Psych NPs Patient Schedules - Is this the norm?

MarleyGrace, MSN, APRN, NP · Oct 31, 2020

56 minutes ago, myoglobin said:

I believe that you describe an optimal arrangement for many if not most NP's. Even states without IP should be able to arrange a roughly equivalent set up with the difference being that they would have to "pay" one or more psychiatrists to act as collaborators. However, even with a typical "10%" payment for such a service most NP's would still come out ahead earning 70% of revenue as opposed to the salaries of less than 150K which they often earn.

I live in MA and have to have a collaborating psychiatrist. My cost is one monthly fee ($200) that covers the cost of him missing a visit with a client which is what he would be doing by meeting with me. Not a percentage of income.

myoglobin, ASN, BSN, MSN · Oct 31, 2020

2 hours ago, MarleyGrace said:

I live in MA and have to have a collaborating psychiatrist. My cost is one monthly fee ($200) that covers the cost of him missing a visit with a client which is what he would be doing by meeting with me. Not a percentage of income.

That just confirms my viewpoint that most NP's would be exponentially better compensated (and have practices more conducive to optimal patient care in terms of time with patients) if they "led" or managed their own practices even in states that do not have IP. As a first year graduate in Florida I was offered 100K working for a large psychiatric practice. However, by working for a Washington practice I am on pace to earn around 250K. There is no reason that the other NP's working at the practice where I was offered 100K could not be earning what I am and rather than being expected to see three patients per hours could have a more reasonable schedule. Better for them and better for the patient,

MarleyGrace, MSN, APRN, NP · Oct 31, 2020

11 hours ago, myoglobin said:

Yes, I wanted to avoid a job that required me to see 3-4 patients an hour. I don't feel this is good patient care. I want quality time with my patients that also allows for therapy. So, I am hoping this works out. It's just a matter of the credentialing coming through.

I never expected this to be my first job offer. I totally expected a W-2 position and had never even thought of a 1099 position as a new graduate. Having talked with others, this seems as if it could be optimal for how I'd like to practice while also giving me control of my schedule. It just takes more time waiting for the insurance companies which can be very frustrating.

myoglobin, ASN, BSN, MSN · Oct 31, 2020

3 minutes ago, MarleyGrace said:

Yes, I wanted to avoid a job that required me to see 3-4 patients an hour. I don't feel this is good patient care. I want quality time with my patients that also allows for therapy. So, I am hoping this works out. It's just a matter of the credentialing coming through.

I never expected this to be my first job offer. I totally expected a W-2 position and had never even thought of a 1099 position as a new graduate. Having talked with others, this seems as if it could be optimal for how I'd like to practice while also giving me control of my schedule. It just takes more time waiting for the insurance companies which can be very frustrating.

When I started my job "pre covid" in the Seattle area all of my clients were "cash" pay pending insurance. My cash fee was $275.00 for 90 min intakes and $150.00 for medical management 30min appointments. Even with that set up and only seeing people face to face (at the time now I'm 100% online). I was seeing eight to ten people per day starting my first week. Granted the company I worked with is a "machine" in terms of advertising on social media and other platforms along with Psychology Today. However, you might consider doing some cash only until your credentialing gets more underway. Also, you can market in every IP state in which you are licensed. Thus, I could advertise for clients in Arizona, Washington, Colorado (you are IP for narcotics after something like 1000 hours in Colorado). Now, I could only prescribe controlled substances in Washington because that is the only state where I have paid for a DEA (actually you might even be able to do that in other states right now do to covid exceptions).

Thus, you could cast a "wider net" for the time being to generate more business. I was told that my company despite having over 40 NP's and 200 therapists turns away dozens of clients per day due to not having availability so the demand is out there (and whoever wins on next Tuesday there will be many people on the other side who are likely to have exasperations in their depression and anxiety).

Also, keep in mind that you can often treat conditions like ADHD with medications like atomexatine, bupropion, and guanfacine (to say nothing of OTC interventions like Omega 3 fatty acids, SAM(e), multivitamins, and Rhodiola Rosea and others). Also, you can also make effective use of podcasts such as The Carlat Report (I am especially a fan of the March 16th episode top lifestyle tips for depression and bipolar) and Dr. David Puder's excellent podcast called The Psychiatry and Psychotherapy Podcast (especially episode 96, from Sept 30th about prescribing strength training for depression). These are free and I ask all of my clients to listen to these and summarize key teaching elements from them in my appointments. About 30% of my clients who integrate many of these approaches only need to see me once and don't even need a prescription medication. Nothing makes me happier than to lose a client (who is improved and doesn't need to be seen often).