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Everything posted by Lightspeed

  1. There isn’t an NP program out there that is a direct entry program that is entirely online. Direct entry NP programs are all in person, and involved getting your RN along the way, as having an RN is required as qualification for getting an NP. So unless you are an RN already, it’s more complicated than just going to NP school.
  2. It keeps mentioning state law in that statute. I’m not sure if it’s a top down measure forcing collaboration. It seems to say that if the state law allows for collaboration, then the statute will now support it.
  3. Ha.. she was able to do that because you were tasked to work harder so they could accommodate her! I think you have a sweet job. It provides for you, and lets you have the work life balance you like. You only owe yourself, not anyone else. Not patients (apart from being a competent provider), certainly not administration, and absolutely not that provider that got to keep her sweet workload at your expense. You’re providing an important service by performing admits and taking calls from nursing staff. You can go to sleep knowing that you are an important cog in the wheel. Telepsyche might be the future, but I feel like it’s the kind of future that only an administrator would love. From what I’ve seen, it’s not quite lucrative enough for the provider to be a big draw away from in-person work. The rates are a bit low compared to the promises in the ads. But yeah, “independent provider” means you get in on the game.
  4. Meh.... Texas. Someone has to be the last state left to provide independence. Guess it’s going to be them. Losing no sleep over that.
  5. Status symbols are changing gradually, even though acquiring stuff still persists. But for folks who can hold the line on housing, vehicles, and toys (travel trailers, ATVs, boats, etc), and keep it real with education debt, the world can be your oyster. For me and my spouse, our status symbol for ourselves is to be able to be out of debt, including the house. We keep it between us how well we do financially, and don’t wear our good fortune on our sleeves. The satisfaction of knowing we could have a lot more trumps what we’d get by posting pics of all our vacations.
  6. We are both in the same side, i probably didn’t make my point as well as I should have. Basically my observation is that the job market is changing to force the kind of adaptation you mentioned, and PAs should be given the tools to be able to adapt along with others. I see the FNP market being saturated... tons of RNs include advanced practice in their long range plans, and so many are jumping into school very quickly after graduating RN school. At the core level, NPs have RN as a fallback, and can always put food in the table. A job search in a tight market is just a matter of convenience, and new NPs can sit it out and wait for the best jobs when they are brand new. I didn’t have to do that, but I was ready to. I’ve seen someone have to wait a couple months for their dream job to become vacant, during which time they cut back to part time and burned vacation by going on real vacations. Being frugal is the way to go. Not giving in to the big purchases are the easiest ways to stay out of trouble. I know nurses who live life too large with giant houses full of furniture, new cars and $40,000 trucks(!), campers, ATVs, booze and eating out, expensive hobbies.
  7. What a school accepts is up to them. However, when you fill out the CASPA application (the one size fits all service that distributes your application to the programs you want it to go to), you’ll have to indicate precisely where your different hours came from. After that, it’s up to the individual programs. You would want to do research to find out where the most bang for your buck will go. Don’t apply to programs that won’t consider you based on your stats, whatever those may be. Tons of athletic trainers become PAs. And there are plenty of schools that don’t care about you having very much health care experience. You have to do some research. Start with program websites.
