Psychiatric Nurse Practitioner v. Psychiatrist

[sloanetaylor]

Hi all,

I would be grateful for any insight or help you could provide regarding this. I went all through high school and half of college thinking I was going to be a doctor (leaning towards psychiatrist), but I haven't been so certain lately. My questions:

1. Back to Basics: Why did you choose to go to medical school? Why not nursing school, pursuing an engineering degree, etc.

2. What are the real differences (other than pay, amount of debt, and schooling length) between a psychiatrist and a psychiatric nurse practitioner? If you practice in either of these fields, any input on what you do on a daily basis would be greatly appreciated!

3. I'm also very open to pursing other careers... any suggestions? I love planning events, teaching/working with toddlers, mental health the military community, and the good old "helping people get better".

Thank you guys so much in advance!

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[tskbdmnd]

Psychiatrists pump kids full of drugs (basically recreational drugs), because they couldn't pass a test. Psychiatrists then proceed to think they're doing the right thing, while I had to grow up around kids hopped up on and trying to sell the maximum doses of addy and vyvanse. They also deal in xanax which outright kills teenagers.

They also help people who have serious mental disorders. That's their main job. The other part is just my personal gripe with psychiatrists.

 

[aalamruad]

Psychiatrists pump kids full of drugs (basically recreational drugs), because they couldn't pass a test.

You're not very smart

 

[doctorleospaceman]

Because as a psychiatric nurse practioner, I feel like you end up being none of those 3 things in the title but rather awkwardly floating somewhere in between those limitations.

• I want to both make and take responsibility for my own decisions.
• I don't want someone watching me and breathing down my neck questioning my every move.
• I want to know that I have learned as much as I can about the area of my work and not just enough to get by.
• I want to go into academics both as a teacher and researcher.

 

[tskbdmnd]

You're not very smart

I've grown up around kids hopped up on this stuff. You give all these pills to kids and they don't just religiously take it. They try to sell it, and next thing you know the whole school is paying 5 bucks a pill to get high. I've seen a friend die from xanax. I've seen multiple friends go ******ed by getting addicted to xanax. This stuff is no good for kids.

 

[doctorleospaceman]

I've grown up around kids hopped up on this stuff. You give all these pills to kids and they don't just religiously take it. They try to sell it, and next thing you know the whole school is paying 5 bucks a pill to get high. I've seen a friend die from xanax. I've seen multiple friends go ******ed by getting addicted to xanax. This stuff is no good for kids.

Seems like you focus only on those kids who don't need them rather than those who do. Drug abuse isn't limited to just psychiatric drugs either.

 

[seeinghowitgoes]

lI've seen multiple friends go ******ed by getting addicted to xanax. This stuff is no good for kids.

I have not chosen to go into psychiatry (am still very much deciding), so this response does not come from a place of feeling the need to justify myself personally.

With that in mind, first let me just suggest you stop using the phrase "go ******ed" as it is both in bad taste and provides no relatable description of symptoms (so we have no clue what you're describing happened to these kids). Second, you've cited zero studies suggesting these drugs do net harm on kids - they may be out there, but just saying you've seen it is not evidenced-based.

Now to address your comments on psychiatrists more generally. All of them passed every test required to become a doctor (not that said tests have been proven to correlate to much of anything that is clinically relevant). Furthermore, some that I know personally excelled on that test (well over 250). I recommend reading any number of memoirs from mentally ill patients that exist that describe the good work psychiatrists do and how they have been pushing the field forward in recent years in an attempt to understand what the most complex organ, the brain. You can google for the memoirs, but the patient's perspective, as opposed to the bystander's, is quite a powerful message of the good the field does.

To answer the original questions, and with the caveat that I have not chosen to go into psychiatry (am still deciding between multiple fields), I will say that physicians are much more easily able to do research as well as other scholarly activities and given more autonomy and slightly more clinical privileges (at least where I've worked). For me those types of benefits were enough to pursue medical school.

 

[tskbdmnd]

Seems like you focus only on those kids who don't need them rather than those who do.

And we figure this out with a checklist of behaviors that we don't think are normal right? Evidence based medicine my ass. Even if some kids need them and are responsible, they're also encouraging illicit activities among kids (Selling drugs and trying to get high). The kids aren't even properly identified. No biological tests are done before you decide to prescribe a bottle of vyvanse to a kid for the rest of his life. It's just a ****ing checklist.

So first let me just suggest you stop using the phrase "go ******ed" as it is both in bad taste and provides no relatable description of symptoms (so we have no clue what you're describing happened to these kids). Second, you've cited zero studies suggesting these drugs do net harm on kids - they may be out there, but just saying you've seen it is not evidenced-based.

