psych np's taking over

[cherryalmond]

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I just started a locums job and it is completely outpt work. I realized yesterday that the job i took was previously done by a psych np. I am not sure why the hosp/clinic decided to hire a psychiatrist vs another psyc np but here i am. The np was only supervised by a psychiatrist once every 2 or 3 months from what i have heard. Is this normal? The np managed all these patients. I basically feel a bit like why did i go to med school if i could have gone to nursing school,have much less loans, and done the same job. I feel a bit resentful and am somewhat curious why i was hired. Is outpt work headed in the direction of np's and psychiatrists will mostly run inpt units and supervise partial hosp programs and day treatment. This is crazy.

 

[xpilot]

I just started a locums job and it is completely outpt work. I realized yesterday that the job i took was previously done by a psych np. I am not sure why the hosp/clinic decided to hire a psychiatrist vs another psyc np but here i am. The np was only supervised by a psychiatrist once every 2 or 3 months from what i have heard. Is this normal? The np managed all these patients. I basically feel a bit like why did i go to med school if i could have gone to nursing school,have much less loans, and done the same job. I feel a bit resentful and am somewhat curious why i was hired. Is outpt work headed in the direction of np's and psychiatrists will mostly run inpt units and supervise partial hosp programs and day treatment. This is crazy.

I can imagine how you feel. My baby sister is a psych NP and she gets paid quite well for doing outpt psychiatry with just a master's degree.

 

[DrAwsome]

I can imagine how you feel. My baby sister is a psych NP and she gets paid quite well for doing outpt psychiatry with just a master's degree.

Although I'm not in psych this is something which I question myself as well. Why are we going through med school to end up having NURSES practice medicine with a 4 year degree and maybe a 2 year masters? I think that if the gov feels that doctors are not needed in certain specialties then maybe we should just stop certain specialties from being medical ones. It makes absolutely NO sense to have people go through doctoral training to be in the same positions as nurses. That says that either we are over trained or nurses are under trained. Some ultimate decision should be made about this.

 

[splik]

most of what doctors do in any specialty doesn't take the extensive training we have to do. NPs I find are much better at dotting the t's and crossing the I's than physicians. They can deal with things in a well circumscribed area (i.e. I question their role in primary care or dealing with undifferentiated patients). However, a little learning is also a dangerous things, and non-physicians are sometimes/often not aware that they don't know what they don't know - i.e. less likely to be aware of the limits of their knowledge/training.

The reason we will always be needed to some extent is because of that 10% of the time that medical training is needed, to manage uncertainty, to realize the patient has a diagnosis others may not have heard of, that this is an atypical presentation of a typical disease, that this is an atypical presentation of an atypical disease, or that this an illness that has not even been named or discovered yet. When the guidelines or protocols don't help with the patient in front of you and you need to think outside the box using a more theory-based rather than evidence-based approach. When the patient or family want nothing less than to see a physician.

As Milton Friedman pointed out (not that I am normally a fan of his), organized medicine's bid to restrict entry to the profession led to back routes into it. What is ironic is those who most believe in the free market, are the ones who are often most critical of other providers muscling in our turf. The options are simple, either we train more physicians and take a lesser salary, or we accept the proliferation of physician extenders, which will reduce physician earnings overall. Whatever happens, there will always be a need for psychiatrists and physicians in other fields, and we will continue to earn more than a decent amount. The golden days are long gone, and they were not golden for patients anyway.

 

[AnnoyedByFreud]

I understand why it would be irritating to go through med school and then see people with "lesser" training doing pretty much the same job. However, I really don't think psych NPs are "taking over". Consider that it is a very unpopular specialty for NPs (only 3% of NPs specialize in psych). There are plenty of patients. And yes, I am in a psych NP program, but if it makes you feel better I will never be able to make around 180-200k+... Also, I will have significant loans as well (not as bad as most med students, but still significant).

 

[QuesoAndFromage]

Basically what the person above me said. Psych is pretty unpopular in general and I dont think anyone has to worry about others taking over. Of course this is not great for patient access but from a purely "selfish" point of view it means that those in psych most likely dont have to worry about a job (note that I may be overly simplifying things and someone who is not a pre-rotation medical student might have more accurate insight)

 

[PikminOC]

I just started a locums job and it is completely outpt work. I realized yesterday that the job i took was previously done by a psych np. I am not sure why the hosp/clinic decided to hire a psychiatrist vs another psyc np but here i am. The np was only supervised by a psychiatrist once every 2 or 3 months from what i have heard. Is this normal? The np managed all these patients. I basically feel a bit like why did i go to med school if i could have gone to nursing school,have much less loans, and done the same job. I feel a bit resentful and am somewhat curious why i was hired. Is outpt work headed in the direction of np's and psychiatrists will mostly run inpt units and supervise partial hosp programs and day treatment. This is crazy.

