Current Practice Environment

[xlithiumx]

I see typically between 4 and 8. I'm an early bird so I get in around 7 am, but don't have to be in until 8 am. Most days it's 1-2 new evals and then the rest f/u or discharges. I start my clinic at 1 pm and run until 4:30 (my choice). I document along the way and am home by 5pm 90% of the time.

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[@JackShephard]

Echoing Beezley and Stein, I'll chime in that the opportunities are plentiful and lucrative in the upper Midwest, including in major metro areas. Currently in an employed position, doing hospital work in the AM and clinic in PM (60 minute evals and 30 min f/u). Call 1 weekend in 6. Should clear 300k this year with bonus. It is not all doom and gloom.

Yeah, I agree the NP problem will only be in larger cities with equal rights. Midwest and anything rural will be great for Physicians.

NPs are just like us. They want to be in the best cities and they follow the money. They aren't running to the Midwest or rural cities.

 

[vistaril]

I see typically between 4 and 8. I'm an early bird so I get in around 7 am, but don't have to be in until 8 am. Most days it's 1-2 new evals and then the rest f/u or discharges. I start my clinic at 1 pm and run until 4:30 (my choice). I document along the way and am home by 5pm 90% of the time.

do you have a bunch of consults to do? If you are only averaging 6 inpatients a day(just splitting the number), I have no idea how you could get there at 7 and not be at clinic until 1. Even if a full 2 of them are new pts and there are 2 discharges, I would still be out of there by 930-10 if I get there at 7.

 

[xlithiumx]

What I said is that my clinic is at 1. I am not expected to have AM clinic hours, although I suppose I could if i wanted more money. I didn't say that I am at the hospital until 1. I typically have an hour at home for lunch with my family. Also from 8-9 is our team meeting.

Seriously though, V!?! Any chance to take a pot shot, huh? Enjoy your 95k.

 

[vistaril]

What I said is that my clinic is at 1. I am not expected to have AM clinic hours, although I suppose I could if i wanted more money. I didn't say that I am at the hospital until 1. I typically have an hour at home for lunch with my family. Also from 8-9 is our team meeting.

Seriously though, V!?! Any chance to take a pot shot, huh? Enjoy your 95k.

?? How did you get the impression I was taking a pot shot? I was just curious how you had that big a gap in your day given the extremely low volume of inpatients...and then you partly explained it by accounting for two hours I didn't anticipate(lunch at home and a team meeting).... Sheeesh.....

 

[@JackShephard]

What I said is that my clinic is at 1. I am not expected to have AM clinic hours, although I suppose I could if i wanted more money. I didn't say that I am at the hospital until 1. I typically have an hour at home for lunch with my family. Also from 8-9 is our team meeting.

Seriously though, V!?! Any chance to take a pot shot, huh? Enjoy your 95k.

Hey, low blow to say you're earning 300k then point out his 95k.

 

[xlithiumx]

?? How did you get the impression I was taking a pot shot? I was just curious how you had that big a gap in your day given the extremely low volume of inpatients...and then you partly explained it by accounting for two hours I didn't anticipate(lunch at home and a team meeting).... Sheeesh.....

do you have a bunch of consults to do? If you are only averaging 6 inpatients a day(just splitting the number), I have no idea how you could get there at 7 and not be at clinic until 1. Even if a full 2 of them are new pts and there are 2 discharges, I would still be out of there by 930-10 if I get there at 7.

Well, if you don't get it, you don't get it. I'm not the only one, however, who marvels at your ability to be inflammatory and to shift the argument when a reasonable counter-example is presented. You suggest that the only way to "do a good job" at psychiatry and not "whack and stack" is to take the tremendously rotten job offer you accepted. When others (myself included) provide concrete examples of very desirable job arrangements, this is distressing. You then go digging for ways to prove that that well-paying job must be rotten (i.e. wondering how many inpatients I have to see, with the implication that I must be "grinding"), and then when I tell you a reasonable number, you suggest that any idiot (you, in this case) should be done by 10 AM (all the while assuming that somehow it takes me 6 hours to see 6-8 inpatients). I've been down this road with you before about the competitiveness of psychiatry residency, and I get that it's a dead end, so I'll stop.

People should know, however, that there are jobs out that that will pay you well, have reasonable expectations, and value the service that you provide. We don't have to bottom-feed.

