"I guess we could pay you the same, but we're more comfortable with nps"

[vistaril]

A new low for our field...

trying to scrounge up some extra work for next year to cover some unexpected expenses, and called a local community mental health center near where I'm moving. They said they are open to adding some part time hours, but said they would prefer an np. They would PREFER an NP! Even at the same cost.....said they are more comfortable with them, and had overall had better experiences with them.

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[hamstergang]

I'd prefer an NP to you as well.

 

[vistaril]

I'd prefer an NP to you as well.

this was before we even got in a discussion over my qualifications, practice style, experience, etc......so not really applicable.

 

[erg923]

I'd prefer an NP to you as well.

Bazing!

 

[F0nzie]

My guess is it's more of a turnover issue than their experiences with NPs as providers. I would imagine it would be harder to keep psychiatrists due to the fact that we have greater options. If we get burned out or annoyed we can simply get another job. Cmhcs lose a lot of money if a staff member leaves ie. Locums, interviews, credentialing, etc.

 

[vistaril]

My guess is it's more of a turnover issue than their experiences with NPs as providers. I would imagine it would be harder to keep psychiatrists due to the fact that we have greater options. If we get burned out or annoyed we can simply get another job. Cmhcs lose a lot of money if a staff member leaves ie. Locums, interviews, credentialing, etc.

yep I agree....but people leaving after a month or two is part of their experience with them.

My guess is also in this case that they've had some psychiatrists where english is a second language, poor communication skills, etc.....with psych nps they know they are getting americans with no language/cultural issues. That's not to say all imgs have such issues of course.

 

[smalltownpsych]

The hospital I work at was trying to hire a psychiatrist for several months and with no viable prospects, they decided to give up and use an NP and a telemed psychiatrist for pediatric cases.

 

[Elisabeth Kate]

The hospital I work at was trying to hire a psychiatrist for several months and with no viable prospects, they decided to give up and use an NP and a telemed psychiatrist for pediatric cases.

What does "no viable prospects" mean? No one applied?

 

[PikminOC]

yep I agree....but people leaving after a month or two is part of their experience with them.

My guess is also in this case that they've had some psychiatrists where english is a second language, poor communication skills, etc.....with psych nps they know they are getting americans with no language/cultural issues. That's not to say all imgs have such issues of course.

Why do you always harp on the communication issues and FMG's? Move on.

 

[PikminOC]

this was before we even got in a discussion over my qualifications, practice style, experience, etc......so not really applicable.

You don't know that. Maybe they could tell over the phone.

 

[PikminOC]

My guess is it's more of a turnover issue than their experiences with NPs as providers. I would imagine it would be harder to keep psychiatrists due to the fact that we have greater options. If we get burned out or annoyed we can simply get another job. Cmhcs lose a lot of money if a staff member leaves ie. Locums, interviews, credentialing, etc.

Also, their malpractice rate is much less than ours so it's less for the hiring agent to have to dole out.
They can also see patients 13 years old and above. More flexibility.

 

[jettavr6]

A new low for our field...

Given your low opinion of our field, why would you expect them to choose differently?

 

[masterofmonkeys]

They can also see patients 13 years old and above. More flexibility.

I thought that was the rule for adult psych too?

 

[vistaril]

Why do you always harp on the communication issues and FMG's? Move on.

because it's a reality for many people in our field. Far far more likely that a psychiatrist would have these issues than a psych np.

 

[smalltownpsych]

What does "no viable prospects" mean? No one applied?

From what I understand, there were no qualified applicants for the position. We are in a fairly remote location (although our hospital has about 30k people in it's cachement area) and were looking for a psychiatrist who was able to work with pediatric cases, as well. I think parts of the country like ours are the hardest hit by shortages in providers.

 

[gibits]

NPs and PAs are just a symptoms of lack of supply. I don't really get all the hate towards them, a portion of their income goes into my pocket, if anything I'm grateful for them making money for me while I do other things. It ultimately helps me profits.
I'm guessing vistaril is a resident and likely will not stick around after graduation, added to the fact that a NP at this point in your training would have more experience. NPs are also cheaper in the long run and more stable. I doubt they are trying to degrade our profession so stop taking it personally.

