.

[Alemo]

---

Members do not see this ad.

What’s in it for the psychologists? Are they really needing to drum up more business? Do they stand to make more money?

 

[cara susanna]

What’s in it for the psychologists? Are they really needing to drum up more business? Do they stand to make more money?

We're losing a lot of our scope to Masters level clinicians and some think this would help. I am not one of them, of course

 

[Jules A]

No disagreement with older docs in general, but NP’s create insane regimens in my area. Starting Lamictal at high doses, extreme weight gain using Depakote and Seroquel to treat depression, and diagnosing everyone with bipolar. 5 year olds with Zyprexa for their bipolar (adhd). I could go on forever. One of my “referral” sources is failures with a NP.

Telepsychiatry has made rural areas a problem of the past in many states. $300k is not a pay differential worth moving. In my graduating residency class, 66% earn over $350k. The 1/3rd that doesn’t either works in academia ($250k) or county health system in large urban areas ($250k). The 66% aren’t moving rural for a pay cut. Those that choose $250k to be in a cushy academia gig aren’t going rural for $50k extra. Those that choose a county population to live/navigate an urban area aren’t going rural for $50k. Rural jobs are also typically more demanding and have limited or no coverage when needed. If the government really cared about rural areas, they wouldn’t pump out NP’s which predominantly work in urban areas. They would create grants or bonus pay structures for rural areas to make it worth it.

Correct the urban teaching hospitals around here are paying $250,000 range but even in the burbs it only $275,000 unless one is working a cash practice or excessive hours. I would have thought a 20%-30% premium would be a draw especially when you consider that amount over the course of 5-10 years. FWIW the rural areas I'm talking about are 90 +/- minutes from two nice east coast cities so not exactly the middle of nowhere. But yeah I guess if that isn't enough they will have to increase the offering if they want psychiatrists. It isn't the govt that is pumping out NPs it is the universities who identified a cash cow and started marketing these programs heavily starting with undergraduate nursing education. Again increasing the number of new psychiatrists is going to be necessary or accept that midlevels will quickly outnumber physicians.

 

[Candidate2017]

There is no "ADHD testing." You are referring for a second (diagnostic) opinion. There are no "test results" that should override (or "confirm") your clinical impression based on thorough history, interview, and other diagnostic rule-outs. "Co-morbid" is the most parsimonious conclusion in most cases....

This whole "ADHD testing issue" is especially weird to me because psychologists don't do depression "testing." We don't do schizophrenia "testing." Well, sometimes we are called upon for the more latent stuff, but I'm not really sure who benefits from this most times? I mean, psychiatrists are oddly confident there... but not with ADHD???

Every psychiatrist knows ADHD is a clinical diagnosis. We refer to "ADHD testing" due to the punishing culture of residency and cult of patient satisfaction.
I have no problem telling a patient they do not have ADHD. But many of these "ADHD" patients are drug seekers bent on turning me into their Adderall dealer and will file a complaint with the clinic or mark the box that says “my provider did not listen to my needs” on their patient satisfaction survey, for which I will get a meeting with the powers that be and be forced to defend myself.

 

[Candidate2017]

Traveling out of the state? Take off work for the entire day and, if the patient is a child, take the child out of school for an entire day to travel out of the state to see the psychiatrist. And hope that their BCBS of their home state covers the visit from the out of state provider, and if the patient has Medicaid or managed Medicaid then you have more issues. But I suppose for the copious amounts of people with money here in the rural area who can afford to pay out of pocket, your solution makes perfect sense.

Rural patients travel long distances to see physicians, midlevels, psychologists or any other professional. Or Walmart or McDonald's. Hence rural.

I have quite a few patients traveling 1-4 hours to see me, including some from out of state and some that don’t even have cars(!). Some of these patients live in medically over-served areas and travel by choice, not necessity, because they prefer to not switch psychiatrists after moving away from me.

