Working for a Mom & Pop Practice: Do or Don't

Working for a small practice can have a lot of appeal as a nurse practitioner. You avoid the bureaucracy associated with employment in a large health system. You may be able to work out a flexible employment arrangement with ease. Not to mention, you might simply enjoy the close-knit group of individuals you work with. As you evaluate your options, the size of the practice is important to consider and will directly impact your day-to-day. Consider these things if you're thinking about joining a clinic that could be described as a "mom & pop" practice. 

Primary and secondary job responsibilities 

I once completed a clinical rotation in a mom and pop clinic. The experience working there as a nurse practitioner was much different than in the larger clinic chains and health systems I encountered. Given the size and volume of the practice, there were almost no ancillary staff members. So, I took my own vital signs, administered my own injections and essentially acted not only as a NP but also as a medical assistant. Some days when the clinic was slow, I was even responsible for calling insurance companies to collect on outstanding reimbursements. 

Before you sign on with a mom and pop practice, understand if your job responsibilities as a nurse practitioner will look different than those you're accustomed to. How much assistance will you have from other staff?

Relationships between staff members

Some practices are literally mom and pop establishments. Are the members of the team you're working with actually related? Working in a family business can equal a lot of drama if dynamics are strained. This isn't something you want to be looped into in your professional life. If staff members are not family, you'll still want to evaluate how they communicate with one another, and assess if there's a culture of mutual respect in the clinic. Any facility is drama-prone, but small practices can become toxic workplaces very quickly. 

Management structure 

Along similar lines, the way management is set up will significantly impact your day-to-day. This is especially true if there are family or other staff dynamics at play. One nurse practitioner I talked with worked in a small clinic where the medical director and her supervising physician were married to one another. When she had frustrations with her supervising physician, she had no recourse as she would be expressing frustration to her boss...about his own wife! Think through the reporting structure at the practice and how this might present benefits and/or challenges for you as a nurse practitioner. 

Expectations outside of the clinic  

I talk with a number of practices as part of my work here at MidlevelU and often find that smaller practices pride themselves on community involvement and consider this almost as part of the patient relationship. Small town clinics in particular are looking to hire nurse practitioners eager to get involved in everything from attending high school football games on Friday nights to shopping at the local farmer's market. This increases trust in the care provided at the facility in close-knit communities. Get a feel for if this is something expected at your prospective workplace and if the community is one you'll want to be involved in. 

Owner's end game 

Small practices are subject to the whims of practice owners. A physician-owner nearing retirement age may elect to close shop when they turn 65. Alternately, an owner may have aspirations to expand the practice and open several more clinics in the area giving your career an upward trajectory. In the interview process with a mom and pop practice, it's perfectly appropriate to inquire about future plans for the facility so you can make sure the job has the longevity and trajectory you need. 

Openness to innovation 

Similar to larger healthcare facilities, some small practices are open to fresh ideas whereas others tend to be stuck in their ways. As a nurse practitioner, will your prescribing habits be closely monitored or will you have significant freedom in the way you practice? How technologically advanced is the facility? Will this change? What types of ancillary services or procedures does the clinic offer? Is the owner or management team open to expanding their service lines should you desire to do so? Get a feel for how much say you'll have in the direction the practice takes and how open ownership is to change. 

Do you work for a "mom and pop" practice? What challenges do you face? What are the benefits? 

 

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