the nurse practitioner threat

[Therapist4Chnge]

If you don't think plenty of MD's out in the community prescribe badly then your delusional. Given that all psychiatrists went through essentially the same length of training and passed the same standardized exams its obvious thats not the only thing that determines quality of practice.

Yes and no. The standardized tests are one hurdle, but they lack true specificity (a downfall of most all standardized tests), which means they will only flag the worst of the worst...and a couple of people who suck at standardized tests.

There is still a huge variance in residency training, just do a search on here for residency experiences. I'm not saying NPs (or prescribing psychologists) are the answer, but I do think they get scapegoated a lot. Healthcare is changing, and not for the better. More and more people will be leaving insurance panels, and less people will be able to get adequate services. Such is life in modern healthcare. Thankfully there will always be people who need my services, so I'll just work with the people who can afford to pay out of pocket.

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[zenman]

Excellent point."

I've watched my psychiatry attending wean numerous people off terrible benzo prescriptions. We often wonder who put them on long-term benzo treatment - nurses, psychologists in New Mexico, general practitioners? Don't forget that these three groups have prescribing privileges.

You can't have it both ways - complain people are getting inappropriate prescriptions, AND complain that not enough nurses, psychologists, and GPs should have crash courses to write prescriptions.

In my experience, it's been ED docs and GPs...and some psychiatrists who just can't say no. I try my best to wean patients and if I just have to use benzos I tell the patient it's nothing personal but I'll be checking the pharmacy board to see if they are going to multiple providers.

 

[InBoston]

With Obama or Romney, psychiatry will come to an end. Our nation cannot afford to pay for pseudo-science anymore.

People go to years of therapy covered by insurance in some cases, that results in a big fat goose egg. It's embarassing.

 

[Leo Aquarius]

I smell a rat. Somebody on this board has a thing out for psychiatrists and psychiatry in general.

People suffering from mental disorders deserve care too. Call psychiatry what you will, but in the end we are all trying as physicians to deliver medical care and improve lives. Remove psychiatry, and you condemn millions of people who cannot help themselves to death. Simple as that.

 

[zenman]

With Obama or Romney, psychiatry will come to an end. Our nation cannot afford to pay for pseudo-science anymore.

People go to years of therapy covered by insurance in some cases, that results in a big fat goose egg. It's embarassing.

But they will pay out of pocket for it.

 

[zenman]

I smell a rat. Somebody on this board has a thing out for psychiatrists and psychiatry in general.

People suffering from mental disorders deserve care too. Call psychiatry what you will, but in the end we are all trying as physicians to deliver medical care and improve lives. Remove psychiatry, and you condemn millions of people who cannot help themselves to death. Simple as that.

Psych will always be here (I hope) as the world is so screwed up.

 

[heyjack70]

They're independent factors, but not mutually exclusive.

The skills necessary to get into medical school involves being able ot be good at standardized tests, a baseline minimal aptitude for science, and a masochistic ability to delay gratification until the point that you forgot why you started the process.

So true.!

 

[ghost dog]

Yes and no. The standardized tests are one hurdle, but they lack true specificity (a downfall of most all standardized tests), which means they will only flag the worst of the worst...and a couple of people who suck at standardized tests.

There is still a huge variance in residency training, just do a search on here for residency experiences. I'm not saying NPs (or prescribing psychologists) are the answer, but I do think they get scapegoated a lot. Healthcare is changing, and not for the better. More and more people will be leaving insurance panels, and less people will be able to get adequate services. Such is life in modern healthcare. Thankfully there will always be people who need my services, so I'll just work with the people who can afford to pay out of pocket.

You are correct in stating that standardized tests are an important part of any medical school / residency training program. However, there are many other evaluations that take part in this extremely lengthy evaluation process.

Residents are observed interacting with patients and also examined by way of oral assessments / objective structured clinical exams ( OSCEs) many times during their career.

The above is a quality assurance process to ensure that patients receive appropriate care when a Physician has finished residency, and is then able to manage patients in an independent manner.

Mid-levels are not subjected to such a rigorous quality assurance process.

 

[surftheiop]

You are correct in stating that standardized tests are an important part of any medical school / residency training program. However, there are many other evaluations that take part in this extremely lengthy evaluation process.

Residents are observed interacting with patients and also examined by way of oral assessments / objective structured clinical exams ( OSCEs) many times during their career.

The above is a quality assurance process to ensure that patients receive appropriate care when a Physician has finished residency, and is then able to manage patients in an independent manner.

Mid-levels are not subjected to such a rigorous quality assurance process.

But lets be honest, something like 90%+ of people who start at a US MD school finish a residency (and most of those who don't make it left for non-academic reasons). So realistically the MCAT at age 20 is still the defining characteristic of who becomes a physician and who doesn't, so while all the other assessment is there, in general you have to essentially be criminally incompetent not to make it through once your in medschool (aside from the non-academic life factors that could disrupt any type of career).

That being said, i would suspect midlevel programs are even more slack when it comes to assessment which would obviously raise concern

 

[ghost dog]

But lets be honest, something like 90%+ of people who start at a US MD school finish a residency (and most of those who don't make it left for non-academic reasons). So realistically the MCAT at age 20 is still the defining characteristic of who becomes a physician and who doesn't, so while all the other assessment is there, in general you have to essentially be criminally incompetent not to make it through once your in medschool (aside from the non-academic life factors that could disrupt any type of career).

That being said, i would suspect midlevel programs are even more slack when it comes to assessment which would obviously raise concern

Yes, this is one of the starting points.

Mid levels have a lower bar to start with, and their programs are significantly shorter - thus a lower overall quality assurance process.

I know who I would want assessing one of my relatives - and it ain't a midlevel.