psych np's taking over

[SpecterGT260]

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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.

It is pretty inappropriate to apply extended personal hypotheticals to a situation to write it off. I counter that if I was going to take a test about something I supposedly know as well as the guys who pass it 95% of the time as a way to prove my equivalency I would take it quite seriously and may even use my non-intern schedule to study harder for it.
The truth is probably somewhere in the middle and should be assumed as such until otherwise shown.

 

[vistaril]

It is pretty inappropriate to apply extended personal hypotheticals to a situation to write it off. I counter that if I was going to take a test about something I supposedly know as well as the guys who pass it 95% of the time as a way to prove my equivalency I would take it quite seriously and may even use my non-intern schedule to study harder for it.
The truth is probably somewhere in the middle and should be assumed as such until otherwise shown.

the situation is so meaningless(and study so useless) that nothing is even needed to 'write it off'.....the fact that there is nothing riding on the test is an exclamation point. And it wasn't a 'way to prove equivalence' since nothing will happen or result from the test.

 

[SpecterGT260]

the situation is so meaningless(and study so useless) that nothing is even needed to 'write it off'.....the fact that there is nothing riding on the test is an exclamation point. And it wasn't a 'way to prove equivalence' since nothing will happen or result from the test.

I actually think it was sponsored by the AANP in their continued pursuit of validating claims of equivalency for the purpose of scope expansion.

When the results came in and the machine did this:

Further inquiry was abandoned.

 

[JourneyAgent]

the situation is so meaningless(and study so useless) that nothing is even needed to 'write it off'.....the fact that there is nothing riding on the test is an exclamation point. And it wasn't a 'way to prove equivalence' since nothing will happen or result from the test.

Hold it right there. Your game is up. Goose cooked. You've come across the wrong medical student. One who has read an unhealthy number of spy novels and biographies. Your cover is blown. Your tic marked. Your hand revealed.

Your motivations are off. Not off far enough to be a renegade or heretic physician, just slightly off. You don't add up.

Your a psychiatric NP who's working an elaborate counterintelligence operation!!!


You're dead to me. I read your comments no more unless you prove who you are once and for all! (struggles to pull off your mask scooby doo style)

 

[BS81]

Hold it right there. Your game is up. Goose cooked. You've come across the wrong medical student. One who has read an unhealthy number of spy novels and biographies. Your cover is blown. Your tic marked. Your hand revealed.

Your motivations are off. Not off far enough to be a renegade or heretic physician, just slightly off. You don't add up.

Your a psychiatric NP who's working an elaborate counterintelligence operation!!!


You're dead to me. I read your comments no more unless you prove who you are once and for all! (struggles to pull off your mask scooby doo style)

I had the same thought this morning after reading this post.

Sent from my DROID RAZR using SDN Mobile

 

[billypilgrim37]

I had the same thought this morning after reading this post.

He's definitely a psychiatry resident. At least until the "pc police" say otherwise.

 

[digitlnoize]

He's definitely a psychiatry resident. At least until the "pc police" say otherwise.

I think one thing we can all agree on is that we'd all rather hire a psych NP than Vistaril.

 

[OldPsychDoc]

I think one thing we can all agree on is that we'd all rather hire a psych NP than Vistaril.

Perhaps. But would vistaril consider hiring an NP if they went with him to the "Gentlemen's Club"?

 

[Dkr]

I think one thing we can all agree on is that we'd all rather hire a psych NP than Vistaril.

I actually like Vistaril's point of view. He might a little cynical but he speaks the truth.

 

[vistaril]

I actually like Vistaril's point of view. He might a little cynical but he speaks the truth.

I'm sure people would prefer I do the usual cheerleading, but what good is that?


our drugs aren't very effective in most cases. Psychiatry residents are fairly noncompetitive compared to other specialties. In many outpt settings there may not be a huge difference between the average psych np and psychiatrist. Gaining enough knowledge to practice psychiatry competently is isn't as daunting as gaining enough knowledge to practice medicine competently. There are big issues in our future with midlevel encroachment. There are a lot of psychiatrists out there who don't follow evidence based medicine, and the evidence base is weak in psychiatry to begin with. The biological foundations for our main diseases are still elusive. There aren't a lot of promising drugs on the horizon in our field. There is no real consistency of practice from one psychiatrist to another. Our field is the most removed from 'medicine' in terms of what we learned in med school. Other doctors(and the public) view us with less respect than most other(maybe all?) specialties.

