psych np's taking over

[@JackShephard]

I've run into neurologists training their NPs how to do everything. It's coming, trust me. In that office they literally just randomly grabbed patients, there was no discrimination in who saw the doc and who saw the np.

There's no money in neuro NP. They won't go to that. Neuro also has drastic consequences when you screw up. Also will prevent them from going into Neuro.

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[Armadillos]

There's no money in neuro NP. They won't go to that. Neuro also has drastic consequences when you screw up. Also will prevent them from going into Neuro.

As I mentioned above, NPs are really big in neuro where I am. The clinics like epilepsy and post-stroke all have NPs who do fulltime outpatient work specifically in their one clinic and are supervised by the attending sub-specialty neurologists who do both inpatient and outpatient work. And honestly it makes a ton of sense, the patients get worked up by the specialist physician team as inpatients when they present with their stroke or seizures or whatever and then they get followed by the NP (or resident) clinics afterward.

 

[Zenman1]

Except you do want the position, you do want the authority and the financial reward. You just don't want the accountability and the rigor.

I understand. I've always wanted to be a pilot, I've just never wanted to go to flight school. You'd let me fly your plane, right? I've also always had an interest in being a vet, but again I just didn't want to spend all that time in training. You get it though, you'd let me treat your animals wouldn't you?

Luckily I don't have a lobby to engage in wish fulfillment on my behalf.


No. I'm just saying that if you want to call something equivalent it should meet the same standards of performance.

I've never really cared about authority and actually have a healthly disrespect for it. The position I want is that of a Psych NP. I didn't create it but it was there for me. It blended in best with me wanting time to go off and do other activities that I would have been unable to do with the rigors of med school. A heavy science-based curriculum would have also told me that some things I can do just don't happen. My financial path is good but I make half of what the docs do here and that's ok with me. I'm good at what I do and I know it. It's just a fact and that is due to dedication and studying like a maniac. I've been in healthcare 43 years and still enjoy driving in to work...part of that may be due to my beautiful Jeep!

 

[Tyrone Slothrop]

So long as those are reasonable standards. To outsiders, doctors may seem over-trained for the sake of exclusivity. How can we convince them otherwise?

If we're talking about patients, should we be having to convince them?

Leanness and efficiency are desirable in manufacturing and industry, but perhaps not so much in healthcare. I've always felt the ideal of a physician was to be somewhat over-educated. I wouldn't want my healthcare in the hands of someone who was just barely qualified to handle it. Why would anyone?

On the other hand if we're talking about NPs and other mid-levels, I'm not sure we can. I believe the situation as it's currently playing out is a zero-sum game. They have nothing to gain from cooperation with us. Cooperation is what has gotten us to this point. If we look at the situation in anesthesia and FM, the initial entry was the lure of increased revenue and efficiency. Now those physician extenders are becoming physician replacements. If you let a fox guard your henhouse you can't be surprised when he starts eating chickens.

The fox has less concern for property rights than he does his hunger, and NPs have less concern for educational standards than they do their livelihoods. There is no convincing either.

 

[Tyrone Slothrop]

I've never really cared about authority and actually have a healthly disrespect for it. The position I want is that of a Psych NP. I didn't create it but it was there for me. It blended in best with me wanting time to go off and do other activities that I would have been unable to do with the rigors of med school. A heavy science-based curriculum would have also told me that some things I can do just don't happen. My financial path is good but I make half of what the docs do here and that's ok with me. I'm good at what I do and I know it. It's just a fact and that is due to dedication and studying like a maniac. I've been in healthcare 43 years and still enjoy driving in to work...part of that may be due to my beautiful Jeep!

I believe you, and you have to see I'm not attacking you personally. I believe you're good at your job and you approach it with the respect it deserves. You have to see though, that you're the result of a time when NP training was for experienced working nurses. When you took your course, how many programs were there in the country? I'm certain it's a fraction of the number there are now, and they were all of a reasonable standard. I have very little doubt that you and your contemporaries are good at your jobs.

