New Private Practice Journey

[The Incredible Nurse]

So as I try to join the ranks of the great ones in this forum by following on their footsteps, I decided to start chronicling my journey to opening a cash based private practice.

Background:
Psychiatric Mental Health Nurse Practitioner. Licensed in Delaware, Florida and Ohio. I collaborate and work under the guidance and mentorship of a Board Certified Psychiatrist that I admire. He provides great supervision and counseling when needed.

Practice Basics:

After several months of inaction and back and forth trying to decide on what kind of practice I wanted to launch; I settled on a cash based outpatient private practice. I owe much gratitude to a member of this community to breaking the standstill I was stuck at. I finally decided to go cash pay instead of having to handle all the headaches that come with contracting with insurance. I will provide Super Bills for OON benefits for patients and once I start seeing some volume I will be utilizing Reimbursify to streamline this process for patients.

Pros of Cash Based Practice: As long as you are following best practice guidelines you are in the driver seat. No pesky insurance carriers dictating how to run your practice.

Cons of a Cash Based Practice: This usually comes at the detriment of slow building of patient panel. More marketing spend to attract clients, need to offer a superior service to flourish.

Type of Practice: Integrative Psychiatric Practice. Offering psychiatric evaluations, medication management, laboratory ordering and review (not just your basic labs but digging deeper to all things connected to mental health), psychotherapy, supplements and a big focus on nutritional psychiatry ( gut - brain connection). Offering longer than traditional appointment times to capture a good history and create an appropriate personalized plan of care.

Fees: $295 for Initial Psychiatric Evaluation (75 to 90 mins in length). $200 for follow up appointments.

Backend Set Up:

Website: Build my own website using Square Space and Chat GPT. I was able to achieve a basic above average typical website. See end result at www.atozpsychiatry.com ( I dont mind doxing myself as I have always been extremely cautious of my online presence and what I post). Domain was $12 for the 1st year and $20 for renewals. I also host the domain and website on square space which was about $20 per month, paid yearly and had a discount code so it was sub $200 for a year.

Email: I wanted professional email so I went with google workspace. For less than $10 a month you can have your own @yourpracticename email address. This gives you a more professional presence. You need to have a domain secured before creating this or need to register a new domain with Google when doing this. Verification is straightforward and the tutorials provided are easy to follow.

Phone and Fax: Spruce Health is unbeatable to create your digital communications platform. For $24 a month you can have a number that you can forward to your cell or your office manager cell. Keeping your personal information secure. Spruce also includes Fax and SMS communication. You can further customize automatic replies, create presets to send messages, etc.

Psychology Today: A must have in the mental health world. $30 a month to advertise your presence. Took me an evening to build up a decent profile.

Malpractice Insurance: I went with Berxi. They are backed by a big player in the insurance world so it should be safe long term. Paid about $760 for first year, I expect it to go to about $1600 on renewal.

EMR: Practice Q/ Intake Q is a great solution for medical records and practice management. Includes e-prescribe, customizable templates and much more that I need to discover yet. They have a low volume plan that cost $55 plus $65 for the e prescribe component. So about $115 monthly.

Practice in Practice:

So I have been officially open for less than 1 week. I have 0 patients at this time. I am working on reaching out to therapy groups to market to their patients. I expect the grow to be slow. I have 2 jobs currently so I wont starve until this either takes off or becomes a life learning experience. Look forward to sharing more updates.

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[ObsequiousAplomb]

ugh. I need to raise my rates.

 

[The Incredible Nurse]

ugh. I need to raise my rates.

I mean I have 0 patients yet. So maybe hold on that idea till I come back with an update

 

[Doctor Eliza]

You mention three states. Are you exclusively telehealth? If so, that is going to also hamper growing your practice. I’m a psychologist and I am always looking for psychiatric providers to refer to. However, I generally won’t refer to someone who does not have the option to be seen in person. I think many patients feel this way too. I also have a hard time getting clients to see a provider who doesn’t take their insurance…even when they are the most seasoned and respected psychiatrists in the community and the patient can clearly afford it. Being a newer(?) NP I think it may be an uphill battle for you. You have to answer the question of why would a patient want to see you over someone in person and/or on insurance and/or with an MD.

