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BridgeWell Briefs #4: Practice Independence Requires More Than Owning the Practice · The Integrative Clinician by BridgeWell

• 0:00
  Speaker: Welcome to the Integrative Clinician.
• 0:02
  Speaker: I'm Dr.
• 0:03
  Speaker: Sheri Erwin, and this is Bridgewell Brief, a short clinical conversation designed to give you one idea you can take directly into practice.
• 0:11
  Speaker: There's a conversation happening among nurse practitioners right now that I think is incredibly important.
• 0:17
  Speaker: Independence.
• 0:19
  Speaker: More and more nurse practitioners are thinking about leaving traditional employment.
• 0:23
  Speaker: They're exploring cash pay practices, telehealth, direct primary care, or DPCs, functional medicine, hormone practices, weight management, and other models that give them greater control over how they practice.
• 0:39
  Speaker: And I understand why.
• 0:41
  Speaker: Many nurse practitioners are tired of seeing patient after patient every 15 minutes.
• 0:46
  Speaker: They're tired of productivity metrics, determining how much time someone deserves.
• 0:52
  Speaker: They're tired of knowing that a patient needs a deeper conversation while simultaneously watching the clock.
• 0:58
  Speaker: So we talk about practice independence as a solution.
• 1:02
  Speaker: And I absolutely believe it can be part of the solution.
• 1:05
  Speaker: But there's something I don't think we talk enough about.
• 1:08
  Speaker: Owning the practice doesn't automatically change how you practice.
• 1:13
  Speaker: You can leave the conventional healthcare system, open your own clinic, schedule 60-minute appointments, and still approach patients exactly the same way you did during a 15-minute appointment.
• 1:26
  Speaker: You just have more time.
• 1:27
  Speaker: And that's an important distinction because there are actually two kinds of independence.
• 1:33
  Speaker: There's practice independence, that's having greater control over your schedule, business model, patient population, services, and how you structure care.
• 1:44
  Speaker: But there's also something I would call clinical independence.
• 1:48
  Speaker: Clinical independence is having the reasoning skills and the confidence to think beyond the algorithm when the algorithm doesn't fully explain what you're seeing.
• 1:58
  Speaker: It's being able to look at the patient with fatigue, weight gain, poor sleep, increasing glucose, GI symptoms, and brain fog and not immediately separate those complaints into five unrelated problems.
• 2:13
  Speaker: Instead, you start asking, could there be physiology connecting them?
• 2:18
  Speaker: That's a very different kind of independence.
• 2:21
  Speaker: And here's where I think some NPs get stuck.
• 2:24
  Speaker: They know they want to practice differently.
• 2:26
  Speaker: So they start looking for things to add hormones, functional labs, peptides, supplements, weight management, gut testing, continuous glucose monitors, maybe longevity medicine, and those tools can absolutely have a place in clinical practice.
• 2:45
  Speaker: But adding different tools does not necessarily create a different clinical model.
• 2:51
  Speaker: You can practice medicine with functional medicine tools.
• 2:55
  Speaker: That's the trap.
• 2:56
  Speaker: Instead of the patient has a diagnosis X, so prescribe medication Y, it becomes the patient has symptom X, so order functional test Y and prescribe supplement Z.
• 3:10
  Speaker: The tool changed, the thinking didn't.
• 3:12
  Speaker: And if you're building an independent practice, I think that's one of the most important things to recognize early.
• 3:19
  Speaker: Before you ask what services you're going to offer, ask what kind of clinician you want to become.
• 3:25
  Speaker: When a patient walks through your door, how do you want to think?
• 3:29
  Speaker: What questions do you want to ask that you didn't have time to ask before?
• 3:34
  Speaker: What physiology do you want to understand more deeply?
• 3:38
  Speaker: How do you decide which data actually matters?
• 3:42
  Speaker: How will you distinguish an interesting biomarker from an actionable clinical finding?
• 3:48
  Speaker: How will you integrate a conventional medicine with nutrition, movement, sleep, stress, behavior, and other evidence-informed approaches?
• 3:59
  Speaker: And perhaps most importantly, how will you know when not to intervene?
• 4:05
  Speaker: Because clinical independence isn't about ordering more tests.
• 4:09
  Speaker: It isn't about prescribing more supplements.
• 4:11
  Speaker: And it certainly isn't about doing the opposite of conventional medicine.
• 4:16
  Speaker: It's about having a larger clinical framework from which to make decisions.
• 4:21
  Speaker: That's why education matters before the menu of services.
• 4:25
  Speaker: If you're thinking about building your own practice, there's nothing wrong with learning the business side.
• 4:30
  Speaker: You need to understand pricing, marketing, documentation, billing, operations, patient acquisition.
• 4:39
  Speaker: Those things matter because a practice that isn't financially sustainable can't take care of anyone.
• 4:46
  Speaker: But while you're learning how to build the business, you also need to build the clinician who is going to practice inside of it.
• 4:54
  Speaker: Because the freedom to spend an hour with a patient only matters if you know what to do with that hour.
• 5:00
  Speaker: And that's the opportunity I see for nurse practitioners right now.
• 5:04
  Speaker: We don't just have an opportunity to own more practices.
• 5:07
  Speaker: We have an opportunity to rethink what happens inside of them, to practice earlier in the disease trajectory, to recognize patterns before they become diagnosis, to connect physiology across systems, to combine the strengths of conventional medicine with evidence-informed functional, lifestyle, and integrative approaches, and to create practices that don't simply give us more autonomy.
• 5:33
  Speaker: They allow us to provide the kind of care that made us want autonomy in the first place.
• 5:38
  Speaker: So if you're dreaming about leaving the traditional model and building something of your own, keep dreaming, learn the business, understand the numbers, build something sustainable, but don't stop there.
• 5:51
  Speaker: Ask yourself one more question.
• 5:53
  Speaker: Am I only building a different practice?
• 5:56
  Speaker: Or am I becoming a different kind of clinician?
• 5:59
  Speaker: Because those are not the same thing.
• 6:01
  Speaker: I'm Dr.
• 6:02
  Speaker: Sheri Erwin, and this has been a Bridgewell Brief from the Integrative Clinician.
• 6:07
  Speaker: Until next time, keep asking the questions that change everything.
• 6:11
  Speaker: What is the physiology telling me?