The problem is that now we have an explosion of all sorts of direct-entry online courses. That is where the profession is heading. Moreover it's a course of education that was developed to increase the knowledge of experienced nurses to a point where they would still be working under some level of physician supervision. Now it's being sold as a way to take people with no healthcare experience and releasing them to work entirely independently. Surely you'll agree this is a flawed premise?

 

[vistaril]

tyrone, aren't you an img? The thought of imgs and nps bickering with each other always struck me as odd.....

 

[Tyrone Slothrop]

tyrone, aren't you an img? The thought of imgs and nps bickering with each other always struck me as odd.....

I believe the word you were looking for was physician. In Europe I am very much a domestic graduate. I suppose when and if I return to the US I'll be an IMG. Then the only real tangible difference between you and I will be that I most likely have higher board scores and attended a better institution.

This isn't bickering either, it's a friendly debate.

 

[xlithiumx]

I believe the word you were looking for was physician. In Europe I am very much a domestic graduate. I suppose when and if I return to the US I'll be an IMG. Then the only real tangible difference between you and I will be that I most likely have higher board scores and attended a better institution.

This isn't bickering either, it's a friendly debate.

That time when V gets his azz handed to him. Priceless.

 

[vistaril]

lmao.....please, 'tyrone'

I believe the word you were looking for was physician. In Europe I am very much a domestic graduate. I suppose when and if I return to the US I'll be an IMG. Then the only real tangible difference between you and I will be that I most likely have higher board scores and attended a better institution.

This isn't bickering either, it's a friendly debate.

this is a US based forum. So viewing things through a US lens is just the way it is. I'm there are UK or euro forums somewhere if you are interested in that sort of thing....

 

[@JackShephard]

lmao.....please, 'tyrone'


this is a US based forum. So viewing things through a US lens is just the way it is. I'm there are UK or euro forums somewhere if you are interested in that sort of thing....

His posts seem to be more welcome here than yours.

 

[Nasrudin]

His posts seem to be more welcome here than yours.

Seriously. Tyrone, don't get into with a conversation terrorist. You're points are strong and welcome. If the satisfaction of asking him to step outside was possible then all manner of preliminary word conflict would be enjoyable. But he simply wants to draw out irrational conflict and then cry foul when you get sick of playing around.

Ignore.

 

[Tyrone Slothrop]

lmao.....please, 'tyrone'


this is a US based forum. So viewing things through a US lens is just the way it is. I'm there are UK or euro forums somewhere if you are interested in that sort of thing....

I appreciate your candor colleague. Despite whatever else I may accomplish, I fear I will never have your unique charm or way with people.

Good day Doctor.

 

[vistaril]

His posts seem to be more welcome here than yours.

fairly irrelevant to the point that everything in this forum(and other forums here) is US based....it's based on the US system. From practice models to even what is done clinically.

 

[hamstergang]

The thought of imgs and nps bickering with each other always struck me as odd.....

Why?

 

[F0nzie]

In my state there is no real distinction between Psychiatrist and Psychiatric Nurse Practitioner. We are referred to as BHMPs "Behavioral Health Medical Providers". The companies that employ BHMPs include private hospitals, state hospitals, CMHCs that look for either a Psychiatrist OR a Psychiatric Nurse Practitioner to fill the positions. And it's not like there are a ton of open positions either so it seems to me that "psychiatrist shortage" is not necessarily synonymous with "lots of job openings". I applied for CL work at several private hospitals that were already filled with NPs.

As I mentioned in one of my previous posts regarding the current practice environment in my area, NP's outnumber us 4:1. Really? 4x as many NPs practicing a specialty that we created? I was completely unaware of this when I was in medical school. It wasn't until residency when I moonlit for a hospital and was paid less than the nurse practitioners that I got upset about it. How long will it take for the market to get saturated? If the market corrects itself and there is no real shortage of prescribers, then the subsidies that keep our salaries high may start to decline. Another scenario is we coexist with NPs and there will be no ecological impact on our natural habitat ie. older psychiatrists retire, population growth, etc.

