Hiring Nurse Practioner

[Village]

Hi all
I just started my private practice 1month now and its building gradually. Am seeing patients all day mon and wednesdays and am fully booked 830 to 430 those 2days with new patients. I have a NP with 3years outpatient psych experience approach me that they will like to work with me. Am just curious how others who have NPs in their practice have things set up?
- when did you consider to hire NP?
-Did you consider FNP with psych experiencs or just psych certified NP?
- How does credentialing with insurances work?
Will appreciate any info.

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[randomdoc1]

I would be very careful. I work in private practice and our last NP literally had half her folks on Adderall IR. Her ddx was poorly developed, she was especially not good at suspecting medical causes or most importantly AODA. She missed a case of DTs. She was also too loose with her benzodiazepines as was the other NP. Fortunately both are leaving. The three years of experience is concerning to me. Older NPs with more experience I’ve had better experience with. Even so, I recommend having you be consulted if benzodiazepines or stimulants become a possibility, random chart reviews, and seeing people ages 18-65 only. Especially this early in her career, it’s probably best to be supervised regularly by an MD/DO. It’s your license on the line. I’m sure there are good NPs but my experience in private practice with younger ones has not been the most impressive. Oh, and I’d only consider a PNP. Me and my partners have opted for no more NPs for now after our experiences. We are just going to work really hard for a new psychiatrist.

 

[Village]

I would be very careful. I work in private practice and our last NP literally had half her folks on Adderall IR. Her ddx was poorly developed, she was especially not good at suspecting medical causes or most importantly AODA. She missed a case of DTs. She was also too loose with her benzodiazepines as was the other NP. Fortunately both are leaving. The three years of experience is concerning to me. Older NPs with more experience I’ve had better experience with. Even so, I recommend having you be consulted if benzodiazepines or stimulants become a possibility, random chart reviews, and seeing people ages 18-65 only. Especially this early in her career, it’s probably best to be supervised regularly by an MD/DO. It’s your license on the line. I’m sure there are good NPs but my experience in private practice with younger ones has not been the most impressive. Oh, and I’d only consider a PNP. Me and my partners have opted for no more NPs for now after our experiences. We are just going to work really hard for a new psychiatrist.

I am worried about the length of time wrt experience. I had in mind that she run every patient by me but that will be tricky cos it will be disruptive for my patients and hers too.

 

[randomdoc1]

I am worried about the length of time wrt experience. I had in mind that she run every patient by me but that will be tricky cos it will be disruptive for my patients and hers too.

In the longrun it is not sustainable. The above would work though. But if you don’t have a good NP under you, can still be risky. I was thinking of starting a 4th year resident rotation at my clinic. May recruit people too.

 

[Jules A]

Look for someone board certified with solid inpatient psychiatric RN experience. Many schools are no longer requiring experience as a psych nurse or even RN I'm encounter more and more who are hard pressed to discern psychosis vs delirium, bipolar vs borderline. As randomdoc1 mentioned discuss their philosophies on benzos/stimulants to see if congruent with yours. If you set up billing as such that you are listed as their supervisor, regardless of the level of supervision, you can bill the maximum amount. Insist on a high quality individual, pay them well and overall it can be advantageous if you find a good fit.

 

[Shikima]

Or don't hire them with the context that they have next to no clinical skills, minimal information and could arguably being placed into positions where physicians are no longer needed/wanted.

 

[Attending1985]

I would be very careful. I work in private practice and our last NP literally had half her folks on Adderall IR. Her ddx was poorly developed, she was especially not good at suspecting medical causes or most importantly AODA. She missed a case of DTs. She was also too loose with her benzodiazepines as was the other NP. Fortunately both are leaving. The three years of experience is concerning to me. Older NPs with more experience I’ve had better experience with. Even so, I recommend having you be consulted if benzodiazepines or stimulants become a possibility, random chart reviews, and seeing people ages 18-65 only. Especially this early in her career, it’s probably best to be supervised regularly by an MD/DO. It’s your license on the line. I’m sure there are good NPs but my experience in private practice with younger ones has not been the most impressive. Oh, and I’d only consider a PNP. Me and my partners have opted for no more NPs for now after our experiences. We are just going to work really hard for a new psychiatrist.

