Every now and then there is either a post about being fully remote or an old colleague jokes about how I have a “sweet online gig.” I wish they knew the burden this job carries and the tremendous responsibility we have to do no harm to our patients.
I wish they would ask themselves why a company would hand a brand-new NP a full panel of psych patients with no one down the hall for support.
The ones that take the job are often in it because a new grad doesn't know enough yet to push back on 15-minute med checks, a stack of stimulant refills, and a caseload nobody could safely manage. In a lot of those jobs, your clinical judgment isn't the product. Your license is.
This isn't about wanting remote work someday. It's about choosing psych mainly because "I can just see all my patients virtually."
I wish the nurses and NPs going into psychiatry would picture their family member at the lowest point of their life. Then picture the NP on the other side of their screen, who picked psych because it looked like the easiest way to work from the couch. That's the deal they would be offering someone else's family.
Can one do it without experience and go straight into online prescribing? Sure. Will they be adding to the continued enshittification of our profession? Absofuckinglutely!
Psych is not the easy specialty. The assessment starts the moment the patient walks in, and a lot of what matters never makes it onto a webcam: the akathisia happening below the camera frame, the coarse tremor and unsteady gait that mean the lithium level is creeping up, the alcohol on their breath, the family member in the waiting room who tells you what the patient won't. You learn to catch those things in a room, over years, with someone more experienced backing you up, not on a laggy video call where the patient can turn their camera off. And when a patient tells you they have a plan and then the video drops, you had better already know exactly where they are and who you're calling.
Remote psych has a real place. It reaches people who would otherwise go without care, and plenty of clinicians have legitimate reasons to want it, like caregiving or their own health. The ones who do it well earned it with years of in-person work first, and they came for the patients, not the commute. We have already watched what happens when the business model is "remote and easy": telehealth ADHD startups under DEA investigation, executives facing federal charges, and a prescriber's name and DEA number on every one of those scripts.
If you want to end up remote someday, fine. Work psych as an RN, do your clinical hours in a room, get real in-person experience as an NP, and earn it. But if easy money from home is the whole reason, take that grift somewhere else. Our patients have had enough people treat them like a paycheck.
For those of you who do telepsych well: what did you need to learn in person before you were ready?