Things are still good right now. Psychiatry has for the longest time been a sanctuary for high job satisfaction, mobility, flexibility, great hours, and decent pay. Hoping for good times in the years ahead.

 

[deleted307836]

F0nzie,

You live in one of the two cities/states in which psych NP's have the strongest presence in the country, by far. I'm curious, why not look into relocating to an area where the need is great, or greater, if this is a significantly irritating aspect of where you live?

I understand that what you are observing could be foretelling for the future as laws change.

 

[deleted307836]

fairly irrelevant to the point that everything in this forum(and other forums here) is US based....it's based on the US system. From practice models to even what is done clinically.

This is a very fair point, and the way that undergraduate/graduate medical education and nursing education is structured in the US in comparison to European countries lends context to why NP's may be more highly utilized here in the future. From the government's standpoint (arguably short-sighted), medical residents cost taxpayers ~100k/yr/resident whereas NP's pay their own tuition, can be trained much more quickly, and are generally compensated less. I really don't see many people arguing they are an equivalent product (the only argument I've seen is "good enough"). But they're sure less expensive (arguably, as many utilize diagnostic testing more frequently when unneeded), and for the services they provide, it might be a settlement for that "good enough" level of care. Of course it's not the gold standard. Of course they cannot meet the same standards of knowledge as physicians (on average), but if they can attain a minimum level, is it worth it for them to gain increased practice rights in the mind of the public and policy makers? The answer to that seems obvious to me.

Western European countries seem to lack the the sense of urgency present in the US regarding health care costs, and in some specialties, access to care. I don't mean to suggest Tyrone lacks any such perspective as he clearly has experience in the US. The argument I see from him, though, is really only one that I can see physicians making in the US. No one else has any incentive to agree with that lone perspective. And talk about how NP's are "taking the easy way out" doesn't mean much as the politics and economics of healthcare exist as they do. What is the goal of arguing those menial points? Wanting an admission of superiority - and what is to gain by that?

 

[SixStringPsych]

Vistaril, as I am just a lowly med student interested in psych, can you please just PM me the reason why you are such a self-hating psychiatrist? Not even trying to be patronizing or facetious here. Just extremely curious.

 

[deleted6669]

So basically make NP school medical school?

NOPE, PA SCHOOL.....(SORRY, COULDN'T RESIST..... )

 

[deleted6669]

2. The original intent of NPs and PAs was to expand access to healthcare/medical care to rural areas and low income populations. We do not have a shortage of providers in affluent metropolitan areas, yet that is where the majority of healthcare providers (Physicians, NPs, PAs, etc) work..

That's where all the best PA/NP jobs are anyway....I've had quite a few PA jobs and the best are all rural/inner city. Currently I work at 2 rural depts. and 1 inner city facility. That's where the need is and that's where PA/NP folks are the most respected.

 

[Tyrone Slothrop]

This is a very fair point, and the way that undergraduate/graduate medical education and nursing education is structured in the US in comparison to European countries lends context to why NP's may be more highly utilized here in the future. From the government's standpoint (arguably short-sighted), medical residents cost taxpayers ~100k/yr/resident whereas NP's pay their own tuition, can be trained much more quickly, and are generally compensated less. I really don't see many people arguing they are an equivalent product (the only argument I've seen is "good enough"). But they're sure less expensive (arguably, as many utilize diagnostic testing more frequently when unneeded), and for the services they provide, it might be a settlement for that "good enough" level of care. Of course it's not the gold standard. Of course they cannot meet the same standards of knowledge as physicians (on average), but if they can attain a minimum level, is it worth it for them to gain increased practice rights in the mind of the public and policy makers? The answer to that seems obvious to me.

Western European countries seem to lack the the sense of urgency present in the US regarding health care costs, and in some specialties, access to care. I don't mean to suggest Tyrone lacks any such perspective as he clearly has experience in the US. The argument I see from him, though, is really only one that I can see physicians making in the US. No one else has any incentive to agree with that lone perspective. And talk about how NP's are "taking the easy way out" doesn't mean much as the politics and economics of healthcare exist as they do. What is the goal of arguing those menial points? Wanting an admission of superiority - and what is to gain by that?

