Think of things this way.... your money maker is your PA skill set. Anything that you do that dilutes that during the workday reduces your income stream and affects productivity, not to mention your clinical acumen that would hopefully build up over time as a new provider. Productivity and quality of life can be severely affected a number of ways, like the number of no shows, difficulty collecting on billed services, marketing, etc. I’m picturing a lot of inconsistency in workflow, and an over reliance upon other people in order for you to have the kind of return on your investment that would make it worth it. Plus, you are essentially running three or four businesses in one, and that division in domains means that any one of them failing leads to the whole project collapsing. You go to school to be a provider so that you can go see patient after patient. At some point, you may end up getting a glimpse of an untapped niche that you can take advantage of, and you can branch into that, and do so with some authority based on your experience. Even then, it can be an uncertainty.
As a PA, you are utterly reliant upon the good will of a physician. If they don’t feel comfortable with what you are doing at any point, they tell you “No” and thats the end of it. If they see that you are becoming successful, and they want a bigger piece of the pie, then you give it to them, or else they walk. The next physician won’t give you a good deal if they think they can get more out of you, and the physician community often talks to each other. The physician supervisor you hire is privy to ALL of your secrets as well (their license depends on it), and if they see you doing well, they can walk away with your business model and open up across the street and have more credibility than you do, instantly. They are doctors, after all, and they will let everyone know that when they run ads against you. A physician would be your employee, but also your boss. If there is a more awkward business relationship out there, I don’t know what one would be. Even the PTs would essentially own you.
I know NPs that are hired by practices owned by therapists/counselors so that the practices can have the weight to throw round of a prescriber so that more patients needs can be met. Guess who gets paid more than anyone in those practices, including the owners? The prescribing providers, because none of them are going to stock their neck out at a bargain price. They are going to demand more money, and get it. If there is a falling out, the NPs leave and tell all their friends, and the next NP showing up for an interview to replace them knows that the practice is desperate for a provider that prescribes, and the price goes up. So as you can see, the landscape is fraught with peril. If you have a good idea, keep it close to your chest, and try to simplify it considerably so that you aren’t left begging for someone to help you stay afloat.