 

[xlithiumx]

Hey, low blow to say you're earning 300k then point out his 95k.

What can I say, one bad turn deserves another.

 

[vistaril]

Well, if you don't get it, you don't get it. I'm not the only one, however, who marvels at your ability to be inflammatory and to shift the argument when a reasonable counter-example is presented. You suggest that the only way to "do a good job" at psychiatry and not "whack and stack" is to take the tremendously rotten job offer you accepted. When others (myself included) provide concrete examples of very desirable job arrangements, this is distressing. You then go digging for ways to prove that that well-paying job must be rotten (i.e. wondering how many inpatients I have to see, with the implication that I must be "grinding"), and then when I tell you a reasonable number, you suggest that any idiot (you, in this case) should be done by 10 AM (all the while assuming that somehow it takes me 6 hours to see 6-8 inpatients). I've been down this road with you before about the competitiveness of psychiatry residency, and I get that it's a dead end, so I'll stop.

People should know, however, that there are jobs out that that will pay you well, have reasonable expectations, and value the service that you provide. We don't have to bottom-feed.

whoa lmao....dude for starters I don't even initially remember the discussion we had awhile back on this issue. I don't even remember who you are. I don't deny that we did have a discussion about such things(you clearly remember it), but it certainly wasn't on my mind in asking those questions.

Second, I have no idea where all of the above came from....it's like you just wanted to rehash an old discussion I never even mentioned here.

I simply asked you how many inpatients you saw, and then was doing the math in my head and wondering how you accounted for all that time between 7 and 1. Then you go on and say that within those questions(in this thread) I was implying things I wasn't.

 

[George Anderson]

Thanks to all the current practicioners for posting your experiences. It's so hard to accurately judge work conditions/salary in psych.

Giving the time required for billing, reports and negotiating with Managed Health Care Carriers, it is not realistic to earn much. Additional income streams should really be considered such as training, consulting and marketing related training material.

 

[notdeadyet]

do you have a bunch of consults to do? If you are only averaging 6 inpatients a day(just splitting the number), I have no idea how you could get there at 7 and not be at clinic until 1. Even if a full 2 of them are new pts and there are 2 discharges, I would still be out of there by 930-10 if I get there at 7.

I think this is why folks are a little confused by your posting of your $100K/year job that you negotiated so that you get increased amount of time for better patient care. That newfound concern for patient care doesn't really jibe with your typical thoughts like this.

Here you are saying that you would be able to come in and do 2 intakes of new patients, 2 discharges, and 3 follow-ups on an inpatient unit in 2-1/2 hours. This means that for each new intake, in which you are doing a chart review, getting to know a patient, establishing rapport, coming up with a differential diagnosis, developing a treatment plan, writing orders, and charting, you spend 30 minutes each for these two new patients. You are then doing risk assessments, dispo arrangement, and discharge summary documentation and logistics, in 30 minutes each for two more patients you are discharging. You are then spending 15 minutes for each follow-up, including interview, orders, and charting.

This doesn't jibe.

 

[F0nzie]

So in my initial post I provided my observation of NPs in the workforce. There were some follow up posts about NPs being more "cost effective" for employers. I have also seen this statement in other threads. I can see how they are cost-effective for the healthcare system overall (as far as length of training, etc). But how are they cost effective to the employer? They are billing the exact same codes as we are. The only difference I see in my State is they are getting 85% of the physician reimbursement. Their salaries also seem consistent with 85% of our salaries (in my area anyways).

 

[AnnoyedByFreud]

.

 

[michaelrack]

So in my initial post I provided my observation of NPs in the workforce. There were some follow up posts about NPs being more "cost effective" for employers. I have also seen this statement in other threads. I can see how they are cost-effective for the healthcare system overall (as far as length of training, etc). But how are they cost effective to the employer? They are billing the exact same codes as we are. The only difference I see in my State is they are getting 85% of the physician reimbursement. Their salaries also seem consistent with 85% of our salaries (in my area anyways).

For some insurers NP's can bill at the 100% level. There is a lot of variability on this

 

[F0nzie]

For some insurers NP's can bill at the 100% level. There is a lot of variability on this

If they can bill that high can employers ethically pay them 1/3-1/2 less and keep the change?

 

[michaelrack]

If they can bill that high can employers ethically pay them 1/3-1/2 less and keep the change?

