Choosing first job (psychiatric nurse practitioner)

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petuniajoelle

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Hello Psychiatry! I am a soon-to-be brand new PMHNP graduating this month. I have applied to many jobs in multiple states and have received much interest. I have no loans due to a scholarship. My search is flexible to multiple states, and I already have offers from a few of the interviews I've done. Places also are paying to have me visit and check out their site and do interviews, which is awesome, but also makes me feel kind of guilty, because I can't say yes to them all.

I also just feel weird about the whole thing. There is so much demand and so many places have locums right now and are looking to hire someone on full-time. I feel sort of guilty about the state of society... like I wish there were more people like me willing to move to fill psychiatric need. I can only go to one place!

I don't know how to choose a first job. Choice paralysis.

So, I don't really have a specific question. It's more like the broad topic of: what were your experiences with a first job, if you care to share? What do you think is important to look for? Did you relocate for a job or for residency, and what did you learn or take away from that? What would you have done differently?

Thank you for sharing.
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I hear that, but also wanted to post in a place where people are familiar with the psychiatry market. At least in my part of the country it seems like psychiatry is in particular need compared to other specialties.
 
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Paralysis by analysis. You likely won't be at your first job more than a year or two. Pick a location as a jumping off point and move on from there.
 
Get a job that has a talented psychiatrist you can continue to learn from. Locum right out of school isn't great for psychiatrists or NPs so I would displace a locum somewhere there are talented practitioners. Who supervises you is more than half of the picture when finding a job.
 
MacDonaldTriad said:
Get a job that has a talented psychiatrist you can continue to learn from. Locum right out of school isn't great for psychiatrists or NPs so I would displace a locum somewhere there are talented practitioners. Who supervises you is more than half of the picture when finding a job.
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I sort of agree. With NP's it's flat necessary. But for me I need boutique supervision. I don't need some @sshole with 20 years of dumb experience to supervise me. I'd leave that job immediately. I want a place where if I respect someone I hope there's a collegial atmosphere that I can consult them. Further I want supervision in specific techniques. I can think of many attending that I've seen where I wouldn't ask them anything pertaining to the skills of the job. In that I already thought that as a 2nd year resident.

Now the thing is. That doesn't pertain to you guys. Who I'd be happy to learn from. I mean... do the math for a minute. I'm sure you can think of at leas a significant portion of your residency classes or even former colleagues that you wouldn't and didn't consult for anything.

So, I'm either a cocky bastard or I'm delusional. or both. But that's how i'm rolling.
 
Nasrudin said:
I sort of agree. With NP's it's flat necessary. But for me I need boutique supervision. I don't need some @sshole with 20 years of dumb experience to supervise me. I'd leave that job immediately. I want a place where if I respect someone I hope there's a collegial atmosphere that I can consult them. Further I want supervision in specific techniques. I can think of many attending that I've seen where I wouldn't ask them anything pertaining to the skills of the job. In that I already thought that as a 2nd year resident.

Now the thing is. That doesn't pertain to you guys. Who I'd be happy to learn from. I mean... do the math for a minute. I'm sure you can think of at leas a significant portion of your residency classes or even former colleagues that you wouldn't and didn't consult for anything.

So, I'm either a cocky bastard or I'm delusional. or both. But that's how i'm rolling.
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This sounds pretty reasonable and doesn't sound delusional to me. 20 years of practice in any field does not automatically equate to any of the following: a) expertise or special knowledge in the field, b) practices, habits, or approaches that should necessarily be replicated and adopted or c) that the person knows anything about teaching, mentoring, or supervision. I would argue that a minority of practicing physicians are both strong clinically and in knowledge base, and are simultaneously well-equipped to mentor and teach the next generation. Some of these individuals are in academia, but many are sprinkled around the country in different practice settings. It's on us as new or relatively new graduates (and/or NP's and/or PAs, etc) to seek out and find expert mentors who can help us continue to grow and develop beyond training. These forums are great but are not a substitute for in-person learning and mentorship which I feel is critical, especially in this field.

Going solo and putting blinders on from day 1 after residency (or after training as NP, etc) sounds like a great way to end up as one of those infamous clinicians 20+ years out with ineffective or even unsafe, outdated practices...
 
