Difference between a psychiatric nurse practitioner and a psychiatrist?

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Pharmohaulic

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Other than the obvious length of training, I can't find a clear difference between the two.

Especially now with the increased independense of nurse practitioners, they seem to do and function in the same capacity of psychiatrists it seems.

I aldo hwve heard that Nurse practitioners get much more psychotherapy training, on part with psychologists.

So what's the scoop
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If your goal is to get dramatic posts from folks on all sides starting a thread will be success. If you want to know the answer to your question, I suggest doing a search and more importantly go talk to some psychiatrists and psych NPs in person.
 
Are you trolling or what?
One difference is about $150k.
Seriously though. I love my NPs but they in no way can handle our more complex patients and they have far less experience and expertise than any MD. Good NPs are often about on par with a starting first year resident regarding clinical decision making from what I see every day.
Also, what makes you think NPs get more therapy training? It sounds to me like you have no idea what training NPs or MDs have. I have never met an NP that has had any where near the therapy skills or training or breadth of knowledge a psychiatrist has. Saying an NP=MD is like saying a Chinese $30 smartphone=an iPhone. One is fine a lot of the time, but that doesn't make it the best.
 
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wolfvgang22 said:
Are you trolling or what?
One difference is about $150k.
Seriously though. I love my NPs but they in no way can handle our more complex patients and they have far less experience and expertise than any MD. Good NPs are often about on par with a starting first year resident regarding clinical decision making from what I see every day.
Also, what makes you think NPs get more therapy training? It sounds to me like you have no idea what training NPs or MDs have. I have never met an NP that has had any where near the therapy skills or training or breadth of knowledge a psychiatrist has. Saying an NP=MD is like saying a Chinese $30 smartphone=an iPhone. One is fine a lot of the time, but that doesn't make it the best.
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This is not coming from me this is what I read different places and hear from people... my boss on the psych unit where I work just became a psych APRN and WA touting how her training is more broad than a psychiatrist because she is trained to prescribe and has the in depth therapy training to do ther apt on par with a psychologist.
 
Pharmohaulic said:
my boss on the psych unit where I work just became a psych APRN and WA touting how her training is more broad than a psychiatrist because she is trained to prescribe and has the in depth therapy training to do ther apt on par with a psychologist.
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I'm afraid your boss is fooling herself; don't let her fool you.

Pharmohaulic said:
Other than the obvious length of training, I can't find a clear difference between the two.
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And what do you suppose happens during those additional years of training?
 
wolfvgang22 said:
Are you trolling or what?
One difference is about $150k.
Seriously though. I love my NPs but they in no way can handle our more complex patients and they have far less experience and expertise than any MD. Good NPs are often about on par with a starting first year resident regarding clinical decision making from what I see every day.
Also, what makes you think NPs get more therapy training? It sounds to me like you have no idea what training NPs or MDs have. I have never met an NP that has had any where near the therapy skills or training or breadth of knowledge a psychiatrist has. Saying an NP=MD is like saying a Chinese $30 smartphone=an iPhone. One is fine a lot of the time, but that doesn't make it the best.
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The outpatient across from where I work, the nurse practitioners handle the majority of complex cases... including severely schizophrenic patient on Clozaril with comorbid health issues. the same for a lot of the complex patient admitted to the floor... their primary psychiatric practioner is n NP.


Now... how well these NP's are actually handling these cases is another question.
 
It is true that there is limited difference in the scope of potential practice and available training.

In practice though, these individuals tend to be quite different, and that is reflected in clinical role and pay.
 
When APRNs try to lobby their state congress for independent practice, they often cite studies showing that outcomes are similar when comparing APRNs such as NPs versus MDs. Unfortunately, those studies suffer from a massive confounder since the APRNs always have an MD supervisory backup since it's illegal not to before they lobby for that ability. The studies though make it seem like they are just as "safe" as MDs. However, APRNs typically do NOT take the more complicated cases and refer them out to MDs. For basic things, I'm sure many outcomes may be similar.

