Pain management in primary care

[l3eat]

hello all,

I have a question about my new position.

I am an adult gerontology primary care NP. Worked at ICU and PCU as a RN for 5yrs and has 1 yr experience at internal medicine outpatient as NP.

I recently relocated to new state d/t my husband job, but I was having difficult time to find new position at primary care. I think that is because everybody wants to hire FNP in this town and I only have 1 yr experience as a nurse practitioner.

I finally found one private primary practice who wants to hire me. They are not pain specialist but they told me more than 50% of their pts is here for "chronic pain management." the rest of 50% of primary care pts is all uninsured pts who are paying flat fee for the visit. other insured pts being seen by MDs; has 2 MDs in the office.

I was always working at the university hospital team/group and always deal with insured pts. I did not deal with chronic pain pts form previous work but we all sent them to pain specialist. so I am not familiar with those uninsured flat fee and chronic pain management.

I really like this position since I am going to be a solo provider there, which is exciting since I always saw other physicians' patients from previous work. but I also have some concern for this chronic pain management thing. I am still new NP and had a limited experience with chronic pain management. why most primary care, including my previous work, hesitate to provide chronic pain management? then why this private practice is taking this role? is there anything I am missing? is there any legal issue/liability that I need to consider? any idea/opinion will be appreciated!

[pro-student]

This sounds highly suspicious. Maybe it is legit but could easily be a pill mill. They're willing to hire you without any training/experience in chronic pain management and not provide training/supervision. So it's probably safe to assume you're not prepared to do any pain management procedures and have limited expertise beyond prescribing opiates. If these patient don't have insurance, they are also highly unlikely to be able to pay for referrals to PT/OT or for counseling or CBT. There was an article not too long about that had a similar situation (Medscape: Medscape Access). Basically, a well meaning but under qualified can get into a lot of trouble taking on pain management patients without having the training and resources to provide this highly specialized type of care.

[Darth Practicus]

This really sounds like something I would run away from. Holy Moses. What a nightmare. I also agree with Pro-Student. Sounds like a pill mill to me.

Darth Practicus, FNP