  8. Couple things. I think that decoupling PAs from physicians probably would lead to lower rates, simply because it would likely decrease the incentive to pursue malpractice claims. That is if the theory is correct about high rates being associated with lawsuits aimed ultimately at physicians. I don’t know that physicians are necessarily the big fish being aimed at, I just think they are another potential defendant that can be named, essentially doubling the number of parties that can be shaken down for a settlement. Again, I don’t know this, it’s just me guessing. With an NP getting sued, you get one crack at it, vs two folks potentially when a PA gets sued. Maybe a skilled lawyer would even tend to exploit the supervisory relationship to draw in a physician that is more likely to settle because of the inconvenience of being a distant party with a lot to lose. Keep in mind that the goal for lawyers is to settle rather than go to court. It’s 10 times easier with guaranteed odds of getting something if they enter into settlement before it goes to trial. Another theory is that because PAs are so associated with physicians in specialties, and really tough cases, that maybe there are more avenues for risk because of that. If your physician is only seeing really tough people, and by extension so are you, that means you are more likely to have something go wrong. Or maybe you don’t have the latitude to operate outside of the higher risk activities the physician drags you into by default. Stuff that you might normally be more conservative on might be too light of an approach for what your SP wants to be doing (essentially, if your SP robs banks, and you drive, you are a bank robber too). Mostly I think it’s just more expensive jut because it can be. As dependent providers. You guys are a captive audience. Physicians aren’t going to let you work without it. They are used to paying a bunch for their own, and you guys don’t know any better. Nurses are used to less because as RNs, our policies were cheap. I feel like if you were cut loose to be independent, you’d see your rates go down precipitously. I really don’t see how it goes up, especially with how well trained you guys are. It certainly wouldn’t be because you didn’t have the clinical skills to avoid malpractice events. As for the theory that the number of nurses contributing is higher, I have my doubts. Sure, there are lots of RNs and LPNs, but not very many carry their own malpractice insurance (I’d bet almost no LPNs carry it). The ones that do are paying like $200 a year if even that. I can’t remember what mine was, but it was almost free my first year, and cheap thereafter. It’s not like all 2.7 million nurses carry it. And then among NPs it’s not really that expensive. But every one of the 1.1 million physicians do carry it, and it’s hella expensive for those guys. So if 1.1 million docs are paying on average $50,000-$150,000 per year in malpractice, that’s a lot more than if 1 million nurses (if even that) are paying on average $300 per year (averaging the NPs with the line nurses, of course). It I don’t know if you guys purchase from the same entities the physicians do. If you don’t, then there’s another slight they are aiming to you, akin to kicking you out of the physicians lounge.
  9. I hear the call for streamlining ones life. There are merits to it. And it’s impressive that you accomplished what you did. That’s hardcore, and inspiring. Alternatively, there’s the aspect of wanting to live a little of the life that you sacrificed a lot to improve upon. Those things you mentioned do add up, but the $13 a month for ad free streaming is instead of $100 cable. The $5 a month for streaming music is instead of buying albums. The $60 cell phone bill is instead of a house phone and long distance, as well as the lifeline. The $50 gym membership, if used as intended, is an investment in your physical and mental wellbeing, and possibly the main source of recreation for a stressed out PA. Many PA grads are already doing things on the cheap, and $100,000 of debt at a minimum is a large hurdle for someone who then wants to save for a down payment. I get where you are coming from, and practice that myself to fantastic effect (debt free), but I also know that I can cut back in my lifestyle to near spartan levels and still only save a drop in the bucket compared to the value that comes from increasing my income opportunities. Most people can cut a lot more fat from their life than they think they can, but for spartan living to be the standard across the board says some scary things about the way the profession has gone. I don’t think a wise person ever hits the workforce and acts like they have a free hand to spend, but it shouldn’t be that you have a vow of poverty. A lot of the burden is leftover from undergrad for those folks, but it’s disheartening.