 

[calvnandhobbs68]

Just got to 17:35 and witness our race to the bottom. "As you know, sometimes Beta Blockers, clonidine or propranolol...". This is the "expert" at the "forefront" of RxP. I can't remember the last MS3 on their first psych rotation say something like that.

Edit: He actually calls "them" beta blockers on two occasions...

Come on blood pressure and beta blocker both start with B so that must be right.

 

[clausewitz2]

Every psychiatrist knows ADHD is a clinical diagnosis. We refer to "ADHD testing" due to the punishing culture of residency and cult of patient satisfaction.
I have no problem telling a patient they do not have ADHD. But many of these "ADHD" patients are drug seekers bent on turning me into their Adderall dealer and will file a complaint with the clinic or mark the box that says “my provider did not listen to my needs” on their patient satisfaction survey, for which I will get a meeting with the powers that be and be forced to defend myself.

I don't know, I wish this was true, but I've met psychiatrists who aren't quite ready to accept the pointlessness of testing in 90% of ADHD cases. They prevaricate and equivocate and mumble about "well, helps confirm the diagnosis, gives greater confidence in your assessment etc etc." In my experience they tend to be older. Sometimes medicine, like science, advances one funeral at a time...

 

[splik]

What’s in it for the psychologists? Are they really needing to drum up more business? Do they stand to make more money?

It's all about the $$$$. There are also lots of poorly trained psychologists from diploma mills who can't find jobs and they are the ones who are pushing for this. None of the good psychologists actually want to prescribe. In fact there is a strong movement within clinical psychology to resist prescriptive authority, because many psychologists fear it will alter the role and identity of psychologists for the worse.

We're losing a lot of our scope to Masters level clinicians and some think this would help. I am not one of them, of course

Round here the masters level therapist dx everyone with PTSD and DID regardless of what the problem is and treat everyone with EMDR. Highly skilled clinical psychologists who can do psychological assessment, provide evidence-based treatments like CBT, ACT, DBT, or even dynamically-oriented therapies are very much needed. My main opposition to psychologists' prescribing is we need more people providing high quality psychological interventions, not more people prescribing toxic drugs.

 

[PsyDr]

My fantasy office has a door that leads to a large-ish closet where a psychologist and pharmacist are just hanging out all day so I can ask them any question whenever I think it would be useful.

$400k/yr, a promise not to tell the PharmD what we're being paid, and I can make this happen.

 

[Jules A]

Every psychiatrist knows ADHD is a clinical diagnosis. We refer to "ADHD testing" due to the punishing culture of residency and cult of patient satisfaction.
I have no problem telling a patient they do not have ADHD. But many of these "ADHD" patients are drug seekers bent on turning me into their Adderall dealer and will file a complaint with the clinic or mark the box that says “my provider did not listen to my needs” on their patient satisfaction survey, for which I will get a meeting with the powers that be and be forced to defend myself.

I also have no qualms about saying no to inappropriate medications but suspect in many cases satisfaction scores do influence prescribing patterns. Sad we didn't learn a lesson from the "pain is whatever the patient says it is" debacle.

 

[VA Hopeful Dr]

I also have no qualms about saying no to inappropriate medications but suspect in many cases satisfaction scores do influence prescribing patterns. Sad we didn't learn a lesson from the "pain is whatever the patient says it is" debacle.

Its more sad that we have good quality evidence that correlates higher satisfaction scores with worse morbidity/mortality and yet patient satisfaction is still a major quality measure.

 

[Splenda88]

Everyone wants a piece of the pie. I guess at this rate we will have NP neurosurgeons in the next 1-2 decades.

 

[Mass Effect]

Every psychiatrist knows ADHD is a clinical diagnosis. We refer to "ADHD testing" due to the punishing culture of residency and cult of patient satisfaction.
I have no problem telling a patient they do not have ADHD. But many of these "ADHD" patients are drug seekers bent on turning me into their Adderall dealer and will file a complaint with the clinic or mark the box that says “my provider did not listen to my needs” on their patient satisfaction survey, for which I will get a meeting with the powers that be and be forced to defend myself.

