Job Search - health care systems hiring only psych NPs

[nikeforlife]

Hello! I am a PGY4 graduating next summer with plans of living outside of major metro areas and have been looking into more rural areas in both Western US. and the Midwest as well. I'm finding that many health care systems (that are primarily smaller in size) are not interested in hiring a psychiatrist, however have openings for a psychiatric NP. Any suggestions on how to convey to these systems that a psychiatrist would be worth hiring (it's so frustrating to even have this be a question!)? My current approach has been trying to get in touch with a/the psychiatrist that is currently working for them but some of the health systems (IE St. Charles Behavioral Health in Bend, OR) do not even have a psychiatrist (only psych NPs). Ideally, I would not be wanting to start a private practice just after finishing residency but I might consider...also not sure if there would be an issue with finding patients due to what seems like many psych NPs in private practice, particularly in Bend. Any thoughts are appreciated!

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[heysexylady]

Hello! I am a PGY4 graduating next summer with plans of living outside of major metro areas and have been looking into more rural areas in both Western US. and the Midwest as well. I'm finding that many health care systems (that are primarily smaller in size) are not interested in hiring a psychiatrist, however have openings for a psychiatric NP. Any suggestions on how to convey to these systems that a psychiatrist would be worth hiring (it's so frustrating to even have this be a question!)? My current approach has been trying to get in touch with a/the psychiatrist that is currently working for them but some of the health systems (IE St. Charles Behavioral Health in Bend, OR) do not even have a psychiatrist (only psych NPs). Ideally, I would not be wanting to start a private practice just after finishing residency but I might consider...also not sure if there would be an issue with finding patients due to what seems like many psych NPs in private practice, particularly in Bend. Any thoughts are appreciated!

Why would you want to work for a system that does not appreciate your value as a psychiatrist?

 

[splik]

Remember in Oregon, psych NPs (only psych and family, not all NPs) can bill at the same rate as physicians. OR is also an independent practice state. So many employeed positions are going to NPs since they cost less and can potentially generate as much revenue, and private practice is a booming industry. Also Bend is a saturated area with Descutes county having 250 people per mental health provider.

 

[sighchiatry]

Why would you want to work for a system that does not appreciate your value as a psychiatrist?

Agreed.


Also, most of the better job offers I've received were for positions that were not posted. I would find the phone number for the most senior psych related person or in house/health system employed recruiter I could and said "I'm a psychiatrist, I'm looking to work in the area, what have you got?"

 

[Sushirolls]

~5 years ago you could probably call up some of these Big Box shops and they would express interest in the ARNP postings for a Psychiatrist inquiry. Often times the posting folks just assumed or gave up on Psychiatrist interest. Now, I believe you will likely find these postings to be inflexible. Largely due to the above described cost difference. Many places are replacing Psychiatrists for the cheaper ARNP version.

As I've posted before there is a schism shaping, where ARNP/Big Box shops vs smaller independent physician practices.

If Bend is your preference, look at how many Psychiatrists are there. There is still a market for the patients who have been disappointed by the insufficiency of ARNP care and specifically seek out Psychiatric Medical care. About 0-2 consults I do per week have voiced their ARNP disappointments.

 

[PikminOC]

Yes malpractice costs for the hospital is less too with nurses as they are held to nursing standards

 

[splik]

Yes malpractice costs for the hospital is less too with nurses as they are held to nursing standards

Malpractice costs are less because they get sued less. Patients prefer NPs (i.e. they have higher satisfaction scores regardless of how bad they are) so they get sued less. In independent practice states such as OR, NPs are held to the same standard as physicians.

 

[PikminOC]

Not in the rest of the states. Their malp is much less than mine. Their board rarely censures them too

 

[futuredo32]

Malpractice costs are less because they get sued less. Patients prefer NPs (i.e. they have higher satisfaction scores regardless of how bad they are) so they get sued less. In independent practice states such as OR, NPs are held to the same standard as physicians.

NPs in the clinic where I worked prescribed as much of any controlled substance as a patient wanted and I got 15 minutes with patients they got 30 minutes for a med appointment. They got 90 minutes for a new eval I got 45 minutes.

