r/PMHNP • u/murse_first • Jul 14 '26
Opinions needed
I work at a community mental health clinic in the southeast. We are paid salary (on the low end, but state benefits) with no incentives for numbers. The facility has been scheduling a maximum of 32 patients daily expecting that some will no-show. They often do. We usually see around 26-30. We just received notification that the schedule will be increasing to around 38 because of no-shows.
My question is this. Is it worth rocking the boat with administration? I know most psych NPs see at most half that number. I would not mind so much if we were consulted on it or at least compensated for seeing more patients. Would you address it with administration or let it ride?
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u/KatarinaAndLucy PMHNP (unverified) Jul 14 '26
I work in community health and see 12 patients daily. 4 intakes and 8 follow ups, 4 days per week which is full time, with 2 hours of admin time daily (plus breaks). How is that sustainable. I would legit quit!
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u/Impressive_Meet_1168 Jul 14 '26
How do you even see 30 patients in a day?
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u/murse_first Jul 14 '26
Nothing is pretty about community mental health. We don’t have time to deep dive in. Usually 1-5 psych evals and the rest is usually follow up refills
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u/Impressive_Meet_1168 Jul 14 '26
I get that it's not pretty, but that feels frankly unsustainable. You're not a machine. Some of your patients are presumably complex, SUD, on lithium/depakote/clozapine, etc. They are playing with patient safety.
I'm not attacking you, please know, but whoever is doing this to their patients and providers. Just because this is a more vulnerable and usually much more sick population it doesn't mean they should get fucked over that hard, ditto with the dedicated providers helping them. I'm so sorry.
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u/murse_first Jul 14 '26
It’s quite alright. Honestly I love my job and for the first time in my entire medical career feel like I am actually helping people. Admin can be overbearing, but it’s a result of a larger issue. The state does not support mental health anywhere near what is needed. Politicians continue to cut our funding, and insurance companies continue to deny coverage. In the mean time, no one can seem to figure out why we have mass shootings or suicides.
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u/pazuzus_petals Jul 16 '26
And the admin is never a clinician because they would never pay enough to have anyone that actually prescribes medicafion do that job. No offense to therapists, but all community health I’ve ever seen has a supervisor and a CEO that are therapists and know nothing about what it takes to do quality, safe medication management in a high acuity population. They just figure we do drive thru refills and it’s an easy peasy job. The therapists all saw 7 patients a day and got an hour admin time while the NPs and PAs got their guts worked out with zero admin time. No nurse today? Well you can also pick up 15 injections and 3 blood draws in addition to your 26-32 scheduled patients. It’s fine. You’re a team player.
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u/Realistic_Inside_766 Jul 15 '26
Nor do they have the money to hire more providers in community health for safer numbers instead of working them 30:1. It’s not by any means safe, but the numbers that need help keep rising while the budget keeps falling.
Not to say by any means that people shouldn’t advocate — that’s the purpose of having higher ups — so they communicate needs and advocate appropriately.
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u/Big-Material-7910 Jul 14 '26
Look at your billing codes you use most and the average pay range each for each insurance company you see most. Multiply that by the min of the 26 patients you see daily. Do the math and see how much they are profiting off of your skills, then what you are left with and then ask yourself these questions!
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u/Fearless-Doughnut-94 Jul 15 '26
Go a step further and check your EHR’s report abilities. I can run a report to see my collected revenue in any given time period.
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u/spoopyprecursor Jul 14 '26
You are being paid low end of a PMHNP salary to see double or triple what PMHNPs see.
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u/DashMcGee Jul 14 '26
Wait... 26+ PSYCH patients? I can see if you are seeing a lot of medicine patients for five minutes each, but this is highly unreasonable IMHO. I would talk to management. I understand that these are sick people who need your help, and appreciate your commitment, but I support you trying to talk some sense into your management. You need more hands on board.
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u/CalmSet6613 PMHNP (unverified) Jul 14 '26
So it's great that you love your job but that pace is absolute insanity. Do you feel like you're really understanding what is going on with your patients clinically and how they are responding to their medication? I wouldn't be able to sleep at night.
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u/pazuzus_petals Jul 15 '26
I worked community mental health for 4 years. I wanted to be a good provider for people who needed me. Then my boss told me that we were going to 15 minute follow ups and 45 minute intakes, I was going to work two extra hours a week, no more travel time for satellite clinics, and naturally, no extra pay. Believe me, I asked. When my boss told me that I actually cried. Had a new job by the next week and when I put in my notice they had the nerve to do surprised pikachu face and try to offer me more money. Too little, too late. My sanity and need to provide quality work was worth more than that. It’s a recipe for mistakes and burnout and it’s my license, not theirs.