Unfortunately, just as some psych prescribers easily push the Adderall (and Xanax), I also think there's a subset of prescribers (including psychiatrists) who refuse to diagnose ADHD unless the diagnosis was given in childhood. I find this to be equally problematic. If we're going to suggest ADHD is a real pathology, we need to be open to the fact that not all kids are diagnosed as kids, especially girls, and every 30-something coming to you for evaluation isn't drug-seeking. This isn't meant to you personally, @Candidate2017, but in general, psychiatrists need to be more open-minded to this and not start every ADHD evaluation appointment with suspicion of drug abuse to counter the incompetent prescribers giving Adderall like candy.

 

[clausewitz2]

Unfortunately, just as some psych prescribers easily push the Adderall (and Xanax), I also think there's a subset of prescribers (including psychiatrists) who refuse to diagnose ADHD unless the diagnosis was given in childhood. I find this to be equally problematic. If we're going to suggest ADHD is a real pathology, we need to be open to the fact that not all kids are diagnosed as kids, especially girls, and every 30-something coming to you for evaluation isn't drug-seeking. This isn't meant to you personally, @Candidate2017, but in general, psychiatrists need to be more open-minded to this and not start every ADHD evaluation appointment with suspicion of drug abuse to counter the incompetent prescribers giving Adderall like candy.

Especially since we are talking about psychostimulants here. They aren't risk free but the likelihood of a serious adverse effect used as prescribed is orders of magnitude lower than, say, any antipsychotic ever. If you are doing a risk/benefit analysis the first half of that equation is going to sum to a lot less than most things we prescribe without a second thought. If you are uncomfortable evaluating for ADHD, learn how. Know the criteria of course but also read up on phenomenology and typical experiences of people with ADHD so you can get a sense when getting accounts from people whether they just memorized the DSM definition or whether they actually describing their personal experience.

 

[finalpsychyear]

It's all about the $$$$. There are also lots of poorly trained psychologists from diploma mills who can't find jobs and they are the ones who are pushing for this. None of the good psychologists actually want to prescribe. In fact there is a strong movement within clinical psychology to resist prescriptive authority, because many psychologists fear it will alter the role and identity of psychologists for the worse.


Round here the masters level therapist dx everyone with PTSD and DID regardless of what the problem is and treat everyone with EMDR. Highly skilled clinical psychologists who can do psychological assessment, provide evidence-based treatments like CBT, ACT, DBT, or even dynamically-oriented therapies are very much needed. My main opposition to psychologists' prescribing is we need more people providing high quality psychological interventions, not more people prescribing toxic drugs.

So what exactly can MD/DO's do to stop this utter nonsense? I feel its a tricky situation because most of the docs 5-10 years in practice especially those who have PP are not going to have any impact or give a damn because they are so well set and their demand is insane to the point that they are needing to hire some of these midlevels worsening the issue so its a tricky situation because for them they will only profit from this in some sense or hold their practice income without the mid level at least for the next 5-10 years.

I am on the younger side but likely will not be affected as i keep myself in multiple lines of work and consistently pursuing other certifications such as addiction and potentially IME in the future. I think that is 100% what everyone should be doing to "protect" themselves. Those who are going to feel it are employed docs when their admin figures out they can take that 200-250k salary divide it by 3 and hire 3 Newbie NPs and then stick a "collaboration" agreement with another doc.

Seriously, guys/gals who are on this forum and residents/ med students . It is UP to you to help fight this because YOU are going to be MOST directly effected. So people in a cushy 9-5 working for xyz better watch their back and keep part of those societies AMA, APA, etc. It is shocking how in 10-15 years this has gone from no issue to total chaos. Do not use the current crop of docs situations as to what yours will be like you MUST fight now to prevent major potential declines for you.