Think of it this way: there is some reason they are willing to pay more for you to do the job than the np. You don't know the circumstances but you are worth the extra money and they hired you, not another NP.

Good luck!

 

[vistaril]

I just started a locums job and it is completely outpt work. I realized yesterday that the job i took was previously done by a psych np. I am not sure why the hosp/clinic decided to hire a psychiatrist vs another psyc np but here i am. The np was only supervised by a psychiatrist once every 2 or 3 months from what i have heard. Is this normal? The np managed all these patients. I basically feel a bit like why did i go to med school if i could have gone to nursing school,have much less loans, and done the same job. I feel a bit resentful and am somewhat curious why i was hired. Is outpt work headed in the direction of np's and psychiatrists will mostly run inpt units and supervise partial hosp programs and day treatment. This is crazy.

yeah, it is concerning.

I think it depends on the type of outpt work. NP's are definately taking over a lot of private for profit mental health outpt outfits that deal with a non-SMI population....as they should. It's ridiculous to pay 175k for me to increase someone's wellbutrin to 300mg when they can pay an np slightly less than half that to do it to maximize profits(or cut costs) for themselves.

 

[peppy]

The reason we will always be needed to some extent is because of that 10% of the time that medical training is needed, to manage uncertainty, to realize the patient has a diagnosis others may not have heard of, that this is an atypical presentation of a typical disease, that this is an atypical presentation of an atypical disease, or that this an illness that has not even been named or discovered yet. When the guidelines or protocols don't help with the patient in front of you and you need to think outside the box using a more theory-based rather than evidence-based approach. When the patient or family want nothing less than to see a physician.

Yes, we need to be careful not to underestimate ourselves. I don't know about you, but I see a lot of bad practices related to psych meds out there (a person on both benzos AND stimulants, using three antipsychotics at once, Seroquel being prescribed solely for insomnia, a nursing home patient with signs of NMS that the PA at the nursing home didn't recognize, etc.). Any decently trained psychiatrist should know better than to do that kind of stuff - but yet this stuff happens all the time in the community due to the lack of access to a well trained psychiatrist and settling for a "good enough most of the time" precriber (whether a midlevel, a PCP, or even a crappy psychiatrist) to manage psych meds.
I definitely feel there are a lot of people out there who know just enough psychopharmacology to be dangerous.

Even though we are very fortunate that psychiatric medication has become fairly safe compared to the old days when docs were giving suicidal patients TCAs, I think that there is still enough potential for harm that there is a substantial benefit to having a well trained psychiatrist rather than an NP/PA (or even a PCP with an interest in psych) managing someone's psych meds.
I am not defining "harm" as just patients dropping dead, btw. When patients suffer side effects or don't improve because they're not on the right meds, that is harmful to them - wasting their time, limiting their quality of life. I think you see more of that kind of harm with midlevel psych prescribers than patients dropping dead.

Sure, anyone can look at a textbook case of MDD in a healthy young patient and know that an SSRI is the right place to start. However, there are nuances to using different meds, especially in a medically complex patient, patients who have side effects to the first line treatments, etc. Not to mention that psychiatry is evolving and what may be good practice today might change as the scientific literature evolves.

 

[vistaril]

Yes, we need to be careful not to underestimate ourselves. I don't know about you, but I see a lot of bad practices related to psych meds out there (a person on both benzos AND stimulants, using three antipsychotics at once, Seroquel being prescribed solely for insomnia,QUOTE]

ummm...unfortunately it *is* psychiatrists who are more likely to do some of those things.....

in fact, I would say for some of those things(like pts on three different AP's) it is ALMOST ALWAYS psychiatrists who have a pt on three antipsychotics.

 

[F0nzie]

I just started a locums job and it is completely outpt work. I realized yesterday that the job i took was previously done by a psych np. I am not sure why the hosp/clinic decided to hire a psychiatrist vs another psyc np but here i am. The np was only supervised by a psychiatrist once every 2 or 3 months from what i have heard. Is this normal? The np managed all these patients. I basically feel a bit like why did i go to med school if i could have gone to nursing school,have much less loans, and done the same job. I feel a bit resentful and am somewhat curious why i was hired. Is outpt work headed in the direction of np's and psychiatrists will mostly run inpt units and supervise partial hosp programs and day treatment. This is crazy.

