r/PMHNP

As the title states, I am a MH therapist--for many years. I also live with chronic pain. Like many of you, I have been gaslit, and told to see a therapist. Sorry--but therapists really are not equipped to deal with the reality of chronic pain. So, last week, I took a training on "the psychology of chronic pain." And OMFG--it angered me. Here are some of the gems that therapists are learning: "pain is not solely a result of physical injury, but rather a complex experience, influenced by cognitive and emotional factors."

Yeah, that's right--it's all in our heads.

Pain is not an accurate indicator of tissue damage, but rather your brain’s best guess based on the information available--again--all in your f*ck*ng head.

Pain is never purely physical-again--you are imagining this.

"Pain is located in your head, in your brain!  When you have pain, your brain is actively processing it. " No sh*t, Sherlock.

"CBT is recommended" for how we process pain, as is acceptance commitment therapy, as is mindfulness, and visualizing moving.

So your thoughts about pain are distorted, you need to breath more, and visualize getting off your a$$. I promise you--as a therapist I will never gaslight a patient like this. CBT is the biggest thing used to gaslight patients. It is a perfect modality for acute anxiety, phobias. But chronic stuff? Umm. nope.

140,000 a year as a PMHNP fully remote. I think bonuses are available depending on how many patients you see but I am not sure. what do you guys think? (still interviewing). you are on call once a month. I am a new graduate

• 12 vacation days per year
  • Accrued at about 1 day per month
  • Allowed rollover up to 40 hours
• 12 wellness days per year
  • Front-loaded
  • Reset on your anniversary date
• 3 floating holidays per year
• 9 paid company holidays
• 3 bereavement days

They match your 401k by 3% and you are fully vested after 2 years. They pay for my licensure and professional coverage. Also offers CME reimbursement of up to 3,000$. Offer FMLA and unpaid leave if need be.

Edit: not sure why this post had a lot of downvotes. Lool but the patient load is anywhere between 10-15 patients a day.

New PMHNP here looking for opinions on a PRN SNF psych offer in Oklahoma.

This would be a side gig (l1 day a week (not my primary job). Current offer is:

- $35 per patient encounter
- $15 telephone management note
- $.78/mile reimbursement
- malpractice covered
- precharting done by staff the night before
- mostly follow-up geriatric psych / memory care patients
- they estimated around 25–30 patients/day
- usually 1 facility/day
- W2 PRN position

A few things giving me pause:
- contract has a 120-day notice requirement from provider side
- 2-year noncompete/non-solicit language (although they verbally clarified my outpatient psych private practice + university psych job are fine and they mainly care about competing nursing facility work)

They do seem reasonable overall and have already clarified some contract questions for me.

For those experienced in SNF psych:
- Is $35/encounter reasonable for this type of setup?
- Is the workflow usually manageable if precharting is done?
- Is the 120-day notice clause a red flag or pretty standard in SNF psych?
- Anything else I should specifically ask before signing?

Trying to figure out if this is a decent entry into geriatric psych or if I’m undervaluing myself.

Need input on work environment.

I have 4 years experience as a pmhnp. Have worked all 4 years at a small, pmhnp owned private practice. The owner is a good person but a shitty leader/boss. And I need input helping me decide if it’s time to stay or go…

The pros - flexible work schedule, good pay and freedom to say “yay or nay” to the patients that want to be seen. No micromanaging from the boss… but…

The Cons - office manager is insufferable. Tries to tell us (two other providers) what to do, how to respond to messages, when to discharge etc. the boss knows this - does nothing about it but tells us providers “you do what you want. You don’t have to listen” BUT says NOTHING about correcting her behavior. This person takes every disagreement personally. If I disagree - it’s days of petty behavior. The boss says “ignore it”.

The two other providers are part time as well - we all hate it there for this very reason - like we all love the freedom and autonomy but loathe having poor leadership and a old, salty office manager try to tell us how to do our jobs.

Today was just hard. I’ve gotten to the point I just smile and do whatever I want. It’s easier.

So - am I being to sensitive or expecting too much? I’m happy to answer questions.

Thank you! 😊

I do lots of education and rule out their health issues all that . But pts push back .
I explain what ADHD look like , but they say that’s what they have .
Experienced PMHNPs here , what do you say to your pts regarding what is adhd ?

I swear to god these young kids have their script .

Posting this because it's something I experience often (although a bit less as I get more experienced) but never really hear much about:

Decision fatigue in medicine/psychiatry & how it impacts clinicians + patient outcomes.

This includes making diagnoses, picking the right med in a field where the treatments are really based on a best guess & sometimes there are very marginal differences within a drug class, ordering tests (what's too much, whats not enough?), managing folks with personality disorders, or even cognitive biases.

Leaks out into delayed care for patients, broken therapeutic alliances when pts lose trust bc of decisions, etc. etc. etc.

Of course following guidelines and evidenced based care is the way to go - make the decision and trust it's the right one, but psychiatry can be a bit tricky here for varying reasons.

I don't think this is a me problem, although I do run a bit on the anxious side. Nonetheless certainly just part of the job, but curious what others do to help, be it through tools / resources / etc.

I have heard alot about PracticeQ, TherapyNotes and Simplepractice. I currently use PracticeFusion at my W2 and am considering that too though no experience as admin with it. What are my fellow solo private practitioners using and why/why not?

This is their compensation for PMHNP in Illinois.

Hello!

I just started a new position about 4 weeks ago in a mid-sized city. I am credentialed with all major insurances including medicare and Medicaid. How long does it take to build a patient panel? Some days I see 2 or three pts some days 10-12. I am also starting a spravato tram that starts in June.