Back to my weekend moonlighting.

 

[Mass Effect]

The sky is falling posts never really do much for posters here. There are more than enough patients to go around and more than enough jobs to be filled. The APA and the AMA have done crap about midlevels and I don't see them starting now so I'd rather save my money. Rather, I think we all just need to go about our business and understand that if our current job replaces us with a midlevel, there are about 200 other jobs we could do or we could go into PP or academics.

 

[AcronymAllergy]

As a psychologist, even if psychologists obtained RxP in all 50 states, I don't see psychiatrists going anywhere. The city I practice in now could probably quadruple the number of psychiatrists (or even just "prescribers" more broadly) and still have months' long waiting lists.

I'd be interested in additional psychopharm education/training for the added knowledge, if it were of reasonable quality and weren't prohibitively expensive. I have no interest at present in prescribing. I'd rather focus on increasing compensation for psychotherapy and, as was mentioned earlier, possibly tightening the definitions and standards of what qualifies as such, but that train may have already left the station.

 

[downwithDTB]

The sky is falling posts never really do much for posters here. There are more than enough patients to go around and more than enough jobs to be filled. The APA and the AMA have done crap about midlevels and I don't see them starting now so I'd rather save my money. Rather, I think we all just need to go about our business and understand that if our current job replaces us with a midlevel, there are about 200 other jobs we could do or we could go into PP or academics.

Maybe, but maybe not. There are ICUs being staffed in person only my NPs. Emergency rooms without phsyicians at all or only available by restrospective chart review. Even major academic hospitals in direct supervision states have NP medical services with a physician covering up to 40 inpatients.

As the market continues to flood with diploma mill NPs, they will become cheaper and cheaper and no hospital system will pay MDs unless medicare/caid steps in... and it looks like they are about to do the opposite. Non-surgeon MDs will be replaced almost entirely or be relegated to chart signing and surgeons will be forced to sign off on CRNA work.

Go PP they said! Well, if Aetna can panel only NPs and bargain down the prices, they will. You'll be left with cash only as the only option and the market will start to get really saturate in a lot of places.

Ok, fine, the market doesn't saturate and PP is fine and you can still afford to pay all your MD bills out of pocket since none take insurance. You start having the big one and call 911. Do you want to be seen only by non-physicians? This is already happening today, in America. It's not a worse case scenario. Get sent to the wrong hospital or live in the wrong place and, no matter the money you have, you do not have emergency access to physicians. You may have no access to an anesthesiologist if you need an appy it worse a major heart surgery. All the money you are wasting on Medicare taxes is going to get you nothing more than a webNP.

 

[Mass Effect]

Maybe, but maybe not. There are ICUs being staffed in person only my NPs. Emergency rooms without phsyicians at all or only available by restrospective chart review. Even major academic hospitals in direct supervision states have NP medical services with a physician covering up to 40 inpatients.

As the market continues to flood with diploma mill NPs, they will become cheaper and cheaper and no hospital system will pay MDs unless medicare/caid steps in... and it looks like they are about to do the opposite. Non-surgeon MDs will be replaced almost entirely or be relegated to chart signing and surgeons will be forced to sign off on CRNA work.

Go PP they said! Well, if Aetna can panel only NPs and bargain down the prices, they will. You'll be left with cash only as the only option and the market will start to get really saturate in a lot of places.

Ok, fine, the market doesn't saturate and PP is fine and you can still afford to pay all your MD bills out of pocket since none take insurance. You start having the big one and call 911. Do you want to be seen only by non-physicians? This is already happening today, in America. It's not a worse case scenario. Get sent to the wrong hospital or live in the wrong place and, no matter the money you have, you do not have emergency access to physicians. You may have no access to an anesthesiologist if you need an appy it worse a major heart surgery. All the money you are wasting on Medicare taxes is going to get you nothing more than a webNP.

