NP discussion (employer's standpoint)

[randomdoc1]

Hey, I know this discussion has been had so many times about psych NPs. But thought it would be cool to share what an employer sees. Our clinic website recently put a banner on the homepage, indicating we're open to considering new hires (for any position). We got so many applications for psych NPs (the competition is intense). It seems like this over churning out of psych NPs is experiencing it's own set of outcomes. The market is just saturated. A well trained physician remains in high demand from employers in general. Yes, NPs may be cheaper to hire and to find. But get this, MDs/DOs get insurance reimbursement that will always be higher and rightfully so. That alone keeps us as a priority higher and rightfully so. Not to mention, the lawsuit involving over prescribing of controlled substances and how many NPs were working at Cerebral (and there's probably more of these telehealth services with similar activities). Also, on our intake line, we're increasingly hearing of patients who express strong preference for a physician. The ones who don't seem to care or know the difference, there's a higher tendency towards a more difficult population to work with anyways. There's a lot of good news out there. Perfect? No. But we got a lot of good things going.

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[MedMan80]

I think we will always be in demand, my hospital was unable to staff our CL services with NP's (the cases are too complex), they refused to be on the service and now we are left scrambling to find people.

 

[GHPA]

Recently talked with a person from VC that were interested to acquire my group to "open more office and supervise NP/PA". He expressed no interest in MD/DO overall and only interested in getting more NP/PA. Yes, mid-level get paid less, but the margin is much higher for them than physicians. He blandly stated "we make nothing from MD, they take too much and left no margin (for the VC)"

 

[wolfvgang22]

Recently talked with a person from VC that were interested to acquire my group to "open more office and supervise NP/PA". He expressed no interest in MD/DO overall and only interested in getting more NP/PA. Yes, mid-level get paid less, but the margin is much higher for them than physicians. He blandly stated "we make nothing from MD, they take too much and left no margin (for the VC)"

I look forward to their referrals.

 

[calvnandhobbs68]

Recently talked with a person from VC that were interested to acquire my group to "open more office and supervise NP/PA". He expressed no interest in MD/DO overall and only interested in getting more NP/PA. Yes, mid-level get paid less, but the margin is much higher for them than physicians. He blandly stated "we make nothing from MD, they take too much and left no margin (for the VC)"

And then ya end up with...

Cerebral under federal investigation for possible violations of controlled substances law

Mental health startup Cerebral said Saturday it is under investigation by the Department of Justice (DOJ) for "possible violations" of the Controlled Substances Act. | Mental health startup Cerebral said Saturday it is under investigation by the Department of Justice for "possible violations" of...

www.fiercehealthcare.com

This is the inevitable result of VC/for profit psychiatric care. Who are the profitable patients? The ones paying cash or with private insurance you can force to keep coming back every month for their controlled med prescriptions. Who is easier to coerce into convincing that everyone who self diagnosis with ADHD or has panic d/o needs stimulants/benzos? A bunch of NPs who don't have many other job prospects. What they'll continue to insist up and down is that they don't recommend any type of care, that's a decision between the patient and their "prescriber" but once they own you they then have things like metrics to hit for pay incentives for patient retention or patient satisfaction or whatever that are obviously about 1 degree removed from "prescribe patients whatever they ask for".

 

[nexus73]

And then ya end up with...

Cerebral under federal investigation for possible violations of controlled substances law

Mental health startup Cerebral said Saturday it is under investigation by the Department of Justice (DOJ) for "possible violations" of the Controlled Substances Act. | Mental health startup Cerebral said Saturday it is under investigation by the Department of Justice for "possible violations" of...

www.fiercehealthcare.com

This is the inevitable result of VC/for profit psychiatric care. Who are the profitable patients? The ones paying cash or with private insurance you can force to keep coming back every month for their controlled med prescriptions. Who is easier to coerce into convincing that everyone who self diagnosis with ADHD or has panic d/o needs stimulants/benzos? A bunch of NPs who don't have many other job prospects. What they'll continue to insist up and down is that they don't recommend any type of care, that's a decision between the patient and their "prescriber" but once they own you they then have things like metrics to hit for pay incentives for patient retention or patient satisfaction or whatever that are obviously about 1 degree removed from "prescribe patients whatever they ask for".