Realizing I’m coming off as negative and I don’t want to discourage you. Being my own boss is the best thing ever. I hope you succeed in your new practice!

 

[The Incredible Nurse]

You mention three states. Are you exclusively telehealth? If so, that is going to also hamper growing your practice. I’m a psychologist and I am always looking for psychiatric providers to refer to. However, I generally won’t refer to someone who does not have the option to be seen in person. I think many patients feel this way too. I also have a hard time getting clients to see a provider who doesn’t take their insurance…even when they are the most seasoned and respected psychiatrists in the community and the patient can clearly afford it. Being a newer(?) NP I think it may be an uphill battle for you. You have to answer the question of why would a patient want to see you over someone in person and/or on insurance and/or with an MD.

Realizing I’m coming off as negative and I don’t want to discourage you. Being my own boss is the best thing ever. I hope you succeed in your new practice!

I appreciate your feedback. I have a physical presence on all those States but it would be only to meet DEA criteria if the tele-health exceptions are not extended. I would mainly see patients tele-health on those 3 States.

As far as what can I offer, less corporatized psychiatric care and more time with the patient to address needs beyond just prescribing medication.

For Insurance I am hoping I can sell them on using Reimbursify for OON reimbursements.

Again I appreciate any feedback and criticism so keep it coming. If you have a minute to check the Website, let me know what you think.

 

[ObsequiousAplomb]

So your rates are about what mine are, that's why I said I need to raise my rates. For your intakes, it's very reasonable to ask for that amount (if you were where I am), though it is nearly double what insurance would reimburse you. For your follow-ups, that's actually lower than what insurance reimburses me for my in-network patients. I'm sure that the states you are licensed in might not pay as much as they do in the states where I practice. I think that for Ohio, those cash rates are just plain too expensive. You may need to cut them in half unless you're only targeting the affluent areas in Ohio. Even then, they're a little high. Are you sure you've opted out of Medicare and everything?

I do wonder why those three states? If I were a prospective patient, I'd get the impression your practice is a team of providers in multiple states. It seems weird to have three non-contiguous licenses. It's not like you're expanding your practice's geographical catchment area, and it's more like you have three entirely distinct locations. This seems a little odd and a real challenge for marketing. Who are you targeting to refer patients to you? Are you targeting exclusively self-referrals? What are your plans for screening those referrals?

It would probably be a better business move to have a fully brick-and-mortar location in at least one of these three states that you operate out of. Based on your schedule, it would be a good idea to be in that location all day on Fridays. I agree with others who have said that it's difficult to obtain referrals if people know you won't actually be seeing people in person. While my practice is close to 50/50 for in-person/virtual, all of the virtual people have said that they need to know I could be available were they to need to be seen in-person. It's a good idea to try to see everyone in-person at least once a year, independent of what the federal law regarding controlled substances is.

Also, I think that A-to-Z is a catchy name. The problem I have is that when I saw the website URL I thought it was "Atoz Psychiatry." I was wondering what the heck an Atoz is. My practice is my initials, which also spells a latin word. I thought it was really catchy when I came up with it, but 50% of patients ask me who the other two letters are for (since they come to the conclusion that I'm Dr. third letter). The other 50% ask me how many practices are owned by the three letter company. Nobody has realized that it's a latin word that fits the field of psychiatry very well, except my wife and parents who got a good chuckle.

There's a really beautiful picture of a homestead on your website that looks like it's in the western half of the country, yet your practice is in DL, OH, and FL. So what's the picture supposed to mean? That you go on vacation to some fancy place out west a lot and are oftentimes unavailable?

Based on your "book a consultation" button, it seems you have a full-time job 4 days a week and your practice runs 5-8 pm those four days, plus you work all day Friday in your practice, and both weekend days. I understand you are trying to show an open schedule for people, but this can backfire. First, it's obvious that you are working a second job from these hours. Then there's the fear a patient has when they see that all of your hours are open otherwise "what's wrong with them that they're so available?" Then there's my worry that you will burn out quickly. It's far more frustrating to work one or two additional hours 7 days a week than it is to just limit yourself to, for example, Fridays all day and Sunday afternoons. Then you can expand after you fill those two days and eventually leave your full-time job to be in practice full-time (a process that very well may take several years).

