A wise provider refers out. Physicians refer out, as do PAs and NPs. As a psyche NP, I get referrals from physicians every day. I refer out cases to others. I also understand that much psyche management, especially in the early stages, takes place in primary care settings. I’m booked 3 months out, so it’s probably a good thing to try. But I also get patients that come in after primary care management that need a lot of med adjustments to fix some problems that arise from that. But that’s understandable because their primary providers often are trying to use their 8 minutes of actual face time with their patient to do something that I have an hour on intake and 30 minutes in follow up on. That and their primary care provider usually has to address all their physical illness in their brief visits too. You won’t see me criticize them for doing the best they can. But you also won’t see me sit back and take it when a physician downplays my work as an NP simply to imply there needs to be a hierarchy with them at the top of the food chain for hierarchy sake. Do something to reduce the mental health backlog, because I am. If I want to be an independent provider to do that job that someone else isn’t doing, the critics aren’t in the position to tell me that I need to have direct physician supervision to do it, especially when that supervision is merely a formality that serves primarily to line the pockets of a supervising position and increase their control over us for control sake. I don’t need to be the Np squire to the physician knight in order to do my job. We operate independently in halfback of states, and the sky has not fallen, and we haven’t tried to walk into surgery to replace physicians. We practice within our scope.