MacDonaldTriad said:
I agree, (not the cocky bastard or delusional part) it is easy to find mentors to learn bad psychiatry from. It is important to tell who to model from and who to ignore.
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Which is particularly problematic with the hoards of new psychNPs who have zero psych experience. They don't know who is skilled because they have no clue what medications should be prescribed. They haven't seen the differences over the course of time on an inpatient unit with multiple psychiatrists when it becomes very clear who knows what they are doing based on how their patients fare.

Unfortunately it seems some of the less skilled psychiatrists tend to be the loudest, narcissistic pontificators and to the unaided eye I guess that seems brilliant. The bottom line especially for NPs and I have seen it repeatedly is that you will learn your prescribing style from your mentor and if your mentor writes crap you will also.
 
This is very helpful, thank you. One organization just told me they won't consider me until I'm licensed in the state. This makes me wonder if I should just pick a state, get licensed there, and go from there. At the same time, many places do seem very willing to interview/hire me with the contingency of getting licensed in their state.

I'm basically looking at OR, WA, CA, and AZ.
 
Jules A said:
Which is particularly problematic with the hoards of new psychNPs who have zero psych experience. They don't know who is skilled because they have no clue what medications should be prescribed. They haven't seen the differences over the course of time on an inpatient unit with multiple psychiatrists when it becomes very clear who knows what they are doing based on how their patients fare.

Unfortunately it seems some of the less skilled psychiatrists tend to be the loudest, narcissistic pontificators and to the unaided eye I guess that seems brilliant. The bottom line especially for NPs and I have seen it repeatedly is that you will learn your prescribing style from your mentor and if your mentor writes crap you will also.
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I'll go ahead and take it one step further in the direction of the distinctly politically incorrect: stupid don't know what ain't stupid.

In other words. On average, our IQ is higher. You have to have a minimum amount of intelligence, creativity, industrious and openness to understand and respond to the call of what the role could be. Rather than what will get you paid to do it.

The only thing NP's and Physicians are probably equal on as population samples are openness and agreeableness as vaguely the sort of people who would dedicate themselves to a health care profession.

Averages. Exceptional people are everywhere.

I'd say there's proabably roughly the same difference between social workers and psychologists.
 
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petuniajoelle said:
Hello Psychiatry! I am a soon-to-be brand new PMHNP graduating this month. I have applied to many jobs in multiple states and have received much interest. I have no loans due to a scholarship. My search is flexible to multiple states, and I already have offers from a few of the interviews I've done. Places also are paying to have me visit and check out their site and do interviews, which is awesome, but also makes me feel kind of guilty, because I can't say yes to them all.

I also just feel weird about the whole thing. There is so much demand and so many places have locums right now and are looking to hire someone on full-time. I feel sort of guilty about the state of society... like I wish there were more people like me willing to move to fill psychiatric need. I can only go to one place!

I don't know how to choose a first job. Choice paralysis.

So, I don't really have a specific question. It's more like the broad topic of: what were your experiences with a first job, if you care to share? What do you think is important to look for? Did you relocate for a job or for residency, and what did you learn or take away from that? What would you have done differently?

Thank you for sharing.
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pick a job based on pay, pt load, lifestyle, etc....same as anything else
 
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wolfvgang22 said:
You may get better responses in the NP forum.
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most of them are going to be not geared towards her specialization. She has far far more in common with us psychs as a psych np than she would a non-psych np.
 
vistaril said:
most of them are going to be not geared towards her specialization. She has far far more in common with us psychs as a psych np than she would a non-psych np.
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just like we have far far more in common with her/him than a pathologist, nephrologist, neurologist, etc
 
Nasrudin said:
I'll go ahead and take it one step further in the direction of the distinctly politically incorrect: stupid don't know what ain't stupid.

In other words. On average, our IQ is higher. You have to have a minimum amount of intelligence, creativity, industrious and openness to understand and respond to the call of what the role could be. Rather than what will get you paid to do it.

The only thing NP's and Physicians are probably equal on as population samples are openness and agreeableness as vaguely the sort of people who would dedicate themselves to a health care profession.

Averages. Exceptional people are everywhere.

I'd say there's proabably roughly the same difference between social workers and psychologists.
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I spend a lot of time trying to explain the principle of group differences to undergrad students. They love to say things like, "but I know a doctor who is really dumb and an NP who was really smart."
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smalltownpsych said:
I spend a lot of time trying to explain the principle of group differences to undergrad students. They love to say things like, "but I know a doctor who is really dumb and an NP who was really smart."
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I hear you. It always puzzles me why this is not obvious. It's not exactly a complex idea. As if a black guy with a small penis is some kind of incomprehensible phenomenon.
 