I’ve had this experience with older pnps with many years of practice

 

[SeniorWrangler]

NP regulations work differently in every state in terms of licensing and need for supervision. It might be good to check with your insurance provider to see what they think about this and how it will effect your rates since you are effectively exposed to twice as much risk under captain of the ship doctrine (or whatever it's called, I'm not a lawyer).
If you have a policy that nobody gets controlled substances on the first visit, then the NP will have time to staff cases with you before anything gets prescribed.
Get permission to call some of her previous supervisors or coworkers before you do anything else.

 

[robri]

I’ve had this experience with older pnps with many years of practice

PNP's being pediatric nurse practitioners....

 

[randomdoc1]

PNP's being pediatric nurse practitioners....

PMHNP. There. Still better than Adderall free for alls and the resulting ER visits for cardiac issues, hypertensive crisis, psychosis, and severe anxiety =P. Don't even get me started on the scary polypharm I've seen in borderlines...

 

[leslieknope2]

Why is that?

 

[thoffen]

My experience supervising a psych CNS is either I have to trust her clinical acumen or I have to dedicate quite a lot of time digging into things that always leaves me uncomfortable. I'm really doing the former because she is experienced and a good clinician, but things would definitely be done differently if I dedicated more time to it. It's only a temporary role in an academic setting and small number of patients, but I personally don't think I could ever elect to do it in private practice with a full time mid-level.

 

[Sunny in Psych]

Hi all
I just started my private practice 1month now and its building gradually. Am seeing patients all day mon and wednesdays and am fully booked 830 to 430 those 2days with new patients. I have a NP with 3years outpatient psych experience approach me that they will like to work with me. Am just curious how others who have NPs in their practice have things set up?
- when did you consider to hire NP?
-Did you consider FNP with psych experiencs or just psych certified NP?
- How does credentialing with insurances work?
Will appreciate any info.

Let me help a little. I' a PMHNP with 14 years experience and own my private practice. With that said, FNPs are NOT adequately trained to work psychiatry and are out of their scope of practice if they do so. I see many negative posts here... remember that there are good and bad in all fields. Not all psychiatrists even wanted to go into psychiatry and may have slid through by the skin of their teeth. Same goes with PMHNPs. Experience is better, of course, but with a psych NP, you know they have the basics. Many concerns I hear you voice here are second nature to me now. I know a borderline before I get to their trauma history on intake. It is more unusual incidences like, "Why did trileptal increase my patient's BP severely while only taking Viibryd? Surely not SS?" that I have to investigate. In any case, use your PMHNPs... and we are a great team. I appreciate all the support I get in Corpus Christi. I have been disappointed at some negative attitudes toward us on this forum.

 

[Sunny in Psych]

I would be very careful. I work in private practice and our last NP literally had half her folks on Adderall IR. Her ddx was poorly developed, she was especially not good at suspecting medical causes or most importantly AODA. She missed a case of DTs. She was also too loose with her benzodiazepines as was the other NP. Fortunately both are leaving. The three years of experience is concerning to me. Older NPs with more experience I’ve had better experience with. Even so, I recommend having you be consulted if benzodiazepines or stimulants become a possibility, random chart reviews, and seeing people ages 18-65 only. Especially this early in her career, it’s probably best to be supervised regularly by an MD/DO. It’s your license on the line. I’m sure there are good NPs but my experience in private practice with younger ones has not been the most impressive. Oh, and I’d only consider a PNP. Me and my partners have opted for no more NPs for now after our experiences. We are just going to work really hard for a new psychiatrist.

Just one note on this. It is not your license on the line. They would definitely name you in a lawsuit but I haven't found one case where it stuck. If the PMHNP made the clinical decisions, he or she has a license and is responsible for that. Just fyi.

 

[Sunny in Psych]

Just one note on this. It is not your license on the line. They would definitely name you in a lawsuit but I haven't found one case where it stuck. If the PMHNP made the clinical decisions, he or she has a license and is responsible for that. Just fyi.

In addition, over 15 studies show our patient outcomes are equal to physicians'. Because you met one bad apple does not speak to us as a whole. I know a psychiatrist who diagnoses every borderline with DID as well. Another one, who just passed away, had most of his patients on 8mg xanax a day. They were coming in by the dozens wanting their xanax. Don't assume the worst.