Now to mention your comments on psychiatrists more generally, all of them passed every test required to become a doctor (not that said test has been proven to correlate to much of anything that is clinically relevant). Furthermore, some that I know personally excelled on that test (well over 250). I recommend reading any number of memoirs from mentally ill patients at exist that describe the good work psychiatrists do and how they have been pushing the field forward in recent years in an attempt to understand what the most complex organ, the brain..

Think of a ******ed person. That's what a bartard seems like. The bartard might be a little bit more capable mentally and a lot more capable physically. My own experiences obviously aren't enough for you though, so whatever. I did make it clear that I just had a gripe with what they do to children. See my main post.

 

[seeinghowitgoes]

And we figure this out with a checklist of behaviors that we don't think are normal right? Evidence based medicine my ass. Even if some kids need them and are responsible, they're also encouraging illicit activities among kids (Selling drugs and trying to get high). The kids aren't even properly identified. No biological tests are done before you decide to prescribe a bottle of vyvanse to a kid for the rest of his life. It's just a ****ing checklist.

A checklist that has been correlated to predict functional deficits in ability to navigate society is indeed evidenced-based.

Lupus diagnosis is also a checklist, diabetes is a checklist of blood sugar levels and other findings that has been shown to correlate with other bodily harm...checklists are all over medicine and, as long as they aren't just created out of thin air, are evidenced-based. Look at diagnostic criteria for many, many diseases - they're all basically checklists lol.

Have you searched the psychiatry literature? I mean I'm the first to admit there is a lot that needs a better evidence base, but to claim the whole field isn't evidenced-based because there are "checklists" is quite an overstatement and not logically consistent given how medicine diagnoses things more generally (unless you think none of medicine is evidenced-based because it's a "checklist").

 

[doctorleospaceman]

And we figure this out with a checklist of behaviors that we don't think are normal right? Evidence based medicine my ass. Even if some kids need them and are responsible, they're also encouraging illicit activities among kids (Selling drugs and trying to get high). The kids aren't even properly identified. No biological tests are done before you decide to prescribe a bottle of vyvanse to a kid for the rest of his life. It's just a ****ing checklist.

That's a you problem if you don't consider changes in behavior as symptoms. The rest of the medical community does. Just because you can't attach a number to it like a fever doesn't make it any less medically relevant. Misdiagnosis is more common because medicine involving the brain is still in its early stages. Psychiatric illnesses are becoming better understood every day and measurable qualities such as neurotransmitter levels and genetic variation are leading to more concrete diagnosing.

 

[tskbdmnd]

My gripe has to do with the use of the current checklists as "evidence" that a kid needs a bottle of recreational drugs every month. No more, no less. I understand that a lot of real things can be diagnosed by checklists. I also understand that some sort of evidence is usually found within the checklist. I don't believe that the current method of giving millions of kids bottles of vyvanse and addy is good.

Too keep from derailing, I'll use this post to respond:

There is a lot more nuance to this issue than you give it credit for. You cannot reduce a very complex problem to "lack-of-evidence" for the guidance (not dogmatic authority) of the DSM. If you want to make this argument, there are ways to make it that aren't stupid. This is not one of those ways. If you want, make a separate thread about it and bring some evidence to back up your claims and try to seriously consider what you are arguing against to begin with.

In no way was I reducing the problem to "lack of evidence". I had stated my experience with these drugs being rampant in schools. Someone told me that I'm discounting the kids who need the drugs. I pointed out that the evidence to show that a kid needs them is just a checklist.Whether the checklist describes someone with add/adhd very well, I don't believe that it's a properly exclusive test (especially when you're testing insanely underdeveloped brains). For example, I have many friends who went to a psychiatrist, pretended to be aloof, took the test really slow, and walked out with a prescription of vyvanse.

I've said many times that it's just a personal gripe that I have with them. You guys act like I'm trying to debunk psychiatry or some bull****.

 

[Lucca]

My gripe has to do with the use of the current checklists as "evidence" that a kid needs a bottle of recreational drugs every month. No more, no less. I understand that a lot of real things can be diagnosed by checklists. I also understand that some sort of evidence is usually found within the checklist. I don't believe that the current method of giving millions of kids bottles of vyvanse and addy is good.

There is a lot more nuance to this issue than you give it credit for. You cannot reduce a very complex problem to "lack-of-evidence" for the guidance (not dogmatic authority) of the DSM. If you want to make this argument, there are ways to make it that aren't stupid. This is not one of those ways. If you want, make a separate thread about it and bring some evidence to back up your claims and try to seriously consider what you are arguing against to begin with.