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Well, I went through college and my master's degree entirely on scholarship and will be a PMHNP at age 24. I also have had my own mental health struggles, have received additional training in therapy, and speak Spanish. I'm pretty happy with how my intelligence level has worked for me so far. I think I also have humility to ask for help and seek lots of supervision and consultation. So maybe the average psychiatrist is smarter than me. Doesn't really help me know how to pick a job. But thanks for your response to my post! 🙂
 
petuniajoelle said:
Well, I went through college and my master's degree entirely on scholarship and will be a PMHNP at age 24. I also have had my own mental health struggles, have received additional training in therapy, and speak Spanish. I'm pretty happy with how my intelligence level has worked for me so far. I think I also have humility to ask for help and seek lots of supervision and consultation. So maybe the average psychiatrist is smarter than me. Doesn't really help me know how to pick a job. But thanks for your response to my post! 🙂
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OK. So... negotiations for jobs have to begin right there. Be confident in what you can offer. Know your value. We are the resource movers in healthcare. For instance, the janitor who cleans the office building. The MBA who runs the clinic. That pharmacist who fills the rx. The office clerk who does the scheduling. The accountant who organizes the billing. The government agencies who provide benefits, that the taxpayers have given mandate to. The teachers who teach in healthcare schools. The companies that make the drugs. The sales person who provides the clinic with supplies. etc. etc. All of them. All. Of. them. Are in business providing for their families because we... meet the patients and provide a service to them. We are the movers of this industry.

So. You have to pick work that places you in the best position to move your business to the next level. And rather NP or SW'er or psychiatrist... those among us who think entrepreneurially... rather employed or independent... will make the best job choices.

So in your case you may want to pick a job that helps you collaborate with talented people.

Don't feel guilty about a damn thing. That's the angst of the hyper-agreeable personality. You didn't decide how society values the care of it's mentally ill. And in fact, in my opinion, it's the legion of hyper-agreeable, guilt ridden people in government who have created much of the the unproductive demand for mental health services. Disabuse yourself of the notion that demand necessarily means suffering.

Think about your career as an independent, entrepreneurial activity that is the vehicle you drive through the market providing for your family and becoming the better and better product for your patients.

Stagnation could happen at a poorly run public clinic. Or a swanky private practice.

Your location choice should be what makes you happy. Remember. You are the product. People don't need a stagnant, unenthusiastic, passionless turd of a product. They need someone who lives life as richly and as meaningfully as possible.

After you pick the location. Look for the best personal and professional development option.

Residents will have seen thousands more patients than you and worked in a guild system where they will have seen many more examples of how you can operate in this sphere. So recognize that you lack that experience.

My point about intelligence pertains to my interest in psychological research. And how much intelligence is the underlying determinant factor in so many of the unrelated studies. If you have the juice you will automatically sense when a supervisor is a limiting influence or a force multiplier in you own pursuit of excellence. To the extent that we are either, not that smart, or not motivated for excellence, these things wouldn't occur to us. And in that case... it's a simple matter of salary and benefits analysis.

Think of me playing the game at middle age an several hundred thousand dollars of debt at 7 points of interest or so. You think I'm sampling the sdn crowd for how to conduct my operations. F no. I'm learning for the sharpest aspects of entrepreneurial cultures, the sharpest elements of human performance industries, and the most creative ideas I can wrap my mind around. Because, I'm looking to win. My own way. Creatively. With passion and limitless curiosity and enthusiasm about this work we do.

So I come here for certain types of knowledge. And have been lucky to make good mentoring relationships here. But I am always looking for the cutting edge of my own operation. Of my own product... me.

So I might take the highest paying job in one domain, and negotiate like a wall street guy, to push that to the fullest, so that I can afford the space and time to pursue my own ongoing development in another domain. To service my debt. And to create my own business. But overall I'm looking to develop the highest quality, most innovative product, I can deliver.

A job is a thing where I run my own business within the structure of an organization. You might need that to be a developmental relationship to get to minimum competence. I'm already competent and have had the benefit of mentors in our guild system. So that I don't need that from employment. I'd rather negotiate hard and take my resources to the open market for tailored, bespoke, skill development. So. That may be something you're not ready for or don't have the experience or drive to recognize as important yet.

