Curious to hear your opinion on this as the few folks I have spoken to about this are quite positive about their experiences. I do think it depends on the state and the laws put in place though.
Personally, I really enjoy the added benefit of being able to offer this service to patients, and would do it all over again in a heartbeat, as the increased access to care has been so valuable. I feel like my OG training in psychology has also been the right course for me personally too, as I feel like good prescribing should come from the foundational knowledge we learn about psychiatric diagnoses in our doctorate programs. I always joke there's a reason a doctorate is as long as it is. Psych is complicated lol.
From the perspective of the OP's post, it truly is just not a great fiscal ROI. For starters, the legislation differs widely, but almost universally constricts on formularies, including ability to independently manage controlled (Schedule II-IV) prescriptions, with additional barriers caused by some of the states which emphasize collaborative agreements. This, in turn, changes the types of employment in which you can employ the skillset, and in some cases, restricts insurance coverage too. I literally just joked with a non-psychiatric NP recently that most states will not allow me to prescribe a medication like metformin to combat side-effects
listed in package insert for something like an antipsychotic, meanwhile the NP can diagnose and prescribe all the medications plus some, for the condition that I am considered an expert in.
It also takes a significantly lengthy amount of time, upwards to 13 years of training, many of which are at significantly lower rates of pay, as our training years yield lower pay rates compared to psychiatry's course. I literally did my supervised prescribing hours unpaid, because finding a supervisor is sooo arduous. Additionally, the novelty and relative lack of universality has led to inconsistent market variability in terms of reimbursement. When there is a limited paucity to poll from, it's hard to determine what is fair market value. Additionally, when states allow such different things (Utah, I'm looking at you, with your restrictions to almost only allowing RxP to prescribe antidepressants), what is the worth of the provider on a global healthcare ecosystem?
From a market signaling perspective, it's also fraught with longstanding system-level barriers. Systems have long-recognized the authority of medical prescribers (MD/DO) as the holder of medical decision-making, and therefore leadership positions, reflect this. Almost nobody is listing a MSCP, when they post for leadership positions in hospitals or medical systems (although, this may be changing, as I did see a psychiatric hospital post for one in New Mexico recently) and you are always going to be fighting to prove legitimacy.
Overall, the RxP was designed to solve a community-based problem of increasing access to care, but little is done on the legislative side to encourage and promote training in the area. I feel like you could round up a group of ten of us, poll us, and we would all agree we don't do the work for better pay, but rather a true reflection of attempting to increase psychiatric services. This could change for the better in the future (🤞) but I'm not holding my breath, as the development of the movement has been fraught with fragility from the initial onset. We're truly just trying to hold on and increase the number of eligible states. Negotiation/battle for better reimbursement will likely follow that, if it ever reaches an optimal level of states representing the potential for this to be universal. I'm cautiously optimistic that the recent board certification from ABPP might help promote this a bit more, but it's in it's infancy too. This in itself is an additional problem. Because there are so few of us, we are all practically involved in advocacy work, which is unpaid, to help further prove we have a seat at the table.
In short, you invest heavily in training that yields
restricted, conditional authority, while psychiatry yields
default authority across the entire healthcare ecosystem. Stick with the established system for now, if your interest is in financial success. If you're a goofy goober like me, who wants to see true system-wide improvement, and are willing to put in the blood, sweat, and tears, than yeah, RxP is for you.