  10. I haven’t seen issues that wouldn’t still have been issues in a scenario where supervision is in play. Most of you folks see your SP about patients only rarely, and are usually on the right track anyway. Outside of surgery or specialty, how many folks do you send home without running them past your SP at all? Almost all of them. How many of you would have an opportunity for an SP to catch something that you didn’t bring to the SPs attention on your own because you recognized it needed to be? So one way or another, it’s your intellect making the catches. Independent NPs who want to keep their licenses refer out for situations that are above their ability. Independent practice states for NPs actually have better outcomes than states where there is restricted practice. So while you may be interested in being a physician extender, others might recognize their role is better utilized as a practitioner, and that includes PAs. How you feel about what should happen isn’t pertinent because NPs aren’t interested in your viewpoint, and will keep moving toward expansion of independence. The question is where PAs will be positioned. If you aren’t moving forward, then you are moving back. Look at the anesthesiologist assistant profession compared to CRNAs to see where you will end up. I’m sure that anesthesiologists would love nothing more than the AA model to prevail because they have control over AAs in entirety. But it’s too late. CRNAs are out in 50 states and own the non physician provider role in that field. Groups go in and replace so many docs that the hospitals end up hiring just a few as a formality to maybe be department heads. AAs might be just as cheap as CRNAs, but they have to come with a doctor in tow to “supervise”. That doctor is going to be the new anchor weighing down their appeal. If you aren’t independent, you aren’t offering the same kind of cost savings. If PAs do come into the picture by underbidding NPs, it will be because they took a hit to their pay. I don’t see how you all are around as a formidable force in 10 years if you don’t become independent. Independence really isn’t controversial, it’s just a matter of formality. Nurses like it because we aren’t treated like ancillary staff where we are independent. It doesn’t change our approach to care very much. The docs hate it because hospitals are telling them to take a pay cut or they will staff with NPs. Those ads criticizing NPs aren’t aimed at NPs, they are aimed at admins that are using the threat of NPs to tell the docs to ease up on the costs. Apart from that, the specialties thrive on physicians, and none of those guys want to go into primary care where you’ll see most independent NPs trying to go solo. Like there’s enough providers of any kind there. Whose business are they stealing? And heaven forbid a dermatologist not make every red cent in a locale from stupid Botox parties. They will have to settle on having a little less throughput to then upsell the bigger procedures to. Better take out an add so that you can make sure you are able to cash in on multi million dollar profit years. Don’t get sucked into the hype, you guys are already independent providers, you just don’t have it formalized, which means you get all of the headaches and responsibility, and none of the benefits and respect. They fire you guys less for screwing up, and more for not sucking up, and they do it because they know that once you don’t have their name attached to your agreement, your life is upended until you find another physician to set you up to be screwed all over again. And that’s if they don’t pick up the phone and call ahead of you to warn them how frisky you are. The kind of situation where THAT kind of thing can happen (even if it doesn’t happen) is one that is still hanging over EVERY one of you outside of a select few in places like the VA. Just be independent, and make it a bit less easy to get jerked around. At the very least you can go put food in the table by hanging out a shingle in a strip mall storefront until you land another job and start working almost the day that you find one.
  11. The debt I’ve seen PAs come out of school with is tragic. These are folks I personally know. For so long, the mentality for pre PAs has been the same as what you see with some medical, dental, and even POD students, which is “if I can just get into a school, any school, and get through it, I’ll be set.” That might be the case if the field and it’s advocates were rabidly hungry to advance. It used to be that the advice to a student that struggled was for them to hang in there and keep trying for PA school. There’s no way that is good advice now. If you don’t land PA school the first time through with relatively good stats, throw in the towel and move on. The payday and perks aren’t there anymore when you account for debt. It’s to the point that the only people talking sense are the ones who are like “live like you are making poverty wages and do Dave Ramsey for 5 years or else you won’t make it”, and that’s on top of “pick 2 out of three... location, specialty, wages.” Those are both sound pieces of advice, but it’s not even that rosy anymore. I’d suggest that for many folks, they can now only expect to pick one of the three you want, one that you can tolerate, and forget about a third”. It’s that way for FNP’s too, but those are folks with a decent paying income and typically less debt (although that’s changing too with regard to debt). I feel like even physicians and dentists are outside of the golden age of their professions, but they have so much more cushion before they reach the bottom. The opponent isn’t even physicians anymore, it’s administrations and entities. The idea of getting independent practice rights isn’t about setting up shop, shedding the physician overlord, or acting on my own as a sole provider, it’s about being set up to be a valued employee like what physicians are becoming (rather than as support staff like a paralegal). It’s not really as controversial as some folks are making it. It’s just recognizing that the person that goes in and makes a diagnosis ON THEIR OWN and takes on that liability gets treated like they went in and did that work on their own. If a physician reviews every single case, then sure, make them a part of the process. Otherwise, treat the PA like they work on their own merits, not delegated authority. That delegating authority doesn’t see your patients, write your scripts, keep your notes, or pay your bills. You’d be surprised by what that does as far as how the boardroom treats you. Even if we only can bill 85% of what a physician does, that’s 85% more than they would make if you guys weren’t there doing that work. That work doesn’t get done on its own, and a physician is rarely involved. So forget the inferiority complex, you guys are indeed paying the bills, and then some. In all honesty, I don’t think the healthcare system could hold itself up in many places without NPs and PAs taking the haircut on the billing. I know there are primary care practices that literally could not stay afloat without “midlevels” subsidizing the physicians on staff. If they had to staff just with docs, they would have to cut back significantly in other areas to make up for it. Specialties would be ok, sure, but you can’t keep a healthcare system running with specialties.
