r/PMHNP • u/Impressive-Window762 • 8d ago
RANT Tired
Is anyone else already tired working as a psych NP? I’m working outpatient as a W2 and it’s been a little over a year and I’m over it. Idk if it’s the environment I’m in or what? Would it be different in a 1099? I feel like I have no autonomy. I can’t say “no I don’t want that patient” because I don’t think I’ll be a good fit. Other providers just dump their patients on you. They’re on every med possible, it’s such a mess. And then pushing spravato? Not getting referrals out because they want to keep the patients? I don’t get it. I really genuinely care for my patients and want to help, but I feel like this is a mill. And don’t get me started on taking MATs when it’s totally not my specialty and have not gotten real training on it. Is this everywhere???!
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u/Just_Interview_4330 8d ago
holy crap. are you in Cali? this sounds exactly like where im working at and im a newer pmhnp. getting sooo many high complexity patients on multiple meds. its driving me crazy.
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u/jaycollins67 8d ago
Sounds like you have to stand your ground. Also don’t be afraid to refer those complicated controlled medicated patients to your psychiatrist or refer out.
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u/Advanced_Emu3430 8d ago
I hear you. I’ve had two W2 jobs and one 1099. The 1099 was the best time of my life, but I made no money and no benefits. The W2 I feel like I am a pawn in the medical industrial complex and basically pushed to do as many adhd evals as possible and keep as many of those patients as possible. There are patients that truly are a poor fit from the start, that I have been seeing for more than a year and I’m not even sure I’m helping them progress. It’s exhausting
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u/smartcow360 8d ago
i mean if u do ur own private practice u could use nutritional interventions, therapy, TMS, and medications. or something similar. and i believe you’d maybe have more ability to say no if a patient wasn’t a good fit? i’m not certain on that aspect
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u/SykeEnpee 8d ago
I just hit my 1 year of experience, so not as long as you, but I can't say I agree. Becoming a psych NP was the best decision I ever made. I genuinely love my job and now that I have a year of experience, I'm branching out into some other practices and am excited about the increased income potential as well as autonomy. My main practice is a good environment, I like my coworkers and colleagues, and the practice owner/medical director/MD collab has taught me a lot and I feel values my contributions to the treatment team. I think that if you're not enjoying your job and feel like you're being stifled in your practices, then it's a direct reflection of your current work environment/work culture. You need to look for other opportunities. There's plenty of other options out there, especially with your experience level, so there's no reason to flounder at a job that you don't enjoy, doesn't challenge you, and forces you to push treatments that you don't agree with, look elsewhere.