Meanwhile at the pain clinic...(is it really worth it?!)

[mountainaireNP]

I've been there about a year. Day in and day out it's altered pee (we had started having someone go to the bathroom with them but we were losing too many people so the owners had us stop doing that.) A few weeks ago, I got a visit from an investigator at the board of health who collected 18 charts to study because a complaint came from an informant at the police department that I was misprescribing meds. It didn't take long for me to find out who it was, because patients were coming to me to let me know. Turns out, some lowlife crudburger bottom dweller who was caught buying narcs off the street after he was dismissed from my clinic for a number of actions breaching his contract, was willing to act as an informant in exchange for a lighter sentence.

Oh, and we dismissed some weirdo for cocaine (no 2 week probation for illicit drugs here) and I don't know how but he got my cell phone number and he calls all the time. Now I have to change my number and you know what a pain in the rump that is.

Is it like this everywhere???? Or am I just a magnet for scum? I told the investigator I try to be consciensious (sp?) about what I give people. I hope the chart shows this. I worked hard to make sure we have imaging, database, pill counts, notes, etc. on file. I don't know what else to do. I just figure I need out of this line of business but where do I go, with the glut of NPs?

I really feel like I'm cracking up lately.

[coast2coast]

Do you LIKE this job? Do you find it rewarding? If so, then stay.

if not - you almost have a year of experience. Start applying! I remember how hard this first job was for you to find, but you are no longer green. If this place makes you miserable, get out!

Personally I would be gone in a hot second if someone from the board of ANYTHING showed up in a place like that.

[AtomicWoman]

I think I would have left when the owners stopped having someone accompany people to the bathroom because they were losing too many patients that way! You have some experience now; find a better job that doesn't stress you so much. One thing I have learned is there are pain practices and there are pain practices -- know what I mean? Some do everything "by the book"; some just collect their money and look the other way. Any discomfort you feel should have you re-evaluating whether you want to stay there.

[NSUNP]

Are you doing more than pee? Are you going to learn any interventions/injections or other skills you can take with you? Is the money so awesome you can't leave (this is the case in my area where a friend of mine had an 80K bonus working in pain medicine last year). If not, you now have an excellent foundation for working with a surgeon (inpatient or outpatient). I think board complaints are not uncommon in pain medicine. That population is incredibly challenging because you are going to face addiction, misuse and abuse. You have to have your armor on all day. Granny in the pink turtleneck is selling her Roxy to pay for her diabetes meds kind of stuff. My friend seems to think she has become a police officer and NP. She makes so much money (paid cash for a house and her kid's college) that she is basically stuck. Her supervising physician co-located the new office in the same shopping center with highway patrol as a deterrent. She has to have very difficult confrontations with patients about positive or negative pee tests and missing pills. It is certainly not for every one. You have to weigh the pros and cons and decide if type of stress is something you can deal with.

[Psychcns]

Agree with everyone who posted above. Sounds like it is time to look around for another job. Send out one résumé a week. Tell your new employer you want a change. You are now an experienced NP. Best wishes.

[PG2018]

There isn't enough altruism or money in existence for me to staff a pain clinic. It's trying enough getting Xanax away from psych patients.

[Jules A, MSN]

There isn't enough altruism or money in existence for me to staff a pain clinic. It's trying enough getting Xanax away from psych patients.

Lol, it takes a thick skin, intact sense of self and supportive management to pry the benzos, stimulants and opiates from them. It is exhausting but I'm up for it because I feel I am following the present guidelines in an effort to ensure their safety and improve their function. If they have been on Xanax for 30 years and are still a hot mess with a history of falls requiring hospitalization to me its a no brainer. I approach my prescribing philosophy at the first meeting and do not waiver. There are other providers out there who will give them what they request and they are free to seek them out because it will not be me.

I recently had a new patient present with anxiety, active alcohol abuse and antisocial personality disorder who during the initial evaluation managed to slip in the virtues of Xanax 27 times throughout the interview despite my initial and repeated assertions that I would not be starting a benzodiazepine. Red flag there? This patient didn't come to me with an active prescription for Xanax so needless to say didn't leave with one either. This person will not be back and that is fine with me and the psychiatrist who owns the practice.

To the OP I definitely wouldn't work in that specialty for an employer who was lowering their monitoring based on losing patients or not supporting you in terminating services for repeated non-compliant patients because that is incongruent with patient safety. In OP psych we also have to be aware of this when looking for a job because there are many practices who want to keep their patients happy at any price.