To explain, I've lived approximately half my life in the US, and split the other half between the UK and continental Europe. I spent almost a year in Canada as well. I've had first hand experience with a fair number of healthcare systems. In the US we spend more than any other country and arguably get less for it. It isn't relevant here but access to healthcare isn't an issue in Western Europe, not from my experience and not from the research.

The idea of mid-level practitioners doesn't really exist within the EU. The UK has a tiny population of PA's but they're heavily regulated and very new. Patients would never stand for it, they want to be treated by physicians. We live in a democracy, patients are the primary stakeholders in their healthcare. Policymakers are beholden to the electorate, and ultimately healthcare is paid for by the population at large.

My point isn't that NPs have "taken the easy way out", who cares about that? If there is an easier way, we should all take it. The point is there isn't an easy way, and there isn't an equivalence. I'm not discussing the issue to win Internet points, I'm exploring and testing the opposition's language. So far this issue has been lost on language. They've had better lobbying and better language. If it is ever going to be turned around then it'll happen by adjusting public perception.

 

[@JackShephard]

My point isn't that NPs have "taken the easy way out", who cares about that? If there is an easier way, we should all take it. The point is there isn't an easy way, and there isn't an equivalence. I'm not discussing the issue to win Internet points, I'm exploring and testing the opposition's language. So far this issue has been lost on language. They've had better lobbying and better language. If it is ever going to be turned around then it'll happen by adjusting public perception.

The entity you have to convince is our government. The lobbying is where this battle is fought and won.

 

[Atom bum]

So basically I need to do a fellowship to stay "ahead of the curve" at least for a few years before that is taken over as well?
Damn, this thread is depressing and making me further question going into psych. Not that any other specialty is any different really.

 

[TexasPhysician]

So basically I need to do a fellowship to stay "ahead of the curve" at least for a few years before that is taken over as well?
Damn, this thread is depressing and making me further question going into psych. Not that any other specialty is any different really.

I think it would be beneficial to improve our lobbying, but I don't think we are close to seeing a NP takeover either. You'd be surprised how many of my patients quit going to certain clinics if they are seen by only the midlevel. I am the same way, and I refuse to see anyone other than the physician I hand select. Medicine is more of a business now, and it needs to be run as such.

 

[SteinUmStein]

It's not just individual patients and clinics to consider. When a patient is referred within a health system for a psychiatric concern and they show up to a specialty clinic to find a nurse assigned as their provider, they may wonder if their needs and concerns are being taken seriously. "Neighbor Jane got to see a psychiatrist immediately in St. Whatever system, so why is this other hospital system trying to cut corners with my care?" I've heard something similar multiple times from patients who travel long distances to be seen in our health system.

 

[Zenman1]

I believe you, and you have to see I'm not attacking you personally. I believe you're good at your job and you approach it with the respect it deserves. You have to see though, that you're the result of a time when NP training was for experienced working nurses. When you took your course, how many programs were there in the country? I'm certain it's a fraction of the number there are now, and they were all of a reasonable standard. I have very little doubt that you and your contemporaries are good at your jobs.

The problem is that now we have an explosion of all sorts of direct-entry online courses. That is where the profession is heading. Moreover it's a course of education that was developed to increase the knowledge of experienced nurses to a point where they would still be working under some level of physician supervision. Now it's being sold as a way to take people with no healthcare experience and releasing them to work entirely independently. Surely you'll agree this is a flawed premise?

Yes

 

[Zenman1]

If it is ever going to be turned around then it'll happen by adjusting public perception.

That might be a touch one to turn around. My dad sees a PA at the VA. When my mom was alive she preferred the NP at her doc's office. My wife prefers NP for GYN visits. I actually see an NP at a community health center. They are of course gatekeepers and will refer for surgery, etc..