A metric like patient retention or no show rates basically encourage prescribing controlled substances and doling out 30 days max requiring a brief check in to get a refill every month. Will never happen with fluoxetine.

 

[randomdoc1]

A metric like patient retention or no show rates basically encourage prescribing controlled substances and doling out 30 days max requiring a brief check in to get a refill every month. Will never happen with fluoxetine.

Can’t help but notice that the cofounders are not psychiatrists. The main voice Kyle has no healthcare experience. Dr. Ho Anh seems to have an internal medicine background. But mostly residency and very little practice as an attending. His healthcare experience is minimal. That’s a lesson for sure. Psychiatric training is priceless. Especially if you have zero healthcare experience, making something like psych prescribing a customer centric model has drug abuse written all over it. Never ceases shock me how oblivious non psychiatrists are to this. And the sheer greed of course. They said the 2000 accounts suspicious for duplicate accounts is “not a priority”. They pushed stims after running analytics that those on controlled substances had better retention. Well no ****! I hear a lot of providers both prescribing and non prescribing are jumping ship there. Friend of mine says she needs to find a prescriber and a therapist. Clients will be ticked….

 

[PikminOC]

A metric like patient retention or no show rates basically encourage prescribing controlled substances and doling out 30 days max requiring a brief check in to get a refill every month. Will never happen with fluoxetine.

I just got an email from them trying to hire me. 😂

 

[PikminOC]

Can’t help but notice that the cofounders are not psychiatrists. The main voice Kyle has no healthcare experience. Dr. Ho Anh seems to have an internal medicine background. But mostly residency and very little practice as an attending. His healthcare experience is minimal. That’s a lesson for sure. Psychiatric training is priceless. Especially if you have zero healthcare experience, making something like psych prescribing a customer centric model has drug abuse written all over it. Never ceases shock me how oblivious non psychiatrists are to this. And the sheer greed of course. They said the 2000 accounts suspicious for duplicate accounts is “not a priority”. They pushed stims after running analytics that those on controlled substances had better retention. Well no ****! I hear a lot of providers both prescribing and non prescribing are jumping ship there. Friend of mine says she needs to find a prescriber and a therapist. Clients will be ticked….

They aren't oblivious. No different form any other pill mill $$$

 

[PikminOC]

Can’t help but notice that the cofounders are not psychiatrists. The main voice Kyle has no healthcare experience. Dr. Ho Anh seems to have an internal medicine background. But mostly residency and very little practice as an attending. His healthcare experience is minimal. That’s a lesson for sure. Psychiatric training is priceless. Especially if you have zero healthcare experience, making something like psych prescribing a customer centric model has drug abuse written all over it. Never ceases shock me how oblivious non psychiatrists are to this. And the sheer greed of course. They said the 2000 accounts suspicious for duplicate accounts is “not a priority”. They pushed stims after running analytics that those on controlled substances had better retention. Well no ****! I hear a lot of providers both prescribing and non prescribing are jumping ship there. Friend of mine says she needs to find a prescriber and a therapist. Clients will be ticked….

Plausible deniability for the founders.

 

[PikminOC]

A metric like patient retention or no show rates basically encourage prescribing controlled substances and doling out 30 days max requiring a brief check in to get a refill every month. Will never happen with fluoxetine.

Cerebral will throw the doctors and nurses under the bus. After all they actually prescribed the meds.

 

[Ironspy]

I’m starting to get patient referrals from these start ups as they are shutting down. People on a cocktail of controlled substances that they want continued. I won’t see them and wonder who will.

Anecdotally have also noticed that existing patients with adhd are experiencing supply issues at pharmacies when filling their meds.

 

[nexus73]

I’m starting to get patient referrals from these start ups as they are shutting down. People on a cocktail of controlled substances that they want continued. I won’t see them and wonder who will.

Anecdotally have also noticed that existing patients with adhd are experiencing supply issues at pharmacies when filling their meds.

It will get dumped on pcps as usual.

 

[randomdoc1]

I’m starting to get patient referrals from these start ups as they are shutting down. People on a cocktail of controlled substances that they want continued. I won’t see them and wonder who will.

Anecdotally have also noticed that existing patients with adhd are experiencing supply issues at pharmacies when filling their meds.

