Why Nurse Practitioners Making $300K-$1M+ Don't Know How to Deploy Capital (And the Investment Ecosystem Changing That)

A New Economic Model for NP Entrepreneurs: From Self-Employed to Business Owner to Investor

‍‍

By Dr. Kimberly Madison, DNP, AGPCNP-BC, WCC

Listen here.

Over the past five years, I've had strategic conversations with nurse practitioner entrepreneurs across the country, from Virginia to California, from the Midwest to the Southeast. These weren't casual coffee chats, they were intensive discussions about the state of our profession, the barriers we face, and the opportunities we're leaving on the table.

What I heard consistently was this:

NPs are making $300K, $500K, even $1M+ annually.

But when I asked, "What do you do with your capital? How are you deploying it strategically?" the responses ranged from uncertain to nonexistent.

"I don't know what I would do with $50,000."

Not "I don't have $50,000."

I don't know what to do with it.

These aren't struggling practitioners. Some run wellness centers offering IV hydration, hormone replacement therapy, and aesthetic services. Others own mobile practices, telehealth platforms, or brick-and-mortar clinics. Some are midwives transitioning into aesthetics. Others specialize in integrative dermatology. Some work solo, others manage teams of 5-10 people.

They're generating six- and seven-figure revenue.

They have money.

They don't know what to do with it.

And here's the tragic part: while some practitioners are sitting on capital they don't know how to deploy, other nurse practitioners, brilliant, clinically excellent, mission-driven entrepreneurs, are scrambling for seed funding, applying for business loans they can't qualify for, accepting inadequate compensation packages, or worse, giving up before they start because they "don't have the money."

Meanwhile, some who did launch are three years in, break-even at best, contemplating bankruptcy or closure despite working 50-60 hour weeks.

This is the problem I'm solving.

Not "How do we get nurses more money?"

But "How do we help nurses see themselves as investors and invest in each other?"

‍

THE CURRENT MODEL IS BROKEN

Here's how it works right now:

A nurse practitioner has a brilliant idea. She wants to open a practice serving her community. She needs $50K-$100K to get started.

Where does she go?

Option 1: Traditional bank loan
Requirement: 2+ years in business, strong credit, collateral
Reality: She's been employed her whole career. She doesn't qualify.

Option 2: SBA loan
Requirement: Business plan, financials, 680+ credit score, lengthy approval process
Reality: She's never written a business plan. She doesn't have time to navigate bureaucracy.

Option 3: Venture capital
Requirement: Scalable tech, hockey-stick growth projections, 10x return potential
Reality: She's opening a wellness clinic or mobile practice serving underserved communities. VCs won't touch it.

Option 4: Friends and family
Reality: Her family doesn't have $50K. Her friends are nurses, also employees, also living paycheck to paycheck despite six-figure salaries.

So what does she do?

She doesn't start.

Or she starts undercapitalized, burns out in 2-3 years, and goes bankrupt.

Or she takes a predatory loan with 18% interest and spends the next decade paying it off.

Or she accepts an employment contract at $110K when she's generating $1M in collections for her employer, missing bonus thresholds by design, working at a second location 30 miles away to "build her panel" while seasoned providers protect their territory.

Or she opens her dream aesthetic clinic, invests in lasers, hires staff, then faces theft, no-shows, people burning patients, and realizes the overhead is eating her alive while hairdressers down the street offer $4 Botox and she can't compete.

This is the disconnect.

‍

NURSES HAVE CAPITAL. THEY JUST DON'T SEE THEMSELVES AS INVESTORS.

Let me say that again: Nurses have capital.

If you're a nurse practitioner with 5+ years of experience, you're likely making $100K-$150K annually. If you're running your own practice, whether it's aesthetics, wellness, integrative medicine, or telehealth, you're making $200K-$700K+.

You have money.

But nursing school didn't teach you what to do with it.

You were taught:

• Work hard
• Be humble
• Don't talk about money (it's not "professional")
• Save for retirement in a 401(k)
• Pay off your student loans
• Maybe buy a house

You were NOT taught:

• How to deploy capital strategically
• How to invest in assets that generate income
• How to evaluate business opportunities
• How to think like an investor

So you sit on capital you don't know how to use, while your peers struggle to access the capital they desperately need.