 

[st2205]

Yes, we need to be careful not to underestimate ourselves. I don't know about you, but I see a lot of bad practices related to psych meds out there (a person on both benzos AND stimulants, using three antipsychotics at once, Seroquel being prescribed solely for insomnia,QUOTE]

ummm...unfortunately it *is* psychiatrists who are more likely to do some of those things.....

in fact, I would say for some of those things(like pts on three different AP's) it is ALMOST ALWAYS psychiatrists who have a pt on three antipsychotics.

I just did a DC summary yesterday where the NP's admitting orders included three antipsychotics, two benzos, an SSRI and a host of other non-psych meds. This isn't a reflection on NPs, I just share it as it was specifically the scenario mentioned.

 

[cherryalmond]

Well it is just surprising to me. My younger sister is getting her nursing degree and I keep telling her to go into psyc. It is definitely a little disconcerting that in some states np's can practice without a supervising physician. I am not sure how much psyc np's make but i imagine they do quite well.

 

[PikminOC]

in my state, np's need 'collaboration' with a physician. so the physician actually takes responsibility for any mistake the np makes. i worked with a very good np. i made 3 times as much as her.

 

[AnnoyedByFreud]

Well it is just surprising to me. My younger sister is getting her nursing degree and I keep telling her to go into psyc. It is definitely a little disconcerting that in some states np's can practice without a supervising physician. I am not sure how much psyc np's make but i imagine they do quite well.

As far as I can tell, in the independent practice states they make in the lower six figures, with the potential for more, but nowhere near the 200k that a psychiatrist makes. Not bad for a two years masters degree.

 

[LimbicResponse]

Don't fear someone with a lower education. If you remain a leader in your field as a physician you will always have a job and will always be paid more.

-Medicine is a lifelong career that requires a lifelong devotion to learning, caring, teaching, serving. If you become a run of the mill psychiatrist that shames our calling as physicians by treating it as just a job. A job in which you are more focused on the money that you make and what you are going to do with it, then you will fall into the pitfall of practicing logarithmic, mindless medicine. A job that I feel, is perfectly designed for someone with a lower education, and therefore, you deserve to be replaced.

 

[notdeadyet]

-Medicine is a lifelong career that requires a lifelong devotion to learning, caring, teaching, serving. If you become a run of the mill psychiatrist that shames our calling as physicians by treating it as just a job.

Oh please. It IS a job. It ain't the priesthood. Hell, even the priesthood ain't the priesthood anymore.

 

[billypilgrim37]

Oh please. It IS a job. It ain't the priesthood. Hell, even the priesthood ain't the priesthood anymore.

Well, it probably falls somewhere in between the priesthood and a job, to be fair. 😉

 

[notdeadyet]

Unless you're doing it for karma, indulgences, or something other than money, it's just a job. Like nursing, firefighting, police, etc.

I think when potential applicants go in with that view they can look at the career path objectively and not end up one of the multitudes of bitter doctors that regret their career choice with too much loan burden to leave.

We work, we get paid. Like everyone else at the hospital. The sooner young docs drop the "calling" business, the sooner they can be effective leaders of their team.

 

[billypilgrim37]

My chair has a nice canned lecture about this and he has lots of categories in between. He's a pretty nice guy and says some thoughtful things. I wouldn't be as eloquent as he is about it, and it might sound a bit hallmarky, and it's more about how if you want to be a researcher, you should probably feel that the subject you want to work on is more of a "calling" (because otherwise, you're going to be too miserable). Given that we're one of the best research departments around, he's probably right. And the fact that I no longer saw research as a "calling" is why I decided not to sacrifice the rest of my life making a lot less money and working a lot harder when there was other fun stuff I could do.

Broadly, though he has more categories, I think between "job" and "calling" there is the idea of the "professional career". I think the idea of that level is that you can invest a little more of yourself (in a way that increases satisfaction) while still letting you set limits for your family and personal time.

 

[sunlioness]

To be honest, I'd think I'd be a lot happier in this field if I truly felt it was a calling. Looking at it as a job might help me leave work at work, but I don't think it's helping me be happy at work. I think I felt it was a calling once. I'm not sure if that's something I can get back or not. When is burnout just burnout and when is it a symptom that maybe you ought to be doing something else? And what to do when the something elses's require more education, have a bleak outlook, and would earn about a third of what an attending psychiatrist makes even if you could find a job? I wonder about these things.

I come back to thinking I would love psychiatry again if the system were better. If people could get seen fairly easily and everyone got paid. If there were more of us, better access, and I wasn't seeing 6 complicated new people in a day. So, to close and bring it back to topic, if NPs can help with this, I'm all for them.

 

[zenman]

I just did a DC summary yesterday where the NP's admitting orders included three antipsychotics, two benzos, an SSRI and a host of other non-psych meds. This isn't a reflection on NPs, I just share it as it was specifically the scenario mentioned.

