psych np's taking over

[PikminOC]

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a little fact check here....pa's do many more clinical hrs than np's do. that is why they are allowed to switch specialties without going back to school. a typical pa program is 2000-3000 hrs of clinicals over an entire full time year. a typical np program is 500-800 hrs over a part time year while still working as an rn.
for a peds np to do psych they need to get another credential. a pa just needs to apply for a job in another specialty as we have already trained in peds, em, psych, surg, em, fp, ob, etc.
the 2nd yr of pa school is for all intents and purposes the 3rd yr of medschool.
pa program at drexel: 117 credits with 15 mo of clinicals:http://www.drexel.edu/physAsst/programs/physicianAssistant/curriculum/
np program at drexel: 59 credits wuth 720 clinical hrs: http://www.drexel.edu/gradnursing/msn/nursePractitioner/familyPractice/

Even though I completed 3rd year of med school, and 4th, and the 1st and 2nd, I still can't easily slide into another field. The flexibility of PA is nice!

And you still can't direcly compare the hours due to the caliber of students and depth of knowledge. Intellect without thorough knowledge is a problem. You don't know what you don't know.

 

[deleted6669]

Even though I completed 3rd year of med school, and 4th, and the 1st and 2nd, I still can't easily slide into another field. The flexibility of PA is nice!

And you still can't direcly compare the hours due to the caliber of students and depth of knowledge. Intellect without thorough knowledge is a problem. You don't know what you don't know.

I was trying to make the case for pa>np, not pa>md. I am well aware that you guys go into far more depth in the basic medical sciences than we do. the inherent flexibility of pa's is decreasing as hospitals are requiring more intensive credential review, procedure logs, etc. we also have a new set of national postgrad certificate of advanced qualifications exams which likely will become required for certain specialties(em, psych, ortho, surg, nephrology are the currently available CAQ's).
the current 3 yr PA to DO bridge program credits pa's with a full clinical yr...
http://lecom.edu/college-medicine.php/Accelerated-Physician-Assistant-Pathway-APAP/49/2205/612/2395

 

[silas2642]

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

I haven't had a good experience with psych NP's-- your employers may have intentionally chosen an MD instead of another NP for a reason. The last time I admitted a patient with "bipolar" and called for collateral the first things out of the NP's mouth were, "I don't really know the patient... I just prescribe her meds." Turns out her "bipolar" diagnosis was because she was "irritable" and had "mood swings" for which she was prescribed lithium.

 

[PikminOC]

I was trying to make the case for pa>np, not pa>md. I am well aware that you guys go into far more depth in the basic medical sciences than we do. the inherent flexibility of pa's is decreasing as hospitals are requiring more intensive credential review, procedure logs, etc. we also have a new set of national postgrad certificate of advanced qualifications exams which likely will become required for certain specialties(em, psych, ortho, surg, nephrology are the currently available CAQ's).
the current 3 yr PA to DO bridge program credits pa's with a full clinical yr...
http://lecom.edu/college-medicine.php/Accelerated-Physician-Assistant-Pathway-APAP/49/2205/612/2395

I wasn't comparing any specific field. I was saying in any field it's not just the number of hours, but also the depth of training. I know the PA has much more training and depth than an NP. There are many SDN posts on NP vs PA as well.

It is nice the PA has an option to train to become a physician at LECOM. Are there any NP programs like this madglee?

I had an experienced CRNA in my med school (with several children) who matched into IM. She started med school at the age of 42. She realized how much she did not know as a nurse during med school because she graduated from both programs. She is much happier with the autonomy of being a physician.

Other posts by madglee: http://forums.studentdoctor.net/showthread.php?t=775447

 

[PikminOC]

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

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

Being the highest level in your profession does not make you a physician.

http://forums.studentdoctor.net/showthread.php?t=889732

 

[toothless rufus]

Honestly I hate to say it as I have both NP and PA in my family, but I'd rather the concept of a midlevel provider never happened. It's screwing things up for physicians, and it appears that it will only get worse most likely. Would have probably been fine under the original definition but this incessant push for increased scope of practice and salary and independent practice is incredibly annoying and very wrong.

If you want to practice medicine in any form or in any specialty: please go to medical school.

 

[DD214_DOC]

Good catch HooahDoc!

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

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

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

I did get her old records from a prior hospitalization when she initially got her symptoms. They classified her perceptual problem as a hallucination and called her behavior change mania, despite not actually fitting the criteria for mania. They started her on seroquel at 200 I think and kept titrating to 900 despite the, "hallucinations" never going away (of course they wouldn't). Her d/c diagnosis from the psych ward was, "Psychosis NOS, r/o Schizoaffective, r/o Bipolar I with Psychotic Features, r/o MDD with psychic features, r/o Schizophrenia". Imaging never done, even in the hospital.

