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Lexapro

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Everything posted by Lexapro

  1. You're not diagnosing your patients yourself? Do not take this position. You still have to bill for a diagnosis code. This is a big concern to me. My experience is that many masters level clinicians/counselors do not have the breadth of experience to diagnose psychiatric conditions accurately, especially more severe mental illness, personality disorders, atypical presentations, etc. My experience is they over-diagnose PTSD and "bipolar II" disorder. Also a big part of psychiatric diagnosis is ruling out medical concerns, something that these clinicians will be entirely unable to do. I don't understand how this would work and it sounds like a terrible idea. If you don't feel comfortable fully assessing and diagnosing patients yourself (with some backup from your doc at first), you probably shouldn't be practicing in that specialty. At the bare minimum I would insist that the more experienced PA is formally required to mentor you during a certain amount of protected time (no seeing patients, no clinical tasks) once or twice a week. Honestly, I flat out wouldn't take this job and this doc sounds like he just cares about making money. Consider doing a psych PA residency.
  2. I'd argue that psych is very much the opposite and to be competent and effective as a mental health specialist, intense mentoring from people who are experts is essential.
  3. This is an interesting thread. I’ve noticed the same thing - doctors are loathe to criticize each other, even when the doc in question is clearly in the wrong. Any time an NP or PA makes mistakes, doctors go for the jugular, "midlevels are all terrible, blahblahblah". But when a doctor makes mistakes (or is even borderline incompetent) … crickets. It’s the opposite of nursing, where we often gleefully tear each other to shreds for the tiniest of errors. Doctors are very protective of their “guild” to a fault, definitely, but nursing could learn a little bit from them. I do think the protection docs give each other elevates their brand in a way…
  4. I'm pretty sure that NPs in independent practice states who own their practice do just this.
  5. Fiance and I max out our IRAs and 401ks, then have an extra taxable brokerage account. We should be able to retire in ~12-15 years if we so desire, but plan on retiring in more like ~20-25 years quite wealthy. I'm a big bogleheads fan, I prefer bogleheads over Dave Ramsey (who is a bit too conservative when it comes to debt IMO).
  6. LOL. Like the PA I knew who didn't even have a psych rotation and got his 'mental health' hours through his family med rotation? Also I guess suddenly didactics are not important?
  7. It depends what you mean by "woke." The social determinants of health are a real thing and any provider should be well aware of this. Not sure who irritates me more these days, overly woke people or people who complain about overly woke people.
  8. I have a 1099 position that pays $150/hr. I only work there a few times a month though, since the setting (emergency psych) is not my favorite.
  9. 2k/year for CME. All license renewals/DEA/etc are not taken out of CME. It's not great but our PTO and 401k match are pretty great so what can you do. *shrug*
  10. NP insurance is pretty cheap because RNs/NPs get lumped in together, from what I understand. I pay $900/year for 1/5 mil coverage.
  11. For our practice billing for psychotherapy is essential. I mean all you need to do is meet with a pt for 20 min to be able to bill, so for our model it's money left on the table if we can't. Just depends. Also, I only see 2-3 pts per hour in ouptatient. I refuse to see any more than that as it becomes miserable for me. Now in the inpatient setting 4+ an hour is easy, especially with manic/psychotic patients who are highly symptomatic - that's a brief visit.
  12. One thing that blew my mind was when I met a PA who had no psych rotation. It was apparently an elective at his school. He got "mental health" hours through his family medicine rotation. He never rotated through a psych specialty setting under the guidance of psychiatrist during his entire program. What kind of BS is that?! I only hope that is an exception to what is typical. This is the kind of stuff that tells me PAs need to beef it up when it comes to psych, especially if they want to make the big psych $$$ which is totally out there. Psych NPs with experience bring in >150k easy.
  13. I mean you can't actually believe that psych NPs don't get trained in ruling out medical conditions? It seems like you're being willfully ignorant about psych NP education. I am fairly critical of NP education overall but you can't seriously believe that a typical PA will somehow be better prepared to practice in psych than a psych NP? Even the psych 'residencies' for PAs seem pretty thin in didactics, from what I've seen.
  14. I think part of the issue is billing. Many states/insurances will not allow a PA to bill for psychotherapy unless the PA is also an MFT/LCSW (and rightfully so, IMO, as I do not see any PA programs with dedicated didactic/clinical hours towards training to provide real psychotherapy). MDs and psych NPs do get this training, even though it may be somewhat skimpy, it does exist. I know that's a limiting factor in many places, not being able to tack on the therapy code and being reimbursed less is leaving $ on the table. I think PA psych residencies should include a psychotherapy component, but the few I've looked at have (disappointingly) not included this. PAs are doing this to themselves and should advocate for better/more complete psych training IMO.
  15. I mean I'd much rather make 250-300k with no nights or OT in the bay than 65k in PA, but to each their own. It is true that RNs make a lot here, but the only RNs I know who make over 150-175k are working like 60+ hours weekly, holidays, nights, doubles, etc. I prefer to make a lot and work as little as possible, tbh.
  16. Sounds to me like these NPs do not know how to negotiate. I make $150/hr at my 1099 job in this area.
  17. From what I understand it is extremely difficult to sue a provider employed by an FQHC. You basically have to sue the federal government.
  18. Refusing orders? That's absurd. Hearing about these NP vs PA clashes pains me. I wish we could work together towards our mutual goals. Where I work we don't really have many PAs (psych), but the RNs respect both the NPs and docs pretty much the same. I'd hope that would be the case if we had a PA join our team.
  19. Your pay sucks but then again, only 6 patients a day? Do you have to stay the whole time or can you just round fast, see your 6, and leave?
  20. Hopeless, helpless patients with treatment resistant depression who keep shooting down their treatment options. These patients are so frustrating for me. I'd rather deal with borderline personality.
  21. And physicians get busted all the time as well. Should we start a thread about that? At least the thread about the PA was relevant to this forum.
  22. I avoid starting Paxil in basically anyone. Lots of drug interactions, nasty "discontinuation" (aka withdrawal) syndrome, and many adverse effects. I have had luck getting several elderly patients off of it as well. I have seen a few psychiatrists/psych NPs swear by it for very severe anxiety disorders who have failed other options, though I think it's probably just the sedating effect of the med that the patient is perceiving as reducing their anxiety.
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