Even though it was an admission, were these the meds the patient was already on? I've had some like this and I continue home meds till I get hold of the patient's provider to see what the history is.

I don't think you have to worry about us psych NP's. I just left an inpatient job where I also did CL consults. A psychiatrist is replacing me at the hospital. You can have the "bat**** crazy" folks (no disrespect intended). I'm moving in the military outpatient setting where my patients will be relatively stable, have no trouble getting their meds, won't be homeless etc, etc.. I'm going to be so happy. Stand at ease!

 

[LimbicResponse]

Unless you're doing it for karma, indulgences, or something other than money, it's just a job. Like nursing, firefighting, police, etc.

I think when potential applicants go in with that view they can look at the career path objectively and not end up one of the multitudes of bitter doctors that regret their career choice with too much loan burden to leave.

We work, we get paid. Like everyone else at the hospital. The sooner young docs drop the "calling" business, the sooner they can be effective leaders of their team.

this is so disheartening.. I hope you find your calling one day.

 

[st2205]

Even though it was an admission, were these the meds the patient was already on? I've had some like this and I continue home meds till I get hold of the patient's provider to see what the history is.

I don't know why your quote has my text as vistaril but anyhow, no, these were not home meds. There was no rhyme or reason.

 

[notdeadyet]

Broadly, though he has more categories, I think between "job" and "calling" there is the idea of the "professional career". I think the idea of that level is that you can invest a little more of yourself (in a way that increases satisfaction) while still letting you set limits for your family and personal time.

Sure, this makes sense. I think the problem with the calling philosophy is that it reinforces the paternal snobbery that is so inherent in medicine. Calling is yet another way to indicate how special doctors are compared to patients just working jobs.

Career? Fine. I have one of them. So does my accountant and the contractor that works on my house or the shop steward at my Safeway. But talking about our calling is another step back to saving those huddled masses from themselves. My preacher has a calling: a job he believes he was destined for by god to fight a fight the rest of us don't really understand. There are doctors who think along those lines, but in my experience they tend to not be the good ones.

 

[notdeadyet]

this is so disheartening.. I hope you find your calling one day.

That's kind of you, but no need. I have the best job in the world. I get paid to help people. That's tough to beat. I take my job very seriously and like to think I'm pretty good at it and get better at it every day.

Then I get home and enjoy my family, my friends, and my hobbies. My job gives me great satisfaction and enjoyment, but my off-time is where I have the most plain old fun. And you'll notice the further you get in a career that enjoying your off-time is important, because a job, at the end of the day, is a job. It's not your life.

By not viewing my career as a "calling," I am saved a lot of the annoyances and affectations that seems most prevalent in the folks who see themselves bound up in their idealized vision of their job. I don't fight endless fights about whether this program or that is ranked 4th or 5th. I don't moan about the fact that nurses and techs now wear white coats. I don't get elevated blood pressure from the minutia of interdepartmental politics. I don't get personalized license plates with MD or make dinner reservations as DR. Notdeadyet. I get tired from the long hours, sure, but I don't have problems with burn-out since I don't idealize what I do for a living into something resembling mythology.

I'm a fair guy who tries hard to be a better man every day. I take care of my patients, I love my family, and I'm loyal to my friends. I don't need to view my career as a calling as incentive to take it or myself seriously. But to each their own.

 

[OldPsychDoc]

That's kind of you, but no need. I have the best job in the world. I get paid to help people. That's tough to beat. I take my job very seriously and like to think I'm pretty good at it and get better at it every day.

Then I get home and enjoy my family, my friends, and my hobbies. My job gives me great satisfaction and enjoyment, but my off-time is where I have the most plain old fun. And you'll notice the further you get in a career that enjoying your off-time is important, because a job, at the end of the day, is a job. It's not your life.

By not viewing my career as a "calling," I am saved a lot of the annoyances and affectations that seems most prevalent in the folks who see themselves bound up in their idealized vision of their job. I don't fight endless fights about whether this program or that is ranked 4th or 5th. I don't moan about the fact that nurses and techs now wear white coats. I don't get elevated blood pressure from the minutia of interdepartmental politics. I don't get personalized license plates with MD or make dinner reservations as DR. Notdeadyet. I get tired from the long hours, sure, but I don't have problems with burn-out since I don't idealize what I do for a living into something resembling mythology.

I'm a fair guy who tries hard to be a better man every day. I take care of my patients, I love my family, and I'm loyal to my friends. I don't need to view my career as a calling as incentive to take it or myself seriously. But to each their own.

 

[hamstergang]

I don't know why your quote has my text as vistaril

Because back in post 10, vistaril messed up the end-quote tag, and you didn't fix it when you quoted him, and the other guy didn't fix it when he quoted you. If no one is willing to fix the error, it will just continue to get propagated til the end of time!