 

[vistaril]

NPs and PAs are just a symptoms of lack of supply. I don't really get all the hate towards them, a portion of their income goes into my pocket, if anything I'm grateful for them making money for me while I do other things. It ultimately helps me profits.
I'm guessing vistaril is a resident and likely will not stick around after graduation, added to the fact that a NP at this point in your training would have more experience. NPs are also cheaper in the long run and more stable. I doubt they are trying to degrade our profession so stop taking it personally.

no this is a post-res position. Furthermore, psych nps in most situations most definitely aren't putting money in our pockets. Most psych nps are taking jobs we would. And it's only going to get worse....much worse.

And I don't dislike psych nps. I like them and respect them.

 

[PikminOC]

I thought that was the rule for adult psych too?

Nope. We have a separate Child and Adolescent Residency that is extra.

 

[PikminOC]

because it's a reality for many people in our field. Far far more likely that a psychiatrist would have these issues than a psych np.

You don't know that. I know plenty of foreign NP's.

 

[vistaril]

You don't know that. I know plenty of foreign NP's.

very unlikely that they are recent(ie last ten years) immigrants....

 

[Doctor Bagel]

Nope. We have a separate Child and Adolescent Residency that is extra.

You actually can treat people of all ages after completing a general psychiatry residency. However, I think insurance companies and patients have a preference for seeing child and adolescent psychiatrists if they have a choice. I think seeing kids is pretty normal for psychiatrists who practice in areas with significant provider shortages.

 

[DermViser]

You actually can treat people of all ages after completing a general psychiatry residency. However, I think insurance companies and patients have a preference for seeing child and adolescent psychiatrists if they have a choice. I think seeing kids is pretty normal for psychiatrists who practice in areas with significant provider shortages.

Aided and abetted by your specialty by creating a formal fellowship in Child Psych to begin with.

 

[AnnoyedByFreud]

All graduating psych NPs now have one license that is a 'family' license that covers the entire lifespan.

 

[@JackShephard]

vistaril.

Can you name 5 things you like about your field of medicine without saying something negative?

 

[hamstergang]

Aided and abetted by your specialty by creating a formal fellowship in Child Psych to begin with.

You think this is a problem? I do not feel that we get adequate C/A training in my general psych residency. And if we gave more time to it, I don't know what you'd want to take time away from.

 

[st2205]

All graduating psych NPs now have one license that is a 'family' license that covers the entire lifespan.

One of the clever blessings of semantics.

 

[Armadillos]

All graduating psych NPs now have one license that is a 'family' license that covers the entire lifespan.

That may be true, but on the other hand 2nd year residents have licenses to practice the entire scope of medicine and surgery. But that doesn't mean its a good idea for them to do that.

 

[Armadillos]

Aided and abetted by your specialty by creating a formal fellowship in Child Psych to begin with.

Seems almost all specialties have peds fellowships (or you have to do peds first), so thats hardly unique to psych

 

[PistolPete]

I was told general psychiatrists can see adolescents 14 and above. In fact one of our attendings on the adolescent unit is general trained without a C&A fellowship.

 

[AnnoyedByFreud]

That may be true, but on the other hand 2nd year residents have licenses to practice the entire scope of medicine and surgery. But that doesn't mean its a good idea for them to do that.

Eh, I was just clarifying since people seemed unsure about what age group psych psych NPs are licensed to treat. I'm not here to debate competence (got over attempting that on SDN long ago)

 

[masterofmonkeys]

Nope. We have a separate Child and Adolescent Residency that is extra.

I'm aware of that lol. But I thought it was considered within the scope of practice for Gen Psych to see adolescents as well. There are a fair number of gen psychiatrists in both outpatient and inpatient settings managing adolescents after all. And we do have mandatory child experience.

 

[gibits]

no this is a post-res position. Furthermore, psych nps in most situations most definitely aren't putting money in our pockets. Most psych nps are taking jobs we would. And it's only going to get worse....much worse.

And I don't dislike psych nps. I like them and respect them.

Don't NP have to bill under a doctor's name? From my experience a doctor hiring a NP gets a percentage of the NP's earnings for taking on the liability. Hence my assertion that it ends up as money in the doctors' pocket.

 

[jettavr6]

vistaril.

Can you name 5 things you like about your field of medicine without saying something negative?

Five is quite ambitious - don't stress the guy out. Ask him for two...