Psychiatrists may be more efficient (generate more RVU's)

 

[nancysinatra]

What I said is that my clinic is at 1. I am not expected to have AM clinic hours, although I suppose I could if i wanted more money. I didn't say that I am at the hospital until 1. I typically have an hour at home for lunch with my family. Also from 8-9 is our team meeting.

Seriously though, V!?! Any chance to take a pot shot, huh? Enjoy your 95k.

Who eats lunch with their family in this day and age? Who are you, Ward Cleaver?

 

[erg923]

Well, I usually have lunch with my wife and son, either out or at home, 2-3 days of the work week.

 

[nancysinatra]

Here you are saying that you would be able to come in and do 2 intakes of new patients, 2 discharges, and 3 follow-ups on an inpatient unit in 2-1/2 hours. This means that for each new intake, in which you are doing a chart review, getting to know a patient, establishing rapport, coming up with a differential diagnosis, developing a treatment plan, writing orders, and charting, you spend 30 minutes each for these two new patients. You are then doing risk assessments, dispo arrangement, and discharge summary documentation and logistics, in 30 minutes each for two more patients you are discharging. You are then spending 15 minutes for each follow-up, including interview, orders, and charting.

This doesn't jibe.

I agree that Vistaril's claimed efficiency seems a bit exaggerated. However, your numbers are also somewhat dubious for the following reasons:

1) Psychiatrists don't come up with differential diagnoses. Internists do. In psychiatry we have about 10 or so conditions we routinely use, and almost invariably the patient gets fit into one of those 10 or so, rather than a genuine process of "differential diagnosis" occurring. If you disagree then tell me the last time you made a serious list in your "assessment" section of what the problem could be, and what specific diagnostic tests, procedures, or observations you were going to do to "rule out" some of the possibilities and "rule in" others.
2) Risk assessments in real life are boilerplate. They are written with the intention of justifying whatever decision was made. They are not written and then used to make decisions.
3) Dispo arrangements should have already been done by social work.

 

[nancysinatra]

Well, I usually have lunch with my wife and son, either out or at home, 2-3 days of the work week.

So the fifties live on!

Just tell me your son's not in Jr. High.

 

[erg923]

no. but wife is a "housewife" lol. at least for another couple years....

 

[SteinUmStein]

I disagree with the differential comment. I think working through a DDx both in your head and in your notes is a useful exercise, and can help keep your mind open to different (and maybe less likely) possibilities. Probably most useful with a new patient with no known psych history. Also useful on consults, and with patients who may or may not have a personality disorder clouding their picture. I think dismissing the entire approach of using a differential (at least for difficult or complex cases) is throwing away a useful tool and strikes me as pretty sloppy. You could miss some important stuff (i.e. that "easy" case was actually complicated by heavy substance use that nobody knew about, or that simple delirium consult had focal neuro findings from a brain met that nobody really checked for).

 

[xlithiumx]

Who eats lunch with their family in this day and age? Who are you, Ward Cleaver?

I do. I like my wife and son and I'm privileged to have some time with them at midday. Do you have a husband and/or children?

 

[michaelrack]

I disagree with the differential comment. I think working through a DDx both in your head and in your notes is a useful exercise, and can help keep your mind open to different (and maybe less likely) possibilities. Probably most useful with a new patient with no known psych history. Also useful on consults, and with patients who may or may not have a personality disorder clouding their picture. I think dismissing the entire approach of using a differential (at least for difficult or complex cases) is throwing away a useful tool and strikes me as pretty sloppy. You could miss some important stuff (i.e. that "easy" case was actually complicated by heavy substance use that nobody knew about, or that simple delirium consult had focal neuro findings from a brain met that nobody really checked for).

For those of us with more experience, the differential is usually fairly simple - when I admit a psychotic patient (psychosis nos) I know that I will probably need to start an antipsychotic and if the precise dx is not known, start the work up (or suggest the workup if it is a weekend and there aren't SW's around to help)- get collateral history/check labs/get old records. Usually the diff involves primary vs drug-induced, with the rare neurologic/medical etiology. When I admit a pt, I usually spend much more time thinking about their comorbid medical problems (HTN, DM, etc) than the differential. You got to get the patient stabilized and then fine tune the diagnosis during the hospitalization. I am of course talking about psychiatry in an inpatient environment.