We have a distribution problem, not a scarcity problem.

‍

THE CASHFLOW QUADRANT: WHERE ARE YOU REALLY OPERATING?

Robert Kiyosaki's Cashflow Quadrant breaks income into four categories:

E (Employee): You trade time for money. Someone else controls your income.

S (Self-Employed): You own your job. If you stop working, income stops.

B (Business Owner): You own a system. The business generates income without you.

I (Investor): Your money works for you. Passive income through investments.

Most NPs think they're in the B quadrant because they own a business.

But here's the reality check:

• If you stop seeing patients, does revenue stop?
• If you take a two-week vacation, does your business survive?
• If you got sick tomorrow, could your practice run without you?
• Are you the one cleaning rooms, doing all the marketing, handling all the administrative tasks?

If the answer is "yes" to any of these, you're not a business owner. You're self-employed with a fancy title.

You're in the S quadrant, the worst place to be financially. You have all the risk of entrepreneurship (no benefits, no safety net, full liability, personally backing equipment loans) with none of the freedom of true business ownership.

And you're definitely not operating as an investor.

‍

The Founder’s Reality Check: Are You Building an Asset or Just Owning a Job?

‍

WHAT IF EVERYONE WAS IN ONE STADIUM?

I've spent the last five years watching NPs work in silos. During that time, I've come to see being a nurse practitioner entrepreneur a lot like playing football. At first, everyone wants to be the football player, they get a lot of the attention, it's the one role we get the most exposure to, and it's the one everyone thinks makes the most money - so naturally, parents tell their kids to do it. But, the longer I practiced, I realized just like the football player, it's not a game you can play forever. When the time comes, and you need help. You look to your teammates but realize, they can't help you because they're in the game with you!

So, we look to the coach who has the playbook. They have a unique vantage point that positions them to see the whole game, something the player can't do. You can't see the whole picture when you're inside the frame (shout out to Dr. Erica Yuille). Therefore, after playing for a while, many of us find ourselves in a coaching and mentoring position. Myself included. I did some more thinking. I thought there wouldn't be any football players and there wouldn't be a coach, if there weren't a stadium.

‍

"Maybe I should be the lady who built the stadium." - Dr. Kimberly Madison, DNP

‍

Why did we need a stadium? Because I saw a lot of scrimmage games being played separately. Some were really successful, while others were severely struggling. While I like a good scrimmage game, I love the Olympics more. Win or lose, every athlete wants a chance to play at the Olympics.  

‍

I kept thinking: What if everyone was in one stadium, like the Olympics? What if I was the lady who built the stadium?

Not because I want to be the center of attention.

But because someone has to build the infrastructure. Someone has to create the regulatory body, the community, the systems that keep each other in business.

Right now, NPs are:

• Paying consultants $2,500+ for training programs that may or may not be worth it
• Competing against each other instead of collaborating
• Working 50-60 hour weeks while their families wait for them to "finish" one more thing
• Going bankrupt or closing clinics after 3 years because nobody taught them business architecture
• Sitting on capital they don't know how to deploy

And the advice is always the same: "Take a Botox course. Start your own business."

But nobody tells you:

• You need 2+ years of experience to get hired in aesthetics or dermatology
• Weekend Botox courses don't teach complication management or business operations
• You'll spend an average of $100,000 in your first year on training, devices, rent, marketing, and supplies
• Staff management is a full-time job in itself
• Most aesthetic training programs skip skin of color entirely
• No one teaches you about financial literacy, capital deployment, or exit planning

That's the gap I'm filling.

‍

NURSES ARE INVESTORS, AND WE ARE INVESTABLE

Here's my thesis:

Nurses should stop seeking venture capital and start investing in each other.

We have the capital. We just don't see ourselves as investors.