 

[Sunny in Psych]

Just one note on this. It is not your license on the line. They would definitely name you in a lawsuit but I haven't found one case where it stuck. If the PMHNP made the clinical decisions, he or she has a license and is responsible for that. Just fyi.

In addition, over 15 studies show our patient outcomes are equal to physicians'. Because you met one bad apple does not speak to us as a whole. I know a psychiatrist who diagnoses every borderline with DID as well. Another one, who just passed away, had most of his patients on 8mg xanax a day. They were coming in by the dozens wanting their xanax. Don't assume the worst.

 

[psyxh]

Just one note on this. It is not your license on the line. They would definitely name you in a lawsuit but I haven't found one case where it stuck. If the PMHNP made the clinical decisions, he or she has a license and is responsible for that. Just fyi.

In addition, over 15 studies show our patient outcomes are equal to physicians'. Because you met one bad apple does not speak to us as a whole. I know a psychiatrist who diagnoses every borderline with DID as well. Another one, who just passed away, had most of his patients on 8mg xanax a day. They were coming in by the dozens wanting their xanax. Don't assume the worst.

My understanding is that these studies compared supervised NP practice to physician practice, and were crappy studies to boot. You're promoting unsupervised practice. Way, way worse. Our patients deserve better.

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[Sunny in Psych]

My understanding is that these studies compared supervised NP practice to physician practice, and were crappy studies to boot. You're promoting unsupervised practice. Way, way worse. Our patients deserve better.

Your understanding is wrong and you are dismissing any perspective other than your own. I've been practicing for 14 years and have trained residents. I've been here for 3 days and never encountered more bullies in my life. If you can't discuss without insults, please do not comment. I suppose the internet allows you to anonymously be a person I hope you aren't in real life. Our patients deserve better. After 14 years practicing, I'm not easily intimidated and my post here did not invite insults.

 

[Sunny in Psych]

Your understanding is wrong and you are dismissing any perspective other than your own. First, all 15 studies were wrong? Second, no, NPs working independently. Third, we are a separate discipline and after a few years experience, can work to the full extent of our licensure in over half the states. It really should be a federal law. I've been here for 3 days and never encountered more bullies in my life. If you can't discuss without insults, please do not comment. I suppose the internet allows you to anonymously be a person I hope you aren't in real life. Our patients deserve better. After 14 years practicing, I'm not easily intimidated and my post here did not invite insults.

 

[psyxh]

Your understanding is wrong and you are dismissing any perspective other than your own. First, all 15 studies were wrong? Second, no, NPs working independently. Third, we are a separate discipline and after a few years experience, can work to the full extent of our licensure in over half the states. It really should be a federal law. I've been here for 3 days and never encountered more bullies in my life. If you can't discuss without insults, please do not comment. I suppose the internet allows you to anonymously be a person I hope you aren't in real life. Our patients deserve better. After 14 years practicing, I'm not easily intimidated and my post here did not invite insults.

Please cite every single study. Don't reply with anything else without doing so. Thanks.

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[NecFasc92]

Just one note on this. It is not your license on the line. They would definitely name you in a lawsuit but I haven't found one case where it stuck. If the PMHNP made the clinical decisions, he or she has a license and is responsible for that. Just fyi.

In addition, over 15 studies show our patient outcomes are equal to physicians'. Because you met one bad apple does not speak to us as a whole. I know a psychiatrist who diagnoses every borderline with DID as well. Another one, who just passed away, had most of his patients on 8mg xanax a day. They were coming in by the dozens wanting their xanax. Don't assume the worst.

No one is bullying you. We are calling you out for misrepresenting yourself in an attempt to puff up your chest while dismissing the actuality of definitions, all while attempting to serve up your np school kool-aid.

Patients deserve a physicians care, always, not one of a charlatan.

 

[Sunny in Psych]

No one is bullying you. We are calling you out for misrepresenting yourself in an attempt to buff up your chest while dismissing the actuality of definitions, all while attempting to serve up your np school kool-aid.

Patients deserve a physicians care, always, not one of a charlatan.