All those things are true, and yet none of it means practicing psychiatry is terrible. Or not any fun. Or a dead end. It just means those issues are there.

 

[notdeadyet]

I actually like Vistaril's point of view. He might a little cynical but he speaks the truth.

The problem is that he doesn't. The reason his opinions so often go against a lot of other folks is that his training and experiences are counter to what most folks who attend a decent residency have been trained in and experience. He tends towards black and white thinking and doesn't brook any alternative viewpoints, believing his slice of the world is it in its entirety.

It reminds me of the story of the blind men touching the elephant. Most of us, via training and temperament, realize that our understanding is limited and learn from a community at large. Vistaril has a habit of total confidence that elephants are all tusk and you're a fool if you don't know that.

You can get a kick reading posts like this for the same reason you might get a kick out of watching Rush Limbaugh. Rush is loud and makes funny noises that can make you smile because he sounds so unlike people that you typically listen to the in the media. But caveat emptor if he's your source of news.

 

[vistaril]

The problem is that he doesn't. The reason his opinions so often go against a lot of other folks is that his training and experiences are counter to what most folks who attend a decent residency have been trained in and experience. He tends towards black and white thinking and doesn't brook any alternative viewpoints, believing his slice of the world is it in its entirety.

It reminds me of the story of the blind men touching the elephant. Most of us, via training and temperament, realize that our understanding is limited and learn from a community at large. Vistaril has a habit of total confidence that elephants are all tusk and you're a fool if you don't know that.

You can get a kick reading posts like this for the same reason you might get a kick out of watching Rush Limbaugh. Rush is loud and makes funny noises that can make you smile because he sounds so unlike people that you typically listen to the in the media. But caveat emptor if he's your source of news.

first off, my opinions are mainstream. They are certainly the mainstream within the medical community overall. They are probably mainstream for much of psychiatry. It all depends on the company you are comparing my comments with.....you put them up against a bunch of anti-psychiatry people, and I'm the devil himself. You put them up against how a bunch of surgeons see psych, and I'm the biggest psych cheerleader ever.

Your comments about my residency program are humorous. I don't know where you go, and maybe you attend a name program as well(I don't have any reason to suspect otherwise), but by any reasonable measure(funding, quality if residents, competitiveness) it is one of the top programs in the northeast/country.

Third, my comments almost never represent black or white thinking. With the negative, there is usually good....even if it isn't directly stated.

 

[st2205]

It's a shame that last year I broke my nose and bled a significant amount on my Rush Limbaugh shirt.

 

[F0nzie]

There are big issues in our future with midlevel encroachment.

I think this is true and will probably affect psychiatrists further down the line, maybe even after we retire or are dead. Look at what happened to psychotherapy when it was demedicalized 30-40 years ago. Suddenly non-medical providers and lesser trained practitioners could provide psychotherapy and they all called themselves "therapists". It's not surprising psychotherapy reimbursements plummeted and remain significantly lower to this day.

 

[notdeadyet]

our drugs aren't very effective in most cases.

Many moreso than most, but I'm with you there to a point.

Psychiatry residents are fairly noncompetitive compared to other specialties.

Psychiatry is primary care level competitiveness. With Peds and Family. This is most pronounced at the lower level programs. Good quality psych programs have good quality residents, like any other field. Poor psych programs attract poor applicants.

In many outpt settings there may not be a huge difference between the average psych np and psychiatrist.

Again, might be regional. I don't see many psych NPs out my way. The one's I do have very much a nursing function, not as standalone care providers. If NPs are really scaring folks in your program, it might be a program thing.

Gaining enough knowledge to practice psychiatry competently is isn't as daunting as gaining enough knowledge to practice medicine competently.

You should know psychiatry at a deeper level than an internist knows medicine. Same goes for a neurologist, nephrologist, ophthalmologist, etc. Such is the nature of the specialist.

There are big issues in our future with midlevel encroachment.

Most every field states this. For psychiatry, it's a non-issue for folks who are very specialized or who have their heads in their sands. It's a big issue for the "sky is falling" types. For the rest of us, we'll adapt with the future of healthcare.