 

[nancysinatra]

I have the best job in the world. I get paid to help people. That's tough to beat.

I don't buy it. The best job in the world is to be English royalty. They get to help people too (charities, ribbon cuttings), and they get paid, but if they aren't in the mood, they can just take the day and go hunting for partridges, or fly off to some colony.

 

[nancysinatra]

If you become a run of the mill psychiatrist that shames our calling as physicians by treating it as just a job. A job in which you are more focused on the money that you make and what you are going to do with it, then you will fall into the pitfall of practicing logarithmic, mindless medicine.

What is "logarithmic" medicine?

Also does it count as a calling if I heard the "call" while I was watching a marathon of "ER" episodes back in the day and contemplating how far I was likely to get with my useless journalism minor and philosophy major? That's what inspired me to go to medical school! I hope I was not misled!

 

[madglee]

I wouldn't worry about it; there are plenty of patients for both psychiatrists and psych NPs. I understand your question, though. I got a very high MCAT score 12 years ago when I was switching professions, and looked at both medical school and NP school. I chose NP school because I knew I wanted psychiatry and other than ECT, I knew I'd be able to do anything a psychiatrist could do with about 85% of the reimbursement rates, often independently. Granted, I can't demand the same salary despite doing the same work, but hopefully that's changing.

The schooling is similar: 4 year BS + 4 year Med school vs. 4 year BS + 3-4 year doctorate and usually 1 year of residency balled into it. That saves 3 years of residency working 80 hours a week for 40k a year. That is why I think it very important for NPs coming out of school to think of themselves as in residency and have respect for psychiatry rather than running around making mistakes. I actually learned tons in 2 years of working with several psychiatrists and doctorally prepared NPs.

The New England Journal of Medicine recently released facts that despite the more extensive schooling of MD/DOs, outcomes were rarely any different, and in fact some cases better, when patients were seen by NPs. This is probably because NPs are more conscientious in many cases, "dotting i's and crossing t's," although there may be some invalidity there also due to generally lower case loads at this point.

As far as seeing patients on all the wrong meds, this is not an NP thing. I cannot believe the lunacy I get patients on after seeing psychiatrists. Tons of Xanax to come down from the Adderall. Seroquel 100mg AM, Risperdal 1mg HS, multiple low dosage antipsychotics or antidepressants from the same class - the list goes on and on.

With the proper experience, any NP or psychiatrist can be excellent. Without it, any NP or psychiatrist can be terrible. I would say performance in psychiatry is far more dependent on experience and intellect than education. I've worked side by side with many psychiatrists and am often surprised to find myself teaching them. However, I've also met some seriously inept NPs who shouldn't be practicing, and as I said before, learned TONS from some extremely intelligent psychiatrists and NPs who'd been practicing for many years.

It comes down to experience and intellect, really. I wouldn't be quick to lump NPs into somehow not knowing as much as MD/DOs in psychiatry. Sure, you have tons of classes from years ago which gave you a nice foundation in all the systems, but you're not actually using that information in practice, and no doubt forgetting it. That's why there are specialties, and if you understand advanced A&P, patho, pharmacology, psychopharmacology, biology, chemistry, and neuro, you're good to go. NP schools teach all that.

In 19 states NPs are completely autonomous and directly competing with psychiatrists very successfully. But again, there is a nearly endless supply of psychiatric patients. I like working together and collaborating, both inpatient and outpatient, rather than competing. There's always plenty more to be learned, techniques one might not have thought of, etc.

If medical schools want to concentrate on one thing, I'd say surgery. That is something no NP curriculum can possibly compete with, nor will it ever try.

Also, you can be happy about the respect issue. I have to deal with a lot of nonsense being an NP rather than an MD and it's fairly infuriating.

 

[OldPsychDoc]

What is "logarithmic" medicine?

It's when you use too many pneumonics when you're deciding on a medication regiment.
😛

 

[nancysinatra]

If medical schools want to concentrate on one thing, I'd say surgery. That is something no NP curriculum can possibly compete with, nor will it ever try.

This is an interesting statement. For the record I have no gripe about NPs. But is it just surgery that NPs don't do? What about radiology, pathology, radiation oncology, or subspecialties of IM? What about neurology? And that perennial favorite, genetic medicine?

I think NPs and PAs are fortunate because if I understand correctly, they can go from one specialty to another with way less retraining than an MD has to do. A huge pitfall of medical training is that you lose your general medical knowledge by focusing on a specialty, and eventually the question may arise, "what makes you an MD?"