 

[zenman]

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

Isn't this PA week? If so congrats and go buy yourself a beer.👍

 

[deleted6669]

Isn't this PA week? If so congrats and go buy yourself a beer.👍

yup, thanks. nccpa just credentialed their 100,000th PA

 

[LoudBark]

Granted, I can't demand the same salary despite doing the same work, but hopefully that's changing.
.

Nurse,
Please don't get offended, but you have a total misunderstanding of the entire health care system in this country. You don't realize that the entire value of NP's to health care is that they DO get paid less, much less for doing the same work as an MD / DO. If you were ever to demand the same salary, no one would ever hire you. The value of the NP is to save the health care industry money..............by paying you the same, by having you bill the same and then collect the same for your own pocket...........that completely defeats the entire purpose of hiring you in the first place. Medicine is big business.........it is not about "I do the same work as a doctor so pay me the same".

 

[hrandani]

I have to deal with a lot of nonsense being an NP rather than an MD and it's fairly infuriating.

The existence of ****ty psychiatrists doesn't help your case for NPs not being as bad.

You're literally suggesting that two wrongs make a right, which is an absurd level of logical fallacy that quite frankly I find mindblowing in a doctorate level student.

The solution for ****ty psychiatry and ****ty medicine is reform and oversight, not an influx of midlevels with unknown and untested levels of training performing independently.

People want MDs because they're the known historical standard for medical care and treatment, and that's the highest level of certification available. It's not nonsense at all.

 

[PikminOC]

The existence of ****ty psychiatrists doesn't help your case for NPs not being as bad.

You're literally suggesting that two wrongs make a right, which is an absurd level of logical fallacy that quite frankly I find mindblowing in a doctorate level student.

The solution for ****ty psychiatry and ****ty medicine is reform and oversight, not an influx of midlevels with unknown and untested levels of training performing independently.

People want MDs because they're the known historical standard for medical care and treatment, and that's the highest level of certification available. It's not nonsense at all.

 

[zenman]

The existence of ****ty psychiatrists doesn't help your case for NPs not being as bad.

You're literally suggesting that two wrongs make a right, which is an absurd level of logical fallacy that quite frankly I find mindblowing in a doctorate level student.

The solution for ****ty psychiatry and ****ty medicine is reform and oversight, not an influx of midlevels with unknown and untested levels of training performing independently.

People want MDs because they're the known historical standard for medical care and treatment, and that's the highest level of certification available. It's not nonsense at all.[B]

America's Healthcare System is the Third Leading Cause of Death

 

[PikminOC]

America's Healthcare System is the Third Leading Cause of Death

And with nurses/Pa's it may become the First.

 

[Core Dome Ahhh]

Honestly I hate to say it as I have both NP and PA in my family, but I'd rather the concept of a midlevel provider never happened. It's screwing things up for physicians, and it appears that it will only get worse most likely. Would have probably been fine under the original definition but this incessant push for increased scope of practice and salary and independent practice is incredibly annoying and very wrong.

If you want to practice medicine in any form or in any specialty: please go to medical school.

Let me start off by saying that I honestly appreciate a good midlevel-- NP or PA-- they're valuable and are reimbursed well and on par with their education (some of them make a **** load of money). I also, like most physicians that haven't lost their damn minds, don't appreciate the Dr. Fake NP movement and all the garbage put forth on SDN and other anonymous web forums, or the repeated attempts at legislating by nurses to try to take scope of practice from doc's (see recent attempt to practice pain medicine).

We live in a funny time in medicine where midlevels are trying to demand more and more-- actually, mostly NP's and their whole "nurse doctor" movement. Like has already been said, their invention was to decrease costs and act as physician extenders, not create independent pseudo-doc's that are equally reimbursed with less training and less standardized training. While I often see doomsday venting about many things on SDN, including midlevels, I tend to think that the threat is less legitimate.

As far as NP's are concerned, I think their nurse doctor movement is increasingly on the radar of physicians (especially younger physicians) who are being increasingly pissed off by it and who, in many cases, are the ones who do/will hire mid-levels and/or be involved in midlevel training. This could lead to their ultimate demise. PA's in particular are a threat to NP's and their nurse doctor ambitions and, in my opinion, should ( and I think logically will) be preferred by physicians in a position to set policy and hire midlevels. They have more standardized, rigorous educations--- not this online Dr. McFakey nursing stuff. I also think the idea of PA --> MD is great and more doable than NP --> MD (or NP --> fake nurse doctor). This allows an experienced midlevel who thirsts for independence a means to gain a full MD education and do a real medical residency while recognizing their experience and training. I hope this is the trend that we see pick up and it seems like the logical progression of things given the changes in healthcare that should involve more cost cutting (not paying midlevels large sums of money), oversight, and quality control (standardized practices, standardized education).