I wasn't being pointlessly rude with the intelligence point. Your decisions along these lines will track your intelligence and motivations.
 
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If I were a new psych NP, I would ignore $ for my first job. I would seek out the best psychiatrist to learn from which will admittedly be quite difficult. If unable, I would take a higher paying job that is located near a talented psychiatrist, and I would pay that psychiatrist for educational time. I say that because in my experience the better psychiatrists tend to congregate in academics and cash practices where finding a job is much more difficult. These psychiatrists have first recognized that quick appointments while lucrative are not adequate for high quality care.

The goal is to develop knowledge beyond other psych NP's. Once knowledge is superior to most others in the field, better pay/lifestyle jobs will open up as demand will come to you.
 
To summarize this thread, congratulations, you have just managed to slip yourself into the lowliest position of a lucrative field and you have a script pad ready to do great good or harm. You need to continue to strive for excellence. I have met NPs who know ten times more than our residents, but they live in academic centers and have been bathed in the best mentor environs that exist. You end up behaving like those around you no matter how principled you think you are. If you catch yourself using the noun "respect" as a verb, time to move on. (this was purposely nasrudtionian inspired hyperbolic)
 
I appreciate your point about the hyper-agreeable personality, and about seeing myself as an entrepreneur. This definitely aligns well with my interest in personal finance and the gender wage gap. I found a job that offers 0.8 FTE w/ full benefits that would allow me to stay in the metro area that I'm in and give me the chance to have a fifth day each week to seek additional mentorship, or perhaps work a few hours a week with non-underserved populations, as my scholarship requires me to take a job working with underserved populations at least 32 hours per week for two years. The position itself doesn't offer a ton of supervision (HR states there would be mentorship but I'm skeptical- it would mostly be by phone with psychiatrists and psych NPs would work at other locations).
 
TexasPhysician said:
If I were a new psych NP, I would ignore $ for my first job. I would seek out the best psychiatrist to learn from which will admittedly be quite difficult. If unable, I would take a higher paying job that is located near a talented psychiatrist, and I would pay that psychiatrist for educational time. I say that because in my experience the better psychiatrists tend to congregate in academics and cash practices where finding a job is much more difficult. These psychiatrists have first recognized that quick appointments while lucrative are not adequate for high quality care.

The goal is to develop knowledge beyond other psych NP's. Once knowledge is superior to most others in the field, better pay/lifestyle jobs will open up as demand will come to you.
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Well said but probably near impossible for the new breed of NPs who never worked as a RN and therefore have no clue how to identify a good psychiatrist from a lousy one.
 
I think if I were in your shoes as a new NP, I would be asking during job interviews about who would be supervising me and signing off on notes and decisions - specifically, who, and when, and how. Details, not generalities. If at all possible, I would try to meet the psychiatrist(s) I'd be working with. If it's a good psychiatrist they should want to meet with a potential new NP who they would be supervising, particularly if the employer is savvy enough to give the psychiatrist some say in the hiring process. A thoughtful employer would want two high-expense, difficult-to-recruit employees to get along reasonably well before diving into a decision that could make both individuals miserable and want to leave. Of course, if there's no meaningful mentorship relationship and supervision is an automatic rubber-stamp on notes and clinical decisions, then the above is moot, and there's not much opportunity for the new NP to learn, creating a difficult and potentially dangerous situation for everyone involved. If I was a new NP, I would want my supervision and staffing to be robust and organized, ideally scheduled and included as part of the job description, and I would want to be questioned and checked on difficult or controversial/high risk decisions. Thus, I think you need a psychiatrist supervisor who is not only clinically strong and up-to-date on best practices, but who is also interested and invested in collaboration, discussion, and education. I feel like this would be one of the most important components of the job search for an early career NP.

