Cold feet before psych NP program. Should I be thinking about med school?

[priorities2]

I am 21 and have a 3.78 overall GPA, science GPA is probably like a 3.5ish... it depends, do nursing courses count as science? If so, it would be much higher. I applied to four prestigious psych NP programs during my senior year of BSN and got into all of them. I did really well on the GRE, mostly on verbal. I'm not really super interested in physiology except as it applies to mental health. Sophomore year of college, I knew I wanted to be a mental health provider and liked the idea of being able to prescribe but wasn't really interested in going through medical school since it has too much that's not relevant to mental health and I don't like how it seemed less holistic than psychology or nursing routes. That's how I settled on psychiatric-mental health NP as a goal. Well, I picked an NP school and I'm planning to go there next year. I have zero debt from undergrad. I would need loans for whatever school I attend next. I doubt I would do very well on the MCAT because verbal standardized testing is much more my strong suit compared to quantitative. Admissions concerns aside, should I even be thinking about this...? It's so annoying that there isn't one streamlined medical/psychological program that's both holistic and rigorous and leads to becoming a psychiatric provider/prescriber. I guess I feel this is my last chance to back out from this path and decide to pursue medical school instead.

My goal, specifically, is to be an outpatient mental health provider who avoids the marketing influence of big pharma and helps people recover from mood disorders, eating disorders, addiction, etc. I'm not really interested in SPMI or acute psychiatry/psych ERs.

So... ehh... where do you see the field of outpatient psychiatry headed, say, 10 years down the line? 20? 40? Should I just become an NP? I found a really good program that combines therapy and pharmacology and has classes that you take with psych residents. So, I think the education will be good. But will I be at a disadvantage somehow by not just going to med school? Or does the future of outpatient psych look like it's going to midlevels anyway? Medical school does sorta seem like overkill for some of the psych provider jobs that are out there. I guess I just want some validation that I'm making a reasonable choice or educated input on why I should make a change. Thank you so much for your thoughts. I really appreciate having a forum of psychiatrists to anonymously ask questions to.

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[675015]

You may have a hard time finding true validation for any decision you make in life if you turn to an anonymous online forum for such aforementioned validation.

 

[hamstergang]

Can I ask what you mean when you say 'holistic?'

As for med school being overkill for psychiatric practice, I've commented on this before in this forum, and I feel I'm still correct (what a shock):

Thinking more about this thread (from the OP, not where it has gone), I feel that all you are learning now is truly important for you as a psychiatrist. Any specialty can be taught separately from the start -- we could have a psychiatry school, ortho school, rads school, cards school, etc -- without having to teach all that is taught in medical school. This would produce clinicians that are competent at treating what they have been trained to treat. However, it would cause a fragmentation of the health system. You wouldn't be able to really know and understand issues going on outside your domain. Your ability to understand the research being done would be more limited if it ever discussed the actual biochemistry or effects elsewhere in the body. I think this would cause certain issues to be missed and others to be mismanaged.

Having gone through medical school and taken all those classes has provided me with the background necessary to provide a more 'integrated' care when necessary (and I hate that phrase, I don't mean it in this fluffy, pseudoscientific holistic sense that some do, I'm being more concrete). I certainly don't remember all the details of anatomy or biochemistry, but when necessary I can refresh myself rather quickly as this is information I once knew. And it does matter for understanding some research and some patients. For example, I had an outpatient that claimed to have an autonomic neuropathy due to a cutting of the vagus nerve during a uterine fibroid surgery, and we were wondering if there was some malingering/factitious component to her symptoms. I needed to be able to communicate intelligently with the neurologist, gastroenterologist, and pain doctor. I had to understand what they were saying and the tests they did. I had to use my anatomical knowledge to understand if her claims made sense, and if the Ob/Gyn ever sent me the surgical report, then I would have needed my anatomical knowledge again to make sense of what it said.

For most cases, I believe that most of medical school isn't necessary. But these other cases aren't so rare as to make any of medical school unnecessary for us to learn.

