Are psychiatrists in danger of being shafted like primary care physicians

[uclakid]

you hear over and over how NPs and PAs are going to take over primary care....can psych be in danger of something similar?

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[stn2006]

good question. It does not seem like it so far, but I am wondering about the same thing.

 

[notdeadyet]

good question. It does not seem like it so far, but I am wondering about the same thing.

I notice though that a majority of the doomsday predictions for various specialties over the years always come from those outside the actual specialties.

NPs/PAs will replace FPs. Nurse anesthesists will replace Anesthesiologists. Nighthawks/offshores will replace Radiologists. Etc., etc.

But when I talk to folks actually in those fields, almost to a one they seem pretty underwhelmed about their job prospects going away. The specialties will adapt with the times, like all do, but only the real alarmists seem really concerned about their professional futures.

 

[whopper]

This is not a black and white question IMHO.

Several areas will always need a psychiatrist. Several resort to a NP because there is no psychiatrist available.

Several NPs work under a psychiatrist, and by doing so actually make the psychiatrist more money.

I do think it's possible that some specific psychiatrists may lose some business, but as far as I see it now, this is nothing to fear unless you're in an area where there's not a shortage of psychiatrists, and you're working with a patient population whose need for psychotropics is not strong.

In case you didn't know, there's very few areas where this is the situation.

 

[uclakid]

I notice though that a majority of the doomsday predictions for various specialties over the years always come from those outside the actual specialties

good point. i hope you're right.

 

[uclakid]

honestly, will any REAL doctor ever be in danger of losing his job? i think it's so stupid to think some NP is going to replace an MD. COME ON....

i'm not dreaming, right?? tell me i'm not dreaming! haha

 

[hippiedoc13]

In psychiatry it seems that the biggest scope-of-practice issue currently is not regarding PAs/NPs, but rather regarding psychologists who want prescribing privileges.

But I have to agree with those above who point out that there is such a shortage of psychiatrists in most areas, that I don't think any psychiatrist needs to worry about being out of a job.

 

[Manicsleep]

The problem really is not with PAs or NPs.

PAs in psychiatry would be great. The more the merrier in my opinion. They consistently have an excellent training program.

I think psychologists are the greatest problem. They pose a huge problem to patient safety. They claim safety based on numbers of prescriptions written (under supervision and VERY limited severity of illness treated) and a teaching program that is nothing short of a hoax.

The NP program is more difficult. I cannot judge because I have seen excellence as well as complete incompetence. If this was made just a little more stringent, the psychologists would have no leg to stand on.

 

[edieb]

After a period of time (varies from state-to-state), psychologists prescribe with no physician oversight. I am sorry that you are not compelled by facts; thankfully, many of your physician colleages (e.g., Dr Carlatt) and have supported RxP.

 

[billypilgrim37]

For the love of God, can we please not start the whole psychologist prescribing thing again? Please?

It's like watching mommy and daddy fight about Ross Perot all over again.

 

[notdeadyet]

For the love of God, can we please not start the whole psychologist prescribing thing again? Please?

It's like watching mommy and daddy fight about Ross Perot all over again.

Excellent.

 

[whopper]

Don't open this can of worms again. There's really not much we can gain out of this. The last few times this debate occurred, it seemed to me it was just about spewing out political talking points. Only thing missing were people in cheerleader outfits with loudhorns.

 

[Manicsleep]

I am not really interested in debating although I do think that physicians should be more active in the politics of medicine than we are.

To answer the OP, I think that the greatest threat that faces us at this time is our own lack of involvement however, given the shortage of psychiatrists I don't think that jobs are going to be hard to find anytime soon.

 

[ilikepsych09]

My answer will be skewed because of what stage I'm in career-wise, but I cannot imagine NPs or PAs being terribly comfortable with a purview much wider than that of a PCP who treats basic psychiatric cases, e.g., giving a depressed patient an SSRI or doing basic psychotherapy. (Certainly, many psychologists will be more adept at psychotherapy.) The cases I see in the context of a residency program/academic teaching hospital are severe, and then these patients often become outpatients for the residents. Of course, the worried well will need treaters too; but, there will not be a shortage of serious mental illness that will be beyond a PA/NP's comfort level. ...Right? Or do we think that PAs/NPs can treat most/all psychiatric cases?

 

[peppy]

Having seen a patient whose PCP spent like 20 years trying various treatments for treatment-refractory bipolar disorder before finally giving up and referring on to psych, I wouldn't underestimate how much PCPs and NPs/PAs may be willing to take on.
I do think that we should not be complacent and just assume that being a doctor means always having a job. Pathology's job market isn't particularly strong (though there are some disagreements about how bad it really is).
I personally do feel that general psych may be eventually taken over by other providers, looking at the direction of things in anesthesia and primary care (and also considering that in the future psych medications will likely become increasingly safe/effective/easy to use), but at least we do have the option of sub-specializing and finding a niche there.

