I opened a free clinic inside of a community center in Del Rio, TN. I had to pay an attorney to draw up articles of organization and supervision agreement between me and a physician. This cost me $800. Because my business includes housecalls, the corporate address is my home. I cannot open a full time clinic in Del Rio because I would have to pay a physician to come to the clinic once a month and sign twenty percent of my charts. I do the exact same thing for patients in that clinic that a physician would do. I have worked in hospitals, urgent care, GI offices, nursing homes, etc. Laws regarding visits to nursing homes say a physician has to do every alternate visit, which usually ends up being a quick hello and then the NP does the work the rest of the time...if the patient is sick, they send the NP to take care of it. If I order home health services, the home health organization can't get paid by Medicare until they or I go find the physician that I employ and have them sign the order. Medicare will pay that physician for certification of home health even though it is my patient who was referred to me for housecalls, either by another healthcare provider or by family/patient request. Even though I have a DEA number and am trained in pain management, I have to discuss this with a physician if I write more than a 30 day supply. This often results in a cancer patient being in pain until I hear back or get orders signed. Patient test results often to go the physician office instead of mine because the hospital will only put orders in under the doctors name, even though that doctor has never seen the patient. This leads to delays in treatment of abnormal labs and xrays.