My patients who actually do have ADHD are really suffering too. Talk about a large scale drug bust.

 

[deleted1100659]

The reality is, most community mental health places for example, or at least mine which is one of the largest in the region of the country, could give a **** less about quality of care. Its a numbers game. Expand, expand, expand. Obtain all grants. Obtain all funds. Minimize expense. Zero quality control. Shove patients into 20 minute slots that should not be in a 20 min slot, with zero info available. I was told by my job "it takes longer than 20 minutes? Well just go over the apt time then" Like that would work for 14-19 patients a day

 

[hallowmann]

The reality is, most community mental health places for example, or at least mine which is one of the largest in the region of the country, could give a **** less about quality of care. Its a numbers game. Expand, expand, expand. Obtain all grants. Obtain all funds. Minimize expense. Zero quality control. Shove patients into 20 minute slots that should not be in a 20 min slot, with zero info available. I was told by my job "it takes longer than 20 minutes? Well just go over the apt time then" Like that would work for 14-19 patients a day

This is highly variable depending on institution, region, and funding sources. For example, I know multiple that have transitioned away from NPs or have shifted their roles and are actively recruiting physicians. In fact, I'm moonlighting at one with a med director that is hiring psychiatrists, doing more in-house midlevel training, chart reviews and supervision, lengthening appointment times, etc. because of the inconsistency and poor quality of care they were getting from NPs with telepsych companies.

That said, I also know of a CMHC in town that functions more like you describe. It's seems to depend a lot on who is in leadership.

 

[GHPA]

This is highly variable depending on institution, region, and funding sources. For example, I know multiple that have transitioned away from NPs or have shifted their roles and are actively recruiting physicians. In fact, I'm moonlighting at one with a med director that is hiring psychiatrists, doing more in-house midlevel training, chart reviews and supervision, lengthening appointment times, etc. because of the inconsistency and poor quality of care they were getting from NPs with telepsych companies.

That said, I also know of a CMHC in town that functions more like you describe. It's seems to depend a lot on who is in leadership.

Sadly what DrAmazingishere described is more of the norm. Limited resources = less individualized care, when you are serving a large population with lower SES and more comorbid, there is just no way around that. I personally can't do CMHC type of work.

 

[Alemo]

He blandly stated "we make nothing from MD, they take too much and left no margin (for the VC)"

“Hi, I’m interested in f**** up your career prospects and the lives of patients so I can make some money. You would get a small percentage of that money too! It’s free money! Let me know if you’re interested.

Thnx
Chad Dudewinner
Life synergies wealth solutions capital management group”

 

[Alemo]

Can’t help but notice that the cofounders are not psychiatrists. The main voice Kyle has no healthcare experience. Dr. Ho Anh seems to have an internal medicine background. But mostly residency and very little practice as an attending. His healthcare experience is minimal. That’s a lesson for sure. Psychiatric training is priceless. Especially if you have zero healthcare experience, making something like psych prescribing a customer centric model has drug abuse written all over it. Never ceases shock me how oblivious non psychiatrists are to this. And the sheer greed of course. They said the 2000 accounts suspicious for duplicate accounts is “not a priority”. They pushed stims after running analytics that those on controlled substances had better retention. Well no ****! I hear a lot of providers both prescribing and non prescribing are jumping ship there. Friend of mine says she needs to find a prescriber and a therapist. Clients will be ticked….

Don’t even get me started on Kyle. Something about him just makes me want to slap something.

Maybe it’s the fact that we graduated high school around the same time, both in Midwestern cities (which wasn’t that long ago). I mean for-profit health care is just so cartoonishly evil. This trashball goes on TV and lies to everyone-like dude you’re ****ing 31 or something- at least give it 20 years before you become a psychopath executive that may or may not be convicted of white collar crime.

 

[randomdoc1]

Don’t even get me started on Kyle. Something about him just makes me want to slap something.

Maybe it’s the fact that we graduated high school around the same time, both in Midwestern cities (which wasn’t that long ago). I mean for-profit health care is just so cartoonishly evil. This trashball goes on TV and lies to everyone-like dude you’re ****ing 31 or something- at least give it 20 years before you become a psychopath executive that may or may not be convicted of white collar crime.

