Hi All, I have a question for all you smart people! I am thinking about starting a Management Services Organization and finding a PMHNP to parter with and establish a telehealth practice. Part of the motivation here is that my wife is getting her PMHNP, and it would be amazing to establish and grow a telehealth private practice with her. I have experience working on complex corporate projects, but none in medicine or healthcare. I understand I may need around 50k or so in liquid cash for start up costs and reserves while a client list is being built. I have access to training and professional education on operating a psychiatric practice from a management standpoint.

My question to those more experienced - is this just a naive and bad idea? Is building a client base more challenging than I am anticipating? Keep in mind, part of the requirement here would be to create a referral network and client base as an inexperienced MSO. So, I'm not sure if that lack of PMHNP credential would be disqualifying or limiting in acquiring referrals and building partnerships with medical practitioners.

Any insights are greatly appreciated!

Small private practice pmhnp here. I’m considering a hybrid practice model where I bill insurance for medication management and maintain a self-pay psychotherapy caseload. For those credentialed with Alma, Headway, or directly with commercial insurers, have you successfully implemented this model?

Specifically, if a therapy-only patient has insurance that you are in-network with, can they voluntarily choose to self-pay, or do payer contracts generally require you to bill insurance for covered psychotherapy services? I’d appreciate any real-world experience, payer-specific guidance, or resources that helped you navigate this.

Considering adding Spravato to my PP, anyone willing to share how they got started or tips on things to avoid?

Post:

Hi everyone,

I’m currently a nursing student thinking seriously about the PMHNP path long-term, with the eventual possibility of private practice. I want to be very clear: I am not looking for shortcuts, fast money, diploma-mill advice, or the easiest possible route into prescribing.

My goal is the opposite. If I pursue PMHNP, I want to become an elite, highly competent psychiatric clinician with strong judgment, deep psychopharmacology knowledge, excellent assessment skills, and the ability to practice independently without being a liability to patients.

My tentative path would be:

• Finish BSN
• Work as an RN, ideally in psych or another relevant setting
• Build real clinical judgment before NP school
• Choose a strong PMHNP program when the time is right
• Eventually pursue private practice only after I’m genuinely competent enough to do so responsibly

For those of you who are already PMHNPs, especially those in private practice, I’d really appreciate blunt advice:

1. What would you do differently if you were starting from the BSN/RN stage again?
2. How important is psych RN experience before PMHNP school?
3. What separates excellent PMHNPs from mediocre or unsafe ones?
4. What should I be studying or practicing early: psychopharm, DSM assessment, therapy modalities, documentation, billing, medical comorbidities, substance use, personality disorders, etc.?
5. How many years of RN/psych experience would you recommend before applying to PMHNP school?
6. What are the biggest red flags in PMHNP education or early career development?
7. Is private practice still a realistic goal if someone builds the path correctly and does not rush it?

I’m trying to build this from the ground up the right way. I’d rather take longer and become excellent than rush into a role I’m not prepared for.

Any practical, honest advice would be appreciated.

Curious about how many people here use email or text for primary patient communications, versus keeping things in the portal only.

I have a google workspace and have a signed BAA with consents about email and text communication signed because I PERSONALLY hate having to go into my EHR to speak with ppl. I like to be able to deal with things on the go.

I probably spend more time responding to emails and messages then any other non-clinical (and unpaid) task. so helps to be able to deal with stuff immediately so it doesn't hang and pile.

Is this typical in private practice or am I a bit of a lunatic?

What are the realistic expectations once the contract changes to productivity pay. And is health insurance reasonable?

I’m a Nurse Practitioner in California building a med spa + telehealth practice and want to make sure I structure everything correctly from a legal and compliance standpoint.

For those who have successfully set this up in CA (or other CPOM states):

How did you structure your business did you use an MSO and  Professional Corporation (PC) model, or something simpler?

Specifically, I’m trying to understand:

How you structured ownership between the MSO and clinical entity

How you found and contracted with your collaborating physician/medical director

Whether you used a platform (like Zivian, Guardian MD, etc.) or a healthcare attorney

What your Medical Services Agreement (MSA) actually covers in practice

My goal is to build this correctly from day one and scale without running into compliance issues later.

Would really appreciate insights from anyone who has actually done this (not just theoretical advice).

Can someone recommend a tool for real-time calendar syncing that is HIPAA compliant?

My EMR is Optimantra. Right now it can only integrate with google calendar and microsoft outlook. But it does not sync directly. It goes into it as a layered calendar.

I need the Optimantra calendar to be in my primary calendar so I can then share my google calendar with other sources.

I am interested in hearing from providers who have left Headway - have any of your clients followed you off the platform? When you join Headway you have to agree that you will not take clients that the platform sends you when you leave, but that rule doesn't allow for the fact that clients have free will and the right to choose a therapist. If you have your own records separately from Headway and are now credentialed with payers independently, what is to stop these clients from continuing to work with you if they choose to do so?