The philosophy of nursing school is much different than that of medical school and residency. Nursing schools teach similar subjects to medical schools, but are not held to quite the same standard. For example, they don't have to take USMLEs, which if they want to practice independently, they should to demonstrate their clinical knowledge. We look at DOs are equivalent now because they take the same board exams as MDs do, but historically this was not always the case.

Their clinical training also has an emphasis on how to carry out orders - putting in IVs, knowing how to pull drugs and administer them, knowing how to physically take care of patients, skills that physicians often aren't comfortable with. This was historically the division of labor. A medical student and resident training emphasizes how to make the final clinical decision based on physiology, pathology, and pharmacology, especially when you're on call and you are responsible for the outcomes of the patients.

Nursing schools and their clinical training does not give them nearly as much practice in the final clinical decision making and therefore they have much less clinical judgment than an MD has. They often feel like they can though because they're exposed to it often and criticize doctors for making certain decisions, but often don't get to wrangle all the risks and benefits in decisions that MDs make on a daily basis.

And we're not talking about a mere obvious length in training. We're talking about 20 times as many hours. Some NP programs are almost fully online too, with around 2-3 months of clinical work to get an NP degree. (check this website out, linked here highlighting # of clinical hours). That is extremely low and frightening to me that nurses are prescribing and doing procedures with as much experience as a first year, first semester medical student.

Clinical training hrs:
DNP: 700
PA: 2400
MD/DO: >17000
 
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Pharmohaulic said:
This is not coming from me this is what I read different places and hear from people... my boss on the psych unit where I work just became a psych APRN and WA touting how her training is more broad than a psychiatrist because she is trained to prescribe and has the in depth therapy training to do ther apt on par with a psychologist.
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None of our NPs believe they have more therapy training than psychiatrists/as much as psychologists. In fact, many of our NPs frequently request assistance coming up with formulations, and then from there are fine with med management.
 
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Clozareal has answered the question very, very well. Kudos to his or her effort. I'm now ashamed of my low effort response. 😛

Also, Pharmohaulic, ask your self this: If NPs are > or = to MDs, why are clinics, hospitals, and patients willing to pay so much more for an MD's services? Why would insurance reimburse more for MDs? It isn't out of sentimentality or a desire to spend money for no reason.
 
wolfvgang22 said:
Clozareal has answered the question very, very well. Kudos to his or her effort. I'm now ashamed of my low effort response. 😛

Also, Pharmohaulic, ask your self this: If NPs are > or = to MDs, why are clinics, hospitals, and patients willing to pay so much more for an MD's services? Why would insurance reimburse more for MDs? It isn't out of sentimentality or a desire to spend money for no reason.
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I thought it was because hospital and clinic administrators are just great people who are just looking out for the best interest of MDs.
 
Mr. Bub said:
I thought it was because hospital and clinic administrators are just great people who are just looking out for the best interest of MDs.
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ImageUploadedBySDN1481734568.289084.jpg



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Adding on to the helpful explanation that clozareal posted, the distinction between a psychologist and a psychiatric nurse NP comes down in part to many more hours of supervised experience providing psychological assessment and psychotherapy. Psychologists learn clinical skills by having many, many hours of live supervision or audio/videotaped sessions reviewed and critiqued by a more experienced supervising clinician. This goes on for years. Psychologists are also trained to select, administer, interpret, and understand the limitations of various psychological tests such as intelligence and personality tests. At the end of a psychologist's training (around year 5 or 6 for most) we match to an external training site for a one-year, full-time clinical internship. The process is similar to a residency match - applications, interviews, and often a geographical relocation. On completion of the internship year we're awarded a PhD (or PsyD) and, in most states, must have an additional year of full-time supervised experience and pass licensing exams (oral and/or written) prior to being practice able to practice psychology independently. All told, the time between day 1 of grad school to becoming licensed can easily be 7-8 years for a psychologist.

