“I'm doing all of this work and I'm not getting reimbursed... so why am I doing this?”
— Nurse practitioner, 7 years in practice
What they told us about the future of independent practice
We spoke with nurse practitioners considering practice ownership — not through surveys, but in real one-on-one conversations. What they told us challenges the conventional wisdom about who wants to go independent and why.
Two in five active physicians will reach retirement age within the next decade (AAMC, 2024). Medical students are choosing specialty care over family medicine. The pipeline is drying up.
The United States has over 461,000 licensed nurse practitioners — with projected employment growth of 35-40% over the next decade, making NPs the fastest-growing role in healthcare (BLS, 2024). Eighty-seven percent are trained in primary care. In 27 states plus the District of Columbia, they can diagnose, prescribe, and manage patients independently — up from just 22 states before the pandemic. (AANP, 2026; AANP, 2020)
The people most equipped to solve the primary care crisis are themselves in crisis. They're leaving positions at 10–20% per year (Nursing Outlook, 2024) — not because they don't love patient care, but because the system around them has become unbearable. As one psychiatric NP working for a county system told us, "I became a nurse practitioner thinking that I could have the independence of providing the care I want to. And right now I just don't feel like I can do it here."
34% of NPs say they want to own a practice (Nurse.org, 2024). For most, it stays an aspiration — the barriers between wanting to and actually doing it remain significant. Meanwhile, independent practices are disappearing: the share of physicians in private practice fell from 60.1% to 42.2% in just twelve years (AMA Physician Practice Benchmark Survey, 2024).
More providers than ever. Fewer independent practices than ever. The workforce is growing — the pathway to ownership is not.
160 nurse practitioners across 36 states. November 2024 – December 2025. Here's what they told us.
Each dot represents a real conversation — a nurse practitioner who reached out to explore what practice ownership might look like. Together, they form a dataset unlike anything in published NP workforce research: not survey checkboxes, but real dialogue about real decisions. What follows is what we found.
Demographics of 160 NPs exploring independent practice.
The conventional image of a nurse practitioner starting a practice is a seasoned veteran hanging a shingle after decades of clinical experience. Our data tells a different story.
The 160 NPs we spoke with span 36 states and every major specialty. They come from hospital systems, group practices, insurance companies, academic institutions, and government facilities. Nearly one in five currently works for an insurance company — they've seen the healthcare system from inside the payer machine and decided they'd rather be on the other side of it. Psychiatric and mental health NPs make up the largest single specialty at 28%, followed by primary care at 24%. Sixteen percent plan to offer multiple specialties.
In 27 states plus the District of Columbia, nurse practitioners have full practice authority; in the other 23 states, they must work under a physician collaborator or supervisor. (AANP, 2026) Our dataset splits almost evenly across both — 47% from full-practice states, 53% from restricted — and the top four by call volume (Florida, California, Arizona, Texas) reflect population more than regulation. These NPs know the rules cold. One Florida NP told us she was planning to launch her practice in Washington state instead because at home, "I have to pay for a collaborating physician and all that." Interest in ownership shows up across the country — and so does clear-eyed awareness of what it'll cost.
The popular narrative is that NPs go independent because they're burned out. It's more complicated than that. While a quarter of NPs we spoke with expressed frustration with their current situation, only 4% cited escaping their employer as their primary motivation. More often, burnout was the backdrop — not the trigger. The most common primary motivations were entrepreneurial ambition (23%) and a desire for autonomy (20%) — or as one family NP put it, "I'm here Monday through Friday, 8 to 5. I don't like that. Someone else is dictating my schedule."
When we could identify a specific triggering event, the pattern was clear: 68% were life transitions — a relocation, a retirement, a layoff — not workplace frustration. One women's health NP described it simply: "I just moved... I can't commute anymore. So I do telehealth part time and just trying to figure out how to start my own practice."
Veterans want control. Early-career NPs want to build. New grads are split.
mentioned a partner, spouse, or co-founder in their decision. 36 mentioned a spouse specifically. 6 calls were the non-NP partner — doing the research on behalf of the clinician.
