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That's because you're only trained in one area, therefore do not even know what you don't know.
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psych np's taking over
Started by cherryalmond
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That's because you're only trained in one area, therefore do not even know what you don't know.
That's because you're only trained in one area, therefore do not even know what you don't know.
Do you really have a yellow jeep that says psych guy on it? Because...here's the thing...I have a natural disposition to entertain what I glean is your alternative perspective. And I get embarrassed when some of us come off like the frat guys in 80's movies. But...work with me here...cause i just can't take the leap if that's your car and really keep your douche knob all the way to 11 like that.
Remind me of all those nurses, dental hygienists, and dietiicians who put their degrees on their license plates.
SUPR RN
RDH 345
etc.
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i know a volunteer firefighter that put "brb saving lives" on facebook when he went to the fire station
On Facebook a number of chiropractors list their degree as part of their name. I haven't seen it with any other specialty. The most asinine would have to be the email signature of medical students at my school...
John Doe, OMSIII
ER club secretary
Med School Day Out BBQ Chair
Med Students with Internet president
BLS Certified
Woodworking Merit Badge
1994 Junior Soccer League Participant Ribbon winner
yeah. I hate that.
Well I've never heard the expression "keep your douche knob all the way to 11 like that" so I'm assuming it's a teenybopper thing. Yes, it's my jeep and it's exactly as shown. I work on a military base where there is a lot of stigma against mental health so many soldiers go untreated. I put it out there, we laugh, and they love it...and come in. So you have to know the contact and rationale before you comment.
I see. Forgive my interpretation, like most things, it's intention and context related. You have to admit its a loud choice that could easily be mistaken for that other variety of "look at me."
I also, being from California, have an acquired vomitus reaction to hippy spirituality and frivilous dabbling in eastern modalities. But knowing what I know about how I healed my own MSK issues off the map of western modalities I am aware that we are missing certain key elements of how human beings become and stay healthy in our style of practice. It's just that my door is narrow to keep out charlatans who are far more plentiful than the real deal.
I am seeing your point about our natural hubris. But if you are maintaining that new NP grads are equipped for independent practice then we are at an impasse. And I'll have to see if there might be some meaningful exchange on some other topic. With my skepticism for your point of view increased. Anyone who thinks they're ready before they are is the simultaneous epitome of arrogance and idiocy.
Yep, flying under the radar is usually a good thing.
Agree with you here. Have to be aware. I still can't believe that sweat lodge guy getting $10 k and more from people for a sweat lodge (and then killing his customers), especially when you can get one for free or almost nothing. I guess as long as there are idiots willing to pay....
I think NPs need more clinical hours and practice before going independent. But I think we need that option mainly because some NPs have had to shut down their full practice immediately when their collaborating doc died, moved, changed his mind, etc.. New Mexico just passed the 20 yr mark with NP independent practice and that state is not falling apart.
Yeah fair enough. It seemed impossible for the sun to be the center of the solar system to the contemporaries of Copernicus. Which is why I'm hesitant to dismiss novelty. Especially when someone is confident, has insight, and has put a lot of effort into something they think is important.
I think NP's should have a path to independence to prevent beureacratic stupidity like the closure of a clinic but also to deliver on the as of yet mostly undelivered promise of increased access. The falling apart thing? Well that's not necessarily the picture of sloppy psychopharmacology for instance. There's no inherent cataclysm in that. Just the slow creeping insidious damage to a vulnerable patient population. We can barely get anyone to pay proper attention as it is, implicit in the choice of yellow monikered jeeps.
That doesn't mean we shouldn't pursue safety and proper training. We're using a lot of dirty drugs. It takes time and effort to be a good psychiatric clinician. We have enough sloppy practice to be opening up the field to people who couldn't be bothered to train more rigorously.
I'd be happy with a few years of supervision under a psychiatrist who has special training in education and then you sit for our board exams. You pass and your in the club as an equal. This will prevent the almost certain knowledge dilution that will be the inevitable result of the steep ramping up of NP training.