 

[Tyrone Slothrop]

Don't NP have to bill under a doctor's name? From my experience a doctor hiring a NP gets a percentage of the NP's earnings for taking on the liability. Hence my assertion that it ends up as money in the doctors' pocket.

https://www.aanp.org/legislation-regulation/state-legislation-regulation/state-practice-environment

They don't have full independent practice in V's corner of the country yet. I think they're problematic even in areas where they're functioning as revenue streams for doctors. Enriching a few established doctors to the detriment of newer graduates, doesn't look like a very good trade-off from where I'm sitting.

 

[OldPsychDoc]

I'm aware of that lol. But I thought it was considered within the scope of practice for Gen Psych to see adolescents as well. There are a fair number of gen psychiatrists in both outpatient and inpatient settings managing adolescents after all. And we do have mandatory child experience.

There is no law against seeing kids as a general psychiatrist. Most of us just don't consider ourselves comfortable with that scope of practice. When I was hired for my first outpt job they asked me to specify the age range I wanted to see. I told them 16 and up...but I could have set the bar at 12...or 5.

 

[PikminOC]

I'm aware of that lol. But I thought it was considered within the scope of practice for Gen Psych to see adolescents as well. There are a fair number of gen psychiatrists in both outpatient and inpatient settings managing adolescents after all. And we do have mandatory child experience.

All that matters is what the plaintiff's lawyer says. Not what we think.
"So how much training do you Dr. X have in treating 14 year olds?"

 

[PikminOC]

very unlikely that they are recent(ie last ten years) immigrants....

There are a lot of recent immigrants esp from the Phillipines.

 

[masterofmonkeys]

There is no law against seeing kids as a general psychiatrist. Most of us just don't consider ourselves comfortable with that scope of practice. When I was hired for my first outpt job they asked me to specify the age range I wanted to see. I told them 16 and up...but I could have set the bar at 12...or 5.

I've done 3 months inpatient, 1 month consult, and 1 day/week as a third year, plus I'll likely schedule a bit more time as a fourth year. It works out to 20% of my total training time spent doing child. Definitely not on par with a full child fellowship, but I think I'll be pretty comfortable with child as an attending. I'm hoping to see at least adolescents once I'm done even without fellowship, and thought it did fall within our scope of practice. Just wanted to make sure.

 

[gibits]

https://www.aanp.org/legislation-regulation/state-legislation-regulation/state-practice-environment

They don't have full independent practice in V's corner of the country yet. I think they're problematic even in areas where they're functioning as revenue streams for doctors. Enriching a few established doctors to the detriment of newer graduates, doesn't look like a very good trade-off from where I'm sitting.

I think most psychiatrists would rather hire other psychiatrist for their practice but can't due to lack of supply. Hence they settle for NPs. The ones I'm more worried about are the psychologist that can proscribe meds, at least NPs are supervised by a MD and have medical training.

 

[nancysinatra]

All that matters is what the plaintiff's lawyer says. Not what we think.
"So how much training do you Dr. X have in treating 14 year olds?"

I see patients down to 15 and sometimes down to 12, and in every note I document that I told the parents I am not fellowship trained and they are welcome to seek out such a specialist. They never do because it means driving 200 miles and waiting 6 months, which most parents don't want to do.

If you are living in an underserved area and you document your conversation it will help if anything happens down the road. There are some cases where I flat out tell the parents they NEED to go to the child psychiatrist. I am more conservative about younger patients because I have less experience, but I think I'm getting better. If I stay in this job I will plan to attend some adolescent psych conferences.

If you are in a rural enough area, you're going to be doing some of your own neuro stuff too. At least you have to be able to identify it. This applies especially with kids and geriatric patients, where the family docs might also miss things. Last month I caught what I think is a case of a rare genetic syndrome in a 12 year old. A real child psychiatrist in another town had diagnosed him with "sensory disorder" and "bipolar disorder" when he was much younger. The poor kid got stuck with that diagnosis and the pediatrician sent him to me. What he really needs I think is a child neurologist (which is non-existent around here, but still). I think it helps in cases like this that I do not see kids day in and day out, and haven't gotten into the habit of telling every single one they have ADHD or bipolar disorder or autism.

Don't get me started on the geriatric stuff. I find that much harder than child psych.