You didn't spend years in school to become a refill machine or a risk magnet. Yet, in an unsupportive environment, demanding safe practice can feel like an existential threat to your job, leading to emotional fatigue, guilt, and fear of professional inadequacy.

You are allowed to conclude, "I cannot be the only person practicing evidence-based medicine in the building."

The final, critical decision is to move past the emotional chaos and decide, strategically: Should I stay, or should I leave?

When you inherit a high-risk patient panel, you are often being asked to solve a systems failure alone. Leadership knowingly allowed unsafe or out-of-scope prescribing to continue because it kept patients quiet and satisfied (even if it put them, and the clinic, at risk).

You are not just correcting unsafe care; you are swimming upstream against a culture that allowed this to form. This is why providers quickly burn out when they attempt to "clean up" a panel without structural backing.

In primary care Facebook groups, a painful question keeps popping up, often from NPs who are new to their workplaces: "I just took over a panel and realized the previous doctor was prescribing chronic, long-term Xanax and complex psychiatric cocktails. I don't feel safe continuing this. How do I proceed without causing chaos or losing my job?"

If this is your reality, I want you to know two things immediately: You are not alone, and you are doing the right thing by stopping.

You didn't become a provider to function as a refill machine. You became one to provide safe, evidence-based care. The dilemma you face is a high-stakes clash between patient expectations and safe practice.

Documenting a thorough history and physical examination is crucial, even when billing based on time or medical decision-making.