1. Understanding Regulatory Oversight

One common area of confusion among NPs is the regulatory structure of their practices. In the U.S., medical and nursing boards regulate different healthcare providers:

Board of Nursing:

Oversees Nurses (and by extension) APRNs

Board of Medicine:

Oversees Medical Doctors (MDs)

Every state, district and territory in the United States has a Board of Nursing (BON), which establishes standards for nursing care and nursing licenses in accordance with regulations defined in that area's Nursing Practice Act (NPA) legislation. In most states, APRN practices - including NP practices - are defined by the Nursing Practice Act and regulated by the Board of Nursing.

When an NP wants to establish a private practice, the entity can be a:

• Professional corporation (PC)
• Professional limited liability company (PLLC)
• Limited liability company (LLC)

The requirements for which type of entity can and should be set up vary by state. For example:

• California requires a PC
• New York allows a PC or PLLC
• New Mexico allows an LLC or PC

Importantly for NP practice owners, the entity is regulated by the Board of Nursing (BON). This allows NPs to practice independently within the scope of their licensure and authority granted by their state. This also allows a Nurse Practitioner to fully own (100% own) their own practice.

2. Debunking Ownership Myths: Are Majority Physician Owners Necessary?

We've seen some practice consultants mistakenly assert that NPs in certain states, like California, need a physician or medical doctor as a majority owner (owning 51% or more of the practice) for their business to be compliant. For many NPs, this assertion can lead to significant confusion and complication. It also raises the cost of setting up a practice unnecessarily.

For example, in California, Nurse Practitioners are often told that they cannot be full owners of their own practices. However, this is not true. An NP can set up their Professional Corporation (PC) in California and register it with the Board of Nursing. This means that they can fully own their practice, and they do not need an MD as a co-owner.

3. Corporate Practice of Medicine (CPOM): What Does It Mean for NPs?

The Corporate Practice of Medicine (CPOM) doctrine exists in a number of states, limiting corporate ownership of medical practices to licensed physicians. CPOM regulations aim to prevent business entities from interfering with clinical judgment and are often invoked in discussions about physician ownership.

However, the key note here is that in many states, Nurse Practitioners are setting up their practice entities with the Board of Nursing, not the Board of Medicine. So they do not need a physician owner.

• In most states, districts, and territories, MDs are overseen by the Board of Medicine
• In most states, districts, and territories, NPs are overseen by the Board of Nursing
• If you want to structure your entity so that it is formed for the purpose of practicing medicine (e.g., a medical practice PC), you will need a majority MD owner
• If you want to structure your entity for the purpose of the practice of nursing (e.g., a nursing practice PC), you can wholly own your practice as an NP owner
• NPs can 100% own their PC if the entity is formed with the purpose of practicing nursing and employs other NPs, Nurses or other non clinical labor

Conclusion

Owning a practice as a Nurse Practitioner is very doable. By understanding national and state regulations, NPs can enjoy autonomy, flexibility and success in their practices. While conflicting advice from unqualified sources can make this process unnecessarily complicated, with the right resources and support, NPs can confidently navigate independent practice ownership.