 

[NancyPansy]

Hi! From what I investigated, it seems many people (both MD and Ph.D) aren't particularly fond of NPs or rather the training they receive so I'd personally be wary of investing in a degree that generates so much controversy, but maybe that's just me.

How about going for your Ph.D or Psy.D (psychology)? It does take a long time but if I'm not mistaken there are programs out there where you won't have to pay out of pocket because you get to assist with teaching and research and basically aren't charged for the degree or aren't charged much (someone might be able to correct this as I'm not a good source of info on that, just remembering something I read from other people). If you have the means to support yourself or have family members who can help while you're at school it might be worthwhile.

You also have the MSW path if you're interested in psychotherapy. One of the best therapists I had was a LCSW. Clinical social workers don't tend to work with severe mental illness but each degree has its value IMO, people with anxiety or family violence issues also need counseling and desperately so. Good luck

 

[st2205]

It sounds like you're set up pretty well: you'll come out of training with very minimal debt at ~24 and be making ~120k-ish. I didn't even start medical school until 24. If you were to apply to medical school, just jumping through the hoops will take you another 2-4 years, then a lot of debt and at least 8 more years. Yeah, you won't be a psychiatrist, but it looks like you've got a pretty seamless pathway setup.

It's so annoying that there isn't one streamlined medical/psychological program that's both holistic and rigorous and leads to becoming a psychiatric provider/prescriber.

There is such a pathway: it starts with medical school and ends with residency.

 

[Doctor Bagel]

Hi! From what I investigated, it seems many people (both MD and Ph.D) aren't particularly fond of NPs or rather the training they receive so I'd personally be wary of investing in a degree that generates so much controversy, but maybe that's just me.

How about going for your Ph.D or Psy.D (psychology)? It does take a long time but if I'm not mistaken there are programs out there where you won't have to pay out of pocket because you get to assist with teaching and research and basically aren't charged for the degree or aren't charged much (someone might be able to correct this as I'm not a good source of info on that, just remembering something I read from other people). If you have the means to support yourself or have family members who can help while you're at school it might be worthwhile.

You also have the MSW path if you're interested in psychotherapy. One of the best therapists I had was a LCSW. Clinical social workers don't tend to work with severe mental illness but each degree has their value IMO, people with anxiety or family violence issues also need counseling and desperately so. Good luck

While MDs and PhD/PsyD folks might not like NPs, the psychiatric community as a whole has embraced them. Their degree is on controversial with us and not with the general public (or employers) who have generally liked and accepted NPs. From a financial perspective, getting an NP is a more reasonable move than getting a PhD/PsyD -- much quicker and easier with way less debt (excluding fully funded doctorate programs which are really hard to get into, rare and also still probably really freaking hard to complete). We can complain about NPs all we want, but aside from being a psychiatrist, being an NP is probably the next best place to be in mental health from a career advantage/salary perspective.

As for medical school versus being an NP, I don't know. I've got to admit that I've become pretty envious of people who don't have my level of debt. In my state, NPs can practice independently and can really set up practices in all sorts of different ways. Maybe we're better trained, but I'm not sure that pans out for us in terms of better work opportunities, or salary opportunities when you consider the expense of our training.

If you're really not sure about the NP thing, why not be an RN for a year and figure things out.

 

[hamstergang]

If you're really not sure about the NP thing, why not be an RN for a year and figure things out.

I think I know the answer to that one:

I never had any desire to be an RN but chose this path because I wanted to work in outpatient mental health and liked the idea of being able to do both therapy and prescribing without having to go through med school.

 

[NickNaylor]

If you're more interested in the therapy route over prescribing, why not do a social work masters and be a therapist from that angle? The training would be relatively short. If prescribing is important to you, then I guess the NP route is probably the best route as it will give you what you want in the shortest time possible. However, you're a bit of a hen coming into the wolf's den by posting this question - you're focused on the end goal without much consideration with respect to the training required to get there. I agree with @hamstergang in that I couldn't imagine treating patients without having a broad base of knowledge to contextualize their psychiatric care from a medical perspective. I suppose you could make the argument that that additional training is unnecessary, but you might quickly find yourself out of water when you're in independent practice and lack that "foundational" training that you're expected to be familiar with. There are no shortcuts.