Where is this happening? What city/hospital?

 

[downwithDTB]

Where is this happening? What city/hospital?

It's happening all over Iowa, in Arizona,
in Wisconsin, and in Maine in emergency departments at the very least.

In two seconds of googling:

Wapiti Job Board: Locum or Perm Placement - Wapiti Medical Staffing

Wapiti has short-term and long-term locum tenens positions available as well as perm placement opportunities. Flexible scheduling and travel assistance provided for most locum positions.

www.wapitimedical.com

"Physician 'on call' for 'backup'" in this one." Must be "comfortable" running ED shift alone. That means that if someone comes in with a freaking stemi, an NP has the option of calling in physician backup from home OR not.

 

[Mass Effect]

It's happening all over Iowa, in Arizona,
in Wisconsin, and in Maine in emergency departments at the very least.

In two seconds of googling:

Wapiti Job Board: Locum or Perm Placement - Wapiti Medical Staffing

Wapiti has short-term and long-term locum tenens positions available as well as perm placement opportunities. Flexible scheduling and travel assistance provided for most locum positions.

www.wapitimedical.com

"Physician 'on call' for 'backup'" in this one." Must be "comfortable" running ED shift alone. That means that if someone comes in with a freaking stemi, an NP has the option of calling in physician backup from home OR not.

They're running that particular shift alone. You made it sound like there are EDs that don't hire MDs, period, and I'm asking you where that happens.

 

[downwithDTB]

They're running that particular shift alone. You made it sound like there are EDs that don't hire MDs, period, and I'm asking you where that happens.

Does it make a difference if there is no physician in the actual emergency room during your emergency, but they do hire physicians for other shifts? I mean, COME ON. And if they will let having an NP solo for one shift, do you really, honestly believe that they are going to do everything in their power to staff the ED with phsyicians? What about after payment parity hits?

 

[Mass Effect]

Does it make a difference if there is no physician in the actual emergency room during your emergency, but they do hire physicians for other shifts? I mean, COME ON. And if they will let having an NP solo for one shift, do you really, honestly believe that they are going to do everything in their power to staff the ED with phsyicians? What about after payment parity hits?

As someone who did a rural ED rotation, I can tell you that most nights, it was totally dead. The typical thing I'd see is gastritis or lacerations. The entire month, I got two chest pains, neither which turned out to be an MI. Luckily, we had an MD and were able to do the acute rule-out without a problem and in one case, the guy was admitted for full work up (he was a 60-something with risk factors). In the other case, it was heartburn in a 20-something.

I'm not in favor of MDs not being hired to staff an NP because I know they're better at the job and of course, I would always advocate for MDs. However, I think there will always be MD jobs available, even in the ED, and I'm not all that concerned that the NP can't do the job in a rural area if my own experience is any indication. I also have to remember that an ED is attached to a hospital, so I have to believe that people coming in with real pathology will get a consult from IM, surgery, etc. It's really no different (IMO) than what happens in urgent care centers around the country and there's no hospital attached to urgent care.

 

[downwithDTB]

... so I have to believe that people coming in with real pathology will get a consult from IM, surgery, etc. It's really no different (IMO) than what happens in urgent care centers around the country and there's no hospital attached to urgent care.

What's happening with UCs today is...

15 Doctors Fired From Chicago-Area Health System

Physicians 'broadsided' by their termination

www.medpagetoday.com

Yes, in supervised practice states, there is an MD in house who may have to see every patient who comes to UC. In "collaborator" states its basically a piece of paper that says the MD will take on liability but doesn't see the patient. In full practice states, NPs are staffing UCs and EDs without any supervision.

I get that a rural ED can be very slow, but people in rural areas still have serious medical events and deserve phsyician care when they get to an ED.