Again, a bully. Patient a have a right to choose their providers. I have over 1000 who chose me. You should really be ashamed. I showed a physician friend your comments on here and he was embarrssed for you. Of course, he's been practicing for 40 years and isn't so insecure. As for the studies, look them up yourself. Start with JAMA. I haven't misrepresented ****. I own a psychiatric practice and am the only provider, which pulls in over 450k a year. Not because I don't know what I'm doing or I'm a charlatan but bc I get referrals from every doc and psych hospital in town. So grow up and look outside your box!

This was a post about hiring PMHNPs and you don't want to hear the perspective of a PMHNP. What does that say about you, shrinks?

 

[st2205]

Again, a bully. Patient a have a right to choose their providers. I have over 1000 who chose me. You should really be ashamed. I showed a physician friend your comments on here and he was embarrssed for you. Of course, he's been practicing for 40 years and isn't so insecure. As for the studies, look them up yourself. Start with JAMA. I haven't misrepresented ****. I own a psychiatric practice and am the only provider, which pulls in over 450k a year. Not because I don't know what I'm doing or I'm a charlatan but bc I get referrals from every doc and psych hospital in town. So grow up and look outside your box!

This was a post about hiring PMHNPs and you don't want to hear the perspective of a PMHNP. What does that say about you, shrinks?

I would hope that after 14 years of practice and owning your own clinic that you, too, wouldn’t be so insecure, but what’s coming across from your posts and arguments with med students is that your audience here isn’t the primary target of who you’re trying to convince...

 

[Sunny in Psych]

I would hope that after 14 years of practice and owning your own clinic that you, too, wouldn’t be so insecure, but what’s coming across from your posts and arguments with med students is that your audience here isn’t the primary target of who you’re trying to convince...

With all due respect, read my original post and what I got in return. If one is to ask about hiring PMHNPs and has no interest in hearing from a PMHNP, and then the mob of bullies calls names and throws insults, what does that say? That I'm the insecure one? I will surely never post on here again, as i am so disappointed in the group mentality that you project (and if you are an attending, you are inspiring and condoning). This has happened twice now. I had hoped I could post and be heard and treated with a little respect. It has escalated as I have been called names and have been treated so condescendingly... yet you apparently are blind to your students posts. The kool aid that is being taught in med schools is that we are the enemy. That is your choice. I don't have to convince myself of anything sir. I've had a successful career as a psychiatric nurse practitioner with experience as a Commander in the Navy, forensic psych in GTMO, the Pentagon, prisons, courthouses, in Europe and Africa, and called upon as an expert witness across the US in psych practice/negligence cases. At this point in my career I feel I can explain to a psychiatrist why he might consider hiring a PMHNP without bashing from a bunch of students (or residents). But you endorse this. Believe it or not, they may even learn a thing or two.

 

[TexasPhysician]

Just one note on this. It is not your license on the line. They would definitely name you in a lawsuit but I haven't found one case where it stuck. If the PMHNP made the clinical decisions, he or she has a license and is responsible for that. Just fyi.

Incorrect. Happens all the time.

Beyond the lawsuits, physicians lose licenses for inadequate monitoring of PMHNP's that provide inappropriate treatment. Lost a psych friend this way. The psychiatrist did nothing wrong beyond not adequately monitoring and then stopping a poorly trained PMHNP that he hired.

 

[TexasPhysician]

In addition, over 15 studies show our patient outcomes are equal to physicians'. Because you met one bad apple does not speak to us as a whole.

Why not discuss the facts? You report 15 studies which you believe are correct. If so, you have surely read most of them and probably have 1-2 that you believe are high quality. Id invite you to choose one and break it down as you have been trained in its own thread. Expect some criticisms about flaws of the study (every study has them). Maybe you or a peer could even develop better studies to address the flaws or maybe you change some minds on this board. Either way, arguing and becoming frustrated on a psychiatry forum is not winning any battles.

What I suspect is that the studies focus on county health type settings. Schedule 4 patients/hour that are high acuity and low functioning. It may take years to see the difference in performance between a NP, psych intern, or psychiatrist with 10 years experience. 15 minutes or less (walking to get the patients) is not sufficient time to hear recent concerns, review labs, monitor for even the smallest of side-effects, re-evaluate a diagnosis, provide some therapy, choose an ideal medication, etc. It is a very poor and limiting environment. I'd expect results to be similar until many years out. Were the studies 5-10+ years out? This is probably a good setting for NP's.