There are a lot of psychiatrists out there who don't follow evidence based medicine, and the evidence base is weak in psychiatry to begin with.

Again, true of doctors in many fields, but we can be more guilty. It's getting better. If evidence based medicine/psychiatry is not big at your program, that's more your program. This was a criteria I used when evaluating programs and I'm glad I did. The folks just tossing stuff against a while are a dying breed of dinosaur.

The biological foundations for our main diseases are still elusive.

Yep. Psychiatry is not for the faint of heart.

There aren't a lot of promising drugs on the horizon in our field.

Debatable.

There is no real consistency of practice from one psychiatrist to another.

Again, this may be more your program. If your attendings are giving radically different diagnoses and treatment plans to the same patient, its' a reflection of training.

Our field is the most removed from 'medicine' in terms of what we learned in med school.

The more specialized the field, the further it gets away from 'medicine,' which I take it you use to refer to the field rather than the specialty. When you start specializing, you drop emphasis on other fields. Some folks are comfortable doing this, and make great specialists. Others are not, and are meant to be generalists.

Other doctors(and the public) view us with less respect than most other(maybe all?) specialties.

Again, if one is not getting the respect of their colleagues, it's likely program or individual specific. If you go to hospitals and universities with good psych programs and practice good psychiatry, this is not a big issue.

And as for the public, some specialties do not do a good job with PR. The public thinks of psychiatrists as psychoanalysts. Radiologists are thought of as techs. PM&R guys are thought of as physical therapists. But really, who gives a $hit?

So it looks like we agree on some of the issues, but the other ones are just a reflection of how you can look at the same thing differently. It ain't all tusk out there, brother....

 

[notdeadyet]

It's a shame that last year I broke my nose and bled a significant amount on my Rush Limbaugh shirt.

There's a bleeding heart liberal joke in their somewhere, but I'm not witty enough to make it work.

 

[billypilgrim37]

Your comments about my residency program are humorous. I don't know where you go, and maybe you attend a name program as well(I don't have any reason to suspect otherwise), but by any reasonable measure(funding, quality if residents, competitiveness) it is one of the top programs in the northeast/country.

You're the one that describes your practice environment and local resources in such a way that seems entirely inconsistent with a "top northeast program."

And your fascination with how uncompetitive psychiatry seems weird for someone at a "top northeast program." Having just been a part of our rank meeting, I was shocked how many really impressive folks there were this year. I probably would have put myself like 40th on our rank list if I were applying this year, and nobody here would charge me with being particularly humble.

And I only know of one "top northeast program" that lets people spend a big chunk of fourth year moonlighting, and I'm pretty confident that program has NOTHING in common with the way you've described your training.

It's also pretty hard to imagine a guy who thinks that a post-interview dinner strip club run is a good idea would fit in at or even willingly choose to train at a "top northeast program." Especially since you like to point out how much being at a more prestigious program doesn't help much in terms of getting jobs compared to folks who graduated from Texas Tech or Texas A&M, (places I didn't even know had programs!).

So, if you're training at a "top northeast program," you don't act like it. You can of course act any way you'd like, but don't be surprised if the rest of us scratch our heads in a bit of confusion as to why your experience in psychiatry seems so different from ours.

 

[vistaril]

You're the one that describes your practice environment and local resources in such a way that seems entirely inconsistent with a "top northeast program."

And your fascination with how uncompetitive psychiatry seems weird for someone at a "top northeast program." Having just been a part of our rank meeting, I was shocked how many really impressive folks there were this year. I probably would have put myself like 40th on our rank list if I were applying this year, and nobody here would charge me with being particularly humble.

And I only know of one "top northeast program" that let's people spend a big chunk of fourth year moonlighting, and I'm pretty confident that program has NOTHING in common with the way you've described your training.

It's also pretty hard to imagine a guy who thinks that a post-interview dinner strip club run is a good idea would fit in at or even willingly choose to train at a "top northeast program." Especially since you like to point out how much being at a more prestigious program doesn't help much in terms of getting jobs compared to folks who graduated from Texas Tech or Texas A&M, (places I didn't even know had programs!).