One other thought in regards to the fact that you are apparently flying solo with no differences in management choices from your physician colleagues:
When thinking about policy it's not about you. It's about the dumbest, most irresponsible in your cohort. What kind of idiot could make it through my training and be out there doing damage? That's safety. What could go wrong? How do we prevent that? I think is poignantly important in our case, because there's so little public advocacy.
That's what's disappointing sitting across the isle from NP's as a potential supporter. I see absolutely no internally focused quality control efforts. It's all political warfare. With patients used for props. Like Palestinian terrorists firing rockets from school yards. (Ok...that's a bit overboard, but the rhetorical form, if not the circumstance, is accurate)
When thinking about policy it's not about you. It's about the dumbest, most irresponsible in your cohort. What kind of idiot could make it through my training and be out there doing damage? That's safety. What could go wrong? How do we prevent that? I think is poignantly important in our case, because there's so little public advocacy.
That's what's disappointing sitting across the isle from NP's as a potential supporter. I see absolutely no internally focused quality control efforts. It's all political warfare. With patients used for props. Like Palestinian terrorists firing rockets from school yards. (Ok...that's a bit overboard, but the rhetorical form, if not the circumstance, is accurate)
You are wise beyond your MS status.
When I was in NM, I had a patient who moved back from East Texas after being there a year. She was unable to get psychiatric services. I'm from East Texas but will never work in Texas since it's one of the most unfriendly NP states. I'd be right there if the situation was different. Too bad.
I actually don't like drugs except as a last resort. I don't understand psychologists who want to prescribe unless it's because there are no prescribers nearby. Being able to just use words to affect change is way up there in my book. The actual learning of neuroscience and psychopharm is not that difficult; it's the individual patient and their responses where it becomes an art of figuring out what's going on. [/quote]
I'd be happy with a few years of supervision under a psychiatrist who has special training in education and then you sit for our board exams. You pass and your in the club as an equal. This will prevent the almost certain knowledge dilution that will be the inevitable result of the steep ramping up of NP training.[/QUOTE]
Fair enough if I can have a say so in my educational process. I've basically set myself on my own clinical path, studying Chinese and Japanese medicine, Q'ero and Shipibo indian traditions, etc.. Did work in prison, community mental health, impatient, CL consult, and now military setting. I set up my clinicals in school to include VA outpatient clinic and at a Navy base on Okinawa. My Navy psychiatrist preceptor loaned me his psych board book, by Morrison I believe. I have no trouble with most tests. I challenged the California state boards after completing a 1 yr Army medic program and became a registered nurse. I then took courses and earned a BSN at Excelsior College, which offers no clinical, just testing for those who have some type of healthcare background.
You mentioned bureaucratic stupidity. I'm now in Kansas and having to get a KS license in order to renew my DEA. Normally that would not be a problem since I'm working for the military. However, I'm falling through a loophole as a military contractor. Granted, the military is working with the DEA to resolve this oversight.
Now, since I graduated from Excelsior College, Kansas wants proof of 1,000 hrs of work. I have over 70,000 since I've been working many years. So I had to send my last workplace a form for them to sign and have notarized. They faxed the form back to the KS board of nursing. Not good enough as the BON wants the original. Soon as I get my license I intend to send them a piece of my mind. It would have been very efficient for the KS BON to just pick up the damn phone and call my last workplace.
I'm actually not flying solo now as I'm in Kansas. However, here in a military behavioral health clinic we are all just one happy team. Nice team to, with docs, psychologists, social workers, social work assistants, etc. running all over the place if anyone needs help.
I did spend a year working with the dumbest, most socially inept physician to come out of school. It was a miserable year and I threatened many times to write a letter to their school asking how they could unleash such a product on the general public.
