š”ļø Beyond Burnout: How to Leave a Toxic Practice (or Survive it) with Your Professional Identity Intact
The first three parts of this series covered what to do when you inherit an unsafe panel, what happens when you refuse to continue it, and why the problem is organizational rather than personal. This part is about the decision that follows all of that: whether to stay in the environment that produced it.
That decision is not simple, and it is not only emotional. It is a structural one. The question is whether the organization is capable of change and at what cost you are willing to wait for it.
I can tell you from my own situation that the institution eventually did change. New policies, evidence-based guidelines, a formal meeting with pharmacy, behavioral health, and primary care leadership. By the time that meeting happened, I was riding out my notice. The change came. It came too late for me to benefit from it, and the cost of staying long enough to see it was more than I had left to give.
That is not a cautionary tale against staying. It is an honest account of what staying through structural change can require. Know what you are deciding before you decide it.
Unsafe Prescribing is a System Problem, (Not Just a Provider Problem)
Part 3 of 4: Why Individual Refusal Is Not Enough
Parts 1 and 2 of this series covered what to do when you inherit an unsafe prescribing panel and what to expect when you refuse to continue it. This article is about the question underneath both of those: why does this situation exist at all, and what does it actually take to change it?
The answer is not a better-trained provider. The answer is organizational accountability. And the story of how that accountability finally arrived in my situation is not a satisfying one.
When Safe Practice Makes You the "Difficult" Provider
When you draw a line and refuse to continue unsafe prescribing, you are doing the right thing. What happens next is that you become the least popular person in the building.
Patients who were trained by the previous provider to expect easy refills will be angry. Leadership, which quietly tolerated the risk for however long this was going on, will be annoyed that you are creating disruption. Colleagues will respond in ways that have more to do with their own practices and their own discomfort than with anything you are actually doing wrong. And people who cannot prescribe at all will tell you what you should be prescribing.
This is not a clinical problem. It is a cultural one. Here is how to hold the line through it.
When Inheriting a Patient Panel Means Inheriting Unsafe Prescribing
A version of this question comes up regularly in NP communities, almost always from someone who is new to her workplace:
āI inherited a panel and Iām realizing the previous provider was prescribing chronic benzodiazepines and managing psychiatric conditions that are really outside of primary care. I want to practice safely but Iām not sure how to transition these patients without everything blowing up.ā
Here is the honest answer: things are going to blow up. Patients will be upset. People around you will pressure you to go along. Some of them will do it politely and some of them will not. If you want to practice safely, you do not have a choice about any of that.
I know this because I have been in this exact position. Here is what happened, and here is what to do.
Beyond Billing: Why a Thorough H&P Protects You, Your Patients, and Your Practice
If you have ever opened a chart before a visit and found vague notes, an outdated medication list, and no clear record of which active problems were actually being managed, you already know what poor documentation costs. You had to start from scratch. You had to guess. You spent your limited visit time doing archaeology instead of medicine.