That first line. I felt the same way! He makes me think of some immature frat boy. I just don't get it. Practicing decent medicine, even mediocre but not bad enough to run into legal trouble would be plenty to keep the cofounders rich and comfortable. Guess greed does things. But I also get a sense that with the lack of psychiatric experience and not much working knowledge about the prescription drug epidemic, there wasn't full knowledge of how deep this rabbit hole can go. But it's also their responsibility if they wanted to keep their golden goose going.

 

[Stagg737]

Can’t help but notice that the cofounders are not psychiatrists. The main voice Kyle has no healthcare experience. Dr. Ho Anh seems to have an internal medicine background. But mostly residency and very little practice as an attending. His healthcare experience is minimal. That’s a lesson for sure. Psychiatric training is priceless. Especially if you have zero healthcare experience, making something like psych prescribing a customer centric model has drug abuse written all over it. Never ceases shock me how oblivious non psychiatrists are to this. And the sheer greed of course. They said the 2000 accounts suspicious for duplicate accounts is “not a priority”. They pushed stims after running analytics that those on controlled substances had better retention. Well no ****! I hear a lot of providers both prescribing and non prescribing are jumping ship there. Friend of mine says she needs to find a prescriber and a therapist. Clients will be ticked….

Got curious and looked up the list of "prescribers" for Cerebral. Literally hundreds of them and a grand total of 6 of them are physicians, and one isn't even a psychiatrist (IM). Guess that's the next step for all those NP graduates who can't find a position in the saturated market...

 

[adiradirim]

Got curious and looked up the list of "prescribers" for Cerebral. Literally hundreds of them and a grand total of 6 of them are physicians, and one isn't even a psychiatrist (IM). Guess that's the next step for all those NP graduates who can't find a position in the saturated market...

So in a few months when we get hit with these "stimulant refugees" are we going to be talking about the patients who lost their prescribers or the prescribers who lost their jobs?

 

[watto]

Don’t even get me started on Kyle. Something about him just makes me want to slap something.

Maybe it’s the fact that we graduated high school around the same time, both in Midwestern cities (which wasn’t that long ago). I mean for-profit health care is just so cartoonishly evil. This trashball goes on TV and lies to everyone-like dude you’re ****ing 31 or something- at least give it 20 years before you become a psychopath executive that may or may not be convicted of white collar crime.

The board voted him out as CEO yesterday - replaced him with the Chief Medical Officer.

From WSJ:
"Mr. Robertson, who is also Cerebral’s co-founder and controls the other three seats, didn’t participate in the meeting, but afterward he lost access to the company’s Slack messaging system without advance notice, another person said. Mr. Robertson hadn’t agreed to depart his CEO role as of late Tuesday, the people said."

 

[calvnandhobbs68]

The board voted him out as CEO yesterday - replaced him with the Chief Medical Officer.

From WSJ:
"Mr. Robertson, who is also Cerebral’s co-founder and controls the other three seats, didn’t participate in the meeting, but afterward he lost access to the company’s Slack messaging system without advance notice, another person said. Mr. Robertson hadn’t agreed to depart his CEO role as of late Tuesday, the people said."

lol I wonder if David is as enthusiastic about this considering he has an actual medical license to investigate and will probably then end up being the fall guy for whatever the DOJ/DEA investigation turns up

 

[Alemo]

The board voted him out as CEO yesterday - replaced him with the Chief Medical Officer

Let’s goooooooo!

 

[Alemo]

Uh, I mean, “Let’s keep cutting heads off the hydraaaa!!!!”

 

[Sushirolls]

Hey, I know this discussion has been had so many times about psych NPs. But thought it would be cool to share what an employer sees. Our clinic website recently put a banner on the homepage, indicating we're open to considering new hires (for any position). We got so many applications for psych NPs (the competition is intense). It seems like this over churning out of psych NPs is experiencing it's own set of outcomes. The market is just saturated. A well trained physician remains in high demand from employers in general. Yes, NPs may be cheaper to hire and to find. But get this, MDs/DOs get insurance reimbursement that will always be higher and rightfully so. That alone keeps us as a priority higher and rightfully so. Not to mention, the lawsuit involving over prescribing of controlled substances and how many NPs were working at Cerebral (and there's probably more of these telehealth services with similar activities). Also, on our intake line, we're increasingly hearing of patients who express strong preference for a physician. The ones who don't seem to care or know the difference, there's a higher tendency towards a more difficult population to work with anyways. There's a lot of good news out there. Perfect? No. But we got a lot of good things going.

