Psych NPs Patient Schedules - Is this the norm?

Specialties NP

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Psych Eval is 1 hr and Med management is 20 mins - I get that  this is standard at most places.  However is every bit of your time booked to see patients?

So 8:00 am, 8:20 am, 8:40 am, 9:00 am and so forth.  No time in between?  

 I've been practicing for one year and some days I feel like I am being taken advantaged of. If patient A is supposed to get 20 mins that ends at 8:20  - By the time they are out of the office and patient B is in the office its 8:22 or 8:23. We are still working remotely but things can sometimes get even worse with doing things remotely because some patients have technical issues that can put us behind. Am I being petty here, or is this the norm?  

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Specializes in Psych/Mental Health.

1-hr eval and 20-min f/u is pretty common (technically you bill 15-min but you see 3 patients an hour, and 15-min for charting). Do you have any admin time and/or the flexibility to schedule certain patients with 30 min f/u?

I'm new, but just started in a FQHC. I was worried about the 1-hr/20-min set up too but there are more "buffers" in my job. I can share with you more if you PM me.

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Thanks for the reply.  There is no flexibility in the schedule.  No admin time, which is my biggest gripe at the moment.  I also work at a FQHC. I get a ton of daily phone calls. Before Covid, I would get maybe 2 perhaps 3.   Now  some days I have 5-6, or maybe more. Refill requests, meds not working, side effects, to  family member concerns about pt not taking meds, pharmacy phone calls about one thing or other.  More paper work, Forms sent by patients to be filled out.  Then there are labs to review as they come in.  There is no time in my schedule allotted  for those things. Every single minute of the day is assigned to seeing patients. 

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Specializes in Psych/Mental Health.
3 hours ago, mangopeach said:

Thanks for the reply.  There is no flexibility in the schedule.  No admin time, which is my biggest gripe at the moment.  I also work at a FQHC. I get a ton of daily phone calls. Before Covid, I would get maybe 2 perhaps 3.   Now  some days I have 5-6, or maybe more. Refill requests, meds not working, side effects, to  family member concerns about pt not taking meds, pharmacy phone calls about one thing or other.  More paper work, Forms sent by patients to be filled out.  Then there are labs to review as they come in.  There is no time in my schedule allotted  for those things. Every single minute of the day is assigned to seeing patients. 

I see. After seeing several of your posts, I wonder if it's difficult to find PMHNP jobs in your area and what's keeping you there. Not all FQHCs are like that. We have admin time and flexibility.

Private practice probably offers best work-life balance. I honestly think inpatient is hit or miss because there are so many horrible psych hospitals out there.

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I hear you. I work in private practice/psych outpatient and it's relatively the same issue. I do psych follow-ups and it's 20 min back to back with a "30 min" break and "admin time" that is only 20 min at the end of the day...

I have to hope for either camcellations or quick follow-ups to complete all the other admin things I need to do and to feel "caught up". But it can be difficult, esp with COVID19 and everyone being anxious about it...

So no, you're not alone.

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Specializes in DHSc, PA-C.

When I did outpatient psych I worked 9-6.  3 pph 9-10, 4pph 10-12, 3 pph 12-1.  Lunch 1-2.  4pph 2-5, 3 pph 5-6.  A new patient would take 2 slots during an hour I was seeing 3 pph.  When I joined the practice the patients were already used to the providers charting during their visit.  So, I joined in on this practice and did the same.  Unless I got a feeling the patient was not appreciating it and this rarely happened.  So, every chart was done before the patient even left my room.  Usually had 3-5 mins between patients to answer emails or return a quick call.  I was also the assistant medical director and oversaw our TMS program.  I would come in 30 mins early to review my morning patients and normally spend the last 15 mins of my lunch to review my afternoon patients.  One of my favorite jobs thus far.   

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19 hours ago, umbdude said:

I see. After seeing several of your posts, I wonder if it's difficult to find PMHNP jobs in your area and what's keeping you there. Not all FQHCs are like that. We have admin time and flexibility.

Private practice probably offers best work-life balance. I honestly think inpatient is hit or miss because there are so many horrible psych hospitals out there.

I relocated for this job. I just recently hit the one year mark. I was not going to leave before my contract was up. I have not signed a new contract yet. Still contemplating if I will. It's not like its a job from hell where I get up every day hating it. However,  there are definitely things I dislike so that's why I try to get feedback  here from others to see if I am overthinking, what's the norm, what's not, see if I can  get ideas about what I should ask for, should I choose to stay another year and renegotiate my contract.

 

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Specializes in Psychiatric and Mental Health NP (PMHNP).

What you describe is pretty standard.  I have 40 min for new pt, 20 min for f/u.  No breaks except 1 hour for lunch.  The thinking is that there will be no-shows.  However, with telehealth, there are fewer no shows.  I feel your pain, but I'm not sure of the solution.

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Specializes in psych/medical-surgical.

I am gonna go out limb and say that it is the FQHC/government problem... I rotated at a FQHC and know providers in the military. From what I have seen, the government has extra requirements, rigid scheduling and additional documentation/hoops you have to jump through. The AF provider sees one patient every 30 minutes, has to counsel her patients, has to do profiles and other military related things. 

Documentation in the FQHC was monotonous and probably one of the slowest and inefficient EMRs I have seen. All of the providers had templates to work from and worked on them while the platform took minutes to load the patient chart. 

The more independent you get, the more control you have over your schedule, who you see and how you spend your time. A fair amount of people at the FQHC I was at no showed and often there would be no filler. 

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Specializes in Psychiatric and Mental Health NP (PMHNP).

I am currently working in a private practice and my schedule, as stated above, is 40 minutes for new patient and 20 minutes for follow up.  That is indeed the norm, at least in California.

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Specializes in ICU, trauma, neuro.

I am private practice and dictate my own schedule and choose my own codes.  My intakes are 90minutes and my followup appointments are 30minutes. I am on pace to earn about 250K after fees (no benefits 1099) and others at the practice earn about 300K (they however do 60 minute intakes which probably improves their profit margin).  

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Specializes in Psychiatric and Mental Health NP (PMHNP).
8 minutes ago, myoglobin said:

I am private practice and dictate my own schedule and choose my own codes.  My intakes are 90minutes and my followup appointments are 30minutes. I am on pace to earn about 250K after fees (no benefits 1099) and others at the practice earn about 300K (they however do 60 minute intakes which probably improves their profit margin).  

That's awesome, but unfortunately, quite rare.

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