 

[st2205]

If you're more interested in the therapy route over prescribing, why not do a social work masters and be a therapist from that angle?

Because he/she already being accepted to a program could graduate sooner as an NP and make twice as much.

 

[NickNaylor]

Because he/she already being accepted to a program could graduate sooner as an NP and make twice as much.

True, but the fact that he/she is questioning whether or not the NP program is the right way to go - despite them being "prestigious" - makes me think he/she has some doubts about the path. Maybe that doubt is based only on the alternative of going to medical school, I don't know. But it's another option to at least consider if only promptly disregard.

 

[heyjack70]

NPs don't get therapy training that is anywhere close to appropriate for independent practice. It seems many social workers don't either.

 

[Promethean]

You may be disappointed with the quality of the education you receive in a psych NP program.

I know two people in such programs who regret going that route. They had expected a more rigorous clinical program. The prestige of the program isn't the point. It is how well it prepares you to fulfill the role you are stepping up into.

Find role model / mentors who have gone through the programs that you are considering. Contact them and have them debrief you on what you are in for. Allnurses.com is probably a good place to start.

I chose DO over NP, because I didn't feel that I could provide the same quality of care without going through medical school and residency. You will find that to be a popular conclusion around these parts.

FULL DISCLOSURE: I want to do Family Medicine, where NPs are far less qualified and capable than MD/DOs. Psych is a different animal. I do think that the NP role is better accepted in that discipline, and that if you do your due diligence, you could possibly find a program that you are more satisfied with than my friends are with theirs.

 

[MacDonaldTriad]

I have seen some mid-levels who are imbedded in academic centers and take their continuing education seriously. They could teach most senior residents a thing or two and I would be comfortable both working with them and referring to them. Unfortunately they are the exception.

In fairness, I have also seen MD’s who stop progressing after graduation and most of their updated knowledge is provided by industry and they are highly dependent on check list psychiatry. Some of them perform down to the level of a below average mid-level, but fortunately, they are the exception.

Your form of training at some point has less to do with outcome than who you are and who you are surrounded by.

 

[priorities2]

By holistic I meant factoring in psychological, social, economic, physical, and spiritual aspects of health into the treatment plan. My inpatient psych work experiences have been on an acute psych VA floor and a county hospital with limited resources. In these settings it seemed that mental health improvement was compartmentalized into the items on the problem list and the way that drugs can be used to address them. I guess these experiences have already made me a little jaded.

Thanks for all the responses everyone. The one thing you haven't touched on is... what direction is outpatient psychiatry heading in the next 40 years? Do you really think all the surgical etc. rotations in med school are important for a psych prescriber? Would an alternative path (say, 6 years post-college that go in-depth into physiology, pharmacology, and therapy/family studies/sociological issues that influence mental health) that allows someone to become an expert therapist and prescriber be better? I'm thinking that if I do become a PMHNP, maybe I will go back and get a PhD in nursing or something and then try to create an entirely new educational pathway that trains people to be holistic mental health therapists/prescribers who know how to avoid the influence of big pharma.

 

[Shikima]

Psychiatry in the future will be too busy paying extortionist fees with yearly board exams.

 

[675015]

My inpatient psych work experiences have been on an acute psych VA floor and a county hospital with limited resources. In these settings it seemed that mental health improvement was compartmentalized into the items on the problem list and the way that drugs can be used to address them.

Do mental health NPs not have this issue?

 

[freemontie]

From a strictly financial perspective, Psych NP may be the better choice for you. But Psychiatry more than any other field in medicine is one that can be practiced for a loooong time and thus a longer training period is less of a burden. And there are many instances where higher training would make a difference. For example suppose a patient has a prior diagnosis of a psychotic disorder but has acute mental status changes that are really related to depakote-related hyperammonemic encephalopathy; a Psych NP wouldn't pick up on that. And I could name hundreds if not thousands of hypotheticals.