 

[madglee]

You guys are so funny. Let me explain things to you. Psychiatry is fairly easy. Why? Because the brain is not understood. Therefore, you can take 800,000,000,000 to the 12th power classes and you will get no better results. I find it bemusing that I am asked, year after year, to train geriatric fellows in psychiatry, as an NP, when in my state NP's need to be supervised by MD/DO's. Interesting. So, I train all these MD/DO's, and yet later I have to pay some nominal fee to some MD person who is "supervising" me? That's hilarious. And indisputable. Yes, I train MD/DO (not real physicians until the last 10 years) to practice geriatric psychiatry. Every year. And I am an NP. My outcomes are so good that they have me train you guys. And I am not trolling. I couldn't even make this up.

And who cares? Why are we in a piss war, anyway? Let's just try to figure out what the hell is wrong with all the borderlines? I love the MD/DO fixation on agglutination with SSRI's, or the mnemonics with Tegretol and Lithium and VPA. Loved it.

I respect all of you for knowing a hell of a lot more than any NP as far as gross anatomy goes, and understanding organic chemistry. It's really helping the patients.

Rather than having a pissing contest I think we should try to figure out that western medicine may only be good for surgery with the current understanding.

 

[madglee]

Oh, and we're not PA's. They were created as a sort of anti-NP. Also hilarious.

 

[madglee]

Except you do want the position, you do want the authority and the financial reward. You just don't want the accountability and the rigor.

I understand. I've always wanted to be a pilot, I've just never wanted to go to flight school. You'd let me fly your plane, right? I've also always had an interest in being a vet, but again I just didn't want to spend all that time in training. You get it though, you'd let me treat your animals wouldn't you?

Luckily I don't have a lobby to engage in wish fulfillment on my behalf.



No. I'm just saying that if you want to call something equivalent it should meet the same standards of performance.

We're all pilots. All prescribers. The fact that NPs get the same outcomes infuriates all who spend their time and money in med school. But, it doesn't matter. The whole gold economy will explode soon anyway. Physicians know all sorts of stuff NP's don't and vice versa. Who cares? Let's try to help patients and remember that teachers get paid about 40k a year.

 

[SteinUmStein]

The fact that NPs get the same outcomes...

You should do that study, it would be really interesting. Across the country of course, and in both inpatient and outpatient settings with a diverse patient population. It hasn't been done quite yet, so no need to jump the gun and make unsupported statements.

 

[TexasPhysician]

You guys are so funny. Let me explain things to you. Psychiatry is fairly easy. Why? Because the brain is not understood. Therefore, you can take 800,000,000,000 to the 12th power classes and you will get no better results. I find it bemusing that I am asked, year after year, to train geriatric fellows in psychiatry, as an NP, when in my state NP's need to be supervised by MD/DO's. Interesting. So, I train all these MD/DO's, and yet later I have to pay some nominal fee to some MD person who is "supervising" me? That's hilarious. And indisputable. Yes, I train MD/DO (not real physicians until the last 10 years) to practice geriatric psychiatry. Every year. And I am an NP. My outcomes are so good that they have me train you guys. And I am not trolling. I couldn't even make this up.

And who cares? Why are we in a piss war, anyway? Let's just try to figure out what the hell is wrong with all the borderlines? I love the MD/DO fixation on agglutination with SSRI's, or the mnemonics with Tegretol and Lithium and VPA. Loved it.

I respect all of you for knowing a hell of a lot more than any NP as far as gross anatomy goes, and understanding organic chemistry. It's really helping the patients.

Rather than having a pissing contest I think we should try to figure out that western medicine may only be good for surgery with the current understanding.

One of my rotations also involved supervision by a NP ...... due to a lack of options though. I ended up supervising this NP during the rotation unofficially as I was the one always answering care questions despite the 10+ extra years in the field by the NP.

I'm not saying there are not good NP's out there, but having an academic appointment means squat.

There are also no quality studies demonstrating equal care by NP's using objective measures. There are some poorly done studies with a biased agenda.

 

[sunlioness]

We have a neuro NP, but no psych NP. Not for lack of trying though. We're recruiting heavily for both psychiatrists and psych NPs. They're hard to come by and access is a huge problem.