Another distinction is that psychologists' training is grounded in the theoretical and empirical bases for assessment and intervention approaches. (For instance, the main study material for the final exam in my behavior therapy course was a two-foot tall stack of empirical journal articles.) Also, part of how we learn the theory and research behind what we do is by producing research ourselves. It's not uncommon for trainees to develop and test new treatments as their dissertation projects.

While many NPs can provide basic counseling, and some go on to learn more specific intervention skills and techniques, to say that the training is equivalent to that of a psychologist is ridiculous on its face. It's not that NPs cannot provide intervention, but it's a matter of matching their skills to the appropriate setting and patient population.
 
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WisNeuro said:
I have yet to meet a psych NP with anything that I would call substantial therapy training.
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The assertion many NPs have about being equivalent to physicians should be proof enough they have no clue what they're talking about. Medicine/psychiatry is not as simplistic as they believe it to be, and their ignorance prevents them from knowing any different.
 
I remember when a PA student told me their curriculum was the same just shorter. Had a good laugh, just adorable.
 
WisNeuro said:
I have yet to meet a psych NP with anything that I would call substantial therapy training.
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Don't shoot the messenger, I am in no way saying that a NP has equivalent training to a psychologist or psychiatrist... I am just saying that from from what I've seen and heard much of way they do in day to day practice seems the same
 
I think. There's a more salient, corollary factor to the notion of length/type of training. And that is the type of person who can see no other path than to subject themselves to the inexorable pursuit of a more rigorous type of knowledge. As if almost plagued by a greater sense of insatiable curiosity. Be it for a phd in psychology or an MD and psych residency. And also...the opposite. The sort of person that wants the quick route to the low hanging fruit, so they can make it home by 5 to watch their bull**** on the TV, have boring, procreative sex, and **** out a litter of twits. To repeat the cycle with an equal measure of abandon that we sacrifice our youth, vitality, and health in training.

They outbreed us in a layered sense. They are an r-selected species. Whereas we are K-selected. Anachronistic. Poorly corporatizable. Expensive. Ornery. Demanding things be done a certain way. Wanting of diversity and creativity in our work with more hyperallergenic responses to bureaucratic bulls!t.

We are absolutely different archetypes.

These are not scripts that are absolute. There are mixing of types within each type of training pursuit. But this is the pattern as I see it.

I'm listening to a lecture from a psychologist now. I'm listening to a psychology text book after I rise each morning. I dream about my patients. Extra hours happen because I have opportunities to learn and I don't have a "No" in my play book to developmental plays. And this is the real difference.

We are the sort of person who learns.

A superficial regard for anything as complex and inscrutable as human consciousness is pathologically ******ed.

To the OP. You are not being shot at. As an interesting messenger. But you should know. That anyone who is smugly satisfied with superficial knowledge is a flamboyantly dangerous idiot.

It will be a miracle if we survive extinction as a species due to the preponderance of such people amongst us.
 
I think the NPs do a lot better with the psych patients. They must be! All of their patients are on two atypicals, an SNRI, Remeron, Restoril, Ambien, Xanax, Atarax, and either Neurontin or Trazodone. They got all of the neurotransmitters covered. I wuss out after two of three drugs but they have every symptom and side effect therefrom covered. Oh and I forgot....Vyvanse.
 
xavier2000 said:
I think the NPs do a lot better with the psych patients. They must be! All of their patients are on two atypicals, an SNRI, Remeron, Restoril, Ambien, Xanax, Atarax, and either Neurontin or Trazodone. They got all of the neurotransmitters covered. I wuss out after two of three drugs but they have every symptom and side effect therefrom covered. Oh and I forgot....Vyvanse.
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Lol
 