So, if you're training at a "top northeast program," you don't act like it. You can of course act any way you'd like, but don't be surprised if the rest of us scratch our heads in a bit of confusion.

first bp, I've always made it a point to emphasize that I don't think the residents at my program are representative of residents across the country in psych. Most all the negative comments I have made have been geared towards the practice of psychiatry as it exists outside of training. Sure, I do disagree with things here and there that goes on within my program, but they are more philosophical differences than frustrations towards incompetent psychiatrists.

More importantly, it is in part due to the moonlighting that I have that additional perspective of what goes on in the community in general. Seeing what psychs in the community at large do. That's a more valuable perspective than what goes on inside one program. Even many attendings with >15 years experience don't have that perspective if they never step outside of their program and work in the community(and no, doing an afternoon a week at a community program within the program doesnt qualify). I think part of my perspective comes because I am not pursuing an academic career.

Additionally, if I were at tufts or george washington or vermont or whatever I wouldn't be the least bit ashamed to admit it.

 

[PikminOC]

I think one thing we can all agree on is that we'd all rather hire a psych NP than Vistaril.

I said that once about another SDN'er and got an Infraction. What a whiny pants that doc was.

 

[PikminOC]

There is NO respect on here for ppl with more REAL LIFE experience..


Not worth arguing anymore.

 

[CounselortoMD]

I think this is true and will probably affect psychiatrists further down the line, maybe even after we retire or are dead. Look at what happened to psychotherapy when it was demedicalized 30-40 years ago. Suddenly non-medical providers and lesser trained practitioners could provide psychotherapy and they all called themselves "therapists". It's not surprising psychotherapy reimbursements plummeted and remain significantly lower to this day.

This is quite different from mid-levels prescribing meds. You absolutely do not need to go to medical school to practice psychotherapy.

 

[kindasorta]

This is quite different from mid-levels prescribing meds. You absolutely do not need to go to medical school to practice psychotherapy.

You don't need to go to med school to read an X-ray. Or even perform a surgery.

 

[billypilgrim37]

You don't need to go to med school to read an X-ray. Or even perform a surgery.

The only other acceptable path to learn these skill is the Ron Swanson School of Wilderness Survival.

 

[PikminOC]

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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.

Yeah well we had to pass Step 1, 2 and 3 to get our medical license. Oh and that small thing called MEDICAL school too..and residency..

Vistaril, you are wasting your time in residency..

Just go practice...You dont need the rest of it..

 

[vistaril]

Yeah well we had to pass Step 1, 2 and 3 to get our medical license. Oh and that small thing called MEDICAL school too..and residency..

Vistaril, you are wasting your time in residency..

Just go practice...You dont need the rest of it..

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well Im a few months away from finishing residency, so I suppose I will finish.

step 1? really? a mostly non-clinical test with very little relevance to the practice of psychiatry? Not to mention the pass/fail cutoff is ridiculously easy....

most of what we learn in medical school is not that relevant to the day to day practice of psychiatry. Anyone who says otherwise is simply making stuff up. I don't know what exact % I would say is of little relevance, but(when combining years 1-4), it's at least 80%.

Let's face it....to do what most of us do, we have a *very* non-efficient route after college. At least 8 years of training(med school and residency) to see depressed and anxious patients in clinic and give them zoloft? We're fooling ourselves if we think over time and cost pressures others aren't going to take advantage of those inefficiencies(like psych nps).....

 

[vistaril]

This is quite different from mid-levels prescribing meds. You absolutely do not need to go to medical school to practice psychotherapy.

and with the explosion of mid-levels(and it's just starting obviously), you don't need to go to med school to write someone a prescription for Zoloft either. That and the obvious fact that you don't need medical school to practice psychotherapy begs the question what do we as psychiatrists need medical school for.


I think there are increasing numbers of people(both out of medicine and in medicine) who are really questioning/doubting psychiatry falling under the medical model.....or, perhaps if it does belong under the medical model in some sense moving to a model like optometry school, podiatry school, etc......where more focus *in school* could just be on what we deal with. Optometrists don't spend 85% of their schooling on things completely unrelated to ocular health.

Obviously it isn't going to happen anytime soon, but moving psychiatry out of the medical school track would make our training so much better.

 

[Armadillos]

I think the expansion of the use of PA's/NP's has shown that there are numerous aspects of medicine that you don't need to go to medschool to do, but I don't think that means that MD's are going to disappear from any of these fields, they will probably shift more towards the most difficult cases, supervisory roles and research.

