NP considering leaving practice

I cut my teeth in a Community Mental Health Center. I could write a book about what I saw there in 4 years.

Yes, they are famous for poor staffing, and many patients are really looking for disability payments, or benzo's, not help. People don't keep their appointments. Management is either stupid or they just don't care at all. The very few psychiatrists you do work with are not good role models. Low pay, poor benefits. Someone is making money off the place, but you aren't. On and on.

Upon graduation, I took a state job at a forensic facility. Now there was a real learning experience. The pay eventually got fair, and I was there long enough to get a small pension and health insurance.

I tried private practice as well. I didn't mind it, but you have to have firm boundaries with people, as you must see 3 patients an hour, most of the time.

Now I do consulting in LTC. It has it's ups and downs, like anything else. On the positive side, the expectations are lower. No one is looking for a cure. The no-show rate is minimal, although of course residents are occasionally out of the building. You can get to know residents on a long term basis, and the work is at your own pace. It is usually flexible with the hours.

The downside is working in LTC. Many very low functioning people, and you are dependent on staff to tell you how they are really doing.

Possibly it could help to reframe your expectations. Is is realistic to expect to enjoy your work, most of the time? Most of my enjoyment comes from interacting with the staff and other professionals.

It sounds like you are willing to live simply, within your means, and making appropriate plans to retire or semi-retire. I am doing the same thing over the next 5 years. Getting a little sick of the rat race, and arranging finances accordingly.

12 patients a day is not bad at all, though.

As far as books and articles, I am not sure what you are looking for. I am sure there is a ton of literature for people who have decided to retire early, and live very simply. Not specific to NPs.

Different job opportunities? I would check out local jails, prisons and nursing homes. I know, glamorous.

Community Mental Health Clinics really suck, though. I know some of the stuff that really goes on there, and it's hard to believe they get away with it.

It is painful to realize that Medicare reimburses NPs 85% of the MD rate, and other insurances follow suit.

Yet somehow, on average, NPs typically get 50% of an MD salary, at the very most, if we are fortunate.

I recall, 20 years ago, in a different context, being told that Physical Therapists keep their pay high by keeping their numbers low.

Psychologists have done very much the same.

Lawyers have not, and the results have been disastrous.

Many, if not most, NPs seem satisfied to work for 10 or 20k more than their RN salary. This is nothing new, unfortunately.

After taxes and the student loan, it isn't even a raise.

Some NPs are satisfied nonetheless, and others are not.

We are the low-paid workhorse of the health care system. Decades ago, NPs were disrespected because they had 3 years of education, fewer than a kindergarten teacher.

Over the years, as educational requirements advanced to the MSN, we still had various state practice laws in many places that made it seem like we needed close supervision by a physician.

In reality, this rarely happened, but someone collected the money.

The profession is changing rapidly, and I am a fairly old lady. It will be interesting to see what will happen over time with the DNP, and the largely online educational model.

It would be very hard to make anything in LTC if you are a consultant, only seeing maybe 5 patients by referral here, then drive 20 or 30 miles, see another 5 patients, rinse and repeat.

I am part of a team, I carry my own patients, and see many of them monthly. Most of my facilities are quite near my home. Less than 5 miles.

The few that are not that close, have negotiated a substantial stipend, in addition to the billing.

My state has long been in the process of discharging the chronically mentally ill to the community, and they end up in LTC.

Some of local SNF's are full of schizophrenics.

They are very poorly managed by PCPs.

I have also taken over several facilities where "psychiatrists" took the facility stipend, and didn't show up for months at a time.

I am there each week, or every other week, according to the contract.

I am known for my willingness to work with other professionals to come to a consensus, and I even give out my home phone number and email to encourage communication.

For all you truly sucky psychiatrists that are worried that NPs will take your job?

You should be.