On your website there's a casual picture of you in scrubs with your hair not really done. It may look folksy, but most patients would prefer a formal picture of their provider. If this is what you wear to your tele-practice, I've gotta ask - why scrubs? Do you want it to look like you're sneaking in the appointment while on break from your nursing job, from the supply closet? It's especially weird because your blog has a picture of a different NP wearing a white coat. People might be confused as to which one is you.

 

[The Incredible Nurse]

So your rates are about what mine are, that's why I said I need to raise my rates. For your intakes, it's very reasonable to ask for that amount (if you were where I am), though it is nearly double what insurance would reimburse you. For your follow-ups, that's actually lower than what insurance reimburses me for my in-network patients. I'm sure that the states you are licensed in might not pay as much as they do in the states where I practice. I think that for Ohio, those cash rates are just plain too expensive. You may need to cut them in half unless you're only targeting the affluent areas in Ohio. Even then, they're a little high. Are you sure you've opted out of Medicare and everything?

I do wonder why those three states? If I were a prospective patient, I'd get the impression your practice is a team of providers in multiple states. It seems weird to have three non-contiguous licenses. It's not like you're expanding your practice's geographical catchment area, and it's more like you have three entirely distinct locations. This seems a little odd and a real challenge for marketing. Who are you targeting to refer patients to you? Are you targeting exclusively self-referrals? What are your plans for screening those referrals?

It would probably be a better business move to have a fully brick-and-mortar location in at least one of these three states that you operate out of. Based on your schedule, it would be a good idea to be in that location all day on Fridays. I agree with others who have said that it's difficult to obtain referrals if people know you won't actually be seeing people in person. While my practice is close to 50/50 for in-person/virtual, all of the virtual people have said that they need to know I could be available were they to need to be seen in-person. It's a good idea to try to see everyone in-person at least once a year, independent of what the federal law regarding controlled substances is.

Also, I think that A-to-Z is a catchy name. The problem I have is that when I saw the website URL I thought it was "Atoz Psychiatry." I was wondering what the heck an Atoz is. My practice is my initials, which also spells a latin word. I thought it was really catchy when I came up with it, but 50% of patients ask me who the other two letters are for (since they come to the conclusion that I'm Dr. third letter). The other 50% ask me how many practices are owned by the three letter company. Nobody has realized that it's a latin word that fits the field of psychiatry very well, except my wife and parents who got a good chuckle.

There's a really beautiful picture of a homestead on your website that looks like it's in the western half of the country, yet your practice is in DL, OH, and FL. So what's the picture supposed to mean? That you go on vacation to some fancy place out west a lot and are oftentimes unavailable?

Based on your "book a consultation" button, it seems you have a full-time job 4 days a week and your practice runs 5-8 pm those four days, plus you work all day Friday in your practice, and both weekend days. I understand you are trying to show an open schedule for people, but this can backfire. First, it's obvious that you are working a second job from these hours. Then there's the fear a patient has when they see that all of your hours are open otherwise "what's wrong with them that they're so available?" Then there's my worry that you will burn out quickly. It's far more frustrating to work one or two additional hours 7 days a week than it is to just limit yourself to, for example, Fridays all day and Sunday afternoons. Then you can expand after you fill those two days and eventually leave your full-time job to be in practice full-time (a process that very well may take several years).

On your website there's a casual picture of you in scrubs with your hair not really done. It may look folksy, but most patients would prefer a formal picture of their provider. If this is what you wear to your tele-practice, I've gotta ask - why scrubs? Do you want it to look like you're sneaking in the appointment while on break from your nursing job, from the supply closet? It's especially weird because your blog has a picture of a different NP wearing a white coat. People might be confused as to which one is you.

Thank you for the feedback. The reason there is 3 States is that due to working during my career so far I have obtained licenses on those States so I thought I would offer services to those areas.

The pictures on the website are just stock pictures, thats why they may seem a bit odd.

I could try and get a professional picture taken with business clothes and bettee kept hair. I was going for the casual vibe. As far as scrubs, all 4 of the Psychiatrists I currently work under and mentor with prefer to wear scrubs rather than formal attire, so I kind of fell into that dress code.