  12. You see the catch with clear eyes. Docs won’t prop you guys up unless they use you as a bat to beat NPs up with. They would turn on PAs the moment they got wind of rumblings for independence. Wife beaters usually beat their kids too. Imagine the power of a poster that says “NPs practice independent in half of states, and the sky remains intact. Why can’t we?” pkeeeeew! Nuclear bomb goes off. For anyone applauding this flier from the docs, just realize that the best hope you guys have of keeping from being niche providers is to emulate NPs, not cheer when they get their noses bloodied. Guess who isn’t worried about this message from physicians? NPs. Why? Because they already do just fine in the places where we are independent. When they march into California next year and demand and get independence, they will have a map that shows all the existing independent states, and talk about how long they’ve been practicing that way. It’s been tried, it works, it thrives, and outcomes are good. If they are smart they will fly folks in that practice independently to talk about the benefits. This isn’t about supervision, because as many of you folks know, your SPs don’t hover over your work enough to know there’s a problem unless you bring it to them (which is actually you guys supervising yourselves). Your trade better have a plan for piggybacking in on NPs work rather than slow clapping the smears.
  13. Here’s what I’ve noticed that most smart NPs do. Make sure your employer provides malpractice on their dime. Psyche is a hot field right now, and I noticed that most prospective employers didn’t balk at anything asked for, and I was actually impressed at what the initial offers came with. Then carry your own policy on top of that. NP malpractice insurance typically won’t cost you more than $2500 per year for high tier plans. You never hear us complain about our malpractice insurance costs. I’ve always felt that maybe PA malpractice was high because the real target was the physician in a lawsuit. Only a PA who has been sued could enlighten us as to whether that was on the plaintiff’s menu or not. I’ve also heard that NP insurance is low because it comes from the same companies that offer it to the RNs as well. Not sure about the latter because physicians pay out the nose, even though the pool of doctors might be a bit smaller (and I’m not even sure it is).
  14. My malpractice insurance as an independent provider feels like almost nothing.
  15. I’m an NP, and before I did nursing, i briefly pursued PA school. This was almost a decade ago, so my guess is that things have only gotten more competitive. I think you are looking at 2 years at least to get all your prerequisites done from scratch, and you should plan on getting perfect grades in some really tough courses. It’s tough enough to get through a class like organic chemistry, and it’s even tougher to get an A. It’s true that you can apply to PA school with just the minimum coursework, but you are in competition with really good candidates who took the hard classes and excelled in them. If you just do your prerequisites, you will especially need perfect grades to make up for not having extra coursework to bolster your knowledge of the sciences. It’s rather rare that someone just takes only the prerequisites and gets in without other science coursework to show they can handle he workload. Every program has at least 6 candidates for every seat, and most theses days are looking at at least 10 people for each seat. The people that get in are folks that demonstrate they are very invested in the process. As of a couple years ago, PA programs only accepted 31% of folks who applied, so 8,000 or so seats were filled from an applicant pool of 24,000 nationwide. If you get in, then you are looking at two years of pretty intense schooling/training. After that, you have at least a year of significant stress as a new provider... maybe more. It’s not going to be a comfortable half decade. PA school costs around $100,000 for school itself, then you have to have money to live on. I know quite a few PAs that were $200,000 in debt by the end. That’s a rough way to start your professional life with that much debt. I feel like you actually need to do some shadowing to know that you want to be a PA, and see what they do. I can tell you that I’ve seen a ton of business majors pursue PA school and give up because they liked the idea of a job that pays $100k, has a bit of prestige, and the aura of excitement. But its work that can be boring and tedious. When you work so hard to become a provider, it helps to have tunnel vision. I was able to plod through to become an NP, because I never let myself get off track and I ignored the fact that I was sacrificing the kind of lifestyle you have right now, and I did that for years. For years I had homework, studying, and projects hanging over my head all the time. My friends, neighbors, and nurse coworkers had regular lives where they went on vacations and did family things at the drop of a hat. I never knew that kind of freedom. I finally have that now, but looking back, everyone else had a great time while I paid my dues working and going to school every day of the week sometimes. Helping people can feel good, but there are times when you are spending plenty of time not helping people, and they certainly aren’t people you like to be around, and at the same time you are neglecting a family member to be there. So for sure do some shadowing at least before you put in a lot of time pursuing becoming a PA, because if you don’t, you could be pretty far along and expensive and time consuming pathway before you realize that you had it better with your own business. I don’t really even recommend healthcare to people who aren’t familiar with it anymore. It’s just so inundated already with people who got into it without really understanding what it was going to be like. Then they are trapped, and they suck at what they do.