I suggest this thread stops being derailed. OP asked an earnest question and I think once some people further up the pipeline than pre-meds get a chance to respond it could be very worthwhile. They might be discouraged to reply if they have to sift through 5 pages of drivel.

 

[sloanetaylor]

Guys, I really don't want this post to turn into an argument - can anyone help me with my actual questions? Thank you to those of you who did answer!

 

[ndafife]

Hi all,

I would be grateful for any insight or help you could provide regarding this. I went all through high school and half of college thinking I was going to be a doctor (leaning towards psychiatrist), but I haven't been so certain lately. My questions:

1. Back to Basics: Why did you choose to go to medical school? Why not nursing school, pursuing an engineering degree, etc.

2. What are the real differences (other than pay, amount of debt, and schooling length) between a psychiatrist and a psychiatric nurse practitioner? If you practice in either of these fields, any input on what you do on a daily basis would be greatly appreciated!

3. I'm also very open to pursing other careers... any suggestions? I love planning events, teaching/working with toddlers, mental health the military community, and the good old "helping people get better".

Thank you guys so much in advance!

To get the thread back on track relevant to OP's question

The major difference comes down to the scope of practice. NP's and PA's exist to assist physicians. There is less schooling (and therefore debt) as a PNP, as well as more manageable hours, but because of the limited training you're generally going to handle only cookie cutter cases and you are going to operate with physician oversight. Then there are laws state by state that dictate overall what you are allowed to do as an NP (in terms of prescribing, etc...).

For other careers, maybe clinical psychology? It takes a more therapy approach than medical to dealing with mental health problems.

 

[BamaNicole]

Psychiatrists pump kids full of drugs (basically recreational drugs), because they couldn't pass a test. Psychiatrists then proceed to think they're doing the right thing, while I had to grow up around kids hopped up on and trying to sell the maximum doses of addy and vyvanse. They also deal in xanax which outright kills teenagers.

They also help people who have serious mental disorders. That's their main job. The other part is just my personal gripe with psychiatrists.

Please tell me you're being sarcastic......
If not you should actually do more research because this is the most ignorant thing I've read about psychiatrists. Doesn't really surprise me coming from what appears from your ranking to be a pre-med.

 

[Lawpy]

I've said many times that it's just a personal gripe that I have with them. You guys act like I'm trying to debunk psychiatry or some bull****.

Apologies for being blunt, but no one cares about your personal gripe with a specialty. What we do care is that you should stop derailing threads complaining about your personal gripe.

 

[Sust]

1. I was an NIMH IRTA and loved basic science research, but always found myself thinking about how to translate the results into clinical applications so med school was a good avenue for that
2. I only know the psychiatry pathway, but one difference I can think of is that major psychiatry training programs place an equal emphasis on quality psychotherapy didactics/supervision. Most psychiatrists do a mixture of med-management and psychotherapy, but some private practice psychiatrists do only psychotherapy.
3. If I didnt get into med school then I was going to do neuroscience or clinical psych graduate degree. One thing I realize now (that didnt come to mind when I was at your stage) was the possibility of a public health career and maybe even an MBA so that one could do mental health public policy or administrative work thats equally needed as well.

Can elaborate more, but didnt want to derail thread too far from your questions. Also feel free to ask in the psychiatry forum?

Hi all,

I would be grateful for any insight or help you could provide regarding this. I went all through high school and half of college thinking I was going to be a doctor (leaning towards psychiatrist), but I haven't been so certain lately. My questions:

1. Back to Basics: Why did you choose to go to medical school? Why not nursing school, pursuing an engineering degree, etc.

2. What are the real differences (other than pay, amount of debt, and schooling length) between a psychiatrist and a psychiatric nurse practitioner? If you practice in either of these fields, any input on what you do on a daily basis would be greatly appreciated!

3. I'm also very open to pursing other careers... any suggestions? I love planning events, teaching/working with toddlers, mental health the military community, and the good old "helping people get better".

Thank you guys so much in advance!

 

[Akewataru]

In no way was I reducing the problem to "lack of evidence". I had stated my experience with these drugs being rampant in schools. Someone told me that I'm discounting the kids who need the drugs. I pointed out that the evidence to show that a kid needs them is just a checklist.Whether the checklist describes someone with add/adhd very well, I don't believe that it's a properly exclusive test (especially when you're testing insanely underdeveloped brains). For example, I have many friends who went to a psychiatrist, pretended to be aloof, took the test really slow, and walked out with a prescription of vyvanse.