As for the "holistic" qualifier you are using. It really just sounds like "shortcut" or "least amount of medicine possible". You don't want to do surgical rotation in medical school? Understandable, but that's a very tiny portion of it.

Whatever your decision, good luck. You will make good money as a Psych NP, at least at the time being.

 

[hamstergang]

I don't think there's anything specific about MD, DO, NP, or PA training that leads one towards ignoring these:

By holistic I meant factoring in psychological, social, economic, physical, and spiritual aspects of health into the treatment plan.

and falling victim to this:

mental health therapists/prescribers who know how to avoid the influence of big pharma.

It's more about the system you work in and who you are personally. If anything, having more training, and not less, in these areas should be a good thing.

Do you really think all the surgical etc. rotations in med school are important for a psych prescriber?

Yes. Not all cases need such knowledge and experience, and in others you can do an acceptable yet suboptimal job without it. But it really does come into play if you want to be a great provider.

All that said, there's nothing wrong with going the route you're going. That may be what's right for you, and you can certainly help people in this way. But that doesn't negate anything said above.

 

[smalltownpsych]

Most of the midlevels that I have personally known have communicated varying levels of regret at not pursuing the highest degree. The more solid they are with their choice upfront, the less regret. The worst cases are the "I really wanted to be a psychologist like you, but I thought it would be too hard. Now, I just don't know if can go back to school at the age of ____".

 

[NickNaylor]

By holistic I meant factoring in psychological, social, economic, physical, and spiritual aspects of health into the treatment plan. My inpatient psych work experiences have been on an acute psych VA floor and a county hospital with limited resources. In these settings it seemed that mental health improvement was compartmentalized into the items on the problem list and the way that drugs can be used to address them. I guess these experiences have already made me a little jaded.

Thanks for all the responses everyone. The one thing you haven't touched on is... what direction is outpatient psychiatry heading in the next 40 years? Do you really think all the surgical etc. rotations in med school are important for a psych prescriber? Would an alternative path (say, 6 years post-college that go in-depth into physiology, pharmacology, and therapy/family studies/sociological issues that influence mental health) that allows someone to become an expert therapist and prescriber be better? I'm thinking that if I do become a PMHNP, maybe I will go back and get a PhD in nursing or something and then try to create an entirely new educational pathway that trains people to be holistic mental health therapists/prescribers who know how to avoid the influence of big pharma.

Your plan just seems very random with little clear direction with how to get to your goals or an appreciation of the differences in different training pathways. You seem to be discounting the value of a broad medical education by focusing on things that will ultimately be only a small portion of your overall training path. I'm not sure that getting a "PhD in nursing or something" is going to be the substitute for 8 years of medical school/residency that you seem to be looking for.

You strike me as someone that needs to spend a bit more time clarifying what exactly you want to do and what specific options are available to get you to that career endpoint. Once you hash that out, then forge your path.

 

[Zenman1]

By holistic I meant factoring in psychological, social, economic, physical, and spiritual aspects of health into the treatment plan. My inpatient psych work experiences have been on an acute psych VA floor and a county hospital with limited resources. In these settings it seemed that mental health improvement was compartmentalized into the items on the problem list and the way that drugs can be used to address them. I guess these experiences have already made me a little jaded.

Thanks for all the responses everyone. The one thing you haven't touched on is... what direction is outpatient psychiatry heading in the next 40 years? Do you really think all the surgical etc. rotations in med school are important for a psych prescriber? Would an alternative path (say, 6 years post-college that go in-depth into physiology, pharmacology, and therapy/family studies/sociological issues that influence mental health) that allows someone to become an expert therapist and prescriber be better? I'm thinking that if I do become a PMHNP, maybe I will go back and get a PhD in nursing or something and then try to create an entirely new educational pathway that trains people to be holistic mental health therapists/prescribers who know how to avoid the influence of big pharma.