The practices these NPs envision look nothing like the traditional family medicine clinic. When asked about their practice model, 54% described a hybrid approach — combining telehealth with in-person care. Only 9% want a purely brick-and-mortar practice. Five percent are planning mobile practices, bringing care directly to patients' homes.
This hybrid preference has significant infrastructure implications. It means multi-state licensing, dual credentialing tracks, and technology platforms that support both virtual and physical encounters. The infrastructure gap isn't just about getting credentialed — it's about supporting a practice model that didn't exist a decade ago.
want hybrid — telehealth plus in-person
The services these NPs plan to offer reveal an even more dramatic shift.
mentioned weight loss or GLP-1 services
of those are primary care NPs pivoting to weight management
This isn't just opportunism — it reflects a genuine market signal. Cash-pay weight management and hormone therapy allow NPs to generate revenue immediately while the slow insurance credentialing process grinds forward. As one family NP considering direct primary care told us, "I already have patients who tell me as soon as I start my own practice, they'd be the first in line." Primary care becomes the clinical foundation; high-margin wellness services become the financial engine that makes the practice viable.
More than a quarter of NPs we spoke with expressed interest in cash-pay or direct primary care models — practices that bypass insurance altogether. Combined with the GLP-1 and hormone therapy pivot, this signals a structural shift: NPs aren't just building practices differently, they're building them on a fundamentally different business model. Cash-pay eliminates the credentialing bottleneck, accelerates time to first patient, and gives NPs direct financial relationships with the people they serve.
interested in cash-pay or direct primary care
The implication for anyone supporting NP practice launches: the product isn't a "primary care practice launch." It's a multi-service, hybrid-delivery practice launch — fundamentally more complex, but also more financially resilient.
This statistic — that two-thirds of NPs we spoke with had already taken concrete steps toward practice ownership — might sound encouraging. But it masks a harder truth. Having an LLC doesn't mean you have patients. Having an EIN doesn't mean you've navigated credentialing. Most of these NPs are somewhere in the long, confusing middle of a process they don't fully understand. As one NP told us, "I know absolutely nothing of the business aspect, so just trying to do my own research has been difficult."
The barriers they face are structural, not personal. NP education programs include zero mandated business or practice management training (AACN, 2022). A nurse practitioner can complete a doctoral program without ever learning how to read a P&L statement, file for an NPI, or negotiate a payer contract. When they attempt to go independent, they encounter a credentialing system that varies by state, a Medicare reimbursement penalty that pays them 85 cents on the physician dollar (CMS, 2024), and a fragmented ecosystem of tools — each solving one piece of the puzzle, none solving the whole thing.
already formed an LLC, obtained an EIN, or started credentialing
These aren't people at the idea stage. They started and got stuck.
"The fear of failure and not being successful... the uncertainties and the unknown of where to even start."— NP with 15 years experience, 25 years in nursing
These are highly trained clinicians doing exactly what they were trained to do — provide patient care. What they were never trained to do is run a business.
The system doesn't fail them at the clinical level. It fails them at every other level — business formation, credentialing, billing, marketing, compliance. The 66% who have already started are proof that motivation isn't the problem. Infrastructure is.
The primary care crisis will not be solved by training more physicians. The pipeline is too slow, the economics too unfavorable, and the competition from specialty medicine too strong. But there are 461,000 nurse practitioners already in the workforce (AANP, 2025) — trained, licensed, and increasingly looking for a way out of a system that is burning them out.
The path from employed NP to independent practice owner is navigable. The 160 NPs we spoke with prove that the demand exists, the clinical capability is there, and the patient need is urgent. What's missing is the infrastructure to make the journey possible at scale. Four changes would unlock it.
13-year veterans say "I know absolutely nothing about business"
Same work, same training — 85 cents on the dollar
50 different state regulatory systems for a workforce where 54% want hybrid
Credentialing, EHR, marketing, compliance — nobody owns the whole journey
Independent practices have declined from 60.1% to 42.2% in just twelve years (AMA Physician Practice Benchmark Survey, 2024). If that trend continues, the model of community-based, provider-owned care will effectively disappear within a generation — replaced entirely by corporate systems optimized for volume, not outcomes.
Nurse practitioners are the one workforce large enough, growing fast enough, and trained well enough to reverse that trend. But not if the barriers remain.