NP levels peaking!

[Midwest Headshrinker]

I have read a number of posts where folks are concerned about NP's encroaching on psych and other medical specialties. I can tell you that for the first time, I have several NP friends that are unemployed, and having trouble finding new positions.

Why? Because in my larger Midwestern state, 10 years ago there were 9000 NP's, and now there are 20,000. There are just too many new graduates, many coming from horrible on-line classroom programs. Employers have found that these on-line NP's do not make good hires, especially if they do not have any serious, prior RN experience in the hospital.

Most NP's major in family practice, or peds, and those areas are oversaturated with NP's. Only 4% of NP's in my state are psych certified.

The same exact thing is happening in pharmacy. Too many new schools, putting out 15K new graduates each year, and not enough pharmacies to handle that amount of new grads. The pay for pharmacists continues to drop--law of supply and demand.

I do think the future in FM is pleak for MD's. I know my clinic also has a primary care clinic (mainly HTN and DMII type patients). It has two NP's, and three years ago, we had one MD and one NP. Again, just follow the money on why administrators are hiring NP's.

Psychiatry, from my perspective, is a very safe haven for physicians, but I would not be borrowing $150K to go through MD/DO school, hoping to score big in FM or IM. I really think in 10 years, 80% of primary care providers will be NP's, or PA's.

Finally, I had an earlier post about a horrible false sexual harassment incident that I was charged with, and cleared a month ago. I went back to work, and it was like nothing happened. I never got any backpay, but I just decided to let "sleeping dogs lie". Still no apologies from HR, but I like the hours, the location, and for the most part, the patients. The woman who made the phony charge is now under the care of a female NP.

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[wolfvgang22]

Glad it worked out for you.
I would expect NPs to get psych certification in greater numbers.

 

[NickNaylor]

Glad it worked out for you.
I would expect NPs to get psych certification in greater numbers.

I agree. If anything, it is easier to skate by from a medicolegal perspective in psychiatry with poor management because optimal management is less clearly defined than in other medical specialties, and diagnosis is more ambiguous.

 

[futuredo32]

I left a job in Bangor Maine where RNs saw patients and were overseen by NPs. The patients saw a psychiatrist ONCE a year. Trouble concentrating? You must have ADHD , here's Adderall. Your dad died, you are depressed, here's an SSRI. They couldn't catch obvious bipolar diagnoses, it was truly disturbing. The clinic where I worked prior had a few patients follow me to my micro practice. The NP told a patient (stable on lithium) that lithium was "old school" and ineffective...………...………….. It's scary

 

[BorderlineQueen]

I left a job in Bangor Maine where RNs saw patients and were overseen by NPs. The patients saw a psychiatrist ONCE a year. Trouble concentrating? You must have ADHD , here's Adderall. Your dad died, you are depressed, here's an SSRI. They couldn't catch obvious bipolar diagnoses, it was truly disturbing. The clinic where I worked prior had a few patients follow me to my micro practice. The NP told a patient (stable on lithium) that lithium was "old school" and ineffective...………...………….. It's scary

I’ve heard about this type of set-up I know a PA who oversees a RN acting as a provider. The PA is at home and supervises the RN. The RN calls the PA with any questions or concerns they have. The supervising psychiatrist barely talks or supervises the PA. This PA is fresh out of school and already handling complicated processes like detox and other complex situations. Probably a bad situation but this is what’s happening.

 

[futuredo32]

I’ve heard about this type of set-up I know a PA who oversees a RN acting as a provider. The PA is at home and supervises the RN. The RN calls the PA with any questions or concerns they have. The supervising psychiatrist barely talks or supervises the PA. This PA is fresh out of school and already handling complicated processes like detox and other complex situations. Probably a bad situation but this is what’s happening.

scary. One patient was OBVIOUSLY manic and said she wasn't sleeping, I was with the NP and the NP said oh, you aren't sleeping, you look depressed (the woman had so much make up on she looked like a clown, she was speaking a mile a minute). I screened her for bipolar disorder in the whole 8 minutes I had and the patient said she was previously diagnosed with bipolar disorder. The NPs got upset whenever I made a change to their meds. My supervisor there was nice, but said I was a visitor...………………….. GREAT money, but I stayed 2 months (this was a job I went to that was supposed to be me learning addictions to get BC via the practice pathway.) It's going to take a huge or many huge publicized malpractice case(S) by an NP to have them utilized as they should be used, if they should even be used. I do the little I can by refusing to train NPs or PAs and refusing to see them as a patient.

 

[brycew85]

Now telling patients who want to see a Physician that seeing them is just fine

 

[Nines]

I hope you're right. I'm currently interviewing for outpatient jobs and almost all of them have entering into collaboration agreements with NPs as a requirement of taking the job. The more frustrating thing is that I've hearing "we believe in utilizing NPs at the top of their license" from doctors (always docs in admin) in these interviews. When I voice concerns about vicarious liability the response is usually "oh we've never had that issue and we provide malpractice insurance. " Not terribly comforting.