Mark Twain said, "Don't let schooling interfere with your education." Get your degree as your real learning starts then. No, I don't think you need to go through all the rotations physicians have to go through although one in IM would be helpful. You can learn in a few hours about giving meds to pregnant women for example. I've had OB-GYN docs ask me for my opinion so I know they must of slept through that class. You just have to know how every fricken drug in the world might mimic psych symptoms or interact with psych meds. You just have to know how every fricken medical condition might mimic psych conditions. That's all. Where did you get all this about big pharm influence? I haven't seen a pharm rep in over 5 years. I still don't use the latest drugs till I see how many people die from them. You don't have to be a holistic therapist/prescriber to know how to avoid big pharm influence. Just avoid them. I work for the Army and do my own thing teaching Medical Qigong and and having a Tai Chi group. Yes, I bill for it. I don't know if I'm the top revenue king in my department but I bring in almost double my target revenue and have 100% patient satisfaction among those who respond to surveys. Anyone want to hire me! You can get any speciality training you want after you finish your schooling. I certainly wouldn't want to get a Ph.D. in order to do it.

 

[Doctor Bagel]

I think I know the answer to that one:

Oops, paying attention fail on my part.

 

[NancyPansy]

NPs don't get therapy training that is anywhere close to appropriate for independent practice. It seems many social workers don't either.

Not to derail this thread but I was wondering what people's position is overall on LCSWs. Do you feel about them the same way you do about NPs (that they're severely undertrained for the work they do) or do you feel their contribution is valuable as long as they don't attempt to treat complex mental disease like, say, severe PTSD, psychopathy or OCD and stick to, say, supporting someone through a divorce, mild anxiety, or distancing themselves from a controlling relationship? I'm asking this because I had a LCSW therapist for a long time and I felt pretty satisfied with his performance, then again my issues weren't so complex.

 

[freemontie]

Mark Twain said, "Don't let schooling interfere with your education." Get your degree as your real learning starts then.

Your ego in this field is too high. Learning-as-you-do is obviously primary- but outside of a medical residency where you are advised, corrected and taught as you learn- you're just deluding yourself.

No, I don't think you need to go through all the rotations physicians have to go through although one in IM would be helpful. You can learn in a few hours about giving meds to pregnant women for example. I've had OB-GYN docs ask me for my opinion so I know they must of slept through that class. You just have to know how every fricken drug in the world might mimic psych symptoms or interact with psych meds. You just have to know how every fricken medical condition might mimic psych conditions.

Practical minimums. But that isn't comprehensive enough to be the top of your field.

all. Where did you get all this about big pharm influence? I haven't seen a pharm rep in over 5 years. I still don't use the latest drugs till I see how many people die from them. You don't have to be a holistic therapist/prescriber to know how to avoid big pharm influence. Just avoid them. I work for the Army and do my own thing teaching Medical Qigong and and having a Tai Chi group. Yes, I bill for it. I don't know if I'm the top revenue king in my department but I bring in almost double my target revenue and have 100% patient satisfaction among those who respond to surveys. Anyone want to hire me! You can get any speciality training you want after you finish your schooling. I certainly wouldn't want to get a Ph.D. in order to do it.

The rest I would agree with. I'm not sure how extensive any "specialty" training can be via the NP pathway though to be perfectly honest.

 

[Doctor Bagel]

Not to derail this thread but I was wondering what people's position is overall on LCSWs. Do you feel about them the same way you do about NPs (that they're severely undertrained for the work they do) or do you feel their contribution is valuable as long as they don't attempt to treat complex mental disease like say, severe PTSD, sociopathy or OCD and stick to, say, supporting someone through a divorce, alcoholism or distancing themselves from a controlling relationship? I'm asking ask this because I had a LCSW therapist for a long time and I felt pretty satisfied with his performance, then again my issues weren't so complex.

I think it really depends. The thing is that lots of midlevels and master's level types have years of experience and training that they completed after graduating. Even to get your licensure as an LCSW, I think you need something like 2000 hours and supervision, which requires most of them a few years to complete. Lots of analysts in my community are LCSWs, which requires 4+ years of fairly intensive study and supervision following graduation. As MacDonaldTriad said above, I think a lot of it is about who you are and how willing you are to improve your skills versus what your degree is.