Yeah. There's so much more we have in common since our general goal of aiding the patient's condition or at least improving their function is the same. I'm actually looking for a possible game changer when NP's can get free enough from medical establishment to practice with their own cultural strength. Because when that happens. And we have enough proof of efficacy then we'll have to look at what we're doing. And answer to why these other clinicians can achieve the same safe outcomes without all the unhealthy aspects of our training and the weaknesses in our culture will have a chance to be examined.
I see an opportunity in the NP model that is being missed because it can easily be dismissed by us when someone wants the same rights with less training. Exams and a short residency would narrow the range of possible excuses for us. And instead of bunch of old grumpy doc's clinging to their narcotic script pads, NP's might engage a silent majority of us that have our own issues with the way we're getting trained, in a positive constructive way.
Good luck with the bureaucrats.
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likewise.
Wow!
Wow, what?
I can at least speak to this part (not for all psychologists, of course, but at least for a good chunk). It comes down to a few things:
1) Money
2) Job security/stability/demand
3) Improved care (which includes improved access to care; see below)
I agree that psychotherapy is an excellent resource, and is very rewarding to practice. Unfortunately, many of the bill payers don't share that view, and reimburse it at a far lower rate (that continues to decline) relative to medication-related appointments/codes. Additionally, while jobs for psychologists can sometimes be hard to come by (depending on where you're looking), jobs for prescribers are generally much easier to find.
As for the improved care, it just gets back to the idea of being able to provide a "one-stop shop" for both talk-based therapy and pharmacotherapy, particularly when it's difficult to get patients in to see a psychiatrist or other prescribing practitioner.
Not saying that I necessarily ascribe to all these views myself, just that (based on my experience) those are the main driving forces.
I'll stop there, though, to avoid derailing this thread from its topic. There's actually a stickied thread in the psychology forum addressing the whole RxP movement for psychologists (with arguments from most sides being represented).
Granted i have much less knowledge than many who have posted, if money (ie loans/ income/ time spent) is your concern then consider the fact that having Np's and Pa's that can handle a lot of patients well is truly a financial benefit for a physician if you have a private practice. You could have say two trusted Nps doing med checks and pay them half? of the total payment. You double check their work and take on the more complicated patients and i would think you could make great money and have a more satisfying job since you get the interesting cases.... But i might be naive
D
deleted310399
There are a LOT of CRAPPY psychiatrists out there , some that I have had the personal misfortune of working with.... I am sorry to say this...but this particular field of medicine has the crappiest doctors overall....especially in the private sector....and much more in the academic setting than expected....
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I question how you would be equipped to make such a claim.
So at least concede what their training is: med school, residency, board exam, etc and tell me how an NP or PA would be better.
YOU DONT KNOW WHAT YOU DONT KNOW..
Hahahaha, this thread with all of its NP and other mid level trolling and MD insecurity epitomizes the ridiculousness of sdn. Chin up psychiatrists, no one is going to take your jobs. Also, you guys are way nicer than most other forums that would not allow this level of mid level trolling--- this is an MD psychiatry forum, right??? Because I thought for a bit I had wandered into the NP forum... Although based on the opinions here, it seems that NPs are cross trained super doctors, hahahahahahahaha!!!!!!
yep
85%(or more) of med school is not relevant or applicable to day to day psychiatry practice.
Board exam? Which one? The ridiculously easy usmle steps or the ridiculously easy(and massively high pass rates even for bad psychs) psych board to get bc?
It's hard to score 250+ on the steps. I'm impressed by that and that means something. But it sure as hell isn't hard to pass, especially with all the Most of the steps have little to do with psychiatry anyways.
Obviously, nobody is saying psych nps are on average 'better' than psychiatrists. but in many settings there is a lot of overlap to the point that I know several np/pas who are better than some crappy to mediocre psychiatrists I know....
Foolishness!
The question is not what this or that person is like....? How do you skip past logic with that much abandon. The question is what minimal amount of training is permissible for independent practice.
Sell yourself and your sacrifice that cheaply if you must, but you don't represent me, and from your inspired reactions not many of us.
I just stormed in on this thread and havent read many of the posts, so I wasn't really looking at it in terms of the question you framed.