  16. I don’t know.... he says I “get it”. How bad can he really be? LOL!
  17. I used to think that name change was the most important first step, but that kind of motion was one best suited for 5 years ago. Right now, what you guys need is just an independent practice state, and name change be damned. Incrementalism isn’t a luxury PAs have right now. The more I thought about it the last few days, the more it seemed logical to just keep the same jerseys if it means you can still win the games. You can be independent with the name “physician assistant”. There really is nothing to be gained by a sneak attack anymore. The only way to make independence happen is to make the kind of noise that lets them know you are coming. -Illinois just allowed NPs to be independent after 4000 of supervised practice: https://www.illinoispolicy.org/rauner-signs-bill-expanding-practice-authority-for-certain-nurses/ Thats how NPs compromise... they get what they want, but they just have to wait a little bit as new grads. This is in Illinois... one of the biggest states in the US. That’s the kind of place you’d never expect NPs to be independent, and where physicians are king. Is it as good as just pure independence right out if the gate? No. But it’s better than PAs have it anywhere. Here’s the disconnect between Nps and PAs: Nurses are like “dang, have to wait 4000 hours before I’m free”. PAs are like “I wish we had something like that anywhere.” -If PAs have ever dreamed of having an NP as their boss or supervising provider, OTP will be the vehicle that provides it. Here’s how it goes: 1) An NP independent state passes OTP. PAs rejoice because scope is now determined at the practice level. Yay... now you are a step towards being like your independent NP colleagues. PAs still need to contract with a “participating” physician, but now the “practice” is their boss, and they are utilized according to what the practice determines, vs the old way of the SP determining scope. More freedom, right? 2) The practice hires a DNP who has a resume that includes leadership from things like being a charge nurse and unit manager (if you are lucky). The DNP curriculum is geared towards practice management and evidence based practices for the clinic level. Everyone used to make fun of that as fluff instead of providing enhanced clinical skills. 3) The PAs quit laughing at the DNP degree because now that the “practice” is the boss that PAs report to, and since the DNP is the manager of the “practice”, the DNP is now your supervising provider...... yes, your supervising provider. Or better yet, your supervising practitioner (rolls off the tongue a lot better since it’s an NP that’s doing the supervising. 4) You answer to an NPs whims. If your opinion runs counter to that of the “practice”, you are akin to arguing with your supervisor. You have now realized that you substituted a supervising physician for a supervising practitioner. Roh roh! Too late suckers. Your states AAPA chapter just went all in to get OTP so you would shut up and leave them alone. There’s no more political capital to fix that mess they created. -Forget OTP nonsense. Go to Montana or Alaska and spend a million dollars on lobbying the legislature to make PAs independent. No name change, no OTP, just get on the books as independent providers. That’s your Boston Tea Party. Expect all hell to break loose in the rest of the country, but at least your friends and enemies will know you mean business. There’s no going back, you just need to do it. Burn the ships so everyone knows the only way home is to fight through the jungle. What have PAs got to lose at this point? You are one well intentioned but misplaced OTP push from becoming directly subservient to not only to physicians, but also NPs. Long ago, that was only an academic concept that came up in fanciful threads on these forums (I’ve read them, and everyone was like “there’s no way NPs could be our supervising providers like doctors are”). Don’t keep thinking that. .