 

[@JackShephard]

You guys are so funny. Let me explain things to you. Psychiatry is fairly easy. Why? Because the brain is not understood. Therefore, you can take 800,000,000,000 to the 12th power classes and you will get no better results. I find it bemusing that I am asked, year after year, to train geriatric fellows in psychiatry, as an NP, when in my state NP's need to be supervised by MD/DO's. Interesting. So, I train all these MD/DO's, and yet later I have to pay some nominal fee to some MD person who is "supervising" me? That's hilarious. And indisputable. Yes, I train MD/DO (not real physicians until the last 10 years) to practice geriatric psychiatry. Every year. And I am an NP. My outcomes are so good that they have me train you guys. And I am not trolling. I couldn't even make this up.

And who cares? Why are we in a piss war, anyway? Let's just try to figure out what the hell is wrong with all the borderlines? I love the MD/DO fixation on agglutination with SSRI's, or the mnemonics with Tegretol and Lithium and VPA. Loved it.

I respect all of you for knowing a hell of a lot more than any NP as far as gross anatomy goes, and understanding organic chemistry. It's really helping the patients.

Rather than having a pissing contest I think we should try to figure out that western medicine may only be good for surgery with the current understanding.

Why is it that people who say they aren't trolling just go on to troll?

Anyway, there are good and bad NPs. That's the whole issue. There is no standard of training, an experienced NP is much much better than some of the newer grads training out of poor institutions.

 

[Therapist4Chnge]

It's been my experience that there is a night and day difference between an seasoned nurses (5-10+ yrs) + NP >>> Direct-Entry NP program student. Approach, knowledge, etc….it isn't even close.

 

[Nasrudin]

It's been my experience that there is a night and day difference between an seasoned nurses (5-10+ yrs) + NP >>> Direct-Entry NP program student. Approach, knowledge, etc….it isn't even close.

Couldn't agree more. The NP model was conceived to capitalize on a decade or so of varied and critical care nursing experience. If you're not going to learn the basics academically you need a pattern recognition based curriculum that is voluminous. Allowing you enough time to see when and why clinical patterns change.

Were the above the case and when in fact it is they can bring solid general medical experience to the table that would help a psychiatry department. When it is not then they have circumvented the system, freeloaded on it, and sacrificed all sorts of competency at the alter of access.

Access to what has to be asked at a certain point. Access how is something of our own grumbling that doesn't involve the public since there is no such thing as as independent clinican. We stand on the shoulders of those who came before us and they do the same. Albeit adding considerably less height when they do it....

 

[st2205]

I train MD/DO (not real physicians until the last 10 years)

Link? I hope this notion is not indicative of your exposure to the field of medicine.

My outcomes are so good that they have me train you guys.

Glad to hear things are going well.

I respect all of you for knowing a hell of a lot more than any NP as far as gross anatomy goes, and understanding organic chemistry. It's really helping the patients.

Straw man.

Rather than having a pissing contest I think we should try to figure out that western medicine may only be good for surgery with the current understanding.

Then it would probably behoove you to stop pissing. Also, medicine and surgery are awfully broad disciplines. Your comment doesn't seem to appreciate the nuances of either field by making two large, sweeping generalizations.

 

[@JackShephard]

Rather than having a pissing contest I think we should try to figure out that western medicine may only be good for surgery with the current understanding.

?

Western medicine is good only for surgery? Really?

- ANTIBIOTICS!
- Oncology (chemo or radiation)
- Diabetes (Type 1 or Type 2), Thyroid pathologies and associated medications, adrenal insufficiency
- Have you ever met a person with rheumatoid arthritis?! DMARDs have literally changed their ability to function
- Lung disease (steroids / beta agonists) --> breathing = living
- etc. etc. etc.

I could literally list hundreds of non-surgical advances that have drastically changed people's lives.

I'm surprised any medical professional could make a statement like the above. People who make comments like that have never needed western medicine. It's a dumb statement to make.