 

[vistaril]

I think this is why folks are a little confused by your posting of your $100K/year job that you negotiated so that you get increased amount of time for better patient care. That newfound concern for patient care doesn't really jibe with your typical thoughts like this.

Here you are saying that you would be able to come in and do 2 intakes of new patients, 2 discharges, and 3 follow-ups on an inpatient unit in 2-1/2 hours. This means that for each new intake, in which you are doing a chart review, getting to know a patient, establishing rapport, coming up with a differential diagnosis, developing a treatment plan, writing orders, and charting, you spend 30 minutes each for these two new patients. You are then doing risk assessments, dispo arrangement, and discharge summary documentation and logistics, in 30 minutes each for two more patients you are discharging. You are then spending 15 minutes for each follow-up, including interview, orders, and charting.

This doesn't jibe.

sure it does....since you're comparing apples to oranges here(inpatient and outpt).

Now not every inpatient falls in the category where it doesn't matter if you work really efficiently and finish it up quickly vs taking a thorough and slow approach, but many do. For every 100 inpatients you see, think about how many are patients where the outcome and/or care isn't going to vary whether you spend x minutes or 4x minutes. A *lot*. At least at the different inpatient places I've worked. Yes, it does take a good bit of time to go over pt education with a low functioning family whose 19yo son is in the hospital for the first time with psychosis. But for every 1 case like that, there are 5-6 that don't have issues where time is required like that.

Now for the most part I don't think inpatient is where patients really get better or where much of anything positive happens....and that's why I'm not going to do it. But if I did do it, I think I would be pretty darn efficient at it.

 

[hamstergang]

1) Psychiatrists don't come up with differential diagnoses.

Good ones should.

If you disagree then tell me the last time you made a serious list in your "assessment" section of what the problem could be, and what specific diagnostic tests, procedures, or observations you were going to do to "rule out" some of the possibilities and "rule in" others.

Earlier this week.

 

[Jester25]

I agree that Vistaril's claimed efficiency seems a bit exaggerated. However, your numbers are also somewhat dubious for the following reasons:

1) Psychiatrists don't come up with differential diagnoses. Internists do. In psychiatry we have about 10 or so conditions we routinely use, and almost invariably the patient gets fit into one of those 10 or so, rather than a genuine process of "differential diagnosis" occurring. If you disagree then tell me the last time you made a serious list in your "assessment" section of what the problem could be, and what specific diagnostic tests, procedures, or observations you were going to do to "rule out" some of the possibilities and "rule in" others.
2) Risk assessments in real life are boilerplate. They are written with the intention of justifying whatever decision was made. They are not written and then used to make decisions.
3) Dispo arrangements should have already been done by social work.

Ummm what?? Are you serious about not having a differential diagnoses. I view psychiatric disorders as diagnosis of exclusion. Everyone gets a medical workup and drug screen. Anything less and you are providing substandard care and essentially not using what you should have learned in medical school. Can't say how many times I have pressed this point to medical students and insurance companies that initially deny tests only to approve it after I contact them. I have found tumors on MRIs, (+) syphillis tests, obviously numerous sub induced disorders including bath salts, etc...

People are talking about psych NPs encouragement on psychiatrists and us needing to shorten our training. What needs to happen is that within our own speciality there needs to be a better standard of care. I may poke fun at some NP med management skills, but I am appalled at some of the diagnosis and polypharmacy that is rampant in our speciality and it is quite embarrassing.

Deliver better standard of care and show superior results compared to the NPs.

As far as jobs go, everyone in my program landed a solid job. One has the same setup as Vistaril. 60 min intake, 30 min follow up. 215K.

 

[vistaril]

Ummm what?? Are you serious about not having a differential diagnoses. I view psychiatric disorders as diagnosis of exclusion. Everyone gets a medical workup and drug screen. Anything less and you are providing substandard care and essentially not using what you should have learned in medical school. Can't say how many times I have pressed this point to medical students and insurance companies that initially deny tests only to approve it after I contact them. I have found tumors on MRIs, (+) syphillis tests, obviously numerous sub induced disorders including bath salts, etc...

People are talking about psych NPs encouragement on psychiatrists and us needing to shorten our training. What needs to happen is that within our own speciality there needs to be a better standard of care. I may poke fun at some NP med management skills, but I am appalled at some of the diagnosis and polypharmacy that is rampant in our speciality and it is quite embarrassing.