 

[hamstergang]

Oops, paying attention fail on my part.

Not really. I got that quote from another thread. I like looking at other posts from posters I don't recognize to try to get some idea of who I'm talking to.

 

[IlDestriero]

I am 21 and have a 3.78 overall GPA, science GPA is probably like a 3.5ish... it depends, do nursing courses count as science? If so, it would be much higher. I applied to four prestigious psych NP programs during my senior year of BSN and got into all of them. I did really well on the GRE, mostly on verbal. I'm not really super interested in physiology except as it applies to mental health. Sophomore year of college, I knew I wanted to be a mental health provider and liked the idea of being able to prescribe but wasn't really interested in going through medical school since it has too much that's not relevant to mental health and I don't like how it seemed less holistic than psychology or nursing routes. That's how I settled on psychiatric-mental health NP as a goal. Well, I picked an NP school and I'm planning to go there next year. I have zero debt from undergrad. I would need loans for whatever school I attend next. I doubt I would do very well on the MCAT because verbal standardized testing is much more my strong suit compared to quantitative. Admissions concerns aside, should I even be thinking about this...? It's so annoying that there isn't one streamlined medical/psychological program that's both holistic and rigorous and leads to becoming a psychiatric provider/prescriber. I guess I feel this is my last chance to back out from this path and decide to pursue medical school instead.

My goal, specifically, is to be an outpatient mental health provider who avoids the marketing influence of big pharma and helps people recover from mood disorders, eating disorders, addiction, etc. I'm not really interested in SPMI or acute psychiatry/psych ERs.

So... ehh... where do you see the field of outpatient psychiatry headed, say, 10 years down the line? 20? 40? Should I just become an NP? I found a really good program that combines therapy and pharmacology and has classes that you take with psych residents. So, I think the education will be good. But will I be at a disadvantage somehow by not just going to med school? Or does the future of outpatient psych look like it's going to midlevels anyway? Medical school does sorta seem like overkill for some of the psych provider jobs that are out there. I guess I just want some validation that I'm making a reasonable choice or educated input on why I should make a change. Thank you so much for your thoughts. I really appreciate having a forum of psychiatrists to anonymously ask questions to.

The fact that you say you aren't interested in medical school "because it has too much that's not relevant to mental health" and then that it is less holistic than psychology is laughable.
One of my good friends is a psychiatrist. He is very happy with his career, though nobody knows what will happen in 10+ years. As a psychiatrist, you can always go cash only if it all goes bad. I'm not sure of that market for NPs. Why see a psych nurse when you can see a physician when you're paying cash for better access, etc.

 

[Nasrudin]

Not completing a residency and winging it for supervision when your you're expected to be moving the meat in a clinic is a recipe for poor habits and poor quality of practice. There is no polishing up a turd of that sort. A prestigious NP program is like saying a prestigious boxing gym. You don't learn to fight in posh sports clubs. What you need is a heap ton of good ol fashion book learnin. No matter what the Zenman will tell you. And then you need old fashioned one on one with supervisors in a residency program. NP programs provide none of this. None of them. None of the time.

Also a surgery rotation is in order. You don't get whipped into proper clinical shape without these experiences. We have to catch the errors of triage and the medical circumstance around our patients not create them. You need a proper medical background.

Otherwise you're just an NP....oh right....that's your point. The holistic short cut.

No. You've guessed correctly. I'm not one for copping the traditional codependent liberal plea bargain here. You're offendedness is my objective.