If you get to meet the psychiatrist(s) you'll be working with, you may get some sense of their personality, approach to care, approach to supervision, and whether you can work with them interpersonally. Meeting them in person or at least by phone could also provide a chance for red flags to go up to help you look elsewhere - i.e. "Oh, you'll be the new nurse on the team, just send me the notes and I'll sign them." or "I don't know why they make me do this, I didn't sign up to teach nurses to do my job." or "Great, I have some patients I don't want to see any more, we'll get you started with them."
 
petuniajoelle said:
I appreciate your point about the hyper-agreeable personality, and about seeing myself as an entrepreneur. This definitely aligns well with my interest in personal finance and the gender wage gap. I found a job that offers 0.8 FTE w/ full benefits that would allow me to stay in the metro area that I'm in and give me the chance to have a fifth day each week to seek additional mentorship, or perhaps work a few hours a week with non-underserved populations, as my scholarship requires me to take a job working with underserved populations at least 32 hours per week for two years. The position itself doesn't offer a ton of supervision (HR states there would be mentorship but I'm skeptical- it would mostly be by phone with psychiatrists and psych NPs would work at other locations).
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Ah, Nurse Corps or NHSC, I'm guessing? I was in your position. I took a job that qualified that offered me a ton of supervision. I cannot stress this enough: do not take a job that doesn't offer you supervision. Have the supervision written into your contract. I have 2.5 hours a week and I rotate psychiatrists at my facility. I have learned so much (coming up on ~2 years of practice) it's crazy. Do not skimp on strong supervision from knowledgeable psychiatrists as a new NP, it is the absolute most essential thing you can do for your career and the patients you serve. I am guessing you are looking to work with undeserved populations (given your scholarship) in a community mental health setting - these are some of the sickest individuals, both medically and psychiatrically. Don't underestimate the medical issues, they come up all the time in complicated ways. You will need the help. Also, it will set you far, far apart from other NPs. To emphasize my point, I interviewed for a per diem gig and the psychiatrist started asking me clinical questions and I could tell that other psych NPs he had interviewed had been terrified/had difficulty answering questions - it was very simple for me to answer his clinical questions because of the complicated cases I deal with and the amount of support I've had these few years. They offered me the position 10 minutes after my interview. Take a lower paying job that will give you the skills you need to set yourself up as an excellent PMHNP, that's my advice. Once you are highly skilled/trained the world will be your oyster.

Also, do anything to make yourself uniquely qualified (suboxone training and waiver for example, as well as experience in addiction). MAT is the future and I think the need for competent addiction med specialists is going to skyrocket.
 
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AnnoyedByFreud said:
Ah, Nurse Corps or NHSC, I'm guessing? I was in your position. I took a job that qualified that offered me a ton of supervision. I cannot stress this enough: do not take a job that doesn't offer you supervision. Have the supervision written into your contract. I have 2.5 hours a week and I rotate psychiatrists at my facility. I have learned so much (coming up on ~2 years of practice) it's crazy. Do not skimp on strong supervision from knowledgeable psychiatrists as a new NP, it is the absolute most essential thing you can do for your career and the patients you serve. I am guessing you are looking to work with undeserved populations (given your scholarship) in a community mental health setting - these are some of the sickest individuals, both medically and psychiatrically. Don't underestimate the medical issues, they come up all the time in complicated ways. You will need the help. Also, it will set you far, far apart from other NPs. To emphasize my point, I interviewed for a per diem gig and the psychiatrist started asking me clinical questions and I could tell that other psych NPs he had interviewed had been terrified/had difficulty answering questions - it was very simple for me to answer his clinical questions because of the complicated cases I deal with and the amount of support I've had these few years. They offered me the position 10 minutes after my interview. Take a lower paying job that will give you the skills you need to set yourself up as an excellent PMHNP, that's my advice. Once you are highly skilled/trained the world will be your oyster.

Also, do anything to make yourself uniquely qualified (suboxone training and waiver for example, as well as experience in addiction). MAT is the future and I think the need for competent addiction med specialists is going to skyrocket.
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This is extremely helpful feedback. My real passions are addiction/substance-abuse treatment, eating disorder treatment, EMDR, trauma therapy, intergenerational trauma/intersections between sociology and psychiatry. Love the idea of MAT. It is NURSE Corps, and I'm finding addiction treatment jobs, but none that offer much supervision in the region I'm looking at (NW/SW). I know it's nothing compared to the role I'll be taking on soon, but I do have equivalent of a year full time experience as a psych RN. Please feel free to PM me if you know of any organizations that might fit this bill, if you know of any from your search. Thank you!
 
You're probably not going to like what I am going to say here, but, well, you did come to a physician forum, so here's an honest opinion:

If you were coming to work with me, quite frankly, I would refuse to have anything to do with training you. I feel no obligation to help people take shortcuts to do my job. Would you help a HUC with no nursing experience who thought she could just kind of wing it and learn how to be a nurse by just asking for some tips from RNs while working as a nurse herself? That's what it looks like to me when NPs think they can do my job but expect me to help them learn how.