I've said many times that it's just a personal gripe that I have with them. You guys act like I'm trying to debunk psychiatry or some bull****.

Have YOU, not a friend or a family member, ever been diagnosed with ADHD? If so, then you would know that your symptoms have to be corroborated by a family member or a teacher to have occurred before the age of six (although I believe in DSM-V they upped this to 12). They have you and that person fill out a 114 to 120 question questionnaire on your symptoms to rule out other disorders and malingering. I will say this, there is a definitely problem with high school and college students malingering in order to get the medication no doubt about that. That being said, I would keep my distance from such people. If they are willing to pretend and lie to a doctor/NP to get drugs for illicit purposes, what won't they do?

Anyhow, the above evaluation is by far the simplest and takes an hour. If you want accommodations for high-stakes exams such as the MCAT or the USMLE your evaluation will be several hours. It will include on top of the initial interview, corroboration, and questionnaire, you will undergo a battery of tests pushing your executive functioning and processing speed to their limits. Heck, if you really got money to burn you can get a SPECT scan too.

 

[Kazaki]

Hi all,

I would be grateful for any insight or help you could provide regarding this. I went all through high school and half of college thinking I was going to be a doctor (leaning towards psychiatrist), but I haven't been so certain lately. My questions:

1. Back to Basics: Why did you choose to go to medical school? Why not nursing school, pursuing an engineering degree, etc.

2. What are the real differences (other than pay, amount of debt, and schooling length) between a psychiatrist and a psychiatric nurse practitioner? If you practice in either of these fields, any input on what you do on a daily basis would be greatly appreciated!

3. I'm also very open to pursing other careers... any suggestions? I love planning events, teaching/working with toddlers, mental health the military community, and the good old "helping people get better".

Thank you guys so much in advance!

How on Earth are you comparing a doctor to a bloody nurse??
A psychiatrist is doctor that has the knowledge, training, clinical judgement, and experience to take care of a patient.
A nurse is just that. A nurse. No knowledge, zero training, the clinical judgement of a shoe, and the experience in patient care that cannot be compared to medical student, let alone a doctor.
The fact that you're asking about the difference says a lot about what these nurses have fooled you into thinking.

 

[seeinghowitgoes]

How on Earth are you comparing a doctor to a bloody nurse??
A psychiatrist is doctor that has the knowledge, training, clinical judgement, and experience to take care of a patient.
A nurse is just that. A nurse. No knowledge, zero training, the clinical judgement of a shoe, and the experience in patient care that cannot be compared to medical student, let alone a doctor.
The fact that you're asking about the difference says a lot about what these nurses have fooled you into thinking.

It seems you've gone through at least some of medical school, so I'm surprised you haven't had this experience where you're at (unless it isn't in the US, where the health system may be different), but Psychiatric Nurse Practioners at most institutions are actually able to have many of the patient management roles that physicians have. They are not "nurses" in the traditional RN sense and to any outside observer who did not see the letter behind their name they would appear much closer to a physician than the nurses on the ward.

Having gone through a a psych clinical rotation, I'll say that where I worked (a very large academic healthcare institution) there are still some limitations as to what Psych Nurse Practioners can do from a clinical standpoint (little day-to-day things and most of the research limitations, less administrative opportunities, etc, that have been mentioned) but if one ONLY wanted the patient care aspect then they might save money and time and forgo medical school in favor of that role.

 

[Kazaki]

Psychiatric Nurse Practioners are actually able to have many of the patient management roles that physicians have. They are not "nurses" in the traditional RN sense and to any outside observer who did not see the letter behind their name they would appear much closer to a physician than the nurses on the ward.

Having gone through a a psych clinical rotation, I'll say that where I worked (a very large academic healthcare institution) there are still some limitations as to what Psych Nurse Practioners can do from a clinical standpoint (little day-to-day things and most of the research limitations, less administrative opportunities, etc, that have been mentioned) but if one ONLY wanted the patient care aspect then they might save money and time and forgo medical school in favor of that role.

They're just nurses. Plain and simple. They do not know ANYTHING about the brain or the psyche. All they know how to do, is parrot what they see the attending physician says/does.
If doctors pick up and leave, and they have no one to watch over all their incompetencies, people will never allow these nurses to interfere with their care.

 

[seeinghowitgoes]

They're just nurses. Plain and simple. They do not know ANYTHING about the brain or the psyche. All they know how to do, is parrot what they see the attending physician says/does.
If doctors pick up and leave, and they have no one to watch over all their incompetencies, people will never allow these nurses to interfere with their care.