 

[calvnandhobbs68]

Hello! I am a PGY4 graduating next summer with plans of living outside of major metro areas and have been looking into more rural areas in both Western US. and the Midwest as well. I'm finding that many health care systems (that are primarily smaller in size) are not interested in hiring a psychiatrist, however have openings for a psychiatric NP. Any suggestions on how to convey to these systems that a psychiatrist would be worth hiring (it's so frustrating to even have this be a question!)? My current approach has been trying to get in touch with a/the psychiatrist that is currently working for them but some of the health systems (IE St. Charles Behavioral Health in Bend, OR) do not even have a psychiatrist (only psych NPs). Ideally, I would not be wanting to start a private practice just after finishing residency but I might consider...also not sure if there would be an issue with finding patients due to what seems like many psych NPs in private practice, particularly in Bend. Any thoughts are appreciated!

you say you’re “looking at areas in both the western US and Midwest” but then you just mention Bend, OR twice...so are you actually just mostly looking at bend?

Things are gonna be quite a bit different if you’re restricting yourself to one small area in Oregon vs multiple states. I guarantee you’ll have no problem finding a job in the Midwest (or most of the plains states for that matter).

Oregon is also one of those states that lets naturopaths prescribe whatever and call themselves patients “PCP”. No thanks.

 

[heartsink]

Oregon is also one of those states that lets naturopaths prescribe whatever and call themselves patients “PCP”. No thanks.

There's a reason its called the wild west.

 

[finalpsychyear]

what a horrible situation in medicine. If only docs had banded together and unionized we would keep it doctor-patient relationship vs
doctor-insurance-patient relationship.

Such a travesty

 

[nikeforlife]

what a horrible situation in medicine. If only docs had banded together and unionized we would keep it doctor-patient relationship vs
doctor-insurance-patient relationship.

Such a travesty

Right?! I think I wanted to just also highlight to people (especially other residents) that this is actually happening and it’s so frustrating. A lot of points taken and helpful advice - thank you all. I am looking at places other than Bend but that was the case in point example of psychiatry comprising primarily of NPs there, per my internet research.

 

[deleted480308]

Right?! I think I wanted to just also highlight to people (especially other residents) that this is actually happening and it’s so frustrating. A lot of points taken and helpful advice - thank you all. I am looking at places other than Bend but that was the case in point example of psychiatry comprising primarily of NPs there, per my internet research.

Just remember this if you become a manager some day and get rid of them

 

[futuredo32]

what a horrible situation in medicine. If only docs had banded together and unionized we would keep it doctor-patient relationship vs
doctor-insurance-patient relationship.

Such a travesty

Why aren't physicians doing anything NOW? One day it may truly be too late. There is still time. But many physicians contribute to the problem by training and hiring NPs and PAs because they are less expensive than hiring physicians.

 

[finalpsychyear]

Why aren't physicians doing anything NOW? One day it may truly be too late. There is still time. But many physicians contribute to the problem by training and hiring NPs and PAs because they are less expensive than hiring physicians.

THAT is exactly a big issue. Docs hire almost only extenders these days. Hosp/Clinics follow suit since its all about the $$.I have given up any hope that docs will do anything. I will work even harder now for next 10 years and get out while living like a resident till i hit the WCI 5 year rule. Thank goodness I got in the field and i would hate to be a med student or early resident right now.

In 2030 I will work only for pleasure via telemedicine.

 

[futuredo32]

THAT is exactly a big issue. Docs hire almost only extenders these days. Hosp/Clinics follow suit since its all about the $$.I have given up any hope that docs will do anything. I will work even harder now for next 10 years and get out while living like a resident till i hit the WCI 5 year rule. Thank goodness I got in the field and i would hate to be a med student or early resident right now.

In 2030 I will work only for pleasure via telemedicine.

I don't follow this forum a ton. WCI 5 year rule? I am screwed due to my student loans. I want to do FP and am applying next year. I would be fine making 150k working 60 hours in FP (if I can get a second residency). I definitely don't like psych enough to do it gratis and I need to save for the future. I pay on my student loans but they are bigger every year due to interest.

