NP specialty with the most patient time?

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Hi there,

I've been working in primary care for several years now and find myself stressed by the short amount of time allotted to see each patient. I know this is the nature of primary care, but I don't feel that I can give the best care to the patient in this format. I'm looking to eventually move into a specialty, though I'm not sure which. Does anyone happen to know which specialties or practices allow for the most amount of dedicated patient time? Thanks in advance for any advice!

0 Votes
Specializes in New Critical care NP, Critical care, Med-surg, LTC.

In my clinical rotations I have been in pulmonology, nephrology and vascular surgery outpatient offices. At all three offices a new patient is allotted a 30 minute visit, all other visits are 15 minutes. No time to do anything. And no one in these offices seems to care about anything other than the one issue related to their specialty that brings the patient there. I couldn't ever do it. 

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Specializes in Psychiatric and Mental Health NP (PMHNP).

I'm working in mental health and you'd think that would provide more patient time, right?  Wrong.  I get 40 min for a new patient and 20 minutes for a follow up.  Welcome to corporate health care

1 Votes
Specializes in mental health / psychiatic nursing.

Private practice in whatever field you chose in an independent practice state - if you are your own boss you can set the amount of time you spend with patients. 

2 Votes
Specializes in mental health / psychiatic nursing.
6 hours ago, FullGlass said:

I'm working in mental health and you'd think that would provide more patient time, right?  Wrong.  I get 40 min for a new patient and 20 minutes for a follow up.  Welcome to corporate health care

New patient intake in 40 minutes!?! That's terrible.  Intakes really should be at least 60 minutes, and at least 90 minutes if peds or with interpreter. I'm lucky inpatient I can take as little/long as I like for intakes (within reason) but the vast majority of the time my intake interviews are close to the 60 minute mark.  As a student both my outpatient rotations had 90 minute intakes (though they didn't always take the full time). Most of my colleagues locally in outpatient world have at least 60 minutes for intakes, and max at 2-3 new intakes in a single day with 20 or 30 minute follow ups and ability to request 40-60 minute follow ups for particularly high acuity/complicated cases. 

2 Votes
Specializes in New Critical care NP, Critical care, Med-surg, LTC.
18 hours ago, verene said:

Most of my colleagues locally in outpatient world have at least 60 minutes for intakes, and max at 2-3 new intakes in a single day with 20 or 30 minute follow ups and ability to request 40-60 minute follow ups for particularly high acuity/complicated cases. 

Is that for mental health or another specialty? That sounds like enough time to actually treat people and build a therapeutic relationship. Sounds like a great set up!

1 Votes
Specializes in mental health / psychiatic nursing.
1 hour ago, JBMmom said:

Is that for mental health or another specialty? That sounds like enough time to actually treat people and build a therapeutic relationship. Sounds like a great set up!

Mental health - several are at FQHCs and a couple are part of small NP owned private practices. And yes, you really do need that time to build some rapport and complete a through assessment. There's also a few CNM owned practices where the CNMs have a similar schedule for intakes/follow-ups (with the exception of when they are on call for delivery).  One of the benefits of being in an independent practice state - if you don't like what the corporate world is offering - you can set up your own business and do things how you want. (And when employers know this - I think it makes them a little more open to negotiating reasonable time frames). 

Which isn't to say there aren't some terrible jobs around here that do push for the tight timeframes and high patient volume, but the provider turnover in these places is BAD and part of networking with other local NPs means you learn where these places are and avoid them. 

2 Votes
Specializes in Psych/Mental Health.
On 3/6/2021 at 9:39 PM, verene said:

Private practice in whatever field you chose in an independent practice state - if you are your own boss you can set the amount of time you spend with patients. 

That's not the case all the time. I recently interviewed a private practice and the HR person started out with how their mission is to provide the best BH care, then immediately shifted onto productivity and expectations for psych NPs to see 4 f/u per hour (45 min for intakes). To top that off, the pay royally sucks. I struggled to maintain my professional composure without showing my "next!" face.

3 Votes
Specializes in mental health / psychiatic nursing.
13 hours ago, umbdude said:

That's not the case all the time. I recently interviewed a private practice and the HR person started out with how their mission is to provide the best BH care, then immediately shifted onto productivity and expectations for psych NPs to see 4 f/u per hour (45 min for intakes). To top that off, the pay royally sucks. I struggled to maintain my professional composure without showing my "next!" face.

Ah... yeah. I suppose I should make it clear I was thinking Private Practice where you are the one who owns the practice - or are a partner in the practice with some say over how it is run. The folks I know in private practice either own their own practice or are partners to the owner with a fairly high degree of say in how things are run. That may not be the case if you are working for someone else's private practice - in which case I'm sure it can have all the same messes or more as corporate run outpatient. 

2 Votes
Specializes in Psychiatric and Mental Health NP (PMHNP).
On 3/6/2021 at 7:12 PM, verene said:

New patient intake in 40 minutes!?! That's terrible.  Intakes really should be at least 60 minutes, and at least 90 minutes if peds or with interpreter. I'm lucky inpatient I can take as little/long as I like for intakes (within reason) but the vast majority of the time my intake interviews are close to the 60 minute mark.  As a student both my outpatient rotations had 90 minute intakes (though they didn't always take the full time). Most of my colleagues locally in outpatient world have at least 60 minutes for intakes, and max at 2-3 new intakes in a single day with 20 or 30 minute follow ups and ability to request 40-60 minute follow ups for particularly high acuity/complicated cases. 

You are very fortunate.  I am in California and looking into several PMHNP positions, they are all 40 to 45 minute intake and then 20 minutes for follow ups.  The reason is that therapy is separated out from med mgt in most mental health practices now.  PMHNPs generally only do med mgt.  Psychologists or LCSWs do talk therapy, and they get 50 minute appointments.  

I wish I had more time with some of my patients, as they need it.  It is also very frustrating that we have a terrible shortage of therapists in large parts of California.

Individuals with a private practice have more flexibility, but unless they can build a cash-pay practice, they must set up their schedule to reflect insurance company reimbursements.

Also, most PMHNPs are simply not qualified to provide talk therapy.  I am in a post-master's PMHNP certificate program now, and there is no way that in 3 semesters I will learn enough to perform talk therapy.  Consider that a psychologist or LCSW needs a master's degree to do this and that is focused on providing therapy, unlike the PMHNP curriculum.

 

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Thanks, all, for your responses. It seems that there is no ideal NP job with reasonable patient/admin time... I wonder if a specialty like palliative care gets more time? Maybe it's time to move into admin...

1 Votes
On 3/10/2021 at 8:58 AM, haels said:

Thanks, all, for your responses. It seems that there is no ideal NP job with reasonable patient/admin time... I wonder if a specialty like palliative care gets more time? Maybe it's time to move into admin...

Hospice and palliative care: 1-2 hrs for initial visit. Shortest visits average 30 minutes

1 Votes
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