Nasrudin said:
The sort of person that wants the quick route to the low hanging fruit, so they can make it home by 5 to watch their bull**** on the TV, have boring, procreative sex, and **** out a litter of twits.
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This I agree with. If they really wanted more responsibilities with higher pay, why not just go to medical school? Some people go to nursing school, and then realize they want a shortcut to what MDs have. Anesthesiologists are struggling with CRNAs for that and now CRNAs get paid almost $200k and have almost as much independent practice based on their lobbying. It's a fraction of the school length with a fraction of the effort (grades, tests, etc) as going to medical school, but they want to practice with equal responsibility and pay. I'm sure nursing school is "tough" to get into, and I'm sure that it's "tough" to get through, but damn, don't equate it to how tough it is to get into medical school, residency, and all those exams we had to take and GPAs we had to achieve to prove our worth.
 
clozareal said:
This I agree with. If they really wanted more responsibilities with higher pay, why not just go to medical school? Some people go to nursing school, and then realize they want a shortcut to what MDs have. Anesthesiologists are struggling with CRNAs for that and now CRNAs get paid almost $200k and have almost as much independent practice based on their lobbying. It's a fraction of the school length with a fraction of the effort (grades, tests, etc) as going to medical school, but they want to practice with equal responsibility and pay. I'm sure nursing school is "tough" to get into, and I'm sure that it's "tough" to get through, but damn, don't equate it to how tough it is to get into medical school, residency, and all those exams we had to take and GPAs we had to achieve to prove our worth.
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And then want the same level of acknowledgement and respect because they know just as much as an anesthesiologist.
 
clozareal said:
This I agree with. If they really wanted more responsibilities with higher pay, why not just go to medical school? Some people go to nursing school, and then realize they want a shortcut to what MDs have. Anesthesiologists are struggling with CRNAs for that and now CRNAs get paid almost $200k and have almost as much independent practice based on their lobbying. It's a fraction of the school length with a fraction of the effort (grades, tests, etc) as going to medical school, but they want to practice with equal responsibility and pay. I'm sure nursing school is "tough" to get into, and I'm sure that it's "tough" to get through, but damn, don't equate it to how tough it is to get into medical school, residency, and all those exams we had to take and GPAs we had to achieve to prove our worth.
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Yes, nursing school to be a regularge RN is tough, but the Nurse Practitioner route seems like a joke (hence the reason for me asking about their scope of practice in this thread). I looked at the psychiatric nuse practitioner programs that some people I know went to and they only had one "advanced psychopharm" class and one "advanced physical assessment" class... the rest of the courses were all like nursing theory classes and ethics in healthcare. Not to mention half of it was online and there were minimal clinicals.
 
After crushing college courses, doing well on the MCAT, 5 years of med school, (1 additional year for masters training in research/public health), getting into a good residency, and 1.5 years of residency training (6 months of internal medicine/ICU, 2 months of neurology, rest psychiatry), I can honestly say that what I worry about almost every single day while working is how much I STILL DON'T KNOW. And this feeling has gotten worse as I advanced in my training. Without those years of training, being able to provide same level of care to patients is dangerous.
Just to put into perspective as someone mentioned the clinical hours previously.

NP needs 700 hours, which means
If you averaged 60 hours per week over the course of your clinical years in 3rd and 4th year of medical school, you would have met that requirement 3 months into 3rd year.
If you averaged 80 hours per week (limit set by ACGME) during intern year, you will have met that requirement 2 months into your 4 year residency.
 
Nasrudin said:
I think. There's a more salient, corollary factor to the notion of length/type of training. And that is the type of person who can see no other path than to subject themselves to the inexorable pursuit of a more rigorous type of knowledge. As if almost plagued by a greater sense of insatiable curiosity. Be it for a phd in psychology or an MD and psych residency. And also...the opposite. The sort of person that wants the quick route to the low hanging fruit, so they can make it home by 5 to watch their bull**** on the TV, have boring, procreative sex, and **** out a litter of twits. To repeat the cycle with an equal measure of abandon that we sacrifice our youth, vitality, and health in training.

They outbreed us in a layered sense. They are an r-selected species. Whereas we are K-selected. Anachronistic. Poorly corporatizable. Expensive. Ornery. Demanding things be done a certain way. Wanting of diversity and creativity in our work with more hyperallergenic responses to bureaucratic bulls!t.