I responded specifically to a post related to board exams, and just pointed out that passing step3, for example, is an insanely easy thing to do. It's a test that, with the way the cutoff for passing is set up, measures bare bones competency, and in fact many would argue doesnt even do that. Most people take the test without studying any and still pass very comfortably. The test is so easy that the *really bad* people out there can achieve a minimum passing score by putting some time into it and studying.....
perhaps if they raised the bar for step3(by making the questions much more difficult), passing step3 would actually mean something.
Except that NP's have an abysmal Step3 performance in what little information we have on the subject.
I still fail to see how a solution to the population of psychiatry with sub-optimal physicians is dilution of training.
I actually don't fear NP's taking over anything for the time being. I just think we need a system that accounts for different levels of commitment with different levels of reward. And I'm not opposed at all to opening up the profession to talented people from a variety of clinical backgrounds.
But, honestly, I think you're selling your medical training short. I refuse to believe medical training won't be useful to psychiatric patients or that anyone else but us are better positioned to make sure good health care gets delivered to the mentally ill.
I speculate you just underestimate how much of your medical training you use in delivering psychiatric care, as most of it has become just background thought process. And I think that you might benefit from taking a step back to my level where things are still intimidatingly and frighteningly vast.
Who else could spit out 20 or so quick differentials for AMS in a psychiatric patient and work through them with speed and accuracy with clinically important findings you only learn to look for in all your previous training?
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ummm...I think the key word is 'what little information.....'
There may have been a small meaningless exercise at some point where nps(or pas) were given step 3 and did poorly on it. This would be completely meaningless for a number of reasons, one of which is that they stood nothing to gain from passing it or doing well.
OK. How does that serve your consistent campaign to make us appear as incompetent as possible? That others with less training may...without valid comparisons of training except that we do it for much, much longer....be as well suited to what we need to do as us?
I wonder if you yourself are as fantastic by comparison to these supposed inferior colleagues as you imagine.
Im not neccessarily better than most of the residents I work with. I think I do some things better(I think Im pretty darn efficient for example) than them on average, but they do many things better than me as well(interest in research for example, therapy in some cases)....
that said, the residents I work with are not the typical psychiatry residents. If the residents I work with represented the 'average' psych resident, then psychiatry would come across much better to other specialties. Rather, the residents I work with should be compared to the quality of residents in other specialties not in the same sort of programs.....and if I walk across the street and compare the quality of the people my fiance works with(GI fellow) to the psych residents/fellows here, we don't stack up well....or even close to well.
Likewise, if I went to the University of Kansas-Wichita(just to pick one since it was mentioned a few threads down) and compared the psych residents there to say...the general surgery residents, it would be pretty telling as well. The general surgery residents(if they have such a program) wouldn't be super impressive on the whole. They wouldn't be bad either, and they would be mostly amgs and solid students. The psych residents there, otoh, would be most likely a collection of people who are not amgs mostly and not competent in the least.
Did I unjustly edit your post there, or is that what you really want to have said? (I know it wasn't the point you were making, but it was a point you made while making your actual point.)
Psych programs like kansas-wichita (not to pick on them in particular) have a very difficult time finding good candidates.
But ANY candidate they get has more training than an NP/PA.
I dont know about you Vistaril...
of course they do.....but some programs have to resort to taking IMGS who don't have the best communication skills. NP/PAs are all american for the most part and there isn't a language or culture barrier.
So I guess now you are saying it is better to be an NP/PA without a medical education, than an IMG with a medical education.
Wow.
Im not sure how you jump to that conclusion.....nowhere did I say(or even imply such a thing).
I do know many PA/NP's who work in certain settings who are better than some psychiatrists in those same settings. That doesn't mean that, in general, being an NP/PA is better than being an IMG psychiatrist.
Whoopty-f'n-doo!
There are some cardinals that organize international perpetrator protection programs for child molestors. There are some busboys who are poets. There are some theoretical physicists who are great in the sack. etc.