The bolded statement is false. Each year, insurance after insurance is elevating to pay parity in my area. I think my state or even the neighboring state passed laws saying they are to pay the same...

 

[Orgone]

It turns out the original CMO Dr Ho Anh, also listed as Cerebral co-founder along with Kyle Robertson, had already faced disciplinary action from the California Medical Board for inappropriate telehealth prescribing (for UTI antibiotics of all things). Link: CA Medical Board Reprimand. Fascinating reading in fact, there was an actual sting operation with a government agent posing as a patient. I didn't know they did that.

I guess if you're going to go down, being a glorified meth dealer is way sexier, and more lucrative, than for giving out Macrobid.

I imagine those two have already had bigger pay days than the likes of us will ever see. But still these news make for some lovely schadenfreude on this fine Wednesday morning.

The even nicer, and ultimately more useful, result of all this would be if the downfall of these companies scares away some of the VC money from our space. Cerebral had raised $462 million over the last two years, not exactly peanuts, and it seems possible enough that it will all go up in smoke.

 

[randomdoc1]

The bolded statement is false. Each year, insurance after insurance is elevating to pay parity in my area. I think my state or even the neighboring state passed laws saying they are to pay the same...

Perhaps it varies state by state. I do the medical billing and every insurance pays the MD/DO notably higher. At least locally here, colleagues have had a harder time increasing the NP rates unless they were in some area of desperate need such as the rural places. Medicare rates are generally used as the standard reference point (for insurance fee schedule generation and policy development) and I believe an NP/PA is 75-85% of the doctorate here. I thought since it's Medicare, at least for those on Medicare, it applies nationwide? I'm wondering if situations like your state pertains more often to underserved areas.

Now, NPs may have the hiring edge depending on what company you're talking about, as smartly brought up in this discussion. NPs are easier to milk a larger profit margin out of but the rate difference also has an impact. So it's a weighted out decision.

 

[calvnandhobbs68]

It turns out the original CMO Dr Ho Anh, also listed as Cerebral co-founder along with Kyle Robertson, had already faced disciplinary action from the California Medical Board for inappropriate telehealth prescribing (for UTI antibiotics of all things). Link: CA Medical Board Reprimand. Fascinating reading in fact, there was an actual sting operation with a government agent posing as a patient. I didn't know they did that.

I guess if you're going to go down, being a glorified meth dealer is way sexier, and more lucrative, than for giving out Macrobid.

I imagine those two have already had bigger pay days than the likes of us will ever see. But still these news make for some lovely schadenfreude on this fine Wednesday morning.

The even nicer, and ultimately more useful, result of all this would be if the downfall of these companies scares away some of the VC money from our space. Cerebral had raised $462 million over the last two years, not exactly peanuts, and it seems possible enough that it will all go up in smoke.

I feel like this is what all those companies like "Hims" and stuff still do now though? Although maybe now they actually make you do a 5 minute telemedicine call to get around this, then you can say you "examined" the patient.

 

[PsyDr]

I imagine those two have already had bigger pay days than the likes of us will ever see.

I wonder how much he got from the $400M buyout of Lemonaid Health.

 

[FrustratedFamDoc]

I'm primary care and have similar concerns for my field. Trend is important. As physicians, we absolutely know this. Ask yourself this: do you see things better for us 10 years from now? I don't have a crystal ball, but the wind isn't exactly at our backs on this one. Our ability and skillset is worlds better... to us. I really don't think the board room cares all that much, unfortunately.

I'm sure they have actuaries doing long term cost analysis/risk assessment based on years of historical data and have it down to a complete science on the long term profitability of us vs them that include malpractice awards. If I were an incoming student who is set to begin practice in 7 years, minimum, this would be very concerning to me. I'm a super optimist by nature, but I pay attention to trends, and so far, it's not playing out in our favor.

 

[Stagg737]

So in a few months when we get hit with these "stimulant refugees" are we going to be talking about the patients who lost their prescribers or the prescribers who lost their jobs?