I say this because I just finished a rotation with a psychiatry/psychoanalyst attending who is amazing at helping some of the most mentally disturbed people in the world, but I don't think he knows how to treat the common cold.

 

[nancysinatra]

It's when you use too many pneumonics when you're deciding on a medication regiment.
😛

Yeah it's like when you say, "there are so many pneumonics I will just use them all and exponentially increase this patient's medication complexity."

 

[PikminOC]

http://forums.studentdoctor.net/archive/index.php/t-34468.html

nursing vs medicine has been discussed ad nauseum on SDN.

You cannot compare the number of years of education to any other field of education based solely on the number of years. This is not an opinion.

To othe OP, once again, you were favored over an NP, and there are many reasons for that. Congrats on your new locums position!

 

[SteinUmStein]

Yeah it's like when you say, "there are so many pneumonics I will just use them all and exponentially increase this patient's medication complexity."

Mnemonic

 

[nancysinatra]

Mnemonic

You are totally right!!!

And the person who said "logarithmic" probably meant "algorithmic" if I understand correctly. Well now we are in the same boat.

 

[PikminOC]

To be honest, I'd think I'd be a lot happier in this field if I truly felt it was a calling. Looking at it as a job might help me leave work at work, but I don't think it's helping me be happy at work. I think I felt it was a calling once. I'm not sure if that's something I can get back or not. When is burnout just burnout and when is it a symptom that maybe you ought to be doing something else? And what to do when the something elses's require more education, have a bleak outlook, and would earn about a third of what an attending psychiatrist makes even if you could find a job? I wonder about these things.

I come back to thinking I would love psychiatry again if the system were better. If people could get seen fairly easily and everyone got paid. If there were more of us, better access, and I wasn't seeing 6 complicated new people in a day. So, to close and bring it back to topic, if NPs can help with this, I'm all for them.

Based on the models I have seen with psychiatrists and NP's, the number of complex patients for psychiatrists does not decrease. As vistaril pointed out,the economics don't make sense for more highly trained individuals to work on bread and butter cases. This is esp prevalent with CRNA's and MD Anesthesiologists.

The feeling of burnout can happen in any workplace: the lack of options for MD/DO trained physicians to work in other fields is highly aggravating.

I am happy there are many options I have as a psychiatrist within psychiatry: having my own practice, choosing who to collaborate with and take responsibility for, inpatient, outpatient, locums, administration, etc. If the MD OP is favored over an NP or PA, that also makes the MD have a distinct advantage. 😍

 

[OldPsychDoc]

You are totally right!!!

And the person who said "logarithmic" probably meant "algorithmic" if I understand correctly. Well now we are in the same boat.

Yes, my point exactly...and it's regiMEN, not regiment.
Just having some fun with ya tonight...

 

[madglee]

This is an interesting statement. For the record I have no gripe about NPs. But is it just surgery that NPs don't do? What about radiology, pathology, radiation oncology, or subspecialties of IM? What about neurology? And that perennial favorite, genetic medicine?

I think NPs and PAs are fortunate because if I understand correctly, they can go from one specialty to another with way less retraining than an MD has to do. A huge pitfall of medical training is that you lose your general medical knowledge by focusing on a specialty, and eventually the question may arise, "what makes you an MD?"

I say this because I just finished a rotation with a psychiatry/psychoanalyst attending who is amazing at helping some of the most mentally disturbed people in the world, but I don't think he knows how to treat the common cold.

Oh by no means is surgery the only specialty NPs can't compete with. I completely agree that they cannot function autonomously in any of the specialties you listed, either. PAs are entirely different than NPs. The former were trained as "physician extenders" and generally have far less schooling and are never meant to function autonomously. The national NP association's position statement is that "physician extender" is inappropriate for NPs, as is "mid-level," as we're at the highest level in our profession, whereas PAs are by definition not. I mention this because I've no idea what a PA has to do to switch specialties.

For an NP to switch specialties, even geriatric to adolescent, for instance, a 2 year, post-masters or post-doctorate, with another residency is required, followed by passing one's new board exam. It's not quite as grueling as multiple board-cert in medicine, but it takes long enough and is expensive enough that one would really have to want to change career paths to do it.

 

[madglee]

http://forums.studentdoctor.net/archive/index.php/t-34468.html

nursing vs medicine has been discussed ad nauseum on SDN.

You cannot compare the number of years of education to any other field of education based solely on the number of years. This is not an opinion.

To othe OP, once again, you were favored over an NP, and there are many reasons for that. Congrats on your new locums position!

Sure, and you can't say that a more extensive education leads to better patient outcomes, as quoted in the NEJOM. That's not an opinion, either. I'd never claim that the classes are equivalent; just the meaty, important ones. I WISH we had some more neurobiology and hard sciences rather than the extra "nursing theory" fluff, but judging by the 3-4 years of psychiatry records I've seen, it's not making much difference in actual practice.