WTF point are you making. Besides that you feel superior to most of your colleagues. And that their company is depressingly bogged down in all manner of incompetence compared to your other esteemed classes of physicians. Such that you prefer to work some NP's and PA's that you encounter.
Look. We all don't like certain things about other people. But I could easily see you as naggingly pointing out individuals with negative extrapolations of NP's if you had trained as one. Your consciousness is a filter of psychiatrist disdain.
We get it.
Change the channel. Or focus it productively. Go train some budding psychiatrists. Shed your light upon them. Lest we regress into mouth breathing *****s to a man.
the ridiculousness of your post aside, I'll respond seriously- I'm also sure that there are some PA's/NPs in family medicine and primary care that are as good or better than below average family medicine physicians and pcps. So it's not limited to just psychiatry.
I do think that as we go forward, there will be increasing pressure on psychiatrists to prove their worth in salaried outpatient positions(especially non-smi focused ones) vs NPs/PAs. I think as ACA kicks in(and medicine continues to change) you may see organizations realizing they can hire 2 psych nps for about the same cost(maybe even a tad less) than the cost of 1 psychiatrist.
The VA is an ideal place for these savings to be realized, but otoh the VA doesn't spend money efficiently so wouldn't shock me if the ratio there of outpatient psychs to psych nps stays high.
Still, "not competent in the least" sounds a little strong, no?
probably depends on the year.....many of these programs have 4-6 slots per year, so it's easy to see how 2-3 good breaks or bad breaks could flip a class either way. programs like that though typically get very few(usually none) amgs from other med schools, so part of their success in any given year is to hope a few of the med students at that place have some compelling reason to stay(family for ex)
Your ability to coolly slide the goal post of your intentions and keep playing as if nothing changed is interesting.
You want a more competitive environment for real clinical competence? Cool so do I. But just pointing out variability where it lies--the point of me being ridiculous--does nothing to serve that end.
The job market will always be changing. NP's and PA's might have the answer to being quicker to the clinical endpoint punch. We might be lumbering under the weight of excess training. Gassing out with our oversized income needs as we go into the deeper rounds of american economic malaise. All this is possible.
But clinical excellence, including all it's variability, is still our domain. No one has usurped our system yet. If they do it won't be for quality but by economic scaling.
Your consistent pointing out of our incompetence implies that there are better alternatives. When it is clear, from the training of our competitors, that there is not. If you had wanted to make the economic case you wouldn't have pointed at these fool psychiatrists over there and said look see...?
I have a lifetime of experience working for nurses. There is nothing in their culture superior to ours. Their just beating us to the punch in the job market. If you knew their dirty laundry like I do you would not be shrilly pointing out our incompetence as if it were our sole dominion.
It is, however, the best existing measure for comparison. Step 3 has a ridiculously low fail rate and is hardly studied for. What's the adage? "2 months for step 1, two weeks for step 2, and for step 3? Bring a No.2 pencil". "Clinicians" who tout their experience as their best teacher vs a longer approach like MD have no business failing that test as they do.
It may not be a perfect study but it is heads and tails more valid than the studies put out about clinical outcomes of doctors vs nurses 😀
P.s. you're a resident?
Sent from my DROID RAZR using SDN Mobile
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Yeah... I've never understood the wisdom in citing physician mistakes in justifying mid level expansion. So, even the people with 2-3x the training can't get it right 100% of the time so let's lower the bar! 😕 how does that male any sense?
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something else that no ones brought up is the percent of NP/pas that do psych is pretty small... Even if the big corps decide to get 2 nps vs 1 md it doesnt mean they'll be able to.
How many nps/pas took it? How much prep time did they have? What were the consequences of it for them?
My impression from skimming that study a long time ago that ut was a very small sample with no real structure of any kind....iow just a completely garbage pilot sort of study. I would never cite that as supporting evidence of anythign.
I don't recall off the top of my head, and I think it was only NPs and not PAs that took the test.
