Michelle91518

Hi everyone, I'm looking for advice on something I have always struggled with and should already know by now. I'm an ANP who worked in a clinic setting for several years, and now I do medical disability evaluations as an independent contractor. I only have an hour with patients to complete a full one-time evaluation, and that is all I am getting paid for. I find it very hard to reel it in when patients come in with a multitude of complaints, and even though I try to tell them to give me typically their top 3 problems, it still becomes overwhelming, and I find that I run way over the time I have. I explicitly tell people I only have 30 minutes to gather a history/ROS, and then 30 minutes to do a physical, but when someone comes in with several problems ranging from cardiac to pulmonary to musculoskeletal to everything in-between, I feel as though I have to address each one with some level of adequacy, and by the time I'm done I've probably made only $5 an hour. I have difficulty leaving out details that in all reality probably aren't all that important, and my notes end up long and wordy. If someone is a talker, forget about it! I used to struggle with this very much in primary care, telling patients I could only address 1-2 problems per visit and then going down the rabbit hole when they start complaining about everything. Often times people are late for the appointment too, which leaves me even less time to get it all done. Anyone have any advice for how to manage a patient with several problems that need to be addressed during a one-time, hour long visit? It's hard to leave things out when I want to make sure their issues are well-documented, but then I start drowning. Thanks in advance!

Hi everyone, I would love to connect with any other NPs or get any suggestions anyone may have on specializing in the field of nutrition. I worked as a primary care provider for many years until I pretty much burned out, and have realized that my interests have always been more concentrated on prevention than managing chronic diseases in 15 minute office visits (which is most of primary care in my experience). I have a strong interest in plant-based nutrition, and would love to focus my career on providing health education to clients on this topic. I have searched high and low, and have been unsuccessful in finding any programs for licensed APRNs or other medical providers to get some credentials in plant-based nutrition. There is the eCornell T. Colin Campbell program, though I believe this course is open to anyone and I'm not sure if it would allow me to create the role I am thinking of (though if someone has experience with this program I would love to hear from you!). I am the primary breadwinner in my family, so I do not have the option of going back to school full-time to become a registered dietitian given how vigorous the program requirements are. The role I am imagining for myself is one in which I obtain clients motivated to improve or reverse chronic disease through diet and lifestyle modification, but I would rather work in conjunction with their PCPs than be the PCP myself. Any ideas or recommendations would be most appreciated!

Hi, I feel very similar to you and needed to get out of primary care. I took a position last year doing in-home health assessments for Medicare patients. Not responsible for the patient any longer than the hour that I’m there and once I’m done charting (which I do have to finish at home but nowhere near as terrible as when I was a PCP) the work is actually over. It is not perfect of course and at times I go to unsafe areas and drive all over the place. There is more flexibility with hours and the pay is pretty decent. The main downside I have right now is it feels unstable because my schedule has not been completely booked in some time - luckily I am salaried but I don’t know how long this can go on. I am also looking for any work from home positions - I will let you know if I come across any opportunities. Hopefully there is something out there for us.

Hi everyone, I’m a nurse practitioner who worked in primary care for almost a decade and became pretty much completely burned out. I made a desperate career move to leave this type of direct patient care last year and started doing in-home health assessments for Medicare advantage patients. The work feels unstable and I’m not sure how much longer I will have this job as my schedule has been very light (luckily I’m salaried but most who do this work are per diem). I am trying to think of what else I can do as I really can’t stomach the thought of going back to being a primary care provider/responsible for my own patients. I found it to be very anxiety provoking and really not a good fit for me (and I tried a few different practices). I am considering doing disability evals for social security as my sister does this for psychology and was told they would take NPs for medical evals. Has anyone ever done this before? Did you have to rent out your own office space or equipment ? Any other suggestions would also be most appreciated from anyone else who is out of or wants out of direct clinical work. Thanks in advance for any input!