 

[Nasrudin]

?

Western medicine is good only for surgery? Really?

- ANTIBIOTICS!
- Oncology (chemo or radiation)
- Diabetes (Type 1 or Type 2), Thyroid pathologies and associated medications, adrenal insufficiency
- Have you ever met a person with rheumatoid arthritis?! DMARDs have literally changed their ability to function
- Lung disease (steroids / beta agonists) --> breathing = living
- etc. etc. etc.

I could literally list hundreds of non-surgical advances that have drastically changed people's lives.

I'm surprised any medical professional could make a statement like the above. People who make comments like that have never needed western medicine. It's a dumb statement to make.

Seriously!

This proclivity for fully adopting and swallowing whole some sort of vague "naturism" is disturbingly prevalent in those who scoff at a scientific background. Perhaps the basics in science aren't so useless. Particularly as wingnut weeders.

 

[Atom bum]

This is some bush league level trolling. Get on Vistaril's level son.

 

[st2205]

You guys are so funny. Let me explain things to you. Psychiatry is fairly easy. Why? Because the brain is not understood. Therefore, you can take 800,000,000,000 to the 12th power classes and you will get no better results. I find it bemusing that I am asked, year after year, to train geriatric fellows in psychiatry, as an NP, when in my state NP's need to be supervised by MD/DO's. Interesting. So, I train all these MD/DO's, and yet later I have to pay some nominal fee to some MD person who is "supervising" me? That's hilarious. And indisputable. Yes, I train MD/DO (not real physicians until the last 10 years) to practice geriatric psychiatry. Every year. And I am an NP. My outcomes are so good that they have me train you guys. And I am not trolling. I couldn't even make this up.

Also, I'm curious about a little clarity. You're stating that year after year you're training geriatric psychiatry fellows. Earlier, you mentioned the word neuriatrist (which I had never heard before). When googling it one of the very sparse links is to a page that has your name on it that has you quoted saying:

Here is what I am - Neuriatrist (Nurse Practitioner in Psychiatry), doctorate, 13 years of school w/ residency. Basically, a psychiatrist is a physician and I am a nurse. We both do the same thing but from very different perspectives. I try to focus on the person rather than the disease, and rather than pump everyone full of pharmaceuticals, try to use prevention and education. Then I pump them full of pharmaceuticals. In my early 20's I taught English and Creative Writing at an inner city school in Brooklyn, NYC. Then I realized I would become an angry, grumpy, **** teacher and quit, started doing web sites. Changed professions at 27 and here I am, just finished, at 40 in two days.

http://chooseyourstory.com/member/?Username=madglee

This post is dated 3/21/2014. What you're stating is that you just finished. Would you mind clarifying how you've been teaching geriatric psychiatry fellows "year after year" as well as elaborate on how long you've been getting "outcomes so good" that they have you train us?

 

[nancysinatra]

You guys are so funny. Let me explain things to you. Psychiatry is fairly easy. Why? Because the brain is not understood. Therefore, you can take 800,000,000,000 to the 12th power classes and you will get no better results. I find it bemusing that I am asked, year after year, to train geriatric fellows in psychiatry, as an NP, when in my state NP's need to be supervised by MD/DO's. Interesting. So, I train all these MD/DO's, and yet later I have to pay some nominal fee to some MD person who is "supervising" me? That's hilarious. And indisputable. Yes, I train MD/DO (not real physicians until the last 10 years) to practice geriatric psychiatry. Every year. And I am an NP. My outcomes are so good that they have me train you guys. And I am not trolling. I couldn't even make this up.

And who cares? Why are we in a piss war, anyway? Let's just try to figure out what the hell is wrong with all the borderlines? I love the MD/DO fixation on agglutination with SSRI's, or the mnemonics with Tegretol and Lithium and VPA. Loved it.

I respect all of you for knowing a hell of a lot more than any NP as far as gross anatomy goes, and understanding organic chemistry. It's really helping the patients.

Rather than having a pissing contest I think we should try to figure out that western medicine may only be good for surgery with the current understanding.