Deliver better standard of care and show superior results compared to the NPs.

As far as jobs go, everyone in my program landed a solid job. One has the same setup as Vistaril. 60 min intake, 30 min follow up. 215K.

well my contract is a lot different than that.....those are just the absolute minimums. most wont be that.

 

[notdeadyet]

1) Psychiatrists don't come up with differential diagnoses. Internists do. In psychiatry we have about 10 or so conditions we routinely use, and almost invariably the patient gets fit into one of those 10 or so, rather than a genuine process of "differential diagnosis" occurring. If you disagree then tell me the last time you made a serious list in your "assessment" section of what the problem could be, and what specific diagnostic tests, procedures, or observations you were going to do to "rule out" some of the possibilities and "rule in" others.
2) Risk assessments in real life are boilerplate. They are written with the intention of justifying whatever decision was made. They are not written and then used to make decisions.

Wow. I've inherited a lot of patients from folks with thinking like this and inevitably find myself pulling my hair out because they missed diagnoses and then followed a formulaic and poorly thought out treatment plan and referred them to tertiary care for being "refractory to treatment." For some reason, I always assumed these were folks either trained not in a U.S. residency environment or Way Back When. I may have to revise this thinking. Oi...

People are talking about psych NPs encouragement on psychiatrists and us needing to shorten our training. What needs to happen is that within our own speciality there needs to be a better standard of care. I may poke fun at some NP med management skills, but I am appalled at some of the diagnosis and polypharmacy that is rampant in our speciality and it is quite embarrassing.

This. We need to have accountability as a profession. Do shoddy work and someone else will be happy to do it for you and for cheaper.

 

[Shikima]

Who eats lunch with their family in this day and age? Who are you, Ward Cleaver?

I would love to have lunch with my family - what a pleasure it would be to go home midday.

 

[erg923]

Well, it is pretty unusual, I agree, unless you live in small town and dont live far. It is important in our household that we always have dinner together in the evening though as a family. At least M-F.

 

[vistaril]

Wow. I've inherited a lot of patients from folks with thinking like this and inevitably find myself pulling my hair out because they missed diagnoses and then followed a formulaic and poorly thought out treatment plan and referred them to tertiary care for being "refractory to treatment." For some reason, I always assumed these were folks either trained Way Out There.

the geographic elitism on this forum is off the charts. And yes it's somewhat unfair to pick out this post in particular, since there are seemingly half a dozen such references by multiple different posters daily.

there are more than 5 or 6 cities in the entire country guys.....and with geographic flexibility being what it is, most all places(in this country at least) have a lot more in common with each other than differences.

 

[touchpause13]

the geographic elitism on this forum is off the charts. And yes it's somewhat unfair to pick out this post in particular, since there are seemingly half a dozen such references by multiple different posters daily.

there are more than 5 or 6 cities in the entire country guys.....and with geographic flexibility being what it is, most all places(in this country at least) have a lot more in common with each other than differences.

All of SDN is like that. Don't get so butthurt about it.

I love the Midwest and that's where I want to be, idgaf if others think it's backwards or less cool than the east or west coast. They have a right to their opinions.

 

[vistaril]

All of SDN is like that. Don't get so butthurt about it.

I love the Midwest and that's where I want to be, idgaf if others think it's backwards or less cool than the east or west coast. They have a right to their opinions.

no not all of sdn is like it...or not nearly to the same extent.

And of course people have a right to their opinions. people have a right to believe pretty much anything they want about others....

 

[notdeadyet]

the geographic elitism on this forum is off the charts. And yes it's somewhat unfair to pick out this post in particular, since there are seemingly half a dozen such references by multiple different posters daily.

No, Vistaril's criticism on this one is fair and I happen to agree with it.

Vistaril- you interpreted my comment in a way I didn't intend, but reading over my post, I can completely see how you would infer what you did.

By Way Out There, I meant from a non-U.S. residency training where they teach to a different standard. I certainly didn't mean Out There to imply not from my metropolitan area (which is hardly a hotbed of psychiatry to begin with), and not from anyone else's. No region holds the keys to the kingdom in U.S. psychiatry and you have some ho-hum programs in Boston and New York and some stellar ones in smaller cities. Sorry for sacrificing clarity for cute.