 

[uclakid]

Having seen a patient whose PCP spent like 20 years trying various treatments for treatment-refractory bipolar disorder before finally giving up and referring on to psych, I wouldn't underestimate how much PCPs and NPs/PAs may be willing to take on.
I do think that we should not be complacent and just assume that being a doctor means always having a job. Pathology's job market isn't particularly strong (though there are some disagreements about how bad it really is).
I personally do feel that general psych may be eventually taken over by other providers, looking at the direction of things in anesthesia and primary care (and also considering that in the future psych medications will likely become increasingly safe/effective/easy to use), but at least we do have the option of sub-specializing and finding a niche there.

These "other providers" are going to be NPs and PAs who are going to be taking care of adolescent acne and the common cold. Fine, they might take a case of depression or two on. But that doesn't mean they'll replace general psychiatrists.

 

[zenman]

honestly, will any REAL doctor ever be in danger of losing his job? i think it's so stupid to think some NP is going to replace an MD. COME ON....

i'm not dreaming, right?? tell me i'm not dreaming! haha

Dr. Lawrence H. Climo, in his book, "Psychiatrist on the road: Encounters in healing and healthcare," describes how he was replaced by an NP in a cost-cutting measure at an inner-city mental health clinic. In any case he did locums tenens, loved it, and wrote a book. It's a good read.

 

[uclakid]

Dr. Lawrence H. Climo, in his book, "Psychiatrist on the road: Encounters in healing and healthcare," describes how he was replaced by an NP in a cost-cutting measure at an inner-city mental health clinic. In any case he did locums tenens, loved it, and wrote a book. It's a good read.

locum tenens? who cares.....right??

 

[zenman]

locum tenens? who cares.....right??

Not sure what you mean....

 

[uclakid]

Not sure what you mean....

meaning it was a temporary position to begin with

 

[markglt]

please look up locum tenens.
do not let ur ignorance be totally pervasive

 

[zenman]

please look up locum tenens.
do not let ur ignorance be totally pervasive

No, he lost a full-time, 18 yr position, then went locum. Jeez...

 

[markglt]

that was directed to the op

 

[uclakid]

please look up locum tenens.
do not let ur ignorance be totally pervasive

YEA, it means a TEMPORARY position.
Why don't you look it up.

http://www.studentdoc.com/locum-tenens.html

 

[uclakid]

No, he lost a full-time, 18 yr position, then went locum. Jeez...

Well in that case, OUCH.

 

[zenman]

Well in that case, OUCH.

It was good for him. No one should stay in one position for that long, in my opinion. But then, I'm a fan of migrant work.

 

[Manicsleep]

Locums work is contract work.
Sometimes people are hired on a locums basis for evaluation and if the job is a good fit for both parties a permanent offer is made. Also, sometimes a person is hired as locums for a permanent position until someone can be hired to fill that permanent position.

It is not necessarily temporary.

 

[markglt]

thank you doctor.
there ya go uclakid, gonna argue with an attending...
didnt think so.

and ucla, i was refering to the fact that you said it was temp., "so who cares"... seems a lil' sophmoric..i think maybe you didn't research carefully enough on climo.
lastly, ur op seems.....shall we say, rather trolly in nature.
move along..

 

[kugel]

When there are no more shortages in public-sector psychiatry, and new grads are going into the private sector "for a few years until I can get a job in public psychiatry," then I'll worry.

Right now we are opening a PA Psychiatry Fellowship at our county psych hospital and I can't wait! Love the energy and the questions, and I love teaching. The PA's coming out the Community College here are extremely well prepared. We have interest from PA students who have no intention of going into a career in psych, but who want to learn more because they realize they will be dealing with psych in one form or another in any field.

 

[Manicsleep]

When there are no more shortages in public-sector psychiatry, and new grads are going into the private sector "for a few years until I can get a job in public psychiatry," then I'll worry.

Right now we are opening a PA Psychiatry Fellowship at our county psych hospital and I can't wait! Love the energy and the questions, and I love teaching. The PA's coming out the Community College here are extremely well prepared. We have interest from PA students who have no intention of going into a career in psych, but who want to learn more because they realize they will be dealing with psych in one form or another in any field.

I have found that PAs consistently have excellent training and wish there were more in the psychiatric field.

 

[notdeadyet]

Right now we are opening a PA Psychiatry Fellowship at our county psych hospital and I can't wait! Love the energy and the questions, and I love teaching. The PA's coming out the Community College here are extremely well prepared.

The PA is a master's level degree, no?