I highly doubt that the studies adequately compared NP's to a practice similar to mine as I believe it to be impossible. I have high functioning middle-class and above patients that follow almost every recommendation (I provide many). I provide therapy (I don't think most NP's do this) and refer to specialized therapy if needed. I've personally met therapists in the area and speak to them often to know what sets them apart and keep up with my patients. I spend excessive time with some families to determine the best medication for each situation, monitor side effects, take phone calls with concerns, provide tons of education to maintain compliance, etc. My treatment success rate here is incredible. It isn't that I am better than other psychiatrists who work in fast paced environments. It IS that I spend the time to utilize all that I have been trained and keep up with available nearby professionals to make a difference together.

 

[Carson911]

Hi all
I just started my private practice 1month now and its building gradually. Am seeing patients all day mon and wednesdays and am fully booked 830 to 430 those 2days with new patients. I have a NP with 3years outpatient psych experience approach me that they will like to work with me. Am just curious how others who have NPs in their practice have things set up?
- when did you consider to hire NP?
-Did you consider FNP with psych experiencs or just psych certified NP?
- How does credentialing with insurances work?
Will appreciate any info.

It’s important to only hire a board certified Psych NP. Some insurance companies won’t allow any other type of NP or even a PA treat their members and will deny your claims. Also, many state’s BON won’t allow anyone, other than a Psych NP, to treat more than mild depression and situational anxiety.

 

[Sunny in Psych]

Why not discuss the facts? You report 15 studies which you believe are correct. If so, you have surely read most of them and probably have 1-2 that you believe are high quality. Id invite you to choose one and break it down as you have been trained in its own thread. Expect some criticisms about flaws of the study (every study has them). Maybe you or a peer could even develop better studies to address the flaws or maybe you change some minds on this board. Either way, arguing and becoming frustrated on a psychiatry forum is not winning any battles.

What I suspect is that the studies focus on county health type settings. Schedule 4 patients/hour that are high acuity and low functioning. It may take years to see the difference in performance between a NP, psych intern, or psychiatrist with 10 years experience. 15 minutes or less (walking to get the patients) is not sufficient time to hear recent concerns, review labs, monitor for even the smallest of side-effects, re-evaluate a diagnosis, provide some therapy, choose an ideal medication, etc. It is a very poor and limiting environment. I'd expect results to be similar until many years out. Were the studies 5-10+ years out? This is probably a good setting for NP's.

I highly doubt that the studies adequately compared NP's to a practice similar to mine as I believe it to be impossible. I have high functioning middle-class and above patients that follow almost every recommendation (I provide many). I provide therapy (I don't think most NP's do this) and refer to specialized therapy if needed. I've personally met therapists in the area and speak to them often to know what sets them apart and keep up with my patients. I spend excessive time with some families to determine the best medication for each situation, monitor side effects, take phone calls with concerns, provide tons of education to maintain compliance, etc. My treatment success rate here is incredible. It isn't that I am better than other psychiatrists who work in fast paced environments. It IS that I spend the time to utilize all that I have been trained and keep up with available nearby professionals to make a difference together.

Yes, making a difference together. Speaking from a personal standpoint, I also provide therapy and generally charge a 90833 with most patients. My patients are very sick, and about 50% of my practice is Medicaid, not what most psychiatrists take... If they take Medicaid at all. About 40% of my practice is composed of schizophrenic/ schizoaffective patients, another 30% are high acuity as well. I do my own diagnosing and intakes (of course), so, no not just 15 min follow ups. I also take phone calls. My patients are always up to date on labs and I've never had an adverse incident with lithium or any other med in 14 years. Im quick to notice changes and educate them about side effects. Why am I saying all this? Because I am hearing that folks on this forum do not understand our role. Yes, we ARE colleagues (look up the word) and there are plenty of patients who need our care.