I suspect the reason you're not finding jobs that offer supervision is because other than CA, those states you're looking at allow NPs to practice independently. NP advocacy groups have convinced legislators in places like WA and OR that NPs don't need supervision. In theory, you were supposed to be trained for your job by the training program you went through, not by finding a random doctor who feels sorry for you and/or your patients.

It's a very sad state of affairs when vulnerable patients are seeing people for care who really are not prepared to deal with their issues. Since you mention having your own mental health struggles, I also question how much training you've been given on how to maintain healthy boundaries - which is a very crucial aspect of doing good psychiatric care and hard to learn on the fly in a short period of time.

But, hey, NP groups keep telling me that they have "the heart of a nurse and the brain of a doctor". Let's see how that holds up once malpractice attorneys catch on to how poorly trained so many NPs are nowadays.
 
I am an MD and just want to say that the fact that you are going into psychiatry as an NP with zero residency work is extremely disturbing. Additionally, crashing an MD forum for job advice seems also in line with the presumption that you can do anything an MD can do -- which is not true. College and a master's degree -- typically, for NPs, in fluff courses -- does not equate with developing daily expertise in medical psychiatry through the intensive bedside work that residents have to go through. NPs, however, will never admit this -- despite the fact that the data shows they order excessive tests, the wrong tests, the wrong meds... And I'm sorry, but speaking Spanish and having your own psychiatric issues don't equate with medical expertise either.
 
Is this post for real? Do we really have 24 yo NPs who think that because they have had their own mental health struggles and can speak Spanish they are qualified to practice psychiatry? God bless her future patients. This is a nightmare. As physicians, what are we doing to stop this? We need to be lobbying for more residency training. Patients deserve highly trained physicians. This is absolutely terrifying. Please educate your patients about the VAST differences in education and training between these para-physicians and real physicians. I feel absolutely horrified for patients reading this.
 
Thank you all for being so open about your points of view! Best wishes to you all as well.
 
vkrn said:
I am an MD and just want to say that the fact that you are going into psychiatry as an NP with zero residency work is extremely disturbing. College and a master's degree -- typically, for NPs, in fluff courses -- does not equate with developing daily expertise in medical psychiatry through the intensive bedside work that residents have to go through. the fact that the data shows they order excessive tests, the wrong tests, the wrong meds...
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These are the reasons that posts above more tactfully mentioned the importance of furthering education with quality psychiatrists.

The most dangerous part about being a NP is not knowing what you don't know. Starting off with quality supervision is an absolute must, or there may be plenty of harm done.
 
AnnoyedByFreud said:
Ah, Nurse Corps or NHSC, I'm guessing? I was in your position. I took a job that qualified that offered me a ton of supervision. I cannot stress this enough: do not take a job that doesn't offer you supervision. Have the supervision written into your contract. I have 2.5 hours a week and I rotate psychiatrists at my facility. I have learned so much (coming up on ~2 years of practice) it's crazy. Do not skimp on strong supervision from knowledgeable psychiatrists as a new NP, it is the absolute most essential thing you can do for your career and the patients you serve. I am guessing you are looking to work with undeserved populations (given your scholarship) in a community mental health setting - these are some of the sickest individuals, both medically and psychiatrically. Don't underestimate the medical issues, they come up all the time in complicated ways. You will need the help. Also, it will set you far, far apart from other NPs. To emphasize my point, I interviewed for a per diem gig and the psychiatrist started asking me clinical questions and I could tell that other psych NPs he had interviewed had been terrified/had difficulty answering questions - it was very simple for me to answer his clinical questions because of the complicated cases I deal with and the amount of support I've had these few years. They offered me the position 10 minutes after my interview. Take a lower paying job that will give you the skills you need to set yourself up as an excellent PMHNP, that's my advice. Once you are highly skilled/trained the world will be your oyster.

Also, do anything to make yourself uniquely qualified (suboxone training and waiver for example, as well as experience in addiction). MAT is the future and I think the need for competent addiction med specialists is going to skyrocket.
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In what world are you living? MAT is standard of care (not the future), and there's a well documented need for addiction providers. This leads me to another issue... In addition to the above, for someone to be skilled and practice well, he or she should be reading constantly about clinical questions and new literature (which NPs generally don't do) because they 1) are trained to practice mechanically and 2) don't know what they don't know.