  18. By all means, get OTP set up in states where independent practice is in place. NPs will be waiting to hire plenty of well trained PAs with excellent clinical skills to work i their NP owned practices! Your national organization went a long way to solve the conundrum that NPs faced when trying to supervise PAs. Better stick close to that “participating” physician... they are the only thing between PAs and a “participating” NP.
  19. Washington and Oregon are extremely progressive towards NPs, with some of the best practice environments for them. It’s well beyond them simply having the independence they want... they have the ear of anyone that they want to have. NPs in Oregon, by law, have reimbursement parity with physicians... their equal work for equal pay approach. https://www.oregonrn.org/page/670 PAs are roped into that law, but what does that matter if PAs are still required by law under OTP to be affiliated with a facility or a physician that is a “participating physician”? It means “practices” get to pocket the difference, while independent NPs that run their own practices get as much reimbursement as physicians do. OTP in Oregon and Washington mean that physicians and practices get to hire a bunch more PAs. But physicians that are needed to “participate” are still expensive. NPs to the rescue. OTP is a bureaucrat’s dream. Admin would be your daddy. Admin can be any kind of practice manager. It can even be the new DNP they hire because they have all those fluff classes in practice management and evidence based practice.... the ones that have nothing to do with clinical skills. I’ve said for years that the DNP was all about running the show rather than showing anyone up on the clinical side. I wasn’t sure how nurses were going to capitalize on it, but now I see the light... OTP baby! It’s no longer a physician that’s calling the shots for their supervisee’s... it’s determined at the practice level. Who will be tasked with it on the practice level? DNPs that were nurse supervisors in a former life. Now PAs get to experience the joy that NPs felt when they were RNs and had nurse bosses! This is the kind of unforced error that can only come from within. An NP couldn’t design a better way to take charge, even if given a free hand. Don’t push for OTP there or anywhere else. Independence is the only option. OTP is at best a half step forward when you need to take a full step to make it to your NP friend waiting for you with dry feet across the stream. Conversation on getting at least one state to be PA independent needs to take place at fever pitch.
  20. You point out something that frankly I haven’t thought of, which is PAs being victims of belt tightening directed against physicians. It gets even worse.... in dependent states, PAs and NPs still would need a few physicians around to supervise, and PAs would theoretically be working alongside NPs who were similarly supervised. In independent states, the bean counters would be able to cut back on physicians entirely, and PAs would have to leave with them since there would be nobody around to supervise them. This never quite stood out to me until now, but I have front row seats to this near where I am at, although I don’t want to go into detail for privacy sake. But yeah, being chained to docs is a liability if they are victims of cost cutting as well. Holy cow. After arguing with someone on another forum about OTP, I’ve come to conclude that while more useful than the old status quo, it’s fake progress, especially if it’s at the expense of the independent practice that PAs really really need. Essentially, OTP in Michigan means That physicians get the bulk of the benefit by allowing them to supervise many more PAs, and be potentially relieved of responsibilities of direct supervision, as well as liability. So it comes down to the practice now being the level of supervision... who then is the practice? Well, now it’s administration, AND STILL a physician “participator”. So sure, OTP is a good stealth step towards independence, but not in light of the fact that it’s not the independence PAs need to spark a dramatic change that will save the profession. OTP in a state with a terrible nurse practice act? Sure why not? OTP in a nurse practitioner independent practice state like mine? STATUS QUO! And a slap in the face compared to your capabilities. By all means, don’t let them spend money to peddle that trash in a place where NPs are independent. And in a place like California? Holy cow, if nurses get independence, and PAs get OTP instead of parity with NP independence, PAs are done... and for the reason you highlighted. This is so critical that I would think OTP in California is a false flag by physicians to rein PAs in, or by NPs to keep you guys two steps behind. Don’t settle. If you do you’ll see urgent and primary care (your bread and butter) plucked from you, and the specialties will be your exclusive domain. From there, you’ll be niche providers. Again... your strongest argument for independence isn’t “NPs bad, not trained good”, but rather “NPs have it, and the world hasn’t ended.” But by all means, keep dissing everything NP, and see where that gets the Pa profession. Let’s have 50 more posts about how PAs are superior between now and next year when NPs in California gain their independence, and all PAs get is to have physicians get to have more PAs under them, and not need to review their charts (see what happens to your liability insurance when they get to offload risk on to you guys, but more importantly, see what happens to their liability insurance).