 

[@JackShephard]

Psychiatrists may be more efficient (generate more RVU's)

I think it's the opposite. I think the NPs are more efficient in that they see more patients in less time. The psychiatrists are probably more thorough and doing the job better - but 5-10 min med checks will pay pretty well, especially with some cursory add on therapy or counseling.

 

[@JackShephard]

the geographic elitism on this forum is off the charts. And yes it's somewhat unfair to pick out this post in particular, since there are seemingly half a dozen such references by multiple different posters daily.

there are more than 5 or 6 cities in the entire country guys.....and with geographic flexibility being what it is, most all places(in this country at least) have a lot more in common with each other than differences.

Sure, but most people like bigger cities with more things going on. Hence why the elections in America are won off of catering to the big cities and ignoring the rural people, which is a frustration to many rural cities.

 

[vistaril]

I think it's the opposite. I think the NPs are more efficient in that they see more patients in less time. The psychiatrists are probably more thorough and doing the job better - but 5-10 min med checks will pay pretty well, especially with some cursory add on therapy or counseling.

with what I see the psychs are seeing more patients an hour. My guess is that there are a couple reasons for this:

1) the pt is likely to get even more upset if a nurse rushes them in an out in med check style in less than 5 minutes. If someone who is an md does it, they may just assume that is what md's get to do or whatever. But if a nurse treats them that way....(again not saying it's right, but that may be the perception)

2) the psych(competent ones at least) is more likely able to practice whack and stack psychiatry because they usually can identify obvious pharmaco no-no's quicker almost as a reflex, whereas the psych np may have to think about those things for a second. So in a way the greater fund of knowledge of the psych allows them to practice relative safe whack and stack psychiatry easier.

 

[Nasrudin]

No, Vistaril's criticism on this one is fair and I happen to agree with it.

Vistaril- you interpreted my comment in a way I didn't intend, but reading over my post, I can completely see how you would infer what you did.

By Way Out There, I meant from a non-U.S. residency training where they teach to a different standard. I certainly didn't mean Out There to imply not from my metropolitan area (which is hardly a hotbed of psychiatry to begin with), and not from anyone else's. No region holds the keys to the kingdom in U.S. psychiatry and you have some ho-hum programs in Boston and New York and some stellar ones in smaller cities. Sorry for sacrificing clarity for cute.

Elitism....so what. If I had to listen to thousands of Dixie-loving, bible thumping, nationalistic, thinly disguised racist songs on Redneck Radio whining generically about the lost this or that in pastoral life. Then whoever reads my posts can get earful of vicious geographic elitism. I don't mean it to anyone personally. It's just like what kind of girls you like, or music, or whatever.

Southerners are the bitterest, thinly skinned, whiniest f'ers on the planet when it comes to people not liking their area. Who cares. I don't care that they don't like what I like. And that's what they don't like. They actually care that we think it sucks where they are. That and that everybody with enough spunk and gumption is gone.

I tell you what though. I'm willing to completely re-examine my opinion on the more liberal parts of the midwest thanks to some issues brought up in this thread. That and people like OPD. I'll most likely apply there and go interview post-residency to see for myself.

But Dixie can go f@ck itself forever and ever Amen. Like the Randy Travis song. Except hate.

 

[vistaril]

Elitism....so what. If I had to listen to thousands of Dixie-loving, bible thumping, nationalistic, thinly disguised racist songs on Redneck Radio whining generically about the lost this or that in pastoral life. Then whoever reads my posts can get earful of vicious geographic elitism. I don't mean it to anyone personally. It's just like what kind of girls you like, or music, or whatever.

Southerners are the bitterest, thinly skinned, whiniest f'ers on the planet when it comes to people not liking their area. Who cares. I don't care that they don't like what I like. And that's what they don't like. They actually care that we think it sucks where they are. That and that everybody with enough spunk and gumption is gone.

I tell you what though. I'm willing to completely re-examine my opinion on the more liberal parts of the midwest thanks to some issues brought up in this thread. That and people like OPD. I'll most likely apply there and go interview post-residency to see for myself.

But Dixie can go f@ck itself forever and ever Amen. Like the Randy Travis song. Except hate.

well I can only speak for one southerner, but I've already made it clear that I like the fact you don't like the south......makes it much less likely I'll ever have to run into you.

Also, it's generally posers/wannabes who are so flamboyant with the kind of crap that you write above.

