There is absolutely nothing requiring you to supervise midlevels even in states that require supervision. I was asked/shamed on multiple occasions at my last position to do so for a robust $1000/month and simply said no, including to the CMO in front of the entire Csuite of the organization. Just because the guy down the street is selling heroin does not excuse me from doing so as well.
Yes but this was my first job, and I needed to be in a specific location. Also it got sprung upon me to say the least. Again, these are lessons learned, residency did not teach me negotiating power/red flags for potential job and I learned some stuff the hard way
No shade your way, I get it. I was 2 years out and at a location where I had to be as well, I think my HR was about 130 following one of these conversations. I was content to do telepsychiatry if they got pushier, but it turns out they did value my clinical services more than they desired an expansion via NP's. These are great stories for current residents to read, so I'm glad you are sharing your experience.
Right? There are a lot of rumblings this could happen but I haven't heard of an actual case. I would think with all the focus on midlevels now if this was happening the PPP would be plastering billboards. A colleague just accepted a job supervising 4 PAs for $15,000 each which sounds low and like a bad idea to me regardless of if there are cases pending or not.
Agree that the SMI population lacks the resources to pursue a lawsuit. But overall, outpatient psychiatry medicolegal risk is pretty low. There's hundreds NP run clinics and obviously they are not closing down bc of liability issues. This isn't internal medicine or cardiology, it's a lot harder to kill our patients. I would think inpatient psych liability is higher.
This is actually not surprising, and I see stuff like this all the time on the patients that come in passing out or falling over because of their med regimens. The patients rarely sue, even when it's obviously because of the meds. They just end up seeing someone else if they can.
So you craft a practice towards what a PCP could do and dole out lots of stimulants to adults for ADHD whilst also not managing patients who badly need psychiatrists and the best care possible in an effort to avoid medicolegal risk and post about it on a forum promoting psychiatry learning and practice?
A lot harder to kill quickly.
This is helpful. Of note, the author appears to by an NP...but listing their degree credential only (Master of Science in Nursing, MSN), which is kind of odd given the usual alphabet soup behind most nurse's names these days.Here's a lawyer who could only find 6 cases. There were no "collaborating" physicians not directly involved in patient care and not legally required to review charts who were named in lawsuits. She has some tips for avoiding/minimizing legal exposure if you do supervise NPs.
Physicians Who Work With NPs: What's the Liability Risk?
Attorney Carolyn Buppert lays out the different models of working relationships between physicians and NPs, and the liability faced by physicians in each situation.www.medscape.com
Here's a lawyer who could only find 6 cases. There were no "collaborating" physicians not directly involved in patient care and not legally required to review charts who were named in lawsuits. She has some tips for avoiding/minimizing legal exposure if you do supervise NPs.
Physicians Who Work With NPs: What's the Liability Risk?
Attorney Carolyn Buppert lays out the different models of working relationships between physicians and NPs, and the liability faced by physicians in each situation.www.medscape.com
What did you report the NP for?
Interestingly, several other patients including one new patient and one former patient recently described their experience with online treatment with non-MDs and were not happy with their overall experience. Ironically they are doing full telemedicine with me, paying as much as 10x+ fees. So to me it's really the expertise that gives you the value. It IS really starting to look like buying a $20 bag at Walmart vs. buying a $300 bag at Nordstrum.
I had a pt, white collar professional prescribed adderall by me, get hospitalized with stimulant-induced psychosis. And later found out this wasn't the first time. I don't doubt the individual was "supplementing" from other sources, but it still made for a quite unpleasant experience. And given their behavior, hospitalization was actually a pretty good outcome, it could easily have been much worse.
I mean who's to say they don't have an arrhythmia? That's why you have follow-up. Whenever we prescribe a med there are risks. I'd say the risks of stimulants are on the level as compared to some other psychotropics that we prescribe on a pretty regular basis. Use your judgement, weigh risks and benefits, and discuss them with your patient. Beyond that, there's not much else you can do. Even in private practice, simple patients can become complex and unless you are dropping them the second that happens.
certainly possible.
Is treating cocaine or methamphetamine use disorder with stimulants standard of care? That's news to me.
I believe the theory is that some of the appeal of stimulants is that the person using them has undiagnosed/untreated ADHD symptoms, leading to illicit stimulant use that, theoretically, could've been prevented by appropriate treatment of the ADHD symptoms.
Yes I understand that but I trained at a program with plenty of addiction exposure and we certainly didn't practice like this. Maybe Strattera or welbutrin but definitely would be hesitant to use a stimulant
Interesting, last I checked I didn't see much on that website in the way of actual cases. With with the few cases I have seen including those posted here most involved physicians who weren't actually supervising the incompetent midlevels they agreed to supervise. Its just bad all around.
We actually do treat concomitant ADHD in the MAT clinic here, sometimes with stimulants even in the setting of methamphetamine use disorder. Impulsivity with use is a big issue among those with both ADHD and addiction. There have been a couple people that ultimately abused the prescribed long-acting stimulants to the point where it was physically dangerous, and for those people, their treatments were stopped. Psychosis in the setting of use would also be a strong reason not to prescribe a stimulant.