A little looking:
http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm
Looks like the one commonly mentioned had 45 students from what is considered one of the better DNP schools. So no, it isn't a huge N value. Although someone with a little stats savvy could probably easily tell us that @ n=45 and n=20k for residents passing >95%, the numbers are probably statistically quite different and increasing the n value wont change anything. A low n is a common issue with experiments, but that doesn't mean that outcomes can always be thrown out until everyone is satisfied by the population size. As long s the math works out conclusions can be made
I also reject your arguments that they didnt have enough time to prepare - most residents use their clinical training as the time to prepare and review for a couple days before taking the test. It's somewhat naive to just assume all these nurses came in without having looked at anything and were probably also hung over and hungry or... whatever 🙄. I'd wager they studied a little bit longer than the average resident as they knew this was the opportunity to show they are equivalent to physicians. The test was also watered down from the actual usmle3 which doesn't help.
Personally, I would like to see a study where a program is blinded to the status of its "residents" and gets a mixed bag PGY1s and NPs and then we compare the PD evaluations. The logistics and ethics of this may make it impossible, but IMO there are not good ways to compare the two other than trust the correlation between training and expertise. As it stands now, the majority of DNPs work under physicians anyways in some capacity and sh** often rolls uphill such that poor outcomes due to NP incompetence will be hidden by work done by the entire medical team.
The other way to do it is for physicians to completely wash their hands of patients who get DNP care and that way when something gets missed or screwed up it gets recorded rather than cleaned up by a competent provider. The current papers put out by nurses look at outcomes for all patients in outpatient settings which really isnt a valid way to look at it. They want to run a cohort of DNP vs MD patients when what we need is a case controlled study, or a kind of a hybrid. Patients with disease X are more/less likely to receive proper care from _____. That study has yet to be done.
\I don't recall off the top of my head, and I think it was only NPs and not PAs that took the test.
A little looking:
http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm
Looks like the one commonly mentioned had 45 students from what is considered one of the better DNP schools. So no, it isn't a huge N value. Although someone with a little stats savvy could probably easily tell us that @ n=45 and n=20k for residents passing >95%, the numbers are probably statistically quite different and increasing the n value wont change anything. A low n is a common issue with experiments, but that doesn't mean that outcomes can always be thrown out until everyone is satisfied by the population size. As long s the math works out conclusions can be made
I also reject your arguments that they didnt have enough time to prepare - most residents use their clinical training as the time to prepare and review for a couple days before taking the test. It's somewhat naive to just assume all these nurses came in without having looked at anything and were probably also hung over and hungry or... whatever 🙄. I'd wager they studied a little bit longer than the average resident as they knew this was the opportunity to show they are equivalent to physicians. The test was also watered down from the actual usmle3 which doesn't help.
Personally, I would like to see a study where a program is blinded to the status of its "residents" and gets a mixed bag PGY1s and NPs and then we compare the PD evaluations. The logistics and ethics of this may make it impossible, but IMO there are not good ways to compare the two other than trust the correlation between training and expertise. As it stands now, the majority of DNPs work under physicians anyways in some capacity and sh** often rolls uphill such that poor outcomes due to NP incompetence will be hidden by work done by the entire medical team.
The other way to do it is for physicians to completely wash their hands of patients who get DNP care and that way when something gets missed or screwed up it gets recorded rather than cleaned up by a competent provider. The current papers put out by nurses look at outcomes for all patients in outpatient settings which really isnt a valid way to look at it. They want to run a cohort of DNP vs MD patients when what we need is a case controlled study, or a kind of a hybrid. Patients with disease X are more/less likely to receive proper care from _____. That study has yet to be done.
I would have almost certainly failed step3 had I taken the test under such conditions as the dnp nurses did....after all, the whole point of me passing step3 was to get a medical license. If the outcome would have been the same whether I passed or fail, I certainly wouldn't have bothered to read the questions all that closely or get questions right. I would have flippantly taken the test...with about as much interest and focus as if I were taking a mall survey.