 

[vistaril]

Sure, but most people like bigger cities with more things going on. Hence why the elections in America are won off of catering to the big cities and ignoring the rural people, which is a frustration to many rural cities.

the definition of what is an urban area vs not an urban area can be(in real terms) very confusing.....take someone who lives in greenville, Sc vs 'the atlanta area' or a suburb of houston. Having lived in all three of those places, I can say that greenville, sc felt 5x(at least) more urban(the way most people think of it) than living in atlanta(and not way outside the perimeter either but just outside it) or the houston suburbs. but yet it's a much smaller place by orders of magnitude.

then you have some urban pockets with fairly high population densities with *nothing to do*. Literally. these are usually underserved areas.

Taking things back to medicine, people also tend to overstate(in some cases greatly) the amount of money in most fields one can make in a rural area relative to some urban ones. And again a 'rural area' means far different things to different people.

There are all the same damn Targets everywhere though.....the target I shop in here looks a heck of a lot like the target I could go to in miami...or actually the 10 different targets I could go to in miami.

 

[Jester25]

You have to remember that diversity matters to people too. A few weeks in Mississippi and LA made it crystal clear for me. I'm an east coast person who went to school in the midwest and have enjoyed it, but I'll pass on the deep south.

 

[@JackShephard]

the definition of what is an urban area vs not an urban area can be(in real terms) very confusing.....take someone who lives in greenville, Sc vs 'the atlanta area' or a suburb of houston. Having lived in all three of those places, I can say that greenville, sc felt 5x(at least) more urban(the way most people think of it) than living in atlanta(and not way outside the perimeter either but just outside it) or the houston suburbs. but yet it's a much smaller place by orders of magnitude.

then you have some urban pockets with fairly high population densities with *nothing to do*. Literally. these are usually underserved areas.

Taking things back to medicine, people also tend to overstate(in some cases greatly) the amount of money in most fields one can make in a rural area relative to some urban ones. And again a 'rural area' means far different things to different people.

There are all the same damn Targets everywhere though.....the target I shop in here looks a heck of a lot like the target I could go to in miami...or actually the 10 different targets I could go to in miami.

Oh, I'm not making any judgments. I have enjoyed both big and small town USA. The fact remains that people flock to big cities. It's the nature of most humans.

 

[yellowstreetlamps]

I'm new here; looking for information regarding a career path. I've noticed there is a fair concensus vistral is a jack@ss and so fiery he can't even resist responding to this post. Anyway, my question to anyone interested in answering is, which of the following careers has a greater $ future: Neuropsychologist, Psychiatrist or Psychiatric Nurse Practitioner?

 

[erg923]

I'm new here; looking for information regarding a career path. I've noticed there is a fair concensus vistral is a jack@ss and so fiery he can't even resist responding to this post. Anyway, my question to anyone interested in answering is, which of the following careers has a greater $ future: Neuropsychologist, Psychiatrist or Psychiatric Nurse Practitioner?

I'm not exactly sure what that question means, but if you are asking which career has the highest average earnings/salary, then its going to a psychiatrist. Starting for a psychiatrist is typically 50-100k higher than starting for either of the other two.

 

[yellowstreetlamps]

I'm not exactly sure what that question means, but if you are asking which career has the highest average earnings/salary, then its going to a psychiatrist. Starting for a psychiatrist is typically 50-100k higher than starting for either of the other two.

Thanks for your reply erg923. To clarify, I'm asking what opinions are in regard to a comparison of prospective incomes for each of those careers.

 

[erg923]

Uh, ok. I prospect that physcians, on average, will always be earning more than nonphysician healthcare providers.

 

[digitlnoize]

Uh, ok. I prospect that physcians, on average, will always be earning more than nonphysician healthcare providers.

I concur. For the foreseeable future, in psychiatry.

 

[MLT2MT2DO]

Thanks for your reply erg923. To clarify, I'm asking what opinions are in regard to a comparison of prospective incomes for each of those careers.

Yeah not really sure what you're asking. Psychiatrists on average, much like any mid level vs physician in any specialty, are going to earn more. Now, does all the extra training pay off monetarily? That's a different question with a lot of variables that one would have to account for.

 

[smalltownpsych]

Psychiatrists might get squeezed by the mid-levels in some environments, i.e., services for poor people, but I doubt if private pay rates would ever be affected that much. So in the long run, psychiatrists will always make the most out of any practitioner.