 

[splik]

Not to derail this thread but I was wondering what people's position is overall on LCSWs. Do you feel about them the same way you do about NPs (that they're severely undertrained for the work they do) or do you feel their contribution is valuable as long as they don't attempt to treat complex mental disease like, say, severe PTSD, psychopathy or OCD and stick to, say, supporting someone through a divorce, mild anxiety, or distancing themselves from a controlling relationship? I'm asking this because I had a LCSW therapist for a long time and I felt pretty satisfied with his performance, then again my issues weren't so complex.

this might depend on the state, but where I am the LICSWs actually have more rigorous psychotherapy requirements in terms of hours than even PhD psychologists. I am a big fan of social workers as they tend to be more radical in their outlook and more aware of things like social inequalities, race, gender and LGBT issues, social constructivism and postmodern thinking in psychotherapy as well as family systems stuff. Bizarrely it seems MSWs often fall into the role of providing psychotherapy without any training in some roles, but with some geographic variability, LICSWs often have quite good psychotherapy training in at least one particular modality. One of best therapy supervisors I have is a social worker and she provides supervision to MDs and PhDs routinely.

Also there is no evidence that psychotherapy outcomes differ between PhDs/PsyDs, MDs, LMHCs etc, except that satisfaction is lower for MFTs.

Obviously things like diagnostic evaluations is a different thing altogether but I have to say at several of the hospitals I work at the social workers see pretty much ALL the patients who come to ER for psych evaluation and only call us when they need an expert consult.

 

[MacDonaldTriad]

I think I can speak for a lot of psychiatrists when I say we have no problem with LCSWs. We need good therapists who have been well supervised and know their scope of practice is primarily therapy and case management. This is exactly the kind of assistance psychiatry physicians can use as they are time consuming and can be performed more than adequately without the medical training.

NPs and PAs on the other hand have very fuzzy scopes of practice. They can manage simple cases without complication that are protocol based and do this while under the supervision of an MD. So who defines what simple cases are simple and what does under the supervision of mean? Sometimes it means they know the phone number of a physician, but not necessarily a psychiatrist.

 

[Zenman1]

Your ego in this field is too high. Learning-as-you-do is obviously primary- but outside of a medical residency where you are advised, corrected and taught as you learn- you're just deluding yourself.

I'm probably twice your age so I know better than to assess one's ego via the internet. My psychiatrist preceptor also made the same Mark Twain quote one day when i was complaining about educational BS.

The rest I would agree with. I'm not sure how extensive any "specialty" training can be via the NP pathway though to be perfectly honest.

Actually I wasn't just talking about just staying in the NP track for any additional training. I spent months per year for about 10 years with a medical anthropologist/psychologist for example.

 

[freemontie]

I'm probably twice your age so I know better than to assess one's ego via the internet. My psychiatrist preceptor also made the same Mark Twain quote one day when i was complaining about educational BS.

My great-grandfather is still alive; also that twain quote is relative- obviously.

Actually I wasn't just talking about just staying in the NP track for any additional training. I spent months per year for about 10 years with a medical anthropologist/psychologist for example.

I don't mean to attack you specifically, but rather the deficient NP training model in general.

 

[Zenman1]

My great-grandfather is still alive; also that twain quote is relative- obviously.

I don't mean to attack you specifically, but rather the deficient NP training model in general.

I didn't take it personally, but what are you basing your opinion on that NP programs are deficient?

 

[tellmemore2020]

-

 

[W19]

I was in similar situation. I had to decide b/t NP and MD/DO, but after looking some psych NP curricula, I felt like they were severely lacking. So I decided to go MD. Also, NP can't not prescribe scheduled substances in FL, and that is where I want to practice. I am not sure how effective a psych NP can be if that NP can't prescribe these drugs. Maybe a psychiatrist can chime on that.

 

[st2205]

Also, NP can't not prescribe scheduled substances in FL, and that is where I want to practice. I am not sure how effective a psych NP can be if that NP can't prescribe these drugs. Maybe a psychiatrist can chime on that.

Very effective. Consider that a blessing from heaven. There are occasional exceptions but certainly not run-of-the-mill.

 

[W19]

@st2205 Are you saying one does not need to have scheduled substances prescribing privilege to be an effective psych 'provider'?

 

[smalltownpsych]

@st2205 Are saying one does not need to have scheduled substances prescribing privilege to be an effective psych 'provider'?

I think he is indicating that you can be more effective because you don't have to deal with the patients who want more bentos because that is the only thing that will help even though you know they will actually make things worse.