 

[Carson911]

Why not discuss the facts? You report 15 studies which you believe are correct. If so, you have surely read most of them and probably have 1-2 that you believe are high quality. Id invite you to choose one and break it down as you have been trained in its own thread. Expect some criticisms about flaws of the study (every study has them). Maybe you or a peer could even develop better studies to address the flaws or maybe you change some minds on this board. Either way, arguing and becoming frustrated on a psychiatry forum is not winning any battles.

What I suspect is that the studies focus on county health type settings. Schedule 4 patients/hour that are high acuity and low functioning. It may take years to see the difference in performance between a NP, psych intern, or psychiatrist with 10 years experience. 15 minutes or less (walking to get the patients) is not sufficient time to hear recent concerns, review labs, monitor for even the smallest of side-effects, re-evaluate a diagnosis, provide some therapy, choose an ideal medication, etc. It is a very poor and limiting environment. I'd expect results to be similar until many years out. Were the studies 5-10+ years out? This is probably a good setting for NP's.

I highly doubt that the studies adequately compared NP's to a practice similar to mine as I believe it to be impossible. I have high functioning middle-class and above patients that follow almost every recommendation (I provide many). I provide therapy (I don't think most NP's do this) and refer to specialized therapy if needed. I've personally met therapists in the area and speak to them often to know what sets them apart and keep up with my patients. I spend excessive time with some families to determine the best medication for each situation, monitor side effects, take phone calls with concerns, provide tons of education to maintain compliance, etc. My treatment success rate here is incredible. It isn't that I am better than other psychiatrists who work in fast paced environments. It IS that I spend the time to utilize all that I have been trained and keep up with available nearby professionals to make a difference together.

I see you practice in Texas. No doubt the majority of your patients are funded by Medicare and Medicaid...no? I bet you’d be more than happy referring those fine folks to a Psych NP, even though their illnesses are far more complicated than your “worried well” clients...right? Seriously, what are those patients supposed to do for mental health care? It is like you don’t want to take care of them, yet you don’t want anyone else to either. Reminds me of a law that passed in Illinois a couple of years ago regarding NP full practice authority. They passed a law that allowed independence for NPs AS LONG AS THEY TREATED MEDICAID PATIENTS, but required a supervising physician when they treated anyone else. This is all about MONEY and you know it. Get off your high horse dude!

Why not discuss the facts? You report 15 studies which you believe are correct. If so, you have surely read most of them and probably have 1-2 that you believe are high quality. Id invite you to choose one and break it down as you have been trained in its own thread. Expect some criticisms about flaws of the study (every study has them). Maybe you or a peer could even develop better studies to address the flaws or maybe you change some minds on this board. Either way, arguing and becoming frustrated on a psychiatry forum is not winning any battles.

What I suspect is that the studies focus on county health type settings. Schedule 4 patients/hour that are high acuity and low functioning. It may take years to see the difference in performance between a NP, psych intern, or psychiatrist with 10 years experience. 15 minutes or less (walking to get the patients) is not sufficient time to hear recent concerns, review labs, monitor for even the smallest of side-effects, re-evaluate a diagnosis, provide some therapy, choose an ideal medication, etc. It is a very poor and limiting environment. I'd expect results to be similar until many years out. Were the studies 5-10+ years out? This is probably a good setting for NP's.

I highly doubt that the studies adequately compared NP's to a practice similar to mine as I believe it to be impossible. I have high functioning middle-class and above patients that follow almost every recommendation (I provide many). I provide therapy (I don't think most NP's do this) and refer to specialized therapy if needed. I've personally met therapists in the area and speak to them often to know what sets them apart and keep up with my patients. I spend excessive time with some families to determine the best medication for each situation, monitor side effects, take phone calls with concerns, provide tons of education to maintain compliance, etc. My treatment success rate here is incredible. It isn't that I am better than other psychiatrists who work in fast paced environments. It IS that I spend the time to utilize all that I have been trained and keep up with available nearby professionals to make a difference together.

 

[psyxh]

I see you practice in Texas. No doubt the majority of your patients are funded by Medicare and Medicaid...no? I bet you’d be more than happy referring those fine folks to a Psych NP, even though their illnesses are far more complicated than your “worried well” clients...right? Seriously, what are those patients supposed to do for mental health care? It is like you don’t want to take care of them, yet you don’t want anyone else to either. Reminds me of a law that passed in Illinois a couple of years ago regarding NP full practice authority. They passed a law that allowed independence for NPs AS LONG AS THEY TREATED MEDICAID PATIENTS, but required a supervising physician when they treated anyone else. This is all about MONEY and you know it. Get off your high horse dude!