 

[clausewitz2]

Does it make a difference if there is no physician in the actual emergency room during your emergency, but they do hire physicians for other shifts? I mean, COME ON. And if they will let having an NP solo for one shift, do you really, honestly believe that they are going to do everything in their power to staff the ED with phsyicians? What about after payment parity hits?

Look at the posting. They want someone for two shifts a month. That really sounds like the problem is just that they can't find enough MDs to fill out the schedule completely and are trying to patch a gap. It is exactly what you'd expect might happen if they were trying to hire MDs and just couldn't find enough

 

[downwithDTB]

Look at the posting. They want someone for two shifts a month. That really sounds like the problem is just that they can't find enough MDs to fill out the schedule completely and are trying to patch a gap. It is exactly what you'd expect might happen if they were trying to hire MDs and just couldn't find enough

Jobs
Jobs "8 24 hr shifts per month, often as a solo provider!"
Jobs

How many do I need to find to convince you that NPs are working solo shifts in EDs?

 

[clausewitz2]

Jobs
Jobs "8 24 hr shifts per month, often as a solo provider!"
Jobs

How many do I need to find to convince you that NPs are working solo shifts in EDs?

I notice that at least the first two either explicitly mention being vacation coverage or being on-call and needing to show up for shifts as coverage. "Often as solo provider" sounds like marketing copy and is again totally consistent with covering the cr*ppy shifts.

Where are the EDs that are mostly or even frequently staffing with NPs instead of MDs ?

Really all these listings point to "MDs have enough market power they can refuse to work shifts they don't want and be fine with it."

 

[Jules A]

As a psychologist, even if psychologists obtained RxP in all 50 states, I don't see psychiatrists going anywhere. The city I practice in now could probably quadruple the number of psychiatrists (or even just "prescribers" more broadly) and still have months' long waiting lists.

While I agree there are plenty of patients what I can say for a fact is supply vs demand is a real thing. If your area suddenly had 4xs the providers the opportunities would be fewer and the wages most definitely lower. Employers could care less if someone is competent or not as long as they have the license to prescribe. What I'm seeing in a rural area is psychiatrists are more likely to become medical directors, carry a small patient load, and basically "supervise" all the midlevels. It is a bit of job insurance in an area that is being flooded with psych NPs.

It will definitely take some adaptation from non-surgeons over the next 5-10 years. The numbers of NPs are increasing exponentially. It is looking like midlevels will outnumber physicians soon.

Nurse Practitioner Role Grows to More Than 270,000

Patients are benefiting now more than ever before from the high quality, comprehensive, patient-centered health care services provided by nurse practitioners. Additionally, seven of the top 10 work settings reported Primary Care as the main clinical focus, with certifications in the populations of…

www.aanp.org

U.S. Physician Workforce Data Dashboard

The U.S. Physician Workforce Data Dashboard provides the most current data available about the physician workforce across specialties.

www.aamc.org

 

[downwithDTB]

While I agree there are plenty of patients what I can say for a fact is supply vs demand is a real thing. If your area suddenly had 4xs the providers the opportunities would be fewer and the wages most definitely lower. Employers could care less if someone is competent or not as long as they have the license to prescribe. What I'm seeing in a rural area is psychiatrists are more likely to become medical directors, carry a small patient load, and basically "supervise" all the midlevels. It is a bit of job insurance in an area that is being flooded with psych NPs.

It will definitely take some adaptation from non-surgeons over the next 5-10 years. The numbers of NPs are increasing exponentially. It is looking like midlevels will outnumber physicians soon.

Nurse Practitioner Role Grows to More Than 270,000

Patients are benefiting now more than ever before from the high quality, comprehensive, patient-centered health care services provided by nurse practitioners. Additionally, seven of the top 10 work settings reported Primary Care as the main clinical focus, with certifications in the populations of…

www.aanp.org

U.S. Physician Workforce Data Dashboard

The U.S. Physician Workforce Data Dashboard provides the most current data available about the physician workforce across specialties.

www.aamc.org

Employers are actually financial incentivized to hire independent NPs in independent practice states... They are held to a lower standard of nursing practice, answer to BON not BOM and MDs/PAs can't testify against them as expert witnesses.

