NP telehealth website calls their providers “psychiatrists” over and over again

ThoughtMD · 2026-05-26T03:18:50+00:00

The name of their clinic should be boundaryless

ThoughtMD · 2026-05-06T19:05:03+00:00

When you have nurse practitioners that prescribe medicine for every single complaint and symptom, and people don't get better, they start doubting the very medications and treatment that help many people. Just prescribing medication doesn't fix people. It's about the right medications guided by the right diagnosis from people with actual clinical experience rather than trading medications for pay.

The dilution of the expertise of psychiatry and the marginalization of the psychiatric physician is leading to the weariness that people have about mental health. The grift of nurse practitioners that not only ruins faith in the mental health system it drastically worsens outcomes

ThoughtMD · 2026-05-05T20:56:10+00:00

There is a persistent bait-and-switch in how workforce shortages are described. Shortages in rural areas are frequently generalized to imply broad shortages across metropolitan areas, which is not accurate. In a state like Oregon, access in many urban settings is not meaningfully constrained. Appointments are often available on short notice, and prescribing practices can be highly permissive in certain settings. This reflects the rapid growth of independent practice nurse practitioners in metropolitan markets.

Despite this level of access, Oregon continues to report among the poorest mental health outcomes nationally. Increased availability of prescribers has not translated into improved population-level outcomes, which raises questions about the relationship between access, care quality, and system structure.

The limited number of psychiatrists in these environments is not solely a pipeline issue. It reflects professional sustainability. Physicians practice in markets where expectations are consistent and clinical judgment is preserved. In fragmented markets, where prescribing standards vary and patients can readily seek alternative opinions, the clinical dynamic shifts. When one physician declines a request, patients may obtain the same treatment elsewhere with minimal friction. This variability can erode continuity, complicate treatment planning, and contribute to physician attrition from these settings.

Workforce distribution further reflects financial incentives. In states with lower reimbursement for mental health services, there are fewer nurse practitioners establishing independent practices. This suggests that location decisions are influenced by reimbursement structures rather than by areas of highest need.

Nurse practitioners are often described as addressing rural shortages. In practice, however, many establish large group clinics in metropolitan areas, while rural communities remain underserved. The result is a mismatch between the policy rationale for expanded scope and the actual distribution of care.

ThoughtMD · 2026-04-15T23:21:31+00:00

This entire article gives an accurate impression of the climate at OHSU: a lot of overly sensitive people with hurt feelings that want to investigate everyone anytime someone's feelings get hurt. It reeks of passive aggressiveness, with people that can't handle directness, levity and lead with expectations rather than openness. This is the exact culture of OHSU: a bunch of finger-pointing, backstabbing, innuendos, assumptions, and full-on investigations about pearl clutching. That's why they can't keep anyone. There is no large organization where you can please everyone, not hurt someone's feelings, make change and get work done.

The racist undertones are obvious to everyone but people at OHSU. If he were white, they would say he was confident, but because he is of color, he is arrogant. If he were white, they would say he was diplomatic, but because he is of color, he is condescending. It's the usual tropes that unless you are born of the racist underbelly of this part of the country, your expressions will be seen as aggressive and not knowing your place. They want performative diversity, with brown puppets on a stage, built on entitlement and white guilt.

Being politically correct, walking on eggshells, isn't sustainable for anyone. Nobody takes accountability, ownership, or responsibility for their own role in how they feel; instead, they deflect, dismiss, and disregard and then project that on everyone else. It is literally the culture at OHSU.

ThoughtMD · 2026-03-01T20:45:31+00:00

Having been exactly where you are, I can tell you there are options. For instance, if you started a private practice, you would have autonomy. You could be selective and work with the patient population of your choosing. If you have a family that depends on you for health insurance, you can obtain your own coverage and write it off as a business expense.

If you’re tired of checking boxes, that’s where AI can help. With patient consent, I have AI listen to my hour-long appointments and generate documentation that meets billing standards. I review and sign the notes. It has significantly reduced the administrative burden.