 

[Medstudent85]

I meant algorithmic , my apologies . Watson + NPs = trouble for those who practice it as a job and not as a calling.

 

[xenotype]

Sure, and you can't say that a more extensive education leads to better patient outcomes, as quoted in the NEJOM. That's not an opinion, either. I'd never claim that the classes are equivalent; just the meaty, important ones. I WISH we had some more neurobiology and hard sciences rather than the extra "nursing theory" fluff, but judging by the 3-4 years of psychiatry records I've seen, it's not making much difference in actual practice.

I don't think it can be reasonably claimed that any of those equivalence studies were quality studies, or that they had relevance to patient safety. Airplanes don't crash that often, but having Sullenberger as your captain could make the difference between being killed and having a set of white knuckles. I'd rather have Sullenberger as my pilot over someone with a two year degree. How would you design a study comparing a pilot with a two year degree and Sullenberger? And no, a three year BSN to DNP is not anywhere close to medical education when it can be done online while working a full time job. So yes, I'd say it is an opinion, and a flawed one.

 

[AnnoyedByFreud]

I don't think it can be reasonably claimed that any of those equivalence studies were quality studies, or that they had relevance to patient safety. Airplanes don't crash that often, but having Sullenberger as your captain could make the difference between being killed and having a set of white knuckles. I'd rather have Sullenberger as my pilot over someone with a two year degree. How would you design a study comparing a pilot with a two year degree and Sullenberger? And no, a three year BSN to DNP is not anywhere close to medical education when it can be done online while working a full time job. So yes, I'd say it is an opinion, and a flawed one.

Meh. I think that the whole "NPs are dangerous and untested" narrative doesn't really ring true. NPs have been around for a long time, and practicing with little-to-no supervision in many areas (including places where the supervision is pretty much "in name only" - retroactive chart review, checking in every 2-3 months, etc.). While medical training is far more in depth, it doesn't necessarily produce a superior provider every time. There are good docs and bad docs, good NPs and bad NPs, etc. I agree with you about online education though - what a joke. However, the best NP programs are not online, fortunately, but housed in top universities affiliated with top medical centers. It seems like for-profit universities are taking over many fields though, and it's depressing.

 

[DD214_DOC]

Given the caliber of many of the psychiatrists I have met, I can't imagine what a bad psych NP looks like. Case in point, a recent patient I did an intake on who gained 60 lbs and had a marriage in shambles after she was treated with 900mg of seroquel for bipolar I c psychotic features. After a careful history, her "visual hallucinations" were actually visual illusions and her, "manic" episode lasted a whole day and a half. After 10 minutes of interview, i sent her for an MRI and voila, she has bilateral frontal lobe and right parietal lesions. She's going for an EEG now and further workup by neurology as I taper her seroquel.

And this patient was evaluated by 3 other psychiatrists before she got to me, and I'm just an idiot resident.

 

[PikminOC]

Given the caliber of many of the psychiatrists I have met, I can't imagine what a bad psych NP looks like. Case in point, a recent patient I did an intake on who gained 60 lbs and had a marriage in shambles after she was treated with 900mg of seroquel for bipolar I c psychotic features. After a careful history, her "visual hallucinations" were actually visual illusions and her, "manic" episode lasted a whole day and a half. After 10 minutes of interview, i sent her for an MRI and voila, she has bilateral frontal lobe and right parietal lesions. She's going for an EEG now and further workup by neurology as I taper her seroquel.

And this patient was evaluated by 3 other psychiatrists before she got to me, and I'm just an idiot resident.

Good catch HooahDoc!

Did this patient, who may have been evaluated as an outpt, follow up with any recommendations for imaging? I have seen this as a problem when the patient is not admitted to a hospital. In the hospital, it is very helpful that you have access to labs, MRI, EEG, and neurologists to see the patient. As an outpatient, these are hard and costly things to accomplish. Also, her history may have been different to the other docs as it is difficult to get consistent answers. If she was on seroquel and gained 60 lbs, she was on it for a long time. Did you get a chance to review the old records?

And you have no idea how good or bad an NP is: but you may be in a state where you are required to collaborate with them (because they have to have a collaborating physician) and then you will be responsible for their mistakes too. At least with the other physicians, you aren't responsible for their actions.

This collaboration is not by will. NP's are required to collaborate with a physician in over 30 states. This is not the same as running a case by a colleague (voluntary collaboration) where they are not liable for the decisions you make. I learned a great deal about vicarious liability after the insulated environment of residency.

 

[PikminOC]

.