 

[Jules A]

Employers are actually financial incentivized to hire independent NPs in independent practice states... They are held to a lower standard of nursing practice, answer to BON not BOM and MDs/PAs can't testify against them as expert witnesses.

I hadn't heard that but they are certainly in favor of hiring midlevels because they can pay them a fraction of the price of a physician. Employers in my experience could care less about skill set as long as the person has the credentials to prescribe which is very unfortunate.

 

[clausewitz2]

Employers are actually financial incentivized to hire independent NPs in independent practice states... They are held to a lower standard of nursing practice, answer to BON not BOM and MDs/PAs can't testify against them as expert witnesses.

Source for saying MDs can't testify as witnesses in cases involving NPs? In some jurisdictions pharmacists and biomechanical engineers have testified about medical malpractice involving physicians so it is not the case that expert witness status is determined solely and entirely by the precise degree someone holds.

 

[splik]

Source for saying MDs can't testify as witnesses in cases involving NPs? In some jurisdictions pharmacists and biomechanical engineers have testified about medical malpractice involving physicians so it is not the case that expert witness status is determined solely and entirely by the precise degree someone holds.

Indeed - in states with independent practice, NPs are held to the same standard as attending physicians and thus typically the plaintiff's expert (and probably the defense expert as well) will be a physician. In states without independent practice, it is unlikely the NP would be sued anyway, the supervising or "collaborating" (sic) physician would be on the hook.

 

[downwithDTB]

Source for saying MDs can't testify as witnesses in cases involving NPs? In some jurisdictions pharmacists and biomechanical engineers have testified about medical malpractice involving physicians so it is not the case that expert witness status is determined solely and entirely by the precise degree someone holds.

Indeed - in states with independent practice, NPs are held to the same standard as attending physicians and thus typically the plaintiff's expert (and probably the defense expert as well) will be a physician. In states without independent practice, it is unlikely the NP would be sued anyway, the supervising or "collaborating" (sic) physician would be on the hook.

For example: Iowa Legislature: SF465

147.139 qualifier #1, the plaintiff may only qualify an expert witness in the same or similar substantially similar field.

12-2604 - Expert witness qualifications; medical malpractice actions

www.azleg.gov

During the year immediately preceding the occurrence giving rise to the lawsuit, devoted a majority of the person's professional time to either or both of the following:

(a) The active clinical practice of the same health profession as the defendant and, if the defendant is or claims to be a specialist, in the same specialty or claimed specialty.
(b) The instruction of students in an accredited health professional school or accredited residency or clinical research program in the same health profession as the defendant and, if the defendant is or claims to be a specialist, in an accredited health professional school or accredited residency or clinical research program in the same specialty or claimed specialty.

 

[aim-agm]

For example: Iowa Legislature: SF465

147.139 qualifier #1, the plaintiff may only qualify an expert witness in the same or similar substantially similar field.

Do you have cases of MD/DOs being denied expert witness status against NPs because of this law? Because reading it (a) both are in the field of medicine/healthcare and (b) even if defining doctoring and nursing as separate fields they are undoubtably substantially similar.

 

[cara susanna]

Every psychiatrist knows ADHD is a clinical diagnosis. We refer to "ADHD testing" due to the punishing culture of residency and cult of patient satisfaction.
I have no problem telling a patient they do not have ADHD. But many of these "ADHD" patients are drug seekers bent on turning me into their Adderall dealer and will file a complaint with the clinic or mark the box that says “my provider did not listen to my needs” on their patient satisfaction survey, for which I will get a meeting with the powers that be and be forced to defend myself.

I feel like this speaks to a wider systemic issue and doesn't really justify making patients go through a procedure that just doesn't seem to be all that evidence-based.