Most fields have NP/PA's who are doing certain aspects of their practice, for example I know a couple local hospitals who have a full time interventional radiology PA who handles all the really basic procedures. I have a friend who is a PA and does most of the joint injections for a sports/ortho practice. We all have seen the proliferation of nurse anesthetists, etc. Tons of primary care practices have NP/PA doing all their well baby visits, etc.

If you want to do one very specific thing all day everyday (joint injection, PICCs, anesthesia for scopes, well baby, writing Zoloft for simple cases, etc) then there probably is not a need to go to medical school. That being said, we always are going to need/want MDs to handle the more difficult cases and to develop the practice guidelines that the midlevels will follow.

 

[AnnoyedByFreud]

I think the expansion of the use of PA's/NP's has shown that there are numerous aspects of medicine that you don't need to go to medschool to do, but I don't think that means that MD's are going to disappear from any of these fields, they will probably shift more towards the most difficult cases, supervisory roles and research.

Most fields have NP/PA's who are doing certain aspects of their practice, for example I know a couple local hospitals who have a full time interventional radiology PA who handles all the really basic procedures. I have a friend who is a PA and does most of the joint injections for a sports/ortho practice. We all have seen the proliferation of nurse anesthetists, etc. Tons of primary care practices have NP/PA doing all their well baby visits, etc.

If you want to do one very specific thing all day everyday (joint injection, PICCs, anesthesia for scopes, well baby, writing Zoloft for simple cases, etc) then there probably is not a need to go to medical school. That being said, we always are going to need/want MDs to handle the more difficult cases and to develop the practice guidelines that the midlevels will follow.

I think that argument doesn't ring true for what most NPs do in psych. As far as I can tell, they see a large variety of patients. The sickest, most medically complicated ones go to the psychiatrist (for good reason), but it isn't like NPs only see the worried well. They manage patients with mania, psychosis, etc. I guess it depends on the state and the workplace.

 

[JourneyAgent]

and with the explosion of mid-levels(and it's just starting obviously), you don't need to go to med school to write someone a prescription for Zoloft either. That and the obvious fact that you don't need medical school to practice psychotherapy begs the question what do we as psychiatrists need medical school for.


I think there are increasing numbers of people(both out of medicine and in medicine) who are really questioning/doubting psychiatry falling under the medical model.....or, perhaps if it does belong under the medical model in some sense moving to a model like optometry school, podiatry school, etc......where more focus *in school* could just be on what we deal with. Optometrists don't spend 85% of their schooling on things completely unrelated to ocular health.

Obviously it isn't going to happen anytime soon, but moving psychiatry out of the medical school track would make our training so much better.

Nobody disrespects the finer aspects of what they could do with their position who has trained and sacrificed to do it, unless they're not well, or are actually a scientologist or some other sort of anti-psychiatrist.

So....Mr Cruise wannabe...what's the game here. Why do you diminish all the opportunities you might have to practice Medicine in favor of accentuating the drudgery and passing it off as inevitable fact.

What do you seek to accomplish?

I plan on practicing psychiatric medicine. I realize there are obstacles. But I didn't come all this way to sell out, cop out, take a payoff, or undercut the art, what of it that remains.

Why did you?

 

[JourneyAgent]

I think that argument doesn't ring true for what most NPs do in psych. As far as I can tell, they see a large variety of patients. The sickest, most medically complicated ones go to the psychiatrist (for good reason), but it isn't like NPs only see the worried well. They manage patients with mania, psychosis, etc. I guess it depends on the state and the workplace.

Yes precisely. They do the same job. We've invited them into the house as servants and they do the same thing we do. Is it really a surprise they no longer want the crumbs from the table?

The push from all sides is towards some sort of British GP equivalent that all professions can get to and then progress. Or at least that would be the rational plan. Instead we're headed for a scrappy political fight that physicians are doomed to loose and we'll end up with a medical training system that becomes some sort cultural T-Rex.

 

[vistaril]

I think that argument doesn't ring true for what most NPs do in psych. As far as I can tell, they see a large variety of patients. The sickest, most medically complicated ones go to the psychiatrist (for good reason), but it isn't like NPs only see the worried well. They manage patients with mania, psychosis, etc. I guess it depends on the state and the workplace.

yep.

Also, the 'sickest, most medically complicated' also generally go to an internist at some point(in some capacity) as well.