So yes, the overarching theme of this thread is that the "quality" of the NP is going to be largely dependent on what he or she sees the experienced psychiatrist do (without really understanding why it's done)
 
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HarryMTieboutMD said:
In what world are you living? MAT is standard of care (not the future), and there's a well documented need for addiction providers. This leads me to another issue... In addition to the above, for someone to be skilled and practice well, he or she should be reading constantly about clinical questions and new literature (which NPs generally don't do) because they 1) are trained to practice mechanically and 2) don't know what they don't know.

So yes, the overarching theme of this thread is that the "quality" of the NP is going to be largely dependent on what he or she sees the experienced psychiatrist do (without really understanding why it's done)
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Ouch, looks like I touched a nerve. so, when I say "MAT is the future", I mean legislation is moving towards incorporating PAs/NPs into using it in our practice. We recently are able to rx Suboxone for addiction, for example. Also, many grants exist now to push MAT (as opposed to abstinence only). Obviously anyone who pays attention to addiction medicine knows that MAT is crucial, but I mean from a legislative perspective there is more support for including NPs in that domain, and a push away from abstinence towards harm reduction more generally.

As for the rest of your post... to each their own? We read articles and talk about recent research during my supervision. All the NPs I know attend conferences and read/update their knowledge. Frankly, I know some older docs who don't do this and really should. I don't see how physicians have a monopoly on continuing education or thinking critically about research.
 
AnnoyedByFreud said:
Ouch, looks like I touched a nerve. so, when I say "MAT is the future", I mean legislation is moving towards incorporating PAs/NPs into using it in our practice. We recently are able to rx Suboxone for addiction, for example. Also, many grants exist now to push MAT (as opposed to abstinence only). Obviously anyone who pays attention to addiction medicine knows that MAT is crucial, but I mean from a legislative perspective there is more support for including NPs in that domain, and a push away from abstinence towards harm reduction more generally.

As for the rest of your post... to each their own? We read articles and talk about recent research during my supervision. All the NPs I know attend conferences and read/update their knowledge. Frankly, I know some older docs who don't do this and really should. I don't see how physicians have a monopoly on continuing education or thinking critically about research.
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You've missed the salient points of our training. And displaced that unto what are your own individual characterteristics and then conveniently re-extrapolated that back towards the mean. Acting as if the area under the curve doesn't exist.

You're individual characteristics put you on the flat part of your respective curve. Which puts you somewhere towards the mean or perhaps even above of ours.

What we have a monopoly on is the hard work of seeing thousands of patients before we set out on our own. There are more subtleties to our guild than that, but that carries the bulk of it's weight. There are no short cuts in other words.

The type of people who take the short cut don't suddenly become the type of people who don't. Then if you consider that there are many who take the short cut because they're not even capable of our route and there you have it.

If you think you're covering the distance with a couple hours of periodic supervision. Think again.

You're catching up with our ******s in the distance and thinking you've closed in on our pace setters.
 
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Nasrudin said:
You've missed the salient points of our training. And displaced that unto what are your own individual characterteristics and then conveniently re-extrapolated that back towards the mean. Acting as if the area under the curve doesn't exist.

You're individual characteristics put you on the flat part of your respective curve. Which puts you somewhere towards the mean or perhaps even above of ours.

What we have a monopoly on is the hard work of seeing thousands of patients before we set out on our own. There are more subtleties to our guild than that, but that carries the bulk of it's weight. There are no short cuts in other words.

The type of people who take the short cut don't suddenly become the type of people who don't. Then if you consider that there are many who take the short cut because they're not even capable of our route and there you have it.

If you think you're covering the distance with a couple hours of periodic supervision. Think again.

You're catching up with our ******s in the distance and thinking you've closed in on our pace setters.
Click to expand...

Nowhere did I say I was comparable to the physician, so not really sure what you’re getting at as I don't feel like I'm closing in on anyone. If you need to believe that there is always a qualitative difference between MDs and NPs, have at it. I have to laugh and wonder though - did you ever consider that some highly intelligent people might choose to become an NP because of the excellent pay and work/life balance? The obsession with IQ in this thread is entertaining, but I wonder if you would be surprised to learn that some intelligent people might actually value the NP due to its flexibility and cost/benefit ratio. Generally, I would say it is highly likely that a random physician will have a higher IQ than a random NP though - I agree with that.
 
yeah. the what to do and why of first NP job seeking has been covered. I have a lazy, if intelligent horse in the race of NP/physician politics.