We are absolutely different archetypes.

These are not scripts that are absolute. There are mixing of types within each type of training pursuit. But this is the pattern as I see it.

I'm listening to a lecture from a psychologist now. I'm listening to a psychology text book after I rise each morning. I dream about my patients. Extra hours happen because I have opportunities to learn and I don't have a "No" in my play book to developmental plays. And this is the real difference.

We are the sort of person who learns.

A superficial regard for anything as complex and inscrutable as human consciousness is pathologically ******ed.

To the OP. You are not being shot at. As an interesting messenger. But you should know. That anyone who is smugly satisfied with superficial knowledge is a flamboyantly dangerous idiot.

It will be a miracle if we survive extinction as a species due to the preponderance of such people amongst us.
Click to expand...

Ive missed these posts lately!
 
Jules A said:
It is unfortunate so many physicians have had bad experiences with NPs and I am thankful I was fortunate to have been trained and mentored by a number of amazingly skilled and yet gracious psychiatrists. I am a harsh critic of NP education however in all fairness I have seen as many horrible psychiatrists as NPs which is even more disgusting. I also find it curious that a couple of psyDs are jumping on the NP bashing bandwagon as if insinuating they are equivalent to psychiatrists which I'd imagine would come to a screeching halt if they attempt prescribing rights. I once had a psyD student tell me "you know its just like a psychiatrist but without the medicine". I'm sure she will go on to make you proud, lol.
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I have to agree about the PsyDs, the vast majority of whom I know attended for-profit degree mills and owe 150k+ for their "doctorate". I attended a university-based program attached to an academic medical center with a 12% acceptance rate, but I suppose none of that matters because I didn't shell out a stupid amount of money to become a PsyD from Argosy. I'll always remember during my last year of school I had several PsyD students at my clinical site ask me for my log-in to my university library so they could look up articles... because their "university" did not provide them library access. This is not a joke. The psychologists I work with have nowhere near the caliber of the psychologists I did research with as an undergrad, probably because the latter was a university-based program with standards. But yes, I find the salty comments from psychologists amusing. Those who live in glass houses...

Also, those of you touting the superiority of PA education realize that not all PA programs even include a psych rotation, right? Some have it as an option under electives... comparing a PA to a psych NP (practicing in the psych field) is a bit silly, psych is barely addressed at all in PA education. OP, just talk to psych NPs and psychiatrists you work with, weigh the pros and cons, and go from there. Asking about NPs on this forum is akin to throwing chum in shark-infested water.

Furthermore, I inherited a pt from a psychiatrist the other day. This woman is in her 70s and was on the following: Cymbalta (low-dose), Xanax TID, Vyvanse (v. high dose), Seroquel, and lamotrigine (low d0se). No EKG on file, of course. Pt has fallen 3 times in the past 6 months. I have inherited many a maddening med regimen from people who went to medical school, just saying.

Now, that all being said, I am fortunate to work for a great organization where MDs/PAs/NPs/psychologists work very closely together and respect one another. We only hire NPs from university-based programs and that works well for us. I am supervised by some fantastic psychiatrists and it works out wonderfully as they mentor me and help me to become a stronger clinician on a daily basis. I wouldn't have it any other way.
 
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xavier2000 said:
I think the NPs do a lot better with the psych patients. They must be! All of their patients are on two atypicals, an SNRI, Remeron, Restoril, Ambien, Xanax, Atarax, and either Neurontin or Trazodone. They got all of the neurotransmitters covered. I wuss out after two of three drugs but they have every symptom and side effect therefrom covered. Oh and I forgot....Vyvanse.
Click to expand...

you said it before I could.


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AnnoyedByFreud said:
The psychologists I work with have nowhere near the caliber of the psychologists I did research with as an undergrad, probably because the latter was a university-based program with standards. But yes, I find the salty comments from psychologists amusing. Those who live in glass houses...
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The takeaway point here is that each profession has its own bell curve of standards and performance, but that doesn't justify the false equivalence claim made by the OP (or the OP's boss).

