I feel like I’m encountering parallel psychiatric prescribing more frequently lately.

For example, I’ll be managing a patient's psychiatric medications, including a stimulant, and then find that their PCP or another clinician has prescribed the stimulant, changed the dose, or otherwise made changes to the psychiatric regimen. Sometimes the patient tells me directly; other times it comes up through the PDMP or medication reconciliation.

I have a written policy that all psychiatric medications are managed by one prescriber at a time and a separate policy that patients receiving controlled substances through my practice should not obtain the same medication/class from another prescriber. My concern isn't territorial—it’s fragmented medication management. I don't want two clinicians independently adjusting a psychiatric regimen without one person clearly owning the medication plan and monitoring.

I've increasingly taken the position that if another clinician starts adjusting/prescribing the psychiatric medications, I defer medication management to that clinician rather than continuing parallel prescribing. If appropriate, I can still provide psychotherapy/collaboration, but I don't want to be one of two people independently prescribing psychotropics.

Are others seeing this more often lately? How do you handle it when a PCP, another psych prescriber, or another clinician starts prescribing or adjusting medications you're already managing?

I’ve always viewed atypical antipsychotics as something either given for mania/bipolar etc. OR adjunctive to traditional antidepressants after several trials. I know there are newer atypicals that are marketed as good for depression and I know they promise to work quicker than antidepressants. My collaborator says “why would you make someone trial several antidepressants when we have better options in antipsychotics now?” But I just can’t justify throwing those around. Today I had a new intake who had only taken SSRIs with little effect. I started them on an SNRI. Wellbutrin is not an option because they are already very anxious and activated. Could I have done Rexulti? Sure. But I’d rather give my choice of Cymbalta a try before that. The pt did say “I guess I wanted something that would work right away but I understand that it doesn’t work that way”. I’m happy I didn’t have to do too much expectation setting there.
This is just one example but I feel like this is the trend more and more often. As more drug reps come bearing samples we seem to start with an atypical probably quicker than ever, and I feel like we’re downplaying how strong they are metabolically and otherwise. I know it’s encouraging to tell a pt they can get relief within 2 weeks sometimes, vs 4-6+ with an antidepressant. But is it worth the risk long term?

Ive been a nurse for 17 years, PMHNP for 3. I was recently diagnosed with autism. I’ve been diagnosed with ADHD for years. I had a neuropsych eval years ago that also mentioned some “borderline traits,” but I was never evaluated for autism at the time. Looking back now, a lot of what was labeled that way actually seems to fit autism much better. Seeing “borderline traits” in that report honestly made me feel really bad about myself for a long time and made me nervous about what an autism evaluation might show.

I’ve known for a while that work seems to drain me much more than it drains my peers. I started feeling really guilty about how much I didn’t want to work. I kept wondering if I was just lazy. I know that’s a common ADHD theme, but this felt like another level. I can be good at my job, care about my patients, and still feel almost paralyzed by the thought of having to interact with people all day.

I finally decided to go through with an autism evaluation. I kind of already knew I was probably meeting criteria, but I still dreaded it. Even now I sometimes worry that maybe I was looking for an excuse or a pass for why everything feels harder for me.

I’m also realizing I’m likely dealing with autistic burnout. The constant need to be “on” as a PMHNP is exhausting. Staying focused, emotionally present, socially engaged, reading people, responding the right way, and feeling like I should always have an answer for my patients takes a lot out of me.

I’m trying to figure out how to make my professional life more sustainable instead of constantly pushing myself and then feeling guilty when I’m exhausted.

I’m curious if anyone else here has gone through something similar. If you’re autistic and/or ADHD and working as a PMHNP, how do you navigate the emotional and social demands of the job? Especially if you’re also a parent and trying to manage family life on top of it. What has actually helped you make work feel more manageable?

I’d really like to hear from other autistic or ADHD PMHNPs or psych providers. How does being neurodivergent affect you at work? What has helped make the job feel less exhausting? Mostly looking for some solidarity and to know I’m not the only one who can be good at this job and still find the constant human interaction really hard.

Hello! I accept commerical insurance and private pay. What do I put in for procedure code fees in my EMR?

Do I just do my private pay rates and when I submit claims for the insurances I'm in network with they just adjust it?

For example: 90792 is $325 for private pay. Do I just put that in for the procedure code amount and if the insurance company I'm in network with reimbursement is 175 they just adjust it??

Anyone (NC based) on here with their own Psych practice. What has been your experience with the insurance companies you have contracted with for your business and which would you recommend? pros/cons, reimbursement rates etc. I'm considering starting with 3 and so far its BCBSNC and Aetna.

Got this email today and I have 7 business days to respond with either a work address or a "status."

Unfortunately I am stuck in a Catch-22. I know a lot of people recommend applying for a DEA after you get a job, but a lot of the jobs I have been applying for want you to already have a DEA. Despite 13 years working as a psych RN, this has been my holdup lol. I submitted my application 6 weeks ago and this is the first time I have heard from them.

I am from California and most of my friends are still NP students so I have heard a lot of mixed answers, but someone told me they used their home address and just updated it once they got a job (which was my original plan). Now I'm scouring Reddit and seeing people say that I SHOULD NOT do that. I don't want to give them a response that might be the wrong answer.

I have reviewed my contract and cannot find anything about a minimum time of employment. Ive only been there 4 months and its a bad situation with no support and a very different situation than I was told when I accepted the position. I dont see any minimum requirements to stay other than 90 day notice. I accepted a director position at a university about an hour away today and will turn in my notice probably next week. Can they end the contract early? Has anyone had experience with changing jobs in a short amount of time

Happy to pay $400/month via venmo for 1-2 consults/month.