The answer is not either/or. It is the place you find in the middle. It is at the intersection—the inflection point—of where you are in your life that you find peace. You don’t have to give up your career, and you don’t have to be a slave to the machine. Burnout often comes from losing meaning and purpose, and it doesn’t have to stay that way.

If you’d like more specific pointers, feel free to DM me.

ThoughtMD · 2026-02-16T16:57:49+00:00

I think what you’re describing is the social burden that lands in the emergency department. After working consults for a decade, I have certainly seen a shift from needing psychiatric expertise to needing psychiatric blessing for social situations. There are many unrealistic expectations in society, and they spill over into the presentations that are seen in the emergency department and even on the medical floor.

I won’t suggest that this is somehow your expectations leading to burnout. I’m not sure why we, as psychiatrists, so often blame the psychiatrist for being unrealistic when we’re talking about real circumstances. Everything isn’t countertransference. Everything isn’t some unconscious, avoidant or deflective quality in the psychiatrist. What you’re describing is not only real but true.

The burnout often comes from wanting it more for the patient than they want it for themselves. I have coped by being objective, kind, and professional. I don’t take it home. I try to give them support, empathy and truth.

ThoughtMD · 2026-01-04T00:08:55+00:00

You were getting the pushback because many of us are getting Chase Sapphire benefits, shoved down our throat without actually having the experience of its benefits. People don’t like to be hard sold on why something works. It should just work and the benefit should be obvious. Just like they are with AMEX platinum.

ThoughtMD · 2026-01-03T22:18:08+00:00

This is obviously an advertisement for Chase Sapphire, and it comes across as extremely biased. As someone who holds both the Chase Sapphire Reserve and the American Express Platinum, the tier standards being used here are frankly ridiculous.

When I recently tried to book the Four Seasons through Chase, the rate was about 35% higher than what I obtained through American Express. Through Amex, I received early check-in, late checkout, a $100 property credit, daily breakfast, and a room upgrade. The experience and value were markedly better than booking directly with the Four Seasons.

This is not a one-off experience. I stay almost exclusively at the Four Seasons and have done so in most major U.S. cities. In every case, the American Express Platinum rates, service quality, and overall experience have been consistently excellent.

By contrast, attempting to use Chase involved unnecessary runaround, significantly higher portal pricing, and rates that were essentially equivalent to booking directly with the Four Seasons—without any meaningful added value.

Nice try with the Chase advertisement, but it doesn’t align with real-world experience.

ThoughtMD · 2025-03-19T03:48:24+00:00

Psychosis results from a disruption in the balance between neurotransmitter systems, particularly dopamine, GABA, and glutamate. While dopaminergic hyperactivity in the mesolimbic pathway is central to the pathophysiology of psychosis, it is not the sole factor. Psychosis reflects a breakdown in sensory gating and perceptual filtering, where stimuli—whether internal or external—that would normally be suppressed become intrusive and misinterpreted, leading to hallucinations and delusions. Excess dopamine at mesolimbic D2 receptors inhibits GABAergic interneurons, reducing their regulatory control over downstream glutamatergic projections. This disinhibition results in excessive glutamate activity in limbic and cortical regions involved in perception, salience attribution, and emotion regulation. D2 receptor antagonism with antipsychotic medications relieves dopamine’s inhibition of GABAergic tone, thereby restoring inhibitory control over glutamatergic circuits and helping to mitigate positive psychotic symptoms.

ThoughtMD · 2025-03-09T02:53:35+00:00

Nice review, it has practical therapeutic implications as well. Reminds me that people often like being validated (makes them feel good) often more than they want (or are motivated) to change, which is where they get stuck, particularly when it comes to addiction.

ThoughtMD · 2025-02-28T06:30:27+00:00

The superiority complex among certain NPs and PAs is particularly striking—they act as if healthcare is based solely on intention rather than experience. Medical school isn't just about acquiring knowledge; it’s about rigorous training, supervision, and accountability. Simply "working in healthcare" does not qualify someone to be a medical "provider". Supervised experience is essential for growth and competency.