 

[Jules A]

I hope you're right. I'm currently interviewing for outpatient jobs and almost all of them have entering into collaboration agreements with NPs as a requirement of taking the job. The more frustrating thing is that I've hearing "we believe in utilizing NPs at the top of their license" from doctors (always docs in admin) in these interviews. When I voice concerns about vicarious liability the response is usually "oh we've never had that issue and we provide malpractice insurance. " Not terribly comforting.

That is weird I have never heard a physician endorsing that "top of their license" babble. Remember the choice is yours and accepting a position that entails something you don't feel comfortable doing is generally not a great strategy. Unless you enjoy complaining about how awful things are and yet continue supporting it, as many do.

 

[Ironspy]

That is weird I have never heard a physician endorsing that "top of their license" babble. Remember the choice is yours and accepting a position that entails something you don't feel comfortable doing is generally not a great strategy. Unless you enjoy complaining about how awful things are and yet continue supporting it, as many do.

I refuse to work in a setting that requires supervision of NPs. I am in a large liberal city and I found lots of job options without this requirement and many that “required” this did not protest when I said this was a deal breaker for me.

If NPs are our equivalent like many claim, then they should just supervise and train each other and leave me out of it

 

[Mad Jack]

Glad it worked out for you.
I would expect NPs to get psych certification in greater numbers.

It's an entirely different training process and much like medicine most don't want to do psych

 

[wolfvgang22]

It's an entirely different training process and much like medicine most don't want to do psych

Yes, it is a much easier training process.
If I were to do it all over again, I might look at being an NP or even a PA in psychiatry. I see why people go that route.

 

[WisNeuro]

That is weird I have never heard a physician endorsing that "top of their license" babble. Remember the choice is yours and accepting a position that entails something you don't feel comfortable doing is generally not a great strategy. Unless you enjoy complaining about how awful things are and yet continue supporting it, as many do.

This is going around our system now for midlevels in various departments (NPs, masters therapists, OTs, etc). Hearing about it from colleagues in neighboring systems as well.

 

[Jules A]

This is going around our system now for midlevels in various departments (NPs, masters therapists, OTs, etc). Hearing about it from colleagues in neighboring systems as well.

Yeah its a big thing among midlevels but docs aren't buying into that and actually using the term are they?

 

[WisNeuro]

Yeah its a big thing among midlevels but docs aren't buying into that and actually using the term are they?

Yes, they are, big time. Our system is all about fixing a budget deficit right now. We haven't hired a new MD/DO psychiatrist in the past 3 years I've been in this hospital, but we've hired several NPs. The higher ups and dept heads all seem to be towing the party line. One of the reasons I'm setting up my private practice in the background, so I can still collect a paycheck, and jump ship when I need to, without missing a beat.

 

[calvnandhobbs68]

Yes, they are, big time. Our system is all about fixing a budget deficit right now. We haven't hired a new MD/DO psychiatrist in the past 3 years I've been in this hospital, but we've hired several NPs. The higher ups and dept heads all seem to be towing the party line. One of the reasons I'm setting up my private practice in the background, so I can still collect a paycheck, and jump ship when I need to, without missing a beat.

Wonder how many administrators they’re firing to help fix that budget deficit.

 

[Sushirolls]

0
At least in my local health system(s).

 

[WisNeuro]

Wonder how many administrators they’re firing to help fix that budget deficit.

Well, the CEO got an 18% raise for the new year, so...

 

[Nines]

That is weird I have never heard a physician endorsing that "top of their license" babble. Remember the choice is yours and accepting a position that entails something you don't feel comfortable doing is generally not a great strategy. Unless you enjoy complaining about how awful things are and yet continue supporting it, as many do.

I agree, it's just disappointing. The explanation I get when I ask why all the love for NPs is usually "well we can't recruit enough psychiatrists." When I've spoken to regular docs in these places who aren't admin they are generally against it (np collaboration) but go along with it. I think complacency is a powerful thing. Many would rather just go along with what admin is saying instead of rocking the boat or leaving their job.

 

[Splenda88]

It's an entirely different training process and much like medicine most don't want to do psych

Well, it's changing in medicine. It will be the same in nursing.

 

[Midwest Headshrinker]

Well, it's changing in medicine. It will be the same in nursing.

At my clinic, we now have medical assistants doing the job of LPN's, and LPN's doing the job of RN's. Everything (although admin will deny it), is to save a buck.

 

[Jules A]

When I've spoken to regular docs in these places who aren't admin they are generally against it (np collaboration) but go along with it. I think complacency is a powerful thing. Many would rather just go along with what admin is saying instead of rocking the boat or leaving their job.

That would make me miserable. My financial house is in order and I am willing to turn down a sketchy position or resign if things take a wrong turn. Every time a colleague accepts a bad deal there is a trickle down effect on everyone.

 

[Midwest Headshrinker]

I agree, it's just disappointing. The explanation I get when I ask why all the love for NPs is usually "well we can't recruit enough psychiatrists." When I've spoken to regular docs in these places who aren't admin they are generally against it (np collaboration) but go along with it. I think complacency is a powerful thing. Many would rather just go along with what admin is saying instead of rocking the boat or leaving their job.