Didn't you have to take organic chemistry to get through nursing school? And anatomy?

The classes in med school aren't all devoted to psychiatry. They are devoted to things like biochemistry, pathophysiology and infectious disease. No one would ever claim that they have any bearing on "results" or "outcomes" among psychiatric patients. And residency isn't about "classes," it's about gaining hands-on experience. So what's your point?

 

[Therapist4Chnge]

So what's your point?

:troll:

 

[worfndata]

All this said, do we all agree a np or pa is still 10000x preferred over an ND? Right?

 

[@JackShephard]

All this said, do we all agree a np or pa is still 10000x preferred over an ND? Right?

NP is the best midlevel degree.

 

[Psychobabbling]

I've yet to meet an intelligent NP, and I mean that in the least possible negative sense. Psych NPs around here are INFAMOUS for having, for example, a borderline on lamictal/Wellbutrin/seroquel and calling them bipolar. Or those with adjustment disorders with MDD and putting them on Effexor. Or putting someone with ADHD on Wellbutrin only. Or putting someone with "anxiety" on Wellbutrin only.....

Granted NPs aren't the only idiots who call borderlines "bipolar" ("because it could be a bipolar spectrum...I mean it was on the schizophrenia spectrum and could be on any spectrum but....oh and let's put them on lithium because it decreases suicidality in bipolar disorder....regardless that it's a "true" mood stabilizer for a specific illness, it decreases suicide in EVERYONE!!!....)

But, I feel like I'm losing my f***ing mind.

Best was today where I was reading a psyc NPs note from OP on a patient who came to the psyc ER. Summing up his visit from a week ago (had access on the emr). "History of schizoaffective disorder, bipolar type. Seemed suspicious and paranoid but then he smiled so it was ok. His last lithium level was 0.32 3-4 months ago but he says he's taking it so it's fine. No real changes with him except for someone laughter for no apparent reason. His thoughts are goal directed but he would take long pauses sometimes. Will increase cogentin from 2mg daily to 2mg BID."

Seriously?

 

[@JackShephard]

I've yet to meet an intelligent NP,

You lost me at hello.

 

[touchpause13]

 

[Zenman1]

I've yet to meet an intelligent NP, and I mean that in the least possible negative sense. Psych NPs around here are INFAMOUS for having, for example, a borderline on lamictal/Wellbutrin/seroquel and calling them bipolar. Or those with adjustment disorders with MDD and putting them on Effexor. Or putting someone with ADHD on Wellbutrin only. Or putting someone with "anxiety" on Wellbutrin only.....

Granted NPs aren't the only idiots who call borderlines "bipolar" ("because it could be a bipolar spectrum...I mean it was on the schizophrenia spectrum and could be on any spectrum but....oh and let's put them on lithium because it decreases suicidality in bipolar disorder....regardless that it's a "true" mood stabilizer for a specific illness, it decreases suicide in EVERYONE!!!....)

But, I feel like I'm losing my f***ing mind.

Best was today where I was reading a psyc NPs note from OP on a patient who came to the psyc ER. Summing up his visit from a week ago (had access on the emr). "History of schizoaffective disorder, bipolar type. Seemed suspicious and paranoid but then he smiled so it was ok. His last lithium level was 0.32 3-4 months ago but he says he's taking it so it's fine. No real changes with him except for someone laughter for no apparent reason. His thoughts are goal directed but he would take long pauses sometimes. Will increase cogentin from 2mg daily to 2mg BID."

Seriously?

Consider this your lucky day as now you have met an intelligent Psych NP! Actually your post is funny, especially that last paragraph… “he smiled so it was ok”…”laughter for no apparent reason!” Good one!
Uh, you do know that Wellbutrin (and even Effexor) have been used for ADHD, even by themselves, although I personally have not done so. Wait, I think I did use Wellbutrin for one guy with substance abuse history.

 

[MLT2MT2DO]

Wait, I think I did use Wellbutrin for one guy with substance abuse history.

Over Strattera?