Another nurse who created an account on here just today... Or maybe the same nurse.

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[Jules A]

Whatever happened to the "goodbye cruel board" comments actually indicating someone disgruntled is moving on? Perhaps mods will close this thread because I suspect the OP got sufficient responses to their inquiry.

 

[uname943]

Another nurse who created an account on here just today... Or maybe the same nurse.

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There's like 3-4 nurse accounts started within the past week. All primarily interested in NP politics.

 

[MedMan80]

There's like 3-4 nurse accounts started within the past week. All primarily interested in NP politics.

yea wondering if the mods can do something, multiple threads are being crapped on.

 

[Sunny in Psych]

5000 PMHNPs have seen snap shots of your unprofessional comments.

I especially like the comment on another thread stating that you should get rid of NPs by sexually harassing us until we don't show up for work. Nice bunch of docs here.

 

[psyxh]

5000 PMHNPs have seen snap shots of your unprofessional comments.

Go back to your nurse facebook group and leave us be. They're your true colleagues.

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[Carson911]

I would hope that after 14 years of practice and owning your own clinic that you, too, wouldn’t be so insecure, but what’s coming across from your posts and arguments with med students is that your audience here isn’t the primary target of who you’re trying to convince...

I own a clinic and refer patients to Psych NPs. I don’t understand what all you guys have against NPs. We fill a need that exist.

Interesting how you guys are “all in” for NPs when they work for you and generate revenue. Yet the minute they open a practice and compete with you, you get your panties in a wad and scream we’re incompetent.

 

[psyxh]

I own a clinic and refer patients to Psych NPs. I don’t understand what all you guys have against NPs. We fill a need that exist.

Interesting how you guys are “all in” for NPs when they work for you and generate revenue. Yet the minute they open a practice and compete with you, you get your panties in a wad and scream we’re incompetent.

You lack competence for unsupervised practice. What don't you understand about that?

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[st2205]

I own a clinic and refer patients to Psych NPs. I don’t understand what all you guys have against NPs. We fill a need that exist.

Interesting how you guys are “all in” for NPs when they work for you and generate revenue. Yet the minute they open a practice and compete with you, you get your panties in a wad and scream we’re incompetent.

I’m not certain why you quoted my post for this comment.

 

[TexasPhysician]

Time to get back to the OP’s question.

 

[Village]

This thread was about me the consideration of hiring a NP to help me out and the ramifications surrounding that. This is a forum for advice, support and education of one another not us going after each other. I appreciate all the feedback. I will definitely look into insurance requirements wrt credentialing, billing etc, close supervision.

 

[Baxter911]

Why not discuss the facts? You report 15 studies which you believe are correct. If so, you have surely read most of them and probably have 1-2 that you believe are high quality. Id invite you to choose one and break it down as you have been trained in its own thread. Expect some criticisms about flaws of the study (every study has them). Maybe you or a peer could even develop better studies to address the flaws or maybe you change some minds on this board. Either way, arguing and becoming frustrated on a psychiatry forum is not winning any battles.

What I suspect is that the studies focus on county health type settings. Schedule 4 patients/hour that are high acuity and low functioning. It may take years to see the difference in performance between a NP, psych intern, or psychiatrist with 10 years experience. 15 minutes or less (walking to get the patients) is not sufficient time to hear recent concerns, review labs, monitor for even the smallest of side-effects, re-evaluate a diagnosis, provide some therapy, choose an ideal medication, etc. It is a very poor and limiting environment. I'd expect results to be similar until many years out. Were the studies 5-10+ years out? This is probably a good setting for NP's.