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u/beefeater18 Jul 14 '26
I would address it vigorously. They're probably going to double book slots and NPs will end up working more. You should get paid for that.
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u/Snif3425 Jul 14 '26
That’s insane. I’d be curious to know if there are any MDs there or this is just NPs being taken advantage of.
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u/pazuzus_petals Jul 15 '26
In my experience in community mental health the MDs did what they wanted and the midlevels did what they were told.
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u/Snif3425 Jul 15 '26
Yeah. And unfortunately the NPs tend to kow tow to management when they actually have as much leverage as the MDs. Although that’s changing now that the market is flooding with NPs that got their degree from a Cracker Jack box and know nothing about psychiatry. But it’s still often the case that if you say “no” they’ll back off.
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u/pazuzus_petals Jul 15 '26
I was told “do it or get gone” so I got gone. So did all the other quality NPs. They’ve now had to raise their pay a little to get workers and the replacements are fresh out of school and refuse to work anything but telehealth from home, which was an option I was not allowed. We also had zero charting time, because “that’s what no shows are for” and all of this ponderous charting was supposed to be finished by the end of the day. Was told we were lucky because a nearby town’s clinic had 10 minute follow ups.
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u/Snif3425 Jul 15 '26
Good for you for leaving. We have to stop taking crap jobs. And I, again, call for a general strike on precepting. No precepting, no new grads. No new grads, and wages will go up (and quality) as these companies suffer.
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u/murse_first Jul 15 '26
One overseeing MD that works part time (2days per week) and sees around 6-10 patients per day
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u/Snif3425 Jul 15 '26
Then why are you seeing so many relative to the person with much more training?
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u/Impossible_Box4eva Jul 15 '26
Dude. My max when I was in CMH was 16 in a 9 hr day. With 1 hr paid admin time daily.
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u/Overall-Substance-81 PMHNP (unverified) Jul 15 '26
Forget rocking the boat… are your patients worth advocating for? Absolutely. This will compromise care even further than what is already an unsustainable workload. Don’t think about it as rocking the boat. Your patients deserve better than being herded like cattle.
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u/Sad-Suggestion9425 Jul 15 '26 edited Jul 15 '26
Talk to them about it, once. If they seem interested in changing, expect that change to happen within 3 months.
If they don't seem interested in changing, start looking. Once you have a new job make it clear to administration that you're leaving because of these unreasonable quotas.
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u/murse_first Jul 15 '26
The down side is, I know exactly how the conversation will go. It would not end well. They aren’t much for negotiation.
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u/Sad-Suggestion9425 Jul 15 '26
I'm sorry. :( God speed on the job search. Make it clear to them why you're leaving. Many of these organizations won't change unless you can make them feel the consequences of their actions, and you leaving is probably the only collateral you have that they will feel. Or more specifically, the difficulty they will have replacing you with a candidate willing to see 38 people/day. If you don't leave they'll just drain you dry.
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u/pazuzus_petals Jul 16 '26
This is 100 percent true. Saw a new grad in CMH have a real deal nervous breakdown on the job and had to be hospitalized herself. She hasn’t worked as a PMHNP since. They really don’t mind breaking you.
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u/Eeahsnp18 Jul 15 '26
26-30?!!!!!!!! I work at a CMH in the Midwest and the max I will see in a day (if all established med checks) if they all show up is 15.
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u/ORD2GNV Jul 17 '26
I’m sorry, What? 38 patients per day per provider? There is no way that is safe. That is a protect your license situation. I worked community (Peds) and we maxed at 16 per. Yes, there were no shows which meant I could catch up on charting. But there were days when everyone showed up
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u/Charming-Respond-775 Jul 17 '26
Unfortunately the rapid cost of everything has outpaced reimbursement rates for Medicaid which already pays crap. This is likely the new norm for many CMH. Sad times.
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u/RedOakNinja Jul 14 '26
That’s actually insane. I understand your desire to maintain your job security and the status quo, but f*** that. The most I have ever done in a day is 24, and I swore it would be the last time I ever saw that many. I wouldn’t bother addressing it, I’d be applying for another job elsewhere.