Clinic, in Lincoln, Neb. Since then I’ve opened a second location, and the clinics have started to see some success. Here’s how it worked for me.

Preparation

I’m a family nurse practitioner. I became a nurse in 1979, and I graduated from Clarkson College in Omaha, Neb., with my master’s and postmaster’s as a family nurse practitioner in 2006.

Before going back to school to become an NP, I was the nursing director of a pharmacy infusion company. I gained a lot of experience, from learning how to write polices and procedures to getting the company approved by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) the first time to being responsible for quality control and infection control as well as Occupational Safety and Health Administration. It was the first job I had that made me realize that healthcare not only was about caring for the ill, but also was a business. That was very difficult for me to accept in the beginning, and still is at times.

I was a brand new NP graduate coming into retail healthcare. I still had a year of school while planning and working on the start of the clinic. If there is one thing I’d recommend, it would be not to try both at the same time. But there was urgency to get it started soon: I felt that we needed to be the first in our city to open a convenient care clinic.

Building a Team

I had a great support system to help me get the job done. I knew that to be successful, I needed to have successful people around me. One of my most important advisors is my son, who has a degree in business and finance. My two other partners have experience in business and one in nursing, so they were helpful, too. My husband, who is semiretired, has been a great asset as our “go-fer.”

When I started researching convenient care I found a lot of information, because it was and still is a controversial model of healthcare. But most of the information was statistical; the fine details about how to put it together were not at our fingertips. We were not going to start out as a big name, and we did not have millions of dollars to invest, so we had to plan carefully to make sure our clinic was a place where people would feel we were giving good care.

Our first decision was what store to approach to propose our clinic. We wanted to be involved with a company that was local. Super Saver was local to Lincoln originally and has grown tremendously due to the hard work of one family and a lot of good employees. So we picked them and hoped they would go with us over our other choices. We were lucky that they said yes. The timing was right because they’d just been to a grocery store convention and discussed the benefits of retail health clinics.

Opening the Doors

We all thought that our clinic would sell itself just by being in a grocery store with lots of traffic, and it does help to an extent, but it didn’t quite work that way. In order to survive you have to do a lot of advertising, which is very expensive. Time is a factor, too: It takes time for the clinics to grow, and when you have low patient numbers while it is growing, it takes a lot of money to support the clinic.

We started as cash only and realized quickly that cash only was not going to work. The more you limit yourself, the more you limit the number of patients who will use your services, so we had to start accepting insurance. But, everything you change costs more money.

I originally estimated that a clinic could be started and run for about $160,000 a year, but that isn’t true anymore. Currently it takes closer to $300,000 per clinic per year. The clinics have evolved and staying in the game depends on new elements added to the original concept.

There are many hurdles in this industry, but I think the biggest hurdle that we encounter is providing the best care in such a way that you can still see some sort of profit and keep your doors open. A business-minded NP is continually asking herself how she can care for patients and still be successful financially.

Making Adjustments

You learn as you go, and each community is unique. We have had to make quite a few adjustments. Lincoln is not as mobile a population as Atlanta or New York; you have to prove yourself to our population. The patients did not just drop into our lap. We have had to do a lot of patient education, and increasing our marketing budget was a very important change. We put together commercials to run on local TV stations and built a Web site for the clinics.

We’re always evaluating other potential improvements to the physical setup of the clinics. The first convenient care clinics did not have an exam table; we made sure to have exam tables from the beginning because I felt it totally necessary. Just because you are seeing patients with more common illnesses, it is not always so cut and dried. People have other problems going on, and you have to make sure you separate those problems and treat them safely.

The first clinics did not have running water; we have put a sink in our second clinic and will probably put one in the first. We do use a lot of hand sanitizer, but without water we’re limited. So, some things we have to do at the second clinic and not the first.

We continue to evolve. We have added a few features such as a TV for the waiting area. We are going to extend our hours soon and hire medical assistants, and we started providing sports physicals this summer.

Measuring Success

There are many things that I attribute our clinics’ success to, and although we are still struggling, we are optimistic and very hard working and believe we will continue to be successful. But there are still some things we don’t get paid for. For example, we are doing our own billing, and that has been quite a challenge.

Most important to our clinics are the seven nurse practitioners that we have working for us. I could not do it without them. They all enjoy working at Express Care, and it shows. Some of the children who come to our clinic come visit us when their parents are here shopping, and I think that says a lot about our NPs.

You have to be a jack-of-all-trades working here, because you meet and greet people on the outside, sign them in, and then do the work of a receptionist, medical assistant, nurse practitioner, nurse advocate and janitor by the time your day is over. So I think the NPs that work in our clinics are pretty amazing to be able to jump in and do all of these jobs. They are rewarded with autonomy and a good sense of self.

Another thing that really helped me was being on the sidelines as operations manager the first few months that the clinic was open, before I finished my NP program. I reviewed all of the assessments that the NPs did on our patients, and so did our medical director. That in itself was a great learning experience for me. I felt like I got 6 months of on-the-job training, and there’s nothing better than that in terms of experience.

It is hard to know if our first or second location was better, because the second clinic has not taken nearly as long to start seeing the same number of patients as the first – and, in fact, the second clinic is surpassing the first in patient traffic – but perhaps we can attribute this to the groundwork we laid in community education with the first clinic. Even though nurse practitioners have been around since the 1960s, it has taken quite a while for the community to be familiar with who and what we are.

Now many people tell us they are so grateful we are here when they cannot get into their primary care provider. We are available when patients need us, and we know where to send patients who need more care than we can provide at Express Care. We do educate patients about why they need to see their primary care provider and go in for preventative care as well as general care. We also have the means of finding patients a primary care provider if they don’t have one, and I think that has helped us in the community and helped physicians accept our type of clinic.

We offer a few extra “bonus” services in that we call every patient in 2 to 3 days to follow up. We send a copy of every visit to the patient’s primary care provider. We do quality control and keep statistics on just about everything we are doing at the clinic, which JCAHO training helped me with. And we have 95% to 98% approval ratings from all the patients we call.

One of the questions we ask people when they come in is how they heard about us. The majority say they heard about us from a friend or family member. I think that is the best measure of our patient satisfaction. People who are not satisfied do not refer a friend or loved one.

Words From the Wise

What do I have to say to people striking out on their own? Know yourself, your abilities and your support system. It is a lot of hard work, but everything worthwhile is a lot of work. I guess the end of my story has not been written yet. Sometimes I get frustrated and wonder if I’ll make it, but we all feel that way sometimes. It is not easy, but it can be done.

Some convenient care clinics have not made it, but in my opinion it was because they started out too big, opening too many locations at one time, and then when it took longer for the clinics to be viable, investors gave up. This is where a love for what you do is very important. If it is just a business to you, you are going to become very frustrated; but if your heart is in it, it will be easier. But that said, even with your heart in it, it can become very difficult to wait it out to see if you are going to make it when you do not have deep pockets.

The experience has been both rewarding and challenging. Everyone is different, and it is difficult for me to tell anyone to do it or not do it. Look at your own situation and weigh the pros and cons. So far, owning my own convenient care clinic has begun to be more rewarding than challenging. Keep at it, and it will pay off. And I don’t just mean monetarily.

Source: Advance