I can have my booking widget pretend I am more busy if that helps. I’ll give that a try.

I am surprised Ohio pay less than those rates as I saw the reimbursements for medicaid ohio and they were pretty hefty all things considered. I would have to think about creating rates per State or maybe focusing on just 1 State to start with.

How would you reccomend clarifying the A to Z name without making it sound like ATOZ , just separate with hyphens?

Thank you for your feedback

 

[ObsequiousAplomb]

Thank you for the feedback. The reason there is 3 States is that due to working during my career so far I have obtained licenses on those States so I thought I would offer services to those areas.

The pictures on the website are just stock pictures, thats why they may seem a bit odd.

I could try and get a professional picture taken with business clothes and bettee kept hair. I was going for the casual vibe. As far as scrubs, all 4 of the Psychiatrists I currently work under and mentor with prefer to wear scrubs rather than formal attire, so I kind of fell into that dress code.

I can have my booking widget pretend I am more busy if that helps. I’ll give that a try.

I am surprised Ohio pay less than those rates as I saw the reimbursements for medicaid ohio and they were pretty hefty all things considered. I would have to think about creating rates per State or maybe focusing on just 1 State to start with.

How would you reccomend clarifying the A to Z name without making it sound like ATOZ , just separate with hyphens?

Thank you for your feedback

Are those psychiatrists who mentored you inpatient psychiatrists? Because it's absolutely weird to wear scrubs in outpatient psychiatry, especially telepsychiatry. It's weird but acceptable to wear them inpatient. Maybe an ECT psychiatrist who needs to be in a procedure room that's shared with surgical spaces, it might make sense. Otherwise, it's weird. Studies show patients prefer psychiatrists to wear formal clothes. You can be "casual" by not wearing a tie and a suit and instead wearing a well-fitting collared shirt. I still wouldn't advertise without a tie or at least a nice sweater over a collared shirt.

You can get professional headshots or you could just comb your hair and put on dress clothes and have a spouse/partner take a picture with their cell phone. That would be free but a big improvement. Professional headshots don't cost much in the grand scheme of things.

Ohio's rates for mental health medicaid are tricky. The high rates you're seeing are what you can get if you're a community mental health center approved through the state. Essentially, the big corporate entities that run the big OP clinics get that rate. Everyone else gets a much worse rate.

 

[Merovinge]

Scrubs are for surgeons. Professional attire for any other patient facing doctor. I will give you a swing as a proceduralist as to what makes the most sense. That is per the data. My partner's experience as a female surgeon is that she is treated better in professional attire but clearly still needs to wear scrubs on most days due to being either in the OR or doing procedures in clinic.

 

[Candidate2017]

Are those psychiatrists who mentored you inpatient psychiatrists? Because it's absolutely weird to wear scrubs in outpatient psychiatry, especially telepsychiatry. It's weird but acceptable to wear them inpatient. Maybe an ECT psychiatrist who needs to be in a procedure room that's shared with surgical spaces, it might make sense.

His photo and appearance makes it seem like he just came from the OR after putting the ECT electrodes on the wrong person.

 

[Doctor Eliza]

I appreciate your feedback. I have a physical presence on all those States but it would be only to meet DEA criteria if the tele-health exceptions are not extended. I would mainly see patients tele-health on those 3 States.

As far as what can I offer, less corporatized psychiatric care and more time with the patient to address needs beyond just prescribing medication.

For Insurance I am hoping I can sell them on using Reimbursify for OON reimbursements.

Again I appreciate any feedback and criticism so keep it coming. If you have a minute to check the Website, let me know what you think.

I checked out the website. I think you can tweak it a bit to make it more appealing to potential patients. I think what it is mainly missing is a sense of who you are as a person, as a clinician, etc. It feels somewhat generic, particularly with the stock photos of random people that are not you and places that are not where you are practicing. You also might have a professional photographer do a head shot for you. Your current pic gives off ID badge vibes.

