Can a Nurse Practitioner Start A Private Practice in NY with Less Than 3,600 Hours of Experience?

In New York State, nurse practitioners (NPs) enjoy a significant degree of autonomy, but there are specific regulations governing those who wish to start their own practice with less than 3600 hours of practical experience. Understanding these regulations is crucial for NPs to ensure compliance and to set up their practices properly. A common question that comes up is whether a nurse practitioner can even own their own private practice if they don’t have 3,600 hours of experience. Fortunately, New York law authorizes NPs to own their practices outright, regardless of whether they practice as a sole proprietor, PLLC or P.C. In this post, we’ll discuss the requirements for NPs with under 3600 hours of experience who are looking to set up their own private practice.

NY Education Law § 6902: Authority and Independence of Nurse Practitioners

According to NY Education Law § 6902(3), nurse practitioners are granted the authority to diagnose illnesses and physical conditions, as well as to perform therapeutic and corrective measures within their specialty area of practice. This law underscores the independent responsibility NPs hold for diagnosing and treating their patients, meaning that they are not required to work under the direct supervision of a physician. However, this independence comes with specific prerequisites, particularly for those with less than 3600 hours of practical experience.

Requirements for NPs with Less Than 3,600 Hours of Experience

For nurse practitioners who have not yet completed 3,600 hours of practical experience, New York State mandates that they must practice in accordance with written practice protocols and a written collaborative practice agreement with a collaborating physician. This framework ensures that less experienced NPs have a support system in place to guide their practice while at the same time, putting greater protections in place for patients.

Collaborative Practice Agreement

The collaborative practice agreement is a formal arrangement between the NP and a collaborating physician qualified to practice in the NP’s specialty area of practice. These agreements contain provisions addressing the following:

Patient referral and consultation;
Coverage for emergency absences of either the NP or the collaborating physician;
Resolution of disagreements between the NP and the collaborating physician regarding diagnosis and treatment;
Peer review by the collaborating physician of patent records in a timely fashion, but no less than every 3 months. NY law does not specify the number of charts that must be reviewed by the collaborating physician;
Identification of written practice protocols that the NP will use; and
Any additional provisions as agreed to between the NP and collaborating physician.

See NYSED Practice Requirements for Nurse Practitioners

It is important to note that a copy of this agreement must be kept at the NP’s practice setting and made available for inspection by the New York State Education Department. Fortunately, when it comes to entering into a collaborative agreement this is not a supervisory relationship. The NP can operate their practice completely independently and does not have to share office space or work in the same building as the collaborating physician.

Written Practice Protocols

NPs must adhere to written practice protocols that align with their specialty area. These protocols provide detailed guidelines on the standards of care expected in various clinical scenarios. The New York State Education Department (NYSED) offers recommended practice protocols, which serve as a valuable resource for NPs in developing and refining their own practice standards. More information on these protocols can be found on the NYSED website here.

Filing Form 4NP

In addition to the collaborative practice agreement, NPs with less than 3,600 hours of experience are required to file Form 4NP with the NYSED within 90 days of starting their practice. This form documents the collaborative agreement/relationship and is a necessary step in establishing a compliant practice.

Financial Arrangements Between NPs and Collaborating Physicians

Lastly, NPs should be aware of the restrictions on financial arrangements between them and the collaborating physician. The NP can compensate the physician for their time and services related to the collaborative agreement, such as for consultations, general chart review for the physician’s opinion(with the exception of the charts being reviewed every 3 months), general advice and discussion. However, the NP cannot pay the physician a fee that is contingent upon the number of patients seen. Furthermore, fee splitting and kick-backs are strictly prohibited. The NP may refer patients to the physician, but cannot accept any payment for doing so, the referral must be solely for medically necessary reasons. These restrictions are in place to prevent any conflict of interest that could compromise patient care.

Conclusion

By understanding and adhering to the collaborative practice agreement, written practice protocols, and financial arrangement guidelines, NPs with less than 3,600 hours of experience can successfully establish their practices and begin operating independently. These measures provide a foundation for safe, effective, and independent practice, ultimately benefiting both the practitioners and their patients. If you are a NP with less than 3,600 hours of experience and you would like assistance with setting up your private practice in New York, please do not hesitate to give us a call at (212) 547-8857 or schedule a consultation online and we'd be happy to work with you! Our experienced business attorneys are here to provide the advice you need.

Disclaimer: This blog post and similar posts are not to be considered as providing legal advice. The discussion here is meant for educational and informational purposes only and shall not create an attorney-client relationship with the readers of this content.