J. Caleb Runyon, NP-C
Bradley Free Clinic in Roanoke, VA; Closer Look Project LLC
As nurse practitioners (NPs) and physican assistants (PAs) in dermatology, you already show up every day with your clinical skills and expertise. You assess patient conditions and concerns, explain treatments in patient-friendly language, and keep care moving in the right direction that best fits that patient. Throughout your day to day, many of you also have ideas about better ways to educate patients, ways to connect with communities, or opportunities to share your expertise on a broader scale. What if you took a risk and reached beyond to make your ideas a reality and really see what the impact might be?
The good news is that acting on one of those ideas, whether through an LLC or a nonprofit, does not have to be a big production. Clinicians have actioned on meaningful ideas on the side without leaving their jobs, spending a lot of money, or starting with a fully formed plan. Taking the risk is more about giving an idea structure and opportunity so it can go somewhere than it is about reinventing your career.
Starting something of your own, whether that is an LLC or a nonprofit, does not have to mean walking away from your clinical work or overhauling your entire life. For most clinicians, it is a side project built within the margins of their career. It is carving out time in the day to give their best idea a structure in order to reach people it otherwise never would. Plenty of people in roles just like yours have done exactly this without a business background, without a big budget, and without burning out in the process.
Turning Ideas into Something Real
The best ideas in this field rarely come from conference podiums or consulting firms. They take shape in the exam room when you realize the effort you just gave toward something or someone isn’t actually helping, or that just a few miles from your clinic, patients still have little access to the care you provide every day. Turning one of those moments into something real and actionable, whether through an LLC for consulting, education, or a nonprofit focused on outreach, is what elevates a good clinical observation into something that truly reaches people. Establishing a structure around your idea is important because it provides opportunity to keep your personal finances from your business activity, gives you a professional home for contracts and collaborations, and legitimizes the idea so others are more likely to seriously invest, collaborate, or contribute. Most people start with an LLC because it is straightforward to set up in most states, typically costs less than a few hundred dollars, and gives you the flexibility to grow or change direction without starting over.
A Real-Life Example: How It Happened for Me
For close to a year, I kept hearing the same thing in clinic; patient after patient mentioned that it was their hairdresser who had noticed something and convinced them to make an appointment. Nine times out of 10, whatever that hairdresser spotted turned out to be precancerous or worse. This was not exactly a surprise to me, since my mom has been doing hair for over 20 years, and I grew up hearing her talk about the things she notices from her chair that her clients never seem to bring up with their doctors.
I kept telling myself I would do something about it eventually. Then in February 2025, my 76-year-old papaw in rural West Virginia was diagnosed with stage 4 metastatic melanoma, a man who avoids doctors the way some people avoid traffic but has never once missed his monthly trip to the barber. That hit differently than I expected and made something click into place that I had been circling for a long time, that the people with the most consistent access and deepest trust in communities like his are not always clinicians but the personal care professionals who see their clients every month, the hairdressers, barbers, nail technicians who are often the first to notice the spot on someone’s scalp or the changing lesion on their neck long before anyone else gets the chance to look.
That experience is what led me to start The Closer Look Project as an LLC, a program built around training personal care professionals to recognize warning signs of skin cancer and know when to refer someone, without ever asking them to diagnose anything or step outside their lane. What began as something deeply personal has grown into workshops, community partnerships, free resources, and ongoing collaborations, all while I have kept seeing patients in clinic every week.
Your own work is full of moments just like this one, and the only real question is whether you are ready to stop filing them away and start doing something with them.
LLC vs Nonprofit: Pick What Fits Your Goal
Rather than getting tangled up in the label, start with what you want to accomplish and let that guide you toward the right structure. An LLC or PLLC tends to work well when the goal is consulting, speaking, teaching, or building an online course since the paperwork is minimal, setup is fast in most states, and you can combine your clinical credibility with outside income without creating a compliance headache for yourself.
A nonprofit makes more sense when the goal is grant funding, community access work, or building something with a broader mission at its center. It does require more structure up front, including a board and annual filings, but it also opens doors to funding and partnerships that an LLC simply cannot reach.