 

[Jules A]

You have gotten thoughtful feedback. What I can add is out of network isn't an easy gig to secure even if you have a fair amount of contacts and it doesn't sound like you have that in any of your locations? The people who are willing to pay for this experience are well educated and particular. Without decent connections socially, ED and local therapy practices I'm not sure how long it would take to build up even a part time out of network practice-if ever. I would consider taking insurance even just one like BC or Carefirst would probably fill you up fairly quickly. For some reason the evals don't pay much with insurance but the return visits pay well. My part time out of network practice is in an affluent area where I am well known in the community. I get referrals from psychiatrists , ED + community social workers/therapists I have worked with, PCPs and I also have contacts at multiple private schools. Even with that it took almost 2 years to get where I wanted it. I generally do one day a month in the office, the rest telehealth and charge $450 evals 80 mins, $150 follow ups 15-30 mins.

 

[The Incredible Nurse]

I will take some pictures in professional attire. I am not sure if its a generational thing, but they are all younger Psychiatrists (private practice owners) and they prefer to wear figs scrubs to formal attire

 

[The Incredible Nurse]

Are those psychiatrists who mentored you inpatient psychiatrists? Because it's absolutely weird to wear scrubs in outpatient psychiatry, especially telepsychiatry. It's weird but acceptable to wear them inpatient. Maybe an ECT psychiatrist who needs to be in a procedure room that's shared with surgical spaces, it might make sense. Otherwise, it's weird. Studies show patients prefer psychiatrists to wear formal clothes. You can be "casual" by not wearing a tie and a suit and instead wearing a well-fitting collared shirt. I still wouldn't advertise without a tie or at least a nice sweater over a collared shirt.

You can get professional headshots or you could just comb your hair and put on dress clothes and have a spouse/partner take a picture with their cell phone. That would be free but a big improvement. Professional headshots don't cost much in the grand scheme of things.

Ohio's rates for mental health medicaid are tricky. The high rates you're seeing are what you can get if you're a community mental health center approved through the state. Essentially, the big corporate entities that run the big OP clinics get that rate. Everyone else gets a much worse rate.

Thank you for your feedback and clarifying on reimbursement rates for ohio

 

[The Incredible Nurse]

Scrubs are for surgeons. Professional attire for any other patient facing doctor. I will give you a swing as a proceduralist as to what makes the most sense. That is per the data. My partner's experience as a female surgeon is that she is treated better in professional attire but clearly still needs to wear scrubs on most days due to being either in the OR or doing procedures in clinic.

Based on similar multiple feedback related to dress attire I will work on getting better clothes and taking new pictures. I just honestly hate professional clothes because I am overweight as hell and nothing really looks good on me or makes me feel comfortable.

 

[The Incredible Nurse]

His photo and appearance makes it seem like he just came from the OR after putting the ECT electrodes on the wrong person.

I actually worked many years in the OR with many gifted surgeons so you are closer to reality. Except for the wrong patient, thats a big no no in the field that only the crappiest of surgeons have been fined for

 

[The Incredible Nurse]

I checked out the website. I think you can tweak it a bit to make it more appealing to potential patients. I think what it is mainly missing is a sense of who you are as a person, as a clinician, etc. It feels somewhat generic, particularly with the stock photos of random people that are not you and places that are not where you are practicing. You also might have a professional photographer do a head shot for you. Your current pic gives off ID badge vibes.

Thank you for the Feedback Dr Eliza. I will work on customizing the website and moving away from such generic pictures. Ill also look for professional photos to be taken

 

[The Incredible Nurse]

You have gotten thoughtful feedback. What I can add is out of network isn't an easy gig to secure even if you have a fair amount of contacts and it doesn't sound like you have that in any of your locations? The people who are willing to pay for this experience are well educated and particular. Without decent connections socially, ED and local therapy practices I'm not sure how long it would take to build up even a part time out of network practice-if ever. I would consider taking insurance even just one like BC or Carefirst would probably fill you up fairly quickly. For some reason the evals don't pay much with insurance but the return visits pay well. My part time out of network practice is in an affluent area where I am well known in the community. I get referrals from psychiatrists , ED + community social workers/therapists I have worked with, PCPs and I also have contacts at multiple private schools. Even with that it took almost 2 years to get where I wanted it. I generally do one day a month in the office, the rest telehealth and charge $450 evals 80 mins, $150 follow ups 15-30 mins.