I would not worry about collaborating. In my state, as in most, the collaborating MD can only be sued if the NP messes up, if and only if the MD had direct input into that particular case. If the MD new saw or had any direct knowledge of the case, then the MD is not liable. There has not been one MD sued, for NP negligence, in my state ever...... Plus the MD only has to review six charts, q 6 months. Honestly, it is no big deal having to collaborate.

 

[Ironspy]

I would not worry about collaborating. In my state, as in most, the collaborating MD can only be sued if the NP messes up, if and only if the MD had direct input into that particular case. If the MD new saw or had any direct knowledge of the case, then the MD is not liable. There has not been one MD sued, for NP negligence, in my state ever...... Plus the MD only has to review six charts, q 6 months. Honestly, it is no big deal having to collaborate.

I don’t know what state you are in but there is absolutely precedent for physicians being liable for patients who were only seen by a supervised NP and never discussed with MD. Physicians usually carry more malpractice insurance and are often named in bad outcomes

https://secure.mlmic.com/pdf/DatelineFall2010.pdf

 

[deleted480308]

I would not worry about collaborating. In my state, as in most, the collaborating MD can only be sued if the NP messes up, if and only if the MD had direct input into that particular case. If the MD new saw or had any direct knowledge of the case, then the MD is not liable. There has not been one MD sued, for NP negligence, in my state ever...... Plus the MD only has to review six charts, q 6 months. Honestly, it is no big deal having to collaborate.

If you’re reading one chart a month, that’s not supervision it’s just selling liability

 

[Jules A]

I don’t know what state you are in but there is absolutely precedent for physicians being liable for patients who were only seen by a supervised NP and never discussed with MD. Physicians usually carry more malpractice insurance and are often named in bad outcomes

https://secure.mlmic.com/pdf/DatelineFall2010.pdf

I wonder if as malpractice claims among NPs rise, and they will if for no other reason than the significant increase in numbers of NPs, that will impact physicians' malpractice premiums if they supervise midlevels.

BTW @Ironspy your avatar is one magnificent beast. Nothing better than an orange cat.

 

[Nines]

I would not worry about collaborating. In my state, as in most, the collaborating MD can only be sued if the NP messes up, if and only if the MD had direct input into that particular case. If the MD new saw or had any direct knowledge of the case, then the MD is not liable. There has not been one MD sued, for NP negligence, in my state ever...... Plus the MD only has to review six charts, q 6 months. Honestly, it is no big deal having to collaborate.

I’ve tried to find cases and precedent for these situations and there just isn’t much and what I have found seems to vary greatly by state and situation. I think it’s really unpredictable how a judge or jury will view a given situation or decide if a doctor/patient relationship was established by virtue the doctor’s name being on a treating NPs collaboration agreement. It brings up the question of what, then, is the purpose of a collaboration agreement if it is not meant to put at least some amount of responsibility on a physician to assure a certain quality of care for an NPs panel of patients?

 

[deleted941485]

I’ve heard about this type of set-up I know a PA who oversees a RN acting as a provider. The PA is at home and supervises the RN. The RN calls the PA with any questions or concerns they have. The supervising psychiatrist barely talks or supervises the PA. This PA is fresh out of school and already handling complicated processes like detox and other complex situations. Probably a bad situation but this is what’s happening.

Lol it’s how far down the food chain can we push the actual care for the patient

All the actual educated professionals are now looking to get into management roles. It’s pathetic.

 

[Midwest Headshrinker]

If you’re reading one chart a month, that’s not supervision it’s just selling liability

He is also available, at all times, for any questions I have. I have asked him three in five years.

 

[NontradCA]

While I agree that it’s very easy to be practice crappy psychiatrist and get away with it (and plenty of psychiatrists do just that), the vast majority of patients, in my experience, want to see a psychiatrist. This isn’t going to go away. Rational people want to entrust the most qualified when it comes to their mental health. That’s not going to change.

The flip side to this is that rational people want the most qualified people. The result is that most of the sickest people (irrational, think schizophrenics, Manics) and lowest SES groups are increasingly being treated by the LEAST qualified in the field.

 

[nexus73]

While I agree that it’s very easy to be practice crappy psychiatrist and get away with it (and plenty of psychiatrists do just that), the vast majority of patients, in my experience, want to see a psychiatrist. This isn’t going to go away. Rational people want to entrust the most qualified when it comes to their mental health. That’s not going to change.

The flip side to this is that rational people want the most qualified people. The result is that most of the sickest people (irrational, think schizophrenics, Manics) and lowest SES groups are increasingly being treated by the LEAST qualified in the field.

It would be amazing if pay at community mental health centers was higher commensurate with the acuity of patients and skill required to do the job well, then those places would be able to recruit more psychiatrists. But society clearly doesn’t care about spmi patients and through legislature and state/federal budgets has increasingly cut funding so salary is low and they have to fill with nps and those desperate for loan repayment.