 

[BS81]

yep.

Also, the 'sickest, most medically complicated' also generally go to an internist at some point(in some capacity) as well.

So what should your role be in this "psych NP equivalent" system?

 

[st2205]

Optometrists don't spend 85% of their schooling on things completely unrelated to ocular health.

No, but ophthalmologists do.

 

[vistaril]

No, but ophthalmologists do.

(sigh)

Opthalmologists are surgeons......of course they do.

The attempted opthalmology is to optometry as psychiatry is to psychology thing I guess you are attempted is a fail.

 

[vistaril]

So what should your role be in this "psych NP equivalent" system?

ideally, we would have more efficient training that could better separate our skill set from that of a decent psych np.....right now due to the inefficiency of our training(years and years spent studying stuff unrelated to mental health), the efficiency in training opens up opportunities for other providers.

In an ideal world, there would be a school for doctoral level mental health practioners within a less rigid medical model. Not unlike, say, dental school or podiatry school. With this doctoral level program would be a good mix of diagnostic stuff, therapy, and psychopharm. It would be different from doctorate programs in psychology in that a lot of things(psychological testing, research, a lot of behavioral psych, etc) would be left out.....what you would really have, starting from day 1 and going through whatever post doc training, is a more efficient form of training for psychiatrists where they get a lot more exposure to therapy and human psychology in general. Instead of an MD, we would get another professional degree....dentists seem to be doing ok with a DDS or whatever it is.

Now, given the setup the way it is now, I would say our role will continue to be squeezed to some degree. If people don't think psych np's(and pa's) are going to become much more common in the future and work to drive salaries down, they are fooling themselves.

 

[Armadillos]

ideally, we would have more efficient training that could better separate our skill set from that of a decent psych np.....right now due to the inefficiency of our training(years and years spent studying stuff unrelated to mental health), the efficiency in training opens up opportunities for other providers.

In an ideal world, there would be a school for doctoral level mental health practioners within a less rigid medical model. Not unlike, say, dental school or podiatry school. With this doctoral level program would be a good mix of diagnostic stuff, therapy, and psychopharm. It would be different from doctorate programs in psychology in that a lot of things(psychological testing, research, a lot of behavioral psych, etc) would be left out.....what you would really have, starting from day 1 and going through whatever post doc training, is a more efficient form of training for psychiatrists where they get a lot more exposure to therapy and human psychology in general. Instead of an MD, we would get another professional degree....dentists seem to be doing ok with a DDS or whatever it is.

Now, given the setup the way it is now, I would say our role will continue to be squeezed to some degree. If people don't think psych np's(and pa's) are going to become much more common in the future and work to drive salaries down, they are fooling themselves.

So given how you see the future of the field, what advice do you have for medstudents considering psych? Do you regret your choice of field, or still think you will have a successful and meaningful career despite what the future may hold?

 

[Atom bum]

ideally, we would have more efficient training that could better separate our skill set from that of a decent psych np.....right now due to the inefficiency of our training(years and years spent studying stuff unrelated to mental health), the efficiency in training opens up opportunities for other providers.

In an ideal world, there would be a school for doctoral level mental health practioners within a less rigid medical model. Not unlike, say, dental school or podiatry school. With this doctoral level program would be a good mix of diagnostic stuff, therapy, and psychopharm. It would be different from doctorate programs in psychology in that a lot of things(psychological testing, research, a lot of behavioral psych, etc) would be left out.....what you would really have, starting from day 1 and going through whatever post doc training, is a more efficient form of training for psychiatrists where they get a lot more exposure to therapy and human psychology in general. Instead of an MD, we would get another professional degree....dentists seem to be doing ok with a DDS or whatever it is.

Now, given the setup the way it is now, I would say our role will continue to be squeezed to some degree. If people don't think psych np's(and pa's) are going to become much more common in the future and work to drive salaries down, they are fooling themselves.

The same could be said for every branch of medicine.

Why do surgeons need to go to med school, where isn't there just a surgery school? Why does a surgeon need to know about biochemistry, pharmacology, neurology, psychiatry, genetics, etc etc etc when all they really utilize is anatomy, some information about the disease process, and their manual dexterity.

Also, NPs are becoming much more common across the board. I would like anyone to point out a single specialty that is immune from the encroachment of NPs.