Intel I received from NP entrepreneurs across the country revealed a consistent pattern:

They're making significant income but have no framework for:

• Capital deployment
• Wealth-building
• Investment strategy
• Business valuation
• Exit planning
• Making money while they sleep

‍

They're excellent clinicians. They're hardworking entrepreneurs.

But they're financially illiterate when it comes to making their money work for them.

And that's not their fault. That's a systemic failure of nursing education.

‍

WHAT IF WE BUILT OUR OWN INVESTMENT ECOSYSTEM?

Imagine this:

Instead of applying for bank loans, NPs pitch to other NPs.

A nurse practitioner wants to launch an integrative dermatology telehealth platform. She needs $75K.

Instead of going to Wells Fargo (who will reject her because she doesn't have 2 years in business and collateral), she pitches to a network of NP investors who:

✅ Understand the healthcare industry
✅ Know the market
✅ Can evaluate her business plan with clinical and entrepreneurial expertise
✅ Want to support other NPs
✅ Are looking for investment opportunities that align with their values

Five NPs invest $15K each.

They're not venture capitalists demanding 10x returns in 5 years.

They're strategic partners who:

• Believe in the mission
• Want to see more diverse practitioners succeed
• Understand that a 20-30% annual return on a $15K investment ($3K-$4.5K/year) is solid
• Can provide mentorship, connections, and business guidance

Now the launching NP has:

• Capital to launch
• A network of experienced mentors
• Accountability partners who are invested in her success
• Proof of concept for her business model

And the five investors have:

• Diversified their portfolios
• Generated passive income
• Supported a mission-driven business
• Created opportunities for collaboration and cross-promotion

‍

Everyone wins.

‍

THIS ISN'T CHARITY. THIS IS STRATEGIC CAPITAL DEPLOYMENT.

Let me be clear: I'm not asking NPs to "give back" or "support their community" out of the goodness of their hearts.

I'm asking them to invest strategically in assets that generate returns.

Here's the math:

Scenario 1:
You have $50K sitting in a savings account earning 0.5% annually.
Annual return: $250.

Scenario 2:
You invest $50K in 3-4 early-stage NP-owned businesses, each generating 20-30% annual returns.
Annual return: $10K-$15K.

That's a 40-60x improvement on your capital deployment.

And that's before we talk about:

• Tax advantages of investing in small businesses
• Appreciation in business value over time
• Opportunities for acquisition or partnership
• Cross-promotion and referral networks

‍

This isn't philanthropy. This is smart money.

‍

FINANCIAL LITERACY IS THE MISSING PIECE

The reason NPs aren't investing in each other isn't because they don't want to.

It's because they don't know how.

Nursing school taught you:

• How to assess a patient
• How to administer medication
• How to follow protocols

Nursing school did NOT teach you:

• How to evaluate a business opportunity
• How to structure an investment deal
• How to assess risk vs. reward
• How to build wealth
• How to make money while you sleep

That's why financial literacy education is the cornerstone of everything I'm building.

‍

Through the Alliance of Cosmetic Nurse Practitioners™ and the Financial Literacy for Founders series, I'm teaching:

✅ The Cashflow Quadrant (how to move from S to B and I)
✅ Capital deployment strategies (where to invest your money)
✅ Business valuation (what's your practice actually worth?)
✅ Investment fundamentals (how to evaluate opportunities)
✅ Wealth-building frameworks (how to generate passive income)
✅ Exit planning (how to sell or transition your business)

Because you can't invest in each other if you don't understand the mechanics of investment.

‍

THE TRICKLE-DOWN EFFECT: WHEN NPS THRIVE, PATIENTS THRIVE

Here's what nobody talks about:

When NP entrepreneurs succeed financially, patient access improves.

Here's the chain reaction:

1. Financially whole NPs open more clinics.
More clinics = more access for underserved communities.

2. Financially whole NPs hire more staff.
More jobs = more economic opportunity in the community.

3. Financially whole NPs offer sliding scale services.
Financial stability = ability to serve low-income patients without going bankrupt.

4. Financially whole NPs invest in research and education.
More resources = better training, better outcomes, higher standards of care.

5. Financially whole NPs mentor the next generation.
Security = capacity to give back without sacrificing personal well-being.