Thank you for this feedback. I am giving the full cash model a couple months once everything is setup correctly and then I may start taking some insurances if things dont pan out.

 

[Jules A]

I just honestly hate professional clothes because I am overweight as hell and nothing really looks good on me or makes me feel comfortable.

That wasn't my impression or concern it was that you look kind of disheveled. When you get with a photographer, try a few different shirts, jacket, angles etc.
Pics from the chest up tend to be forgiving anyway.

 

[ObsequiousAplomb]

Based on similar multiple feedback related to dress attire I will work on getting better clothes and taking new pictures. I just honestly hate professional clothes because I am overweight as hell and nothing really looks good on me or makes me feel comfortable.

I'm also overweight. I was obese last year and have been losing weight. I will say that having clothes that fit makes dressing up SO MUCH BETTER. It's worth the cost to go somewhere and have the clothes altered or even custom-made so that they fit your habitus. My confidence went through the roof when I was no longer straining the buttons on my dress shirts. The price difference is meaningless compared to the money you're able to bring in.

 

[Stagg737]

Based on similar multiple feedback related to dress attire I will work on getting better clothes and taking new pictures. I just honestly hate professional clothes because I am overweight as hell and nothing really looks good on me or makes me feel comfortable.

I wear scrubs most days, but I'm also a C/L psychiatrist who goes into the ER, pre/post-op areas, ICUs, etc. My colleagues sometimes wear scrubs, sometimes they don't. However, for outpatient clinic scrubs are generally not going to be appropriate attire. Even an untucked polo would be better. Telehealth may be a bit more forgiving and when I'm coming from consults I'm often in scrubs, but I let my patients know that's part of my job. When I staff our outpatient resident clinic or have an admin day I don't wear scrubs for outpatients. You've got to dress for your setting.

And agree with Jules that scrubs are just part of it. The messy hair with unshaved look isn't going to impress people and may turn potential patients off. I go unshaved a lot of the time and probably shave once a week, so I get it. But for your website picture is meant to impress. So either have sharp lines to your shadow to keep it groomed, or just shave that day. If you're going to be giving patients guidance on how to live a better life you don't want to look like you just rolled out of bed yourself.

 

[untapped]

I actually worked many years in the OR with many gifted surgeons so you are closer to reality. Except for the wrong patient, thats a big no no in the field that only the crappiest of surgeons have been fined for

I think they meant that you look like you administered ECT to yourself. Unless you're talking about that surgeon who did an appendectomy on himself.

I find it interesting that you didn't see an issue with the picture you chose to represent yourself professionally, until people gave feedback here. And being overweight has absolutely nothing to do with anything.

 

[calvnandhobbs68]

I think they meant that you look like you administered ECT to yourself. Unless you're talking about that surgeon who did an appendectomy on himself.

I find it interesting that you didn't see an issue with the picture you chose to represent yourself professionally, until people gave feedback here. And being overweight has absolutely nothing to do with anything.

I'm not surprised....this isn't a rag on OP specifically but for some reason a large amount of people in this field have like no idea what a professional picture should look like. If you go look on psychologytoday half the pictures look like bad selfies.

OP go look at the websites for law firms or financial firms/financial advisors in a city near you and you'll generally get a decent idea of what professional pictures should look like.

 

[untapped]

I'm not....this isn't a rag on OP specifically but for some reason a large amount of people in this field have like no idea what a professional picture should look like. If you go look on psychologytoday half the pictures look like bad selfies.

OP go look at the websites for law firms or financial firms/financial advisors in a city near you and you'll generally get a decent idea of what professional pictures should look like.

That’s exactly what I was getting at. It would be a challenge to find a law/financial practice website photo that looks similar.

 

[brosa]

I will likely get downvoted for this, but I don't know why people are helping you on how to get patients. It is pretty a common sense around here that NPs should not be being patients by themselves. America is funny in that sense. Expectations were having NPs to see Medicaid patients, reality is cash-practice NP working from home.

I am sure you are a great person and this is not a direct attack, although it seems like it. I just don't think NPs should be seeing patients by themselves. I know you said you had a mentor or whatever, and he does what, signs 10% of your charts? Just dangerous for patients.