 

[clausewitz2]

I think he is indicating that you can be more effective because you don't have to deal with the patients who want more bentos because that is the only thing that will help even though you know they will actually make things worse.

It would probably be nice if your problem patients were really just a tad peckish and were craving a bit of katsudon to see them through till dinnertime

 

[smalltownpsych]

It would probably be nice if your problem patients were really just a tad peckish and were craving a bit of katsudon to see them through till dinnertime

That's what happens when I post from my iphone.

 

[PikminOC]

Psychiatry in the future will be too busy paying extortionist fees with yearly board exams.

Its coming to midlevels too.

 

[PikminOC]

I think the OP's concerns are definitely valid. I'm a psych NP, and I often say (half jokingly) I'm not a nurse, and I say that because I never submitted to the nursing indoctrination. I came into the field, largely on a whim while investigating PA school. After I graduated college, I taught high school biology and chemistry for one year, left, and entered law enforcement which I excelled at and often miss. At some point, I went through some night courses, became a paramedic, worked one or two weekends a month (for about six months) as a paramedic, and put that hobby away. The classes were interesting, but I did not like working on an ambulance. I was later in SWAT and served in a medic role, but those skills never had to be employed fortunately. So I found myself, over the course of a year or so, looking at becoming a PA. There weren't any opportunities to go to PA school in my area, and, to the disdain of many, I picked NP because I didn't really have to go anywhere or quit working to go to school. Yes, I did not want to dedicate my life to sitting in class. I love to learn and much of my free time is devoted to learning, but I chose to work and pay the bills and not sacrifice a lot of life. In order to become a NP, I had to become a RN, and I largely worked in the ED while in the three year NP program.

Here's the rub. If you become a NP, you're going to have to dedicate yourself to learning about your choice field, i.e. psychiatry. Undergraduate nursing is largely vapid and shallow, and graduate nursing isn't much better. Your training will not prepare you beyond understanding DSM criteria and indications for use regarding psychotropics. Unfortunately, too many PMHNPs are satisfied with this. My efforts have been in learning much of what NP school didn't teach. For example, I said "hypnopompic hallucination" yesterday, and another NP had no clue what I was talking about. Similarly, I was asked once if I had ever noticed how Epocrates noted Tegretol as interacting with so many drugs. I said, "yeah, how about that?!" but it was evident she never really learned anything about P450 interactions probably because her program didn't teach it. Mine mentioned it passingly. I've put in a lot of effort trying to learn everything I can that influences the science (and business) of my practice. I'm not a therapist and don't choose to be although someday I'd like to learn more about psychotherapy, but presently that won't pay the bills. I live in an area where the median income is 32k and my NP income is many, many times that. For a master's degree career changer with no debt I'm satisfied with that, and I found out a few months ago I was making more than the psychiatrists at the community health center.

The point is, you're largely going to have to prove your worth and abilities on your own as a NP. Your credentials will not do it for you. You'll often be the odd man out, and so you'll need self-confidence, and for the love of Pete do not call your collaborating physician with every question you have. Research it. Research it. Research it. Your master's program will not adequately prepare you, and the 750 hours of training that you'll get are merely a scratch to the clear coat. It's going to take a lot of effort on your part to learn complicated, comorbid practice.

So what do you say you are if not a nurse?

 

[675151]

So what do you say you are if not a nurse?

Well, good question. When asked, I say I'm a nurse practitioner. When I'm ranting about the inefficiencies and ridiculous nature of nursing I distance myself from the field psychologically as the professional leadership and dogma are frequently disappointing.

It's almost as if I'm trying to found my own Bull Moose Party - a lofty but floundering ideal.

 

[Shikima]

Its coming to midlevels too.

We'll see how effective the lobby is in preventing this.

 

[ferning]

Whatever u do, do not go to med school.

Definately not worth it

 

[MacDonaldTriad]

Whatever u do, do not go to med school.

Definately not worth it

sounds like a recent grad.

 

[Nasrudin]

sounds like a recent grad.

That poster is a troll.