I'm chasing the best psychiatrist nasrudin can be. Because here's another non-PC notion. Hierarchies of competence are selective and healthy. I think it's a good thing that it's difficult to become a physician for this reason. And so I'm making that point only.

If I piss off AbyF.... she'll just get better. Same as me.
 
Nasrudin said:
yeah. the what to do and why of first NP job seeking has been covered. I have a lazy, if intelligent horse in the race of NP/physician politics.

I'm chasing the best psychiatrist nasrudin can be. Because here's another non-PC notion. Hierarchies of competence are selective and healthy. I think it's a good thing that it's difficult to become a physician for this reason. And so I'm making that point only.

If I piss off AbyF.... she'll just get better. Same as me.
Click to expand...

Oh, I'm not pissed. I actually enjoy healthy debate. I know what to expect when I post on SDN as an NP anyway, and it sure isn't hugs and kisses.
 
northernpsy said:
If you were coming to work with me, quite frankly, I would refuse to have anything to do with training you.
Click to expand...

I will soon start looking for my first post residency gig, and one thing I have learned here and I am certain of is that I will not take any job where I am expected to supervise and train an NP. The current thread about the guy who learned the first day on the job he was supervising a wet behind the ears NP would have been my last day on that job.

I am freaked out enough over my own liability, so there is no way in hell I will ever let some NP drag me down into a liability hole. I will open a solo practice if necessary to avoid this.
 
Psychotic said:
I will soon start looking for my first post residency gig, and one thing I have learned here and I am certain of is that I will not take any job where I am expected to supervise and train an NP. The current thread about the guy who learned the first day on the job he was supervising a wet behind the ears NP would have been my last day on that job.

I am freaked out enough over my own liability, so there is no way in hell I will ever let some NP drag me down into a liability hole. I will open a solo practice if necessary to avoid this.
Click to expand...

I hear you. Liability is one thing. The other thing is what's the benefit? You're just pimping yourself. I'd rather put the time into exercise. Reading. Attending some lecture at the local psychotherapy institute. Training a psychiatry resident. Why would you want to transmit the art of your practice to those who haven't earned it?

For me liability is on the very bottom end of why I come to the same conclusion as you.
 
I would want to transmit the art of my practice whether they "earned it" or not because either way they will be out in the world treating thousands of patients over a career...


Sent from my iPhone using SDN mobile
 
3lefts said:
I would want to transmit the art of my practice whether they "earned it" or not because either way they will be out in the world treating thousands of patients over a career...


Sent from my iPhone using SDN mobile
Click to expand...

And that is exactly how they've come to exist as a profession. Grifting off the efforts of psychiatrists--or whatever specialist they presume to mimic the specialty of, without even a basis from which to specialize. Monkey-see-monkey-doing it on the job. By the agency of some slapstick, half-hazard, half-baked notion of The Greatest Good For the Greatest Number. Whereas I'm of the opinion is that this stuff done shabbily would be better off not done at all.
 
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3lefts said:
I would want to transmit the art of my practice whether they "earned it" or not because either way they will be out in the world treating thousands of patients over a career...

Sent from my iPhone using SDN mobile
Click to expand...

If you're volunteering your time, I can connect you with many primary care physicians and NPs who would appreciate a mentor and 1:1 educator to guide them as they treat thousands of psychiatric patients over the course of their careers. Would probably benefit many thousands of people who might otherwise go without safe, evidence-based psychiatric care. Without your help, these patients could be consigned to receiving unnecessary benzodiazepines, unwarranted atypical antipsychotics, and underdosed SSRIs for decades to come. What should we do? A little education and they could help thousands for years to come. Who's in?

I'm being half-facetious, but if we are morally obligated to help educate every care provider who is providing dangerous, uneducated, or non evidence-based psychiatric care, we are falling far short. A lot of damage is done every day in both psychiatric and PCP clinics.
 
In other words. You're making yourself feel better about an MBA pimp slap. You're cheek is hot and stingy. So why not just signify something moral for your shame.

I think I'll just stick to my self respect. My respect for the art and what it takes to embody it for real. And not cast my pearls before swine.
 
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