I highly doubt that the studies adequately compared NP's to a practice similar to mine as I believe it to be impossible. I have high functioning middle-class and above patients that follow almost every recommendation (I provide many). I provide therapy (I don't think most NP's do this) and refer to specialized therapy if needed. I've personally met therapists in the area and speak to them often to know what sets them apart and keep up with my patients. I spend excessive time with some families to determine the best medication for each situation, monitor side effects, take phone calls with concerns, provide tons of education to maintain compliance, etc. My treatment success rate here is incredible. It isn't that I am better than other psychiatrists who work in fast paced environments. It IS that I spend the time to utilize all that I have been trained and keep up with available nearby professionals to make a difference together.

Most NPs have been practicing for many uears and see both severe and high level funtioning patients.

 

[Jules A]

Most NPs have been practicing for many uears and see both severe and high level funtioning patients.

Unfortunately that is no longer true as the trend is now favoring direct entry without any requirement of RN experience. The number of NPs almost doubled in the past 10 years so it is a fact many will not have significant experience and as such I anticipate the quality will also be lower.

AANP - More than 234,000 licensed nurse practitioners in the United States

 

[Baxter911]

I agree. There are now diploma mills. The AANP should not only require experience but ensure quality programs. As a psychiatrist, I would surely learn the background of the PMHNP prior to hiring them. There are good and bad in all fields.

 

[Baxter911]

This thread was about me the consideration of hiring a NP to help me out and the ramifications surrounding that. This is a forum for advice, support and education of one another not us going after each other. I appreciate all the feedback. I will definitely look into insurance requirements wrt credentialing, billing etc, close supervision.

The amount of supervision depends on how comfortable you are with the PMHNP. May take time. As for credentialing, he/she must be credentialed under your practice in order for you to be reimbursed. This takes time. In Texas, if you are in the facility, present, you can be reimbursed the physician allowable. If not, you will receive the NP allowable, which is usually 85%. Most malpractice insurance companies do not increase your rate, but check on yours specifically. The PMHNP should also always be required to keep malpractice at 1/6 million. No questions asked (many docs provide this for the PMHNP as a perk, but thats your decision). As for pay, some pay by % and this can get tricky, but works. Then you are assured they are paid for their performance as far as numbers go). Hourly is ok, but agree in advance how much time they have with each patient, be it an intake or follow-up.

 

[Baxter911]

The amount of supervision depends on how comfortable you are with the PMHNP. May take time. As for credentialing, he/she must be credentialed under your practice in order for you to be reimbursed. This takes time. In Texas, if you are in the facility, present, you can be reimbursed the physician allowable. If not, you will receive the NP allowable, which is usually 85%. Most malpractice insurance companies do not increase your rate, but check on yours specifically. The PMHNP should also always be required to keep malpractice at 1/6 million. No questions asked (many docs provide this for the PMHNP as a perk, but thats your decision). As for pay, some pay by % and this can get tricky, but works. Then you are assured they are paid for their performance as far as numbers go). Hourly is ok, but agree in advance how much time they have with each patient, be it an intake or follow-up.

Also, keep in mind, many insurance companies will not reimburse for an FNP working in psychiatry. Always go with a PMHNP.

 

[Osminog]

Also, keep in mind, many insurance companies will not reimburse for an FNP working in psychiatry. Always go with a PMHNP.

Sunny in Psych (aka "Baxter911"), stop making sock accounts and pretending to be a psychiatrist. You're not fooling anyone.

I'm a pre-med whose goal is to eventually become a psychiatrist. I come to the Psychiatry subforum to gain inspiration and insight from those working in the field.

You're ruining this subforum with your obnoxious trolling, and you're making NPs look worse, not better. Please stop.

 

[psyxh]

Go back to your nurse facebook group and leave us be. They're your true colleagues.

Sent from my [device_name] using SDN mobile

Here's what nurse has to say about psychiatrists on facebook...

Sent from my [device_name] using SDN mobile

 

[Baxter911]

Congratulations! Why don't you post all my comments on our NP FPA site that state we should practice for a few years before having FPA? Or my comments about online NP schools and regulation of high standards? Because I'm just an a**hat and none of you have heard a single respectful word I've said. You hear NP and become a pack of wolves. And my post that you copied is sadly true for some in psychiatry. I read it in all of YOUR posts! The rules on here have not applied to you. Several of us were banned from your site... we know you are on our sites snapshotting. Snapshot my comments that matter.

 

[TexasPhysician]

Thread can’t stay on track. Locking.