  21. If not trolling, it’s a tell that there is a set mindset at play that may be feeding into your discouragement. Success in life is often tied to one’s willingness to adapt. Change is rarely as comfortable as we would like it to be. Consider carefully everyone’s suggestion that you seek to adapt, because it’s all coming from people who know what it takes to navigate well through life. It doesn’t mean that you need to complete a residency, or move, but if you are rejecting every approach being thrown out there, then eventually you will be in the position to have to simply quit medicine and do something else. That’s probably not the best idea, but it will be the only one left if you don’t find any of the other options to be palatable.
  22. No way. You’ve busted your back enough to have to go back and do that nonsense. I don’t bill much for psychotherapy anyway. Med management is all that I’m really doing most of the time. For the work I’m doing, I’d feel uncomfortable billing for psychotherapy. If I do it, I’ll bill for it. I’d feel l was milking it if I had 12 patients in a day, and billed for 12 interventions. My notes would have to reflect how I dove into that along with managing all their meds, all in a half hour. There are folks that can manage that, but my process isn’t streamlined to that point yet.
  23. I’m in an independent practice state west of the Mississippi. I’ve seen Psyche NP wages all over the map, but mostly on the higher end. I don’t know what the really experienced NPs are pulling beyond generalities (which most are fine with sharing), but those of us with 5 years or less can easily command $140k. As a new grad I landed more than that in a decent clinic setting. I have direct friends who were offered north of $165 as new grads (which seems nuts), but also saw friends get offers as low as $111k (those places are still trying to fill those positions even a few years later). Unfortunately, there really are foolish new NPs taking some trash offers like that because they don’t know any better. The experienced NPs in the region try to get word out, and social media pages help educate each other on wage negotiating and comps. It’s always shocking to me when I meet an Np student or new Np that doesn’t know their value. Especially the ones who get taken by therapy groups who want to contract with them for med management. I’ve had a couple folks that I’ve steered in the right direction. Theres no reason an independent NP shouldn’t be making top dollar by coming in and lending credibility to a group of counselors or therapists. My friend does that kind of work for counselors and my friends motto is “why can’t I be the most expensive employee they’ve got? I’m the main event.” And it’s true. If they want to keep treatment all in house and not risk losing clients to other groups, they need a med manager bad. And the new med manager should keep most of the revenue they generate. I’ve never sat down to be entertained by a group of therapists, but if I did, I’d be very upfront with how much it was going to cost them, and how they don’t even have a hope of getting a physician to show up for my price. I do contract work for a friend and get to keep most of what I generate. It’s pretty much break even for my friend, and they benefit from simply having that needed service covered. They are generating plenty of profit with their other service lines. Hourly, for what I do for them pays between $120 and 160. Its not really that many hours in the big scheme of things (I’m not really wedded to working a lot of hours under any circumstances), and sometimes I wonder if they would pay me that if I was putting in a lot more time.
  24. I’m a psyche NP. All I have to say is if one place gives you that reply, there’s plenty of other fish in the sea. It’s a bit disconcerting that a recruiter... the used car salesmen of the provider world... is saying that, but how many of those guys are there in the world? Do they find it more lucrative to hire independent psyche NPs due to higher wages they can command? (I’ve not dealt at all with them other than my email inbox being flooded, so I don’t know how they get paid for the recruitment they do). That’s kind of a disrespectful way for them to phrase their denial... had a harsh edge to it. Probably not a good place to work through anyway.
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