 

[nowaysanjose]

Remember in Oregon, psych NPs (only psych and family, not all NPs) can bill at the same rate as physicians. OR is also an independent practice state. So many employeed positions are going to NPs since they cost less and can potentially generate as much revenue, and private practice is a booming industry. Also Bend is a saturated area with Descutes county having 250 people per mental health provider.

Won’t this equal pay movement be the exact undoing of mid levels? If there is no cost difference, what’s the incentive for hospitals to hire them? Because while they parrot the equal outcomes myth, they all damn well know physicians are infinitely better at providing care

 

[Sushirolls]

ARNPs are more likely to simply say 'yes' to bad policies and work demands, in part because they don't know better. ARNPs and lesser so PAs are more compliant to hospital admin. But with the rising hosptial admin culture of seeing "providers" as "providers" we widgets can be changed out readily in their eyes, and quality beyond that means nothing.

I anticipate seeing a swing in some specialities back towards private practice as more physicians start to realize the poor work environments they are entering into with big box shops.

 

[MLT2MT2DO]

Won’t this equal pay movement be the exact undoing of mid levels? If there is no cost difference, what’s the incentive for hospitals to hire them? Because while they parrot the equal outcomes myth, they all damn well know physicians are infinitely better at providing care

I think you're mistaking equal reimbursement for equal pay. Unless you misquoted something.

In these states hospitals are paying NPs far less than Psychiatrists while collections are the same for the hospital

 

[splik]

ARNPs are more likely to simply say 'yes' to bad policies and work demands, in part because they don't know better. ARNPs and lesser so PAs are more compliant to hospital admin.

I'm not sure that's true. Unlike physicians, they are trained to be aggressive about advocating for themselves and their profession. I have shocked at how demanding some of these new NPs are about how much money they want, what hours they will work, what they will and won't do. In my system they aren't cheaper than MDs, and also they are unionized so they are better protected and get overtime for working evenings and weekends etc (unlike MDs) but for some reason leadership likes them. They get almost as much as physicians with fewer hours and seeing fewer patients. It's nuts.

 

[psychapp121]

I'm not sure that's true. Unlike physicians, they are trained to be aggressive about advocating for themselves and their profession. I have shocked at how demanding some of these new NPs are about how much money they want, what hours they will work, what they will and won't do. In my system they aren't cheaper than MDs, and also they are unionized so they are better protected and get overtime for working evenings and weekends etc (unlike MDs) but for some reason leadership likes them. They get almost as much as physicians with fewer hours and seeing fewer patients. It's nuts.

wtf..

 

[deleted480308]

I'm not sure that's true. Unlike physicians, they are trained to be aggressive about advocating for themselves and their profession. I have shocked at how demanding some of these new NPs are about how much money they want, what hours they will work, what they will and won't do. In my system they aren't cheaper than MDs, and also they are unionized so they are better protected and get overtime for working evenings and weekends etc (unlike MDs) but for some reason leadership likes them. They get almost as much as physicians with fewer hours and seeing fewer patients. It's nuts.

Are you saying they get paid dollar for dollar the same

 

[finalpsychyear]

I'm not sure that's true. Unlike physicians, they are trained to be aggressive about advocating for themselves and their profession. I have shocked at how demanding some of these new NPs are about how much money they want, what hours they will work, what they will and won't do. In my system they aren't cheaper than MDs, and also they are unionized so they are better protected and get overtime for working evenings and weekends etc (unlike MDs) but for some reason leadership likes them. They get almost as much as physicians with fewer hours and seeing fewer patients. It's nuts.

lol. This is hilarious if true. The end is much closer than even I thought. Thank god only 10 years left of this crap.

 

[psychapp121]

lol. This is hilarious if true. The end is much closer than even I thought. Thank god only 10 years left of this crap.

you’re so dramatic it’s hilarious

 

[hebel]

To me this reinforces why psychiatry can be such an excellent choice...the ability to open up a private practice is VERY important. I'm willing to play ball with employers, but if things get unreasonable it's nice to have the private practice "escape hatch."