Really the point is, this is all pointless. We can't stop the "wave of progress" of NPs taking a larger role in all of medicine, and if they change the way psychiatrists are educated, it won't make a difference for you or me.
Just do the job you want to do, don't worry about this **** so much.

 

[vistaril]

So given how you see the future of the field, what advice do you have for medstudents considering psych? Do you regret your choice of field, or still think you will have a successful and meaningful career despite what the future may hold?

It all depends on what the med student is looking for. And whether are not they would be happy doing something else.

Keep in mind that some medical students don't like medicine. And a lot of psychiatry residents didn't like medicine either; that's why they aren't doing medicine or some medical subspeciality or peds or obgyn or whatever. So in that respect it is a good fit for them.

I don't regret my choice at all, because I wouldn't be happy practicing in more medicine-like areas. But it's not super important to me to identify as a physician first. I think it would be impossible to identify as a physician first and feel great about doing psychiatry(if one is being honest with themselves). I identify as a psychiatrist first, so it's not an issue for me.

And sure I think I will do pretty well....I generally tend to do so. As to what constitutes 'meaningful'....well that's a loaded word so I won't get into that🙂

With the way public sentiment is trending, and what we are starting to see now about the 'psychopharm revolution', and how health care in general is shaping up.....all this coming together I don't think is good news for the future of psychiatry within the medical model....that said, I think we'll all have jobs 20 years from now.

 

[vistaril]

The same could be said for every branch of medicine.

Why do surgeons need to go to med school, where isn't there just a surgery school? .

and now, on cue, the next ridiculous analogy......

surgeons, opthalmologists, obgyns, pediatricians, etc all obviously work on a day to day basis more closely with the material learned in med school(both preclinically and clinically) than psychiatrists do.....that is the difference. To deny this rather obvious fact is stupid.

 

[Armadillos]

I don't regret my choice at all, because I wouldn't be happy practicing in more medicine-like areas.

What was it that you didn't/don't like about medicine?

Im the type of person who could probably be quite happy doing almost any job, I feel like Im just generally happy/content so I don't think I'm going to be able to choose a field based on what I don't like, it really is going to have to come down to what I like the best and what field I feel like I can make the most positive of an impact in. But if a field like (psych) was going to have the floor fall out from under it, then that may be reason for me to look elsewhere.

 

[JourneyAgent]

Twist the boot on this snake.

And watch how difficult it gets to spin a believable tale of personal motivations while simultaneously blathering practice details until the opportunity to pounce on the essence of the field presents itself.

Separating psychiatry from medicine is a slick way of demeaning it to its core.

This misinformation isn't the product of a burned and cynical psychiatrist. There is a pattern of deception.

 

[vistaril]

Separating psychiatry from medicine is a slick way of demeaning it to its core.

That is where you are wrong, and it really says more about your mindset than anything else....

in an ideal world and more efficient version of training, psychiatrists would be better trained and have a more impressive minimum skill set than we do now.

Do you really think an orthodontist or periodontist is 'demeaned' because he spent most all his post-undergrad training and education working on knowledge and skills that are relevant to what he does? Would periodontists be better thought of now if their total legnth of training and education was the same as it is now(about 7 years start to finish after college), but if 65% of those 7 years were not really concerned with dentistry or periodontics? Of course not....they would be more vulnerable if anything.

 

[hamstergang]

But if a field like (psych) was going to have the floor fall out from under it, then that may be reason for me to look elsewhere.

Vistaril is overly pessimistic and presents a skewed view of psychiatry. I would not make a life decision based on his posts. That everyone else here disagrees with most of what he says should be evidence that this is true.

 

[vistaril]

What was it that you didn't/don't like about medicine?

Im the type of person who could probably be quite happy doing almost any job, I feel like Im just generally happy/content so I don't think I'm going to be able to choose a field based on what I don't like, it really is going to have to come down to what I like the best and what field I feel like I can make the most positive of an impact in. But if a field like (psych) was going to have the floor fall out from under it, then that may be reason for me to look elsewhere.

what did I not like? gross anatomy.....aspects of the physical exam.....invasive procedures....the finer points of electrolyte imbalances, ekgs, chest CT's, etc......

And psych won't have 'the floor fall out under from it'....there is always going to be a need for people to take care of the mentally ill. The problem is our current model of care isn't best positioning us to really stand out in the way we could.

