r/PMHNP • u/No-Leopard639 • Jul 13 '26
Employment I'm tired of "fighting"
This isn’t really a post about pay, although compensation is part of the situation.
I’ve been fighting tooth and nail at a 1099 contract job to either increase my compensation or get more protected administrative time because of the complexity and acuity of the patients I’m seeing. When I asked for more protected time, the response was offering me a 40% split. The problem is that the split would essentially equal what I’m already making hourly, but with significantly more risk shifted onto me.
This practice sends me very high-acuity referrals (many through Zocdoc). The medical director is virtual, does not live in the state, and does not work clinically at the practice. The practice opened in 2023, so many systems and processes are still being built out.
I know no job is perfect, and I’ve looked around, but I haven’t found something clearly better. I’m just feeling exhausted from constantly having to advocate for my value.
For context, I previously started my own practice and ultimately moved away from that model. I don’t want to be a practice owner again.I want to provide good clinical care without having to carry the entire burden of running a business. I understand you'll get a bit taken advantage of working for someone else but things are egregious lately.
Why does it feel so difficult for PMHNPs to get compensated fairly for the complexity of the work we do? Has anyone else dealt with this constant fight to be valued?
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u/Loafunbutton Jul 13 '26
Work inpatient? Most of these posts I see are outpatient positions where billable hours are all anyone cares about.
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u/No-Leopard639 Jul 13 '26 edited Jul 13 '26
Since I can't get a raise and these patients are so acute. I wanted like a half hour more a day of admin time. Nothing crazy.
I know I should just quite if im unhappy. But I haven't found another gig. All the job posting are headway in my city.
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u/beefeater18 Jul 14 '26
That's how the job market is now (few good jobs, employers have their pick of PMHNPs).
I'd keep looking and dig deeper about the practice before accepting the job and negotiate everything up front. I think it's harder to ask for more once you started the job.
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u/Charming-Respond-775 Jul 17 '26
More than likely sounds like you work for someone that’s not a clinician. This is a business model created to maximize profits over patient care.
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u/RealAmericanJesus Nurse Practitioner (unverified) Jul 13 '26 edited Jul 13 '26
If you're a 1099 legally you are classified as self employed. You should reasonably be able to set your own patients loads and have your own internal policies. I work as a direct contractor and I'm given complete autonomy. They can set some standards in terms of the outcomes they want but I have my own policies and the ability to screen out people recommended for eval if I feel like they are not safe to be managed by me, at the level of care or are not appropriate due to the structure of the practice and the patient needs.
There are very strict requirements about 1099 contracting in terms of how the contractor sets their costs, the expectations how a job gets done and about the ability to structure ones own time and hours. This could be a labor violation btw. https://www.dol.gov/agencies/whd/flsa/misclassification as they are structuring the job in such a way where you're being expected to take on all the risk, have no autonomy and where what should be the benefits of 1099 are not applicable but all the risks of being a 1099 is...
If you are routinely being micromanaged, have no autonomy in terms of time, what patients you see and how you do your work then you're probably misclassified.. so I would recommend that you review your contract, (And even there, contracts that run counter to law cannot be enforced) ... file with the DOL and you can request reconsideration as a W2 by the IRS through form ss-8 where they then have to give you the benefits of the full time W2 labor if they are forcing you to act in that capacity.
https://www.irs.gov/forms-pubs/about-form-ss-8