This isn't just about making money.

This is about building an ecosystem where everyone thrives.

‍

WHAT HAPPENS NEXT?

If you're reading this and thinking, "This sounds good, but how do I actually start?"

Here's what I'm asking you to do:

Step 1: Shift your mindset.
You're not "just a nurse." You're a capital holder. You have investable assets. You are an investor.

Step 2: Get financially literate.
Learn the Cashflow Quadrant. Understand investment fundamentals. Know what your business is worth.

Step 3: Look around your network.
Who's trying to start a business? Who needs capital? Who has a solid business plan but can't get a bank loan?

Step 4: Have the conversation.
"I have capital. You have a business idea. Let's talk about a strategic partnership."

Step 5: Build the ecosystem.
One investment at a time. One partnership at a time. One NP helping another NP.

‍

THE VISION: WHAT IF EVERYONE WAS IN ONE STADIUM?

I'm building the stadium.

The Alliance of Cosmetic Nurse Practitioners™ is the regulatory body, the community, the infrastructure that keeps us all in business.

We're creating:

✅ Financial literacy education
✅ Investment networks
✅ Business mentorship
✅ Research partnerships
✅ Clinical training excellence
✅ Wealth-building frameworks

Not because I want to be the only voice in the room. But because someone has to build the stadium. And then, once it's built, I can step back and operate as an investor too.

Because that's the goal:

To work myself out of a job and into the business owner and investor position.

Not just for me. For all of us.

‍

CLOSING THOUGHT: IF WHAT EXISTED COULD SOLVE THE PROBLEM, IT WOULD BE SOLVED

You've been to the Botox courses. You've attended the business workshops. You've read the books. You've paid consultants thousands of dollars.

And you're still stuck in the S quadrant.

If what existed could solve the problem, it would be solved. Yours included.

That's what I realized in my personal life. If the people around me had what it took to get me to the next level, I would be there. But I wasn't. That's when I knew I had to do something different. I sought out community. And when I couldn't find it, I built it. You can do the same thing.

‍

Nurses are investors.

And we are investable.

‍

Let's start acting like it.

‍

Ready to Change How You Think About Money?

You have mastered the clinical science. You are generating the revenue. But if you are still wondering what to do with your capital, you are effectively running a high-paying job, not a wealth-building business.

It is time to close the gap between your income and your financial literacy.

I am launching the Cosmetic NP Financial Literacy Series, a quarterly blueprint designed to move you from "Earner" to "Investor."

Here is the roadmap for 2026:

• Q1 (Jan 16): The Money Workbook – Foundation, Tax Prep, and separating "Business" from "Personal."
• Q2 (April 15): Business Structure & Growth Audit – How to scale operations without scaling your burnout.
• Q3 (July 15): Investment & Wealth-Building Playbook – Strategic capital deployment (The "Nurses are Investors" Thesis).
• Q4 (Oct 15): Year-End Planning & Legacy Guide – Exit strategies and succession planning.

‍

Here is the insider advantage:
These guides will be sold in the Mahogany Dermatology Nursing Bookstore. However, members of our email list (The Founders' Circle) receive exclusive, free access for 72 hours after every drop.

Don't pay for what you can get for free. Join the movement of nurses who are building assets, not just income.‍

‍

Click here to join the list and secure your Q1 Guide.

‍

‍

About the Author

Dr. Kimberly Madison, DNP, AGPCNP-BC, WCC, is a Board-Certified, Doctorally-prepared Nurse Practitioner, educator, and author dedicated to advancing dermatology nursing education and research with an emphasis on skin of color. As the founder of Mahogany Dermatology Nursing | Education | Research™ and the Alliance of Cosmetic Nurse Practitioners™, she expands access to dermatology research, business acumen, and innovation while also leading professional groups and mentoring clinicians. Through her engaging and informative social media content and peer-reviewed research, Dr. Madison empowers nurses and healthcare professionals to excel in dermatology and improve patient care

‍

‍

© 2026 Dr. Kimberly Madison, DNP. All rights reserved.

‍

‍