 

[aquatic ape]

I will likely get downvoted for this, but I don't know why people are helping you on how to get patients. It is pretty a common sense around here that NPs should not be being patients by themselves. America is funny in that sense. Expectations were having NPs to see Medicaid patients, reality is cash-practice NP working from home.

I am sure you are a great person and this is not a direct attack, although it seems like it. I just don't think NPs should be seeing patients by themselves. I know you said you had a mentor or whatever, and he does what, signs 10% of your charts? Just dangerous for patients.

Agreed. Especially when a lot of the recommendations are things that should be quite obvious. I had a lot of M3s concerned about being “relatable” to patients which typically seemed to mean they would over share about their own mental health treatment.

Type of Practice: Integrative Psychiatric Practice. Offering psychiatric evaluations, medication management, laboratory ordering and review (not just your basic labs but digging deeper to all things connected to mental health), psychotherapy, supplements and a big focus on nutritional psychiatry ( gut - brain connection). Offering longer than traditional appointment times to capture a good history and create an appropriate personalized plan of care.

digging deeper, doing psychotherapy, supplements, and big focus on nutritional psychiatry. I think that we can all look at this and realize the context and marketing (do NPs learn psychotherapy? I don’t even see when that could happen except for maybe some very intro manualized stuff?), but the problem is patients don’t. They don’t know what an NP is, and don’t know that what is actually good advice or not.

 

[sloh]

How can OP advise about nutritional psychiatry and supplements when they are very overweight themselves?

Not to mention all of that nutritional psychiatry and 99% of supplements are garbage.

 

[Therapist4Chnge]

How can OP advise about nutritional psychiatry and supplements when they are very overweight themselves?

Not to mention all of that nutritional psychiatry and 99% of supplements are garbage.

It’s not fair to judge a person by their body size or body type. You can’t be that obtuse to not realize a person’s body might have been impacted by a medical condition, medication side effects, etc. Maybe their spouse got sick and they gained weight bc they can’t get to the gym enough?

As for 99% of supplements being garbage, so so true, especially the ones getting pushed in “holistic” practices.

 

[RomeoNP]

I will likely get downvoted for this, but I don't know why people are helping you on how to get patients. It is pretty a common sense around here that NPs should not be being patients by themselves. America is funny in that sense. Expectations were having NPs to see Medicaid patients, reality is cash-practice NP working from home.

I am sure you are a great person and this is not a direct attack, although it seems like it. I just don't think NPs should be seeing patients by themselves. I know you said you had a mentor or whatever, and he does what, signs 10% of your charts? Just dangerous for patients.

Took a bit longer than anticipated but....here it is....

Anyway OP, I would hire a photographer to help with a professional headshot, or if you are somewhat savvy with a camera, go to a barber to get a nice cut, wear a suit or dress shirt with a tie, rent a full frame camera and an 85 mm lens and use a white backdrop (and probably rent a light) for a head shot with the help of a friend then edit in Lightroom.

And don't get bogged down by the anti NP negativity you may come across here. Focus on your skills, your journey and talk to your mentors.

 

[ObsequiousAplomb]

It’s not fair to judge a person by their body size or body type. You can’t be that obtuse to not realize a person’s body might have been impacted by a medical condition, medication side effects, etc. Maybe their spouse got sick and they gained weight bc they can’t get to the gym enough?

As for 99% of supplements being garbage, so so true, especially the ones getting pushed in “holistic” practices.

Lol. You think that comment was being judgemental? How obtuse of you. They're commenting on a concern patients will naturally bring up and possibly avoid talking about. Interestingly, I remember years ago reading that patients listen closer to fatter providers when it comes to weight loss advice.

 

[psychma]

Lol. You think that comment was being judgemental? How obtuse of you. They're commenting on a concern patients will naturally bring up and possibly avoid talking about. Interestingly, I remember years ago reading that patients listen closer to fatter providers when it comes to weight loss advice.

I need to lose weight. I listen to my doctor who is also obese. I stay away from our weight loss clinic because it is staffed by skinny nurses and doctors. I know one of the doctors. She has broken her foot running a marathon and feels fat people need to just do it (diet and exercise). It’s a turn off. If I could just do it, I wouldn’t be in this position. I need a compassionate approach. I’ve lost 30 pounds with my fat doctor. I feel she really understands.