This is for a healthcare organization that has not had behavioral health before. What are good marketing strategies?

I recently received a salary offer for a community mental health Psychiatric NP position in Arkansas paying $150,000 per year. The schedule consists of four 10-hour days. The clinical productivity model is based on 15-minute follow-ups and 30-minute intakes. To start, there is a one-month orientation shadowing another NP. Following that, I would begin with 60-minute intakes/30-minute follow ups, eventually working down to 30/15 minutes. There are also a couple of hours of administrative time built into the weekly schedule. Is this a good offer?

New ADHD medication being fast tracked by the FDA:

https://www.otsuka-us.com/news/otsuka-announces-fda-acceptance-and-priority-review-new-drug-application-centanafadine

Drug is called Centanafadine. It's a norepinephrine dopamine serotinin reuptake inhibitor. Basically wellbutrin + an SSRI.

Many many many of my patients on either wellbutrin or stimulants are also on an SSRI. Always thought it'd be great to have the best of both worlds in one, especially with wellbutrin as the only NDRI, and while useful, often causes anxiety or irritability which makes it intolerable for many.

Adding an SSRI helps in those cases, and in fact i'll typically start one low dose before starting wellbutrin in those who lean towards anxiety with good success, so great that this new drug combines them all.

Bipolar patients were excluded from the study (far as I know). So curious whether it'll be useful for bipolar depression, in the way wellbutrin is. My guess is no. But well see.

Ive been working at a smaller private psychiatry practice for a little over two years now. I started there as a new grad and accepted a pretty low split because I honestly just needed a stable job with benefits. At the time, I didn’t really understand what was standard compensation-wise.

I started on a 30/70 split and after my first year moved to 40/60, where I’ve stayed since. There’s currently no indication that compensation will increase further. The role does include benefits, PTO, paid admin time, and 401k matching, which I know has value especially since so many jobs in this field are 1099. We also have an admin and a biller.

I’m seeing around 50 patients a week on average, my schedule is consistently full, and I’m getting a large number of referrals from existing patients. I’m probably one of the higher-volume providers in the practice at this point. I work hard and honestly feel pretty burned out by how much I’m producing compared to what I’m taking home financially. I’m at the point where I’m working constantly but still feeling financially stuck.

I don’t know whether the right move is to renegotiate compensation, try and find a new job, or slowly build something of my own.

For people who’ve been in this position
- How did you approach the compensation conversation?
- At what point did you realize it was time to leave?
- Is the stability/benefits tradeoff worth it long-term?
- If you started your own practice, what made you finally take the leap?

I would appreciate any insight, I feel like I’m being taken advantage of and it’s disheartening.

Running a psych NP practice means juggling patient care and admin, and billing is the biggest time sink I’ve seen. Between CPT code changes, prior auths for psych meds, and constant claim rejections from Medicaid/Medicare, it’s exhausting.

I’m curious how other PMHNPs are managing this. Are you outsourcing, using a VA, or doing it all yourself? The 90833 add-on code alone gets denied if documentation isn’t perfect. Plus telehealth modifiers keep changing state to state. It feels like revenue is leaking every month just from small errors. What workflows have actually reduced your A/R days?

Came across research of a new class of drugs for ADHD being studied called COMT inhibiting drugs, which typically treat Parkinsons.

Made me wonder whether those with ADHD have higher risk of Parkinsons due to shared dopamine deficit and to my horror (I have ADHD) it seems there's an incredibly higher risk. Study below had an N of 13,098.

https://pubmed.ncbi.nlm.nih.gov/40419147/

Fortunately this can be modified, mostly by exercise. A meta-analysis of prospective studies found frequent moderate or vigorous physical activity is associated with a 34% reduction in Parkinsons risk.

If this isn't enough to scare your ADHD pts (or you) into getting to the gym, not sure what will.

Also as an aside, the hilarious part is that I'm pretty sure I came across this research years ago but my ADHD brain completely forgot. So lucky me, I got to be terrified twice for the same reason, years apart. Off to the gym I go.

Specifically in OC/LA? How has the job search been since graduating and passing boards? Anyone inpatient?

My spouse doesn’t see themselves working for any other agency, not even the same company along with a different location. They are very committed and I support them ofc and want them to be happy..However.. What’s it REALLY like as a psych NP in my city? It’s discouraging to hear about pill mills and poor management with new grads. Anything helps.

Are there any other similar jobs you wished you pursued? Any other careers you think would’ve been a better choice?

I have my bachelor's. I have always done psych. I dont like medical from any of my clincials I did in school and have no desire to go to medical. What are yalls thoughts of someone getting psych np with no medical history? How long should I practice before going back?

I have worked for the same company for 4 years since graduating. I started at 110k I make 120k now I get 184 hours of PTO but most years I have had to cover about 100 hours of this so I wasn’t really off…. I get no reimbursement for DEA , license or anything . I get no education reimbursement. I pay for my own computer and internet and phone and I am telehealth. I work 5 days a week and I am burnt out with 5 days a week. Some days I only see 4 patients some 10 some 8 but regardless I am covering for everyone at least two days a week we have another provider that works 3 days and another one that works one day. In October the md went on maternity leave and I absorbed responsibility for every pt til February. I am now full practice and have a meeting Thursday what should I ask for . I want more money and ideally I want to see pts 3 days a week one day admin covering refills and emergency but no scheduled pts . Is this doable??? I am in AR?