The Psych Nurse Practioners where I worked had their own team and were responsible for the management of their patients (including deciding on medications) with no meaningful direct oversight. I don't know what your experience has been or if you've actually worked with Psych Nurse Practioners, but you are incorrect in your assessment of their abilities and clinical responsibilities. You seem to be confusing them with the nurses who take care of psych patients (though even those nurses still know quite a lot). Nurse in Psych and Psych Nurse Practioners are two different roles on the healthcare team.

I say this from personal experience, and only seek to clarify because I think making it seem like a Psych Nurse Practioner doesn't know "anything" is very misleading (or just plain wrong) to those seeking to decide between Med school and the alternative.

 

[Lucca]

They're just nurses. Plain and simple. They do not know ANYTHING about the brain or the psyche. All they know how to do, is parrot what they see the attending physician says/does.
If doctors pick up and leave, and they have no one to watch over all their incompetencies, people will never allow these nurses to interfere with their care.

Who hurt u

 

[Kazaki]

You seem to be confusing them with the nurses who take care of psych patients (though even those nurses still know quite a lot)

No. I know what you're talking about.

you are incorrect in your assessment of their abilities and clinical responsibilities

No. I say this based on several facts. You see the brain is the most complex piece of matter in the known universe, and doctors and neuroscientists that spend their entire lives studying the brain and mind don't fully understand the brain's pharmacology, to say that a nurse (that has ZERO clinical insight) understands how the human brain works and all different psychological/developmental/behavioural models is a joke.
To say that a nurse, with no knowledge of basic sciences, physiology, pathology, pathophysiology, or pharmacology understand how to use psychoactive drugs is just wrong.
To say that a nurse, with no clinical knowledge besides identifying when they should call the real doctor, understands typical/atypical presentations and comorbidities, understands underlying mechanisms of disease, understands how psychological disease can stem from systemic disease and the exact mechanisms involved, understands how to identify side effects of psychoactive medication (which can be detrimental and irreversible), understands drug-drug interactions, and understands how to put all what I just mentioned, and much much more, into a clinical setting is outrageous and offensive to doctors that dedicated years of their lives to become experts on mental health.

I think making it seem like a Psych Nurse Practioner doesn't know "anything" is very misleading (or just plain wrong) to those seeking to decide between Med school and the alternative.

Nursing is a fine profession with a valuable place in the healthcare system. That place isn't managing patients though, it's assisting physicians in day to day tasks pretty much. But to compare doctors to nurses (no matter the number of years of experience and post grad qualifications) is not fare to nurses. They lose that comparison 11 times out of 10.

Read what I just wrote above and get me a nurse that can answer all those questions, even if the answer is superficial and useless. No nurse can handle what doctors do.

Who hurt u

Batman.

 

[Lucca]

No. I know what you're talking about.

No. I say this based on several facts. You see the brain is the most complex piece of matter in the known universe, and doctors and neuroscientists that spend their entire lives studying the brain and mind don't fully understand the brain's pharmacology, to say that a nurse (that has ZERO clinical insight) understands how the human brain works and all different psychological/developmental/behavioural models is a joke.
To say that a nurse, with no knowledge of basic sciences, physiology, pathology, pathophysiology, or pharmacology understand how to use psychoactive drugs is just wrong.
To say that a nurse, with no clinical knowledge besides identifying when they should call the real doctor, understands typical/atypical presentations and comorbidities, understands underlying mechanisms of disease, understands how psychological disease can stem from systemic disease and the exact mechanisms involved, understands how to identify side effects of psychoactive medication (which can be detrimental and irreversible), understands drug-drug interactions, and understands how to put all what I just mentioned, and much much more, into a clinical setting is outrageous and offensive to doctors that dedicated years of their lives to become experts on mental health.

Nursing is a fine profession with a valuable place in the healthcare system. That place isn't managing patients though, it's assisting physicians in day to day tasks pretty much. But to compare doctors to nurses (no matter the number of years of experience and post grad qualifications) is not fare to nurses. They lose that comparison 11 times out of 10.

Read what I just wrote above and get me a nurse that can answer all those questions, even if the answer is superficial and useless. No nurse can handle what doctors do.


Batman.

So MS1 or MS2?

 

[Kazaki]

So MS1 or MS2?

MS3 m8

 

[Ochem 32]

MS3 m8

I would never want you to be my doctor.

 

[gyngyn]

I would never want you to be my doctor.

Closing dead thread.