Weird that your facility hires NPs from reputable university-based programs but is content with Argosy grads to fill psychologist positions. Ick. I wonder what they pay them.
 
Right. My point is that the field of clinical psychology shares the same problems as nursing (flourishing for-profits that attract weaker students, flooding of the market, etc.) and that's why I find the superior attitude of psychologists on this forum amusing. Other fields have this problem as well, like law. The psychologists I work with have been at my employer for many, many years, likely before for-profits were the norm in the field. My employer doesn't typically hire psychologists anymore, they use LCSWs now, I should have clarified that I suppose.
 
FranzLO said:
I remember when a PA student told me their curriculum was the same just shorter. Had a good laugh, just adorable.
Click to expand...
As far as medical subjects go? Absolutely, PA's cover pretty much the same stuff I did in medical school.

PA training is not field specific, however, so probably not great on any singular measure (vs psych NP for example.)
 
clozareal said:
This I agree with. If they really wanted more responsibilities with higher pay, why not just go to medical school? Some people go to nursing school, and then realize they want a shortcut to what MDs have. Anesthesiologists are struggling with CRNAs for that and now CRNAs get paid almost $200k and have almost as much independent practice based on their lobbying. It's a fraction of the school length with a fraction of the effort (grades, tests, etc) as going to medical school, but they want to practice with equal responsibility and pay. I'm sure nursing school is "tough" to get into, and I'm sure that it's "tough" to get through, but damn, don't equate it to how tough it is to get into medical school, residency, and all those exams we had to take and GPAs we had to achieve to prove our worth.
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N0, it's not.
 
FlowRate said:
As far as medical subjects go? Absolutely, PA's cover pretty much the same stuff I did in medical school.

PA training is not field specific, however, so probably not great on any singular measure (vs psych NP for example.)
Click to expand...
I doubt they cover them in-depth as they do in med school...
 
FlowRate said:
Not sure, my PA friends were studying all the time and seemed to know their stuff very well.
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They might be studying all the time but it's not possible for them to have covered everything you covered in medical school in depth..
 
Seroquel said:
They might be studying all the time but it's not possible for them to have covered everything you covered in medical school in depth..
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Even so, PA school is only 2 years compared to medical school at 4 years.
 
Seroquel said:
They might be studying all the time but it's not possible for them to have covered everything you covered in medical school in depth..
Click to expand...

clozareal said:
Even so, PA school is only 2 years compared to medical school at 4 years.
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Pretty sure the PA school I'm talking about did two years of preclinical studies and one year of clinical. Literally the first three years of medical school, give or take. They even used our anatomy lab.

I doubt it was the *exact same* depth, but they knew their pharm way better than most of my medical school colleagues, because the focus for PA's is that they can function as a PGY1-2 replacement upon graduation, so they spend more time on dosing and other nitty-gritty that we learn in residency.
 
AnnoyedByFreud said:
Right. My point is that the field of clinical psychology shares the same problems as nursing (flourishing for-profits that attract weaker students, flooding of the market, etc.) and that's why I find the superior attitude of psychologists on this forum amusing. Other fields have this problem as well, like law. The psychologists I work with have been at my employer for many, many years, likely before for-profits were the norm in the field. My employer doesn't typically hire psychologists anymore, they use LCSWs now, I should have clarified that I suppose.
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What superior attitude? The only posts I saw here from psychologists said that PMHNPs don't have the level of training that we have in psychotherapy, diagnosis, and assessment. Sure there are the problems with the professional schools in our field, but I'm not sure how that negates our ability to talk about our own skill set and profession. The OP said that the NP he works for thinks their therapy training is superior to psychologists. Might be true in this instance, but I don't think any of us have ever seen that before and the training would have had to be extensive and in addition to what is already provided. One way that these false equivalencies are promulgated is through a misuse of statistical phenomena of the normal distribution. In other words, compare the low end of one group to the middle or high end of another group.
 
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