 

[PikminOC]

I wouldn't worry about it; there are plenty of patients for both psychiatrists and psych NPs. I understand your question, though. I got a very high MCAT score 12 years ago when I was switching professions, and looked at both medical school and NP school. I chose NP school because I knew I wanted psychiatry and other than ECT, I knew I'd be able to do anything a psychiatrist could do with about 85% of the reimbursement rates, often independently. Granted, I can't demand the same salary despite doing the same work, but hopefully that's changing.

The schooling is similar: 4 year BS + 4 year Med school vs. 4 year BS + 3-4 year doctorate and usually 1 year of residency balled into it. That saves 3 years of residency working 80 hours a week for 40k a year. That is why I think it very important for NPs coming out of school to think of themselves as in residency and have respect for psychiatry rather than running around making mistakes. I actually learned tons in 2 years of working with several psychiatrists and doctorally prepared NPs.

The New England Journal of Medicine recently released facts that despite the more extensive schooling of MD/DOs, outcomes were rarely any different, and in fact some cases better, when patients were seen by NPs. This is probably because NPs are more conscientious in many cases, "dotting i's and crossing t's," although there may be some invalidity there also due to generally lower case loads at this point.

As far as seeing patients on all the wrong meds, this is not an NP thing. I cannot believe the lunacy I get patients on after seeing psychiatrists. Tons of Xanax to come down from the Adderall. Seroquel 100mg AM, Risperdal 1mg HS, multiple low dosage antipsychotics or antidepressants from the same class - the list goes on and on.

With the proper experience, any NP or psychiatrist can be excellent. Without it, any NP or psychiatrist can be terrible. I would say performance in psychiatry is far more dependent on experience and intellect than education. I've worked side by side with many psychiatrists and am often surprised to find myself teaching them. However, I've also met some seriously inept NPs who shouldn't be practicing, and as I said before, learned TONS from some extremely intelligent psychiatrists and NPs who'd been practicing for many years.

It comes down to experience and intellect, really. I wouldn't be quick to lump NPs into somehow not knowing as much as MD/DOs in psychiatry. Sure, you have tons of classes from years ago which gave you a nice foundation in all the systems, but you're not actually using that information in practice, and no doubt forgetting it. That's why there are specialties, and if you understand advanced A&P, patho, pharmacology, psychopharmacology, biology, chemistry, and neuro, you're good to go. NP schools teach all that.

In 19 states NPs are completely autonomous and directly competing with psychiatrists very successfully. But again, there is a nearly endless supply of psychiatric patients. I like working together and collaborating, both inpatient and outpatient, rather than competing. There's always plenty more to be learned, techniques one might not have thought of, etc.

If medical schools want to concentrate on one thing, I'd say surgery. That is something no NP curriculum can possibly compete with, nor will it ever try.

Also, you can be happy about the respect issue. I have to deal with a lot of nonsense being an NP rather than an MD and it's fairly infuriating.[/QUOTE]

troll

 

[PikminOC]

Sure, and you can't say that a more extensive education leads to better patient outcomes, as quoted in the NEJOM. That's not an opinion, either. I'd never claim that the classes are equivalent; just the meaty, important ones. I WISH we had some more neurobiology and hard sciences rather than the extra "nursing theory" fluff, but judging by the 3-4 years of psychiatry records I've seen, it's not making much difference in actual practice.

The numerous states the dont let you all practice independently would beg to differ.

The "meaty" classes are nowhere near the same difficulty and depth of knowledge as med school classes.

You are welcome to go to med school to get the respect you find frustrating as an NP. This way you can also take some less "fluff" classes while you are there.

 

[deleted6669]

. PAs are entirely different than NPs. The former were trained as "physician extenders" and generally have far less schooling .

a little fact check here....pa's do many more clinical hrs than np's do. that is why they are allowed to switch specialties without going back to school. a typical pa program is 2000-3000 hrs of clinicals over an entire full time year. a typical np program is 500-800 hrs over a part time year while still working as an rn.
for a peds np to do psych they need to get another credential. a pa just needs to apply for a job in another specialty as we have already trained in peds, em, psych, surg, em, fp, ob, etc.
the 2nd yr of pa school is for all intents and purposes the 3rd yr of medschool.
review the below links. who gets the better education?
pa program at drexel: 117 credits with 15 mo of full time clinicals:http://www.drexel.edu/physAsst/programs/physicianAssistant/curriculum/
np program at drexel: 59 credits wuth 720 clinical hrs:"Students typically complete two eight hour clinical days each week and are required to identify and get approval for their own Preceptors and Clinical Sites each quarter."
http://www.drexel.edu/gradnursing/msn/nursePractitioner/familyPractice/