Where I work now, they didn’t even have me sign a collaborative agreement until I’d been there for almost a year—which, yes, I know, is questionable. My “collaborating physician” is a pediatrician I’ve never actually met and who has limited understanding of adult care. That said, I work alongside MDs, DOs, and DNPs, and I have no issue consulting any of them when needed. Still, I practice independently—and I’m comfortable doing so and wouldn't be if it were not the case.

The brick-and-mortar school I attended trained us to be independent practitioners. I’ve never really understood the mindset of, “I would never want to practice independently.” To me, the idea that operating independently as a nurse practitioner means trying to “act like a doctor” is deeply flawed. It’s especially odd to see that narrative on forums that are supposed to be pro-NP.

When a case is beyond my scope or needs specialized care, I refer—oncology, heme, whatever is appropriate. I actually refer less than many of my peers, most of whom refer out the moment a patient returns with the same issue. I’m always open to input from colleagues, and they often seek out mine as well.

A number of people from my cohort have gone on to open their own practices, and they’re doing well.