 

[The Incredible Nurse]

I'm also overweight. I was obese last year and have been losing weight. I will say that having clothes that fit makes dressing up SO MUCH BETTER. It's worth the cost to go somewhere and have the clothes altered or even custom-made so that they fit your habitus. My confidence went through the roof when I was no longer straining the buttons on my dress shirts. The price difference is meaningless compared to the money you're able to bring in.

Thank you for this reccomendation

 

[The Incredible Nurse]

I appreciate the feedback and suggestions

 

[The Incredible Nurse]

I think they meant that you look like you administered ECT to yourself. Unless you're talking about that surgeon who did an appendectomy on himself.

I find it interesting that you didn't see an issue with the picture you chose to represent yourself professionally, until people gave feedback here. And being overweight has absolutely nothing to do with anything.

Always hated formal attire, even on my leaner years. You all have been brutal with the picture that I felt confident about. But hey feedback is what I wanted and got.

 

[The Incredible Nurse]

I'm not surprised....this isn't a rag on OP specifically but for some reason a large amount of people in this field have like no idea what a professional picture should look like. If you go look on psychologytoday half the pictures look like bad selfies.

OP go look at the websites for law firms or financial firms/financial advisors in a city near you and you'll generally get a decent idea of what professional pictures should look like.

Isn’t the extremely formal look a hit off putting? I have never been a fan of formal wear and have always preferred comfort

 

[The Incredible Nurse]

I will likely get downvoted for this, but I don't know why people are helping you on how to get patients. It is pretty a common sense around here that NPs should not be being patients by themselves. America is funny in that sense. Expectations were having NPs to see Medicaid patients, reality is cash-practice NP working from home.

I am sure you are a great person and this is not a direct attack, although it seems like it. I just don't think NPs should be seeing patients by themselves. I know you said you had a mentor or whatever, and he does what, signs 10% of your charts? Just dangerous for patients.

While I see your point, the collaborator is there to have cases reviewed when necessary and to make suggestions if needed. Lets not all pretend that all NPs are mentally challenged and all Psychiatrists are somehow godly gifted

 

[The Incredible Nurse]

How can OP advise about nutritional psychiatry and supplements when they are very overweight themselves?

Not to mention all of that nutritional psychiatry and 99% of supplements are garbage.

My cardiologist sure likes to tell me about eating healthier when they are about to pass out of an MI anytime but I am not here judging his advise because of their own personal struggles.

 

[The Incredible Nurse]

Thank you for your words. My obesity comes from unhealthy relationship with food since childhood. Tried everything under the sun and it all works only for a bit. I have the knowledge and have practiced the advice I give for years. Just because the looks associated with these practices didnt stuck around doesnt mean it would be bad advise.

 

[The Incredible Nurse]

Took a bit longer than anticipated but....here it is....

Anyway OP, I would hire a photographer to help with a professional headshot, or if you are somewhat savvy with a camera, go to a barber to get a nice cut, wear a suit or dress shirt with a tie, rent a full frame camera and an 85 mm lens and use a white backdrop (and probably rent a light) for a head shot with the help of a friend then edit in Lightroom.

And don't get bogged down by the anti NP negativity you may come across here. Focus on your skills, your journey and talk to your mentors.

Thank you for the feedback. I will try to get together with a photographer to get some proper shots. I am somehow fascinated that most of the feedback has been around looks and perception rather than business plan, costs, etc. I dont know if there is something more to reas in there.

 

[FlowRate]

Isn’t the extremely formal look a hit off putting? I have never been a fan of formal wear and have always preferred comfort

Formal = White or black tie.

A button up shirt is casual-business casual.

 

[Jules A]

Thank you for the feedback. I will try to get together with a photographer to get some proper shots. I am somehow fascinated that most of the feedback has been around looks and perception rather than business plan, costs, etc. I dont know if there is something more to reas in there.

In my experience if you decide to stay with out of network your clients will generally be affluent, highly educated and particular. It will be important to come across as well put together. For better or worse that also means your appearance which can drive first impressions. Apparently I dress semi-formal business as per the examples above.