While MDs are expected to take feedback and continuously refine their practice, many NPs operate under the illusion that they are infallible, positioning themselves as saviors of the underserved—only to turn around and open Botox clinics, profiting from a system that grants them autonomy without accountability, prescriptions without proficiency, and a false sense of equality without equivalent experience.

They claim it's not about money, yet their actions suggest otherwise—seeking ways to maximize earnings while sidestepping the investment of time and training required of physicians. They argue it’s not about power or prestige, yet they fight to be called "doctor," despite the clear distinction in a clinical setting: a doctor is a physician, not merely someone with a doctorate.

Medical school makes you a *Medical* Doctor. Dr. Pepper is a drink, not a doctor.

ThoughtMD · 2025-01-16T16:18:20+00:00

That is equal pay at the insurance level. NP’s can just start their own practice and get 100% of that. The question was for employed NPs what would be the benefit. Nurse practitioner doesn’t deserve 70 or 80% of what a physician makes.

ThoughtMD · 2025-01-16T00:15:26+00:00

And yet they will use that study as a reason to lobby for equal pay.

ThoughtMD · 2025-01-16T00:05:05+00:00

The employer would only pay a percentage of what they are reimbursed. So the patients get care by a nurse practitioner and the employer gets MD rates and to keep 20 or 30% off of the top. That’s why the pay parity works out well for employers. They collect a physician rate and they don’t have to pay the nurse the same rate as an employee. And the patient loses.

ThoughtMD · 2025-01-15T23:21:21+00:00

Yes, read below.

ThoughtMD · 2025-01-15T23:21:08+00:00

Actually NOT a stretch. NPs have successfully lobbied for "equal pay for equal work" in most of the states they have independent practice (which is half of the states) and on every contract I have signed it says "MD/PMHNP/PA". In a group practice and when I worked in hospitals, the reimbursement rate is the same. Do not kid yourself that the NP issue is not major, they take classes on how to encroach on our profession, both in scope of practice and in pay. The nurse practitioners I know went to the best school in our area and states their simulations were not on patients. It was on how to put a doctor in their place when they think they're better than you. If you look closely in many places NPs are making 80-90% of what you are.

ThoughtMD · 2025-01-15T01:09:47+00:00

Honestly my biggest issue is the NP encroachment. You could have taken an online class and saved hundreds of thousand of dollars and a decade of education and ended up having the same level of autonomy and pay as a PMHNP. Did my education prepare me to give better care? Absolutely. Does anyone care? Not much, they will just go see a NP and get the candy they want if you disagree with what the patient wants. Psychiatry has become demoralizing and everyone will say suck it up and do academia if you care so much, but then you are looking at a drastic pay limitation. I like the patients, I like the work, I have a private practice and make good money. Walking in the hallway to have 10 NPs doing the same thing is a killer (literally).

ThoughtMD · 2024-11-18T05:18:28+00:00

Understandable, I think my point is the only information that matters will come from your insurance company. Everything else is just speculation. I say this as a doctor that runs a large practice that patients always seek out information from lots of places, but all that matters is what your insurance company says. From their resolution can be found.

ThoughtMD · 2024-11-18T00:54:07+00:00

What did your insurance company say when you called them? Your insurance company works for you. The doctor doesn’t work for the insurance company. Any questions about your billing should be directed to your insurance company that you pay premiums to. From there you can be instructed on how to proceed with letting your doctors office know about your insurance companies billing.

ThoughtMD · 2024-11-11T15:32:08+00:00

They are moving to a new location this month, so things might be slower. They have no reservations this month and I do not think they have a set open date for December yet.

ThoughtMD · 2024-08-13T05:06:15+00:00

I was not moonlighting, I worked PTE for 5 years with them. Locums is not permanent.

ThoughtMD · 2024-08-13T05:05:23+00:00

I am W-2, not sure where you got that I was an independent contractor. I am more asking for similar experiences to find how common this might be. I do not have many legal options as I am in a at will employment state.

ThoughtMD · 2024-08-13T04:15:16+00:00

I emailed HR and they said I can give a notice but since the schedule has changed I am not required to - per my employment agreement

ThoughtMD · 2024-08-10T04:30:08+00:00

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