 

[Atom bum]

and now, on cue, the next ridiculous analogy......

surgeons, opthalmologists, obgyns, pediatricians, etc all obviously work on a day to day basis more closely with the material learned in med school(both preclinically and clinically) than psychiatrists do.....that is the difference. To deny this rather obvious fact is stupid.

First off, pediatricians and OB don't count.

Now, do please explain how... Please explain how setting a bone requires knowledge of JAK/STAT receptors. Please explain how eye surgery requires knowledge of swelling in the DIP vs the PIP. Please, oh please tell me how laproscopic removal of an appendix requires knowledge of a raised troponins. So you say they use more than psychiatrists do? Perhaps, but that doesn't really matter. They still learn **** that they will never use, just like psychiatry so they could also be more efficiently trained.

That being said, I think you are overlooking much of what you learned in med school.

Please keep petty insults out of this, they serve no purpose.

 

[JourneyAgent]

That is where you are wrong, and it really says more about your mindset than anything else....

in an ideal world and more efficient version of training, psychiatrists would be better trained and have a more impressive minimum skill set than we do now.

Do you really think an orthodontist or periodontist is 'demeaned' because he spent most all his post-undergrad training and education working on knowledge and skills that are relevant to what he does? Would periodontists be better thought of now if their total legnth of training and education was the same as it is now(about 7 years start to finish after college), but if 65% of those 7 years were not really concerned with dentistry or periodontics? Of course not....they would be more vulnerable if anything.

There needs to be medical doctors within the mental health team. The separation of psychopharm and medical problems overlapping with psychiatric illness is poor judgement. Could there be more efficient training...sure. Let's talk about it.

Amongst real people....who aren't putting up a front.

Stop ducking me mf'er! Who are you? And what is your real intention here?

 

[vistaril]

Vistaril is overly pessimistic and presents a skewed view of psychiatry. I would not make a life decision based on his posts. That everyone else here disagrees with most of what he says should be evidence that this is true.

my views are not mainstream here(meaning this particular forum).....As a whole though(meaning ALL the forums on this site), they most certainly are.

 

[vistaril]

First off, pediatricians and OB don't count.

Now, do please explain how... Please explain how setting a bone requires knowledge of JAK/STAT receptors. Please explain how eye surgery requires knowledge of swelling in the DIP vs the PIP. Please, oh please tell me how laproscopic removal of an appendix requires knowledge of a raised troponins. So you say they use more than psychiatrists do? Perhaps, but that doesn't really matter. They still learn **** that they will never use, just like psychiatry so they could also be more efficiently trained.

That being said, I think you are overlooking much of what you learned in med school.

Please keep petty insults out of this, they serve no purpose.

obviously, it's all a matter of degree....there is NO SINGLE FIELD where all of the material learned in school and training is relevant. That much is obvious. Likewise, I'm sure there are some jobs that aren't even on our radars in this discussion(occupational therapists to pick one example) where *some small* percentage of the training and education may be useful. The point is that internists and surgeons and obs and peds work in areas where the day to day practice makes more use of what is learned in med school than psychiatrists.....now we could argue about whether that % is 20% vs 80% or 40% vs 60%(we could throw numbers around all day), but the point is that it is all along a spectrum.

 

[Armadillos]

what did I not like? gross anatomy.....aspects of the physical exam.....invasive procedures....the finer points of electrolyte imbalances, ekgs, chest CT's, etc......

And psych won't have 'the floor fall out under from it'....there is always going to be a need for people to take care of the mentally ill. The problem is our current model of care isn't best positioning us to really stand out in the way we could.

So did you come into medschool knowing you were going into psych? Seems like if none of those things were atleast at some level interesting to you, what was it that motivated you to do medschool instead of PhD/etc?

 

[vistaril]

There needs to be medical doctors within the mental health team. The separation of psychopharm and medical problems overlapping with psychiatric illness is poor judgement. Could there be more efficient training...sure. Let's talk about it.
QUOTE]

another poor argument....there are medical problems overlapping with dental and podiatry issues as well. Probably moreso than in psychiatry.

Also, note that with a more efficient and ideal training model psychiatrists wouldn't neccessarily get less 'of the medical'. Ideally, they would get just as much or more that is relevant.