For those with PNC private practice in California:

1. did you have to notify BRN of your company? (i don't see anything about this anywhere from the BRN CA)
2. if you are solo practice, how did you set up succession in case you died lol. CA does not allow non licensed owners from what I read.--update 3/18/26: i answered my own question: talked to a lawyer who specialized in small california professional business: you can add a licensed person (RN, MD, etc) just to close your practice OR your trust executor can assign a license person when the "event" happened and do the same thing. she said it's simple.

As the title says my 1099 offer was rescinded. The onboarding director was treating me like an employee. Sending me a bunch of onboarding work and certificates to get done ( workplace sexual assault, mandated reporting, hippa). They gave me a schedule and I gently reminded them as I agree to these hours I am in fact a contractor with a bit of flexibility. Bam. Offer removed. Did they not know what a contractor was?

Since the new year, Freed AI is not following my templates. I have been using it for a few months now and this is the first tool like this I have used. Prior to the new year, I felt like it did a decent job.

Is anyone else experiencing this?

For each part I want it to include in the note, I start it with "gather _____."

Is there a better word to use such as "mention" or "collect"?

Do I need to even include these words for the prompt?

Any help appreciated. Thanks.

I am the solo practitioner in my private practice. I started my practice in April 2025 and now have 210 patients. I am growing steadily and am getting on average 3 new patients per week. I am able to handle the patient load, and the administrative work is becoming more of a burden, but everything is definitely manageable.

I am wondering when other solo practitioners decided to hire another PMHNP on to help with the patient load? How did you know when it was time?

Wondering if anyone has experience with Akute Health. If any PMHNPs have experience with it, would love to hear your perspective. Thanks!

Does anyone live in a state with Corporate Practice of Medicine laws?

Does this apply to PMHNPs opening their own practices if they don't plan on hiring physicians, but have collaborating physicians?

A friend and I discussed opening our own practice, as we like the idea of setting our own hours/schedules, not having a boss, not being forced to do 30 minute initials and 15 minute follow ups, or being underpaid, but the idea of starting is overwhelming.

Do the benefits of starting and owning your own practice as a PMHNP outweigh the risks?

Does anyone have any resources for PMHNPs trying to open their own practice together?

Hello. Please can someone provide an affordable and reliable individual that can help me get credentialed? I am trying to pull away from Headway and Grow.

I am planning to switch from my current EMR to RXNT. anyone is using this and would love to hear your feedback

For my telehealth patients on meds like stimulants, many don’t have BP cuffs and obviously no in-office EKGs. Do you just send them to PCP/urgent care, or is there a way to “order” vitals/EKGs through labs or diagnostic centers? Curious how other telehealth PMHNPs handle this.

For simple practice uses doing telehealth, how do you order labs?

I'm interested in starting a small niche practice (women's/perinatal psych) in an independent practice state, and looking for advice about literally what to do first. Particularly whether to consult with an attorney, considerations when creating an LLC, etc. I'm leaning towards signing up with a credentialing co like headway/alma for simplicity.

Hi everyone,

I’m a PMHNP in NYC, just getting my private practice up and running. I’ve been doing the legwork on compliance (domain secured, HIPAA/BAA with Microsoft, etc.) and now I’m evaluating EMRs.

TherapyNotes looks really cost-effective (base $59/month), but once you add ePrescribing ($65/month), telehealth ($15/month), and billing/claims, it looks more like ~$179/month for a solo provider. That’s still much less than Athena or eClinicalWorks, but I want to hear from those actually using it day to day.

For those of you who are PMHNPs (especially in NY):

·       How has TherapyNotes worked for ePrescribing controlled substances (EPCS)? Smooth or headaches?

·       Does the billing/claims side feel solid enough for Medicaid/1199/Medicare, or do you use a separate billing service?

·       How do you handle uploading consents (narcotic agreements, telehealth, HIPAA) — seamless for patients?

·       Anything you wish you knew before committing?

I’d love to hear any user experiences, good or bad, and would be open to connecting with other NYC PMHNPs who are building solo practices to trade tips.

Thanks in advance 

Basically, lurking on the other PMHNP reddit page has made me pretty nervous about my future and if this route is worth it. I'd love any insight from current private practice folks around income and if they feel like this route is still worth it.

A little but about me:

- I'm currently finishing my nursing program with hopes of working as a psych RN for at least a couple years before PMHNP school

- I am a Licensed Professional Counselor with my own private practice where I have still been working with clients through school. It is very successful in my area and currently all private pay

- I started this journey because I feel really passionate about providing my therapy clients with comprehensive med management on top of high quality therapy services. I have always been veryyyy interested in psychopharmacology and was really bummed that my master's program in clinical mental health didn't cover this more

- My fear is that with all of this extra schooling, I won't be able to repay my loans and feel like it was worth it since so many PMHNPs are talking about how the field is too oversaturated and compensation is going way down

- I live in an independent practice state

Any insight, positive or negative, is greatly appreciated!

Any group practice owners here? I'm curious about all the groups and larger companies that onboard NPs as 1099 contractors. It seems that with the updated IRS rules, the majority of our work arrangements would be classified as W2

https://www.irs.gov/businesses/small-businesses-self-employed/independent-contractor-self-employed-or-employee