 

[uclakid]

thank you doctor.
there ya go uclakid, gonna argue with an attending...
didnt think so.

and ucla, i was refering to the fact that you said it was temp., "so who cares"... seems a lil' sophmoric..i think maybe you didn't research carefully enough on climo.
lastly, ur op seems.....shall we say, rather trolly in nature.
move along..

I think you are the troll with your useless post.

 

[Doc Samson]

Quit the bickering - back to the topic or the lock looms.

 

[markglt]

yes sir.

 

[mgdsh]

Overtime mid levels will replace physicians wherever possible through out the field of health care. Those that are in charge and making decisions about the direction of medicine simply care more about extending the reach of it vs. the quality.

At some point in the next 10 years, health care will be rationed.It benefits everyone involved, except the patients and the physicians that mid levels continue to be integrated.

At the end of it, they will only be paying physicians to oversee the mid levels and visit with only the most complicated of all patients.

We have insurance companies with the incentive to book as much profit as possible and a government that has the incentive to cut as much cost as possible.

 

[Manicsleep]

Overtime mid levels will replace physicians wherever possible through out the field of health care. Those that are in charge and making decisions about the direction of medicine simply care more about extending the reach of it vs. the quality.

At some point in the next 10 years, health care will be rationed.It benefits everyone involved, except the patients and the physicians that mid levels continue to be integrated.

At the end of it, they will only be paying physicians to oversee the mid levels and visit with only the most complicated of all patients.

We have insurance companies with the incentive to book as much profit as possible and a government that has the incentive to cut as much cost as possible.

I agree with most of what you say.
However, government cares not as much about cutting cost as about the appearance of cutting cost and getting votes as a result. Mid levels will rule because there will be more of them and physicians will play the role of taking on liability.
A second tier health system will emerge and that is the only place that physicians will have any power left. This will not happen in 10 years but the start is already happening across the country in managed care centers and government run medical facilities. With regard to psychiatry, I often wonder how much technology has a role to play in the future of the field.

 

[Psychiatrypd]

you hear over and over how NPs and PAs are going to take over primary care....can psych be in danger of something similar?

If you are passionate about what you do, good at it, and willing to take care of more seriously ill patients, you will always have a job. There is still a huge shortage of psychiatrists in this country. It is difficult work. Few people are willing to do it, and fewer still do their best, every day. There will always be room for a good psychiatrist. Go into the field that you love best, develop your skills, and keep learning. If you do that, you will have a choice of jobs.

 

[uclakid]

If you are passionate about what you do, good at it, and willing to take care of more seriously ill patients, you will always have a job. There is still a huge shortage of psychiatrists in this country. It is difficult work. Few people are willing to do it, and fewer still do their best, every day. There will always be room for a good psychiatrist. Go into the field that you love best, develop your skills, and keep learning. If you do that, you will have a choice of jobs.

I like what you say, however according to the posts immediately before yours it seems as if mid-levels really are closing in....and taking on "more seriously ill" patients is just an extreme of the spectrum. I'd love to do it, but what about the more common cases?

 

[Sneezing]

It will all boil down to money and who is paying, but with a pinch of risk thrown in.

Inpatient units will need to cut costs. If any happen to have midlevels running around they will be booted and their workload will be dumped upon the remaining psychiatrists. The severity/complexity of cases will require this training and the idea of firing the psychiatrists to have an entire "staff" of midlevels just wouldn't fly. Don't forget the legal issues of hospital discharge. First thirty days out of hospitalization is suicide risk. Lawyer: "really, Mr. PA and 'Doctor' Nurse, you were the most qualified person to treat my now deceased client?" Inpatient units won't go down that path.

Outpatient will depend entirely on the money and not on the risk like inpatient. Who pays sets the standards. So, I predict some psychiatrists will stick it out and work for the same salary as a midlevel plus a little extra change to be the manager and weekend call b*tch. But the total salary will not be worth the amount of schooling, training, and extra hours when compared to the midlevels. So, yes, midlevels will be taking over the ship, but you have to realize the ship is the sinking Titanic and the upper class who get the life raft* will be the psychiatrists.

*The life raft: The remaining option is to open a private practice and make what the market will allow. You will see a re-emergence of full spectrum psychiatry with therapy, and niche psychiatrists, too. No guarantees this will be a rosy future, but it will be far better than the over regulated, minute formulary, insurance controlled world of the sinking Titanic you just left. This is the future. The government is broke and going to squeeze every penny out of healthcare it can regardless of quality. It will never have a complete take over healthcare, because it will eventually go bankrupt, and when it does the only care anyone will get will be out of charity or cash...

 

[DebDynamite]

Come spend an evening in the psych ER where I train, and you will have no doubt that the answer is no. And as the psychotic baby-boomers age, the answer will be, hells no. You feel me ( ooh I hate that one)?