Neither path is better than the other. Many clinicians start with an LLC because it is easier to launch quickly and revisit the structure later if the work grows into something that calls for a different approach. If your state has corporate practice of medicine rules, it is worth a quick conversation with someone who knows them to make sure you are genuinely protected.
Start Small and Keep It Real
You do not need a business plan or a fully formed vision before you begin. Most of the projects that actually take hold started as something very small, such as a single Zoom session on a topic you know well, a 1-page handout shared with a handful of local providers, or a short survey sent to a few colleagues to see whether the idea resonates with anyone besides you. That is honestly enough to get started.
Free tools cover most of what you need in the early stages. Canva handles graphics, Google Workspace keeps things organized, and the free versions of Mailchimp and Zoom are more than enough to get moving. Try one thing, pay attention to how it lands, and adjust from there, because momentum in this kind of work comes from doing small things consistently rather than waiting until everything feels perfectly ready.
For an LLC/PLLC:
- Search and reserve a name on your state’s secretary of state site (eg, bizfilings.com or your state’s official .gov portal).
- File Articles of Organization (use your state’s official secretary of state website).
- Grab a free employer identification number (EIN) from the Internal Revenue Service (IRS) site at irs.gov/businesses/small-businesses-self-employed/apply-for-an-employer-identification-number.
- Open a separate business bank account.
- Check your liability insurance (HPSO and NSO are popular options for NPs and PAs).
- File any annual reports required by your state.
For a nonprofit:
- Nail down a short, clear mission statement.
- Pull together a small founding board.
- File Articles of Incorporation (through your state’s secretary of state site).
- Get an EIN at irs.gov.
- File IRS Form 1023‑EZ or full 1023 (apply at pay.gov, and use the 1023-EZ if your projected annual revenue is under $50K).
- Plan for the annual Form 990 (free resources at nonprofitready.org and councilofnonprofits.org).
- Startup costs typically fall somewhere between $500 and $1,000 total, depending on your state and whether you bring in someone for a quick legal review.
A Few Tips from the Trenches
Before you file anything, look up your state’s scope of practice rules and find out whether there are restrictions on outside professional activities in your current role. From day one, keep your clinical income and your business finances in separate accounts so the two never get tangled together. It is also worth finding a community of NP and PA entrepreneurs, through LinkedIn or elsewhere online, because the people who are already doing this tend to be generous with what they have learned, and connecting with them early can save you a lot of time. Acknowledge the small wins when they happen because those are what keep a project alive through the slower stretches, and if you are building something in the education or consulting space, lead with free content before you ever think about charging. Trust compounds faster than any marketing strategy ever will.
What You Get Beyond the Clinic
When you build something outside the clinic, the reach of your work changes in ways that are hard to fully appreciate until you are in the middle of it. You are no longer limited to the patients who happen to make it through your door. Instead, you can create resources that help people between visits, teach other providers things that took you years to learn, and bring real dermatology education into communities that have never had meaningful access to it. Beyond all of that, there is something harder to name but just as real, which is the feeling of having ownership over a part of your professional life that nobody else can schedule, reassign, or take away from you.
Your Next Move
You already have what this kind of work requires. You know how to explain complicated things to someone who is scared or overwhelmed, and that is honestly the hardest part of building anything that genuinely helps people. If there is an idea that keeps finding its way back to you, give it a single concrete action this week, whether that means searching for a business name, writing your mission down in 2 sentences, or reaching out to a colleague who has already done something like this.
That idea you keep coming back to is not random. It could be the reason a patient walks into your clinic 6 months earlier, the workshop that puts the right knowledge in the hands of a barber seeing someone who has not been to a doctor in years, or the resource that finally reaches a community your clinic never could. You have spent your career building exactly the skills and trust this kind of work needs. Now it is just a matter of deciding the idea is worth more than a footnote in the back of your mind. Our field gets stronger and patients get safer when more of us stop waiting and start building.