All of these lofty future predictions and assumptions aside lets not forget that medicine, and psychiatry in particular, is an art and MD's are the real artists. This is an undeniable truth that you simply recognize if you work with both an MD and NP. Also, let me state the obvious-- MD's are on average much brighter, more articulate people and the average person recognizes that 100% of the time. Yes, people recognize that and I find it hard to imagine NP's making some power move on psychiatry or any field of medicine for that matter. It just won't jive with patient expectations and demands (Psych NP's have existed since the early 80's after all, around the time of my birth). So, lets be confident and determined to pave the future of medicine, keeping in mind our long history of superior training and intellect, eh?😀

 

[88845]

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

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

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

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

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

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

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

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

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

 

[PikminOC]

They want our salary, but not our malpractice risk.

Its not them who are making the power move but rather the new healthcare Affordable Care Act. How did you think it is going to be affordable?

Malpractice Risks With NPs and PAs in Your Practice

Mark Crane
DisclosuresJan 03, 2013
http://www.medscape.com/viewarticle/775746



A $217 Million Malpractice Case Involving a PA
The second-largest malpractice award inUShistory focused directly on how a medical practice credentialed and supervised a midlevel provider. Although the facts in the cases are unique, they can provide lessons for all physicians who work with PAs.
In2007, a jury inTampa,Florida, awarded $217 million, including $100 million in punitive damages, to a man whose cerebellar stroke was misdiagnosed as sinusitis at a hospital ED in 2000. The then-44-year-old mechanic presented with headache, nausea, dizziness, confusion, and double vision. He had a history of hypertension, diabetes, and elevated cholesterol and had a family history of stroke.
A midlevel provider ordered blood tests and CT without contrast, which were approved by the ED physician. Both were employed by a medical group that contracted with the hospital to run the ED. Thefirst CTscan was negative for stroke, as was a second one done a few hours later with contrast. The ED physician didn't repeat the examination, history, or neurologic assessment. Instead, he relied on the extender's findings to diagnose "sinusitis/headache," the lawsuit said. The doctor prescribed a painkiller and an antibiotic and discharged the patient.
The next morning, the mechanic awoke with a severe headache, slurred speech, nausea, confusion, and trouble walking. He returned to the ED. A new CT scan showed that he had had a stroke. A shunt was inserted into his brain to relieve intracranial pressure, but the damage was irreversible. The man was left paralyzed and with mental disabilities. He remained in a coma for 3 months and spent the next 6 months at care facilities. He remains paraplegic.
The lawsuit alleged that the patient presented with classic stroke symptoms that the ED doctor should have detected. The crucial part of the trial involved the midlevel provider. It took 16 months before the medical group revealed his name, describing him only as an "expediter" who served as a note-taker, or scribe, to help the ED doctors. When lawyers deposed him, they learned that he was an unlicensed PA, having failed the state licensure test for PAs 4 times. He denied during depositions that he performed patient examinations.
The ED physician testified that he'd assumed the midlevel was a licensed PA and that he didn't need to redo the history and examination. The doctor and his medical group blamed each other. The doctor said he would have redone the examination if he'd known that the expediter was unlicensed. The medical group's leader said it was the doctor's responsibility to ask the expediter about his status.
There had been no written guidelines for what the midlevel provider was authorized to do. "This group created this system that was ripe for mishap, to push more people through the ED so they could increase profits," said plaintiff's attorney David Dickey. "Instead of hiring a real PA or another ED doctor, they used the midlevel to save money."
The jury was clearly outraged, finding that the group had tried to conceal the midlevel's involvement from the plaintiffs and placed profits over patient safety.
Lawsuits involving midlevel providers are likely to grow as their numbers expand and their scope of practice increases owing to pressure from the doctor shortage and the Affordable Care Act. They can provide a tremendous benefit to your practice -- if you follow established protocols about supervision, say risk managers.

 

[zenman]

Let me start off by saying that I honestly appreciate a good midlevel-- NP or PA-- they're valuable and are reimbursed well and on par with their education (some of them make a **** load of money). I also, like most physicians that haven't lost their damn minds, don't appreciate the Dr. Fake NP movement and all the garbage put forth on SDN and other anonymous web forums, or the repeated attempts at legislating by nurses to try to take scope of practice from doc's (see recent attempt to practice pain medicine).

We live in a funny time in medicine where midlevels are trying to demand more and more-- actually, mostly NP's and their whole "nurse doctor" movement. Like has already been said, their invention was to decrease costs and act as physician extenders, not create independent pseudo-doc's that are equally reimbursed with less training and less standardized training. While I often see doomsday venting about many things on SDN, including midlevels, I tend to think that the threat is less legitimate.

As far as NP's are concerned, I think their nurse doctor movement is increasingly on the radar of physicians (especially younger physicians) who are being increasingly pissed off by it and who, in many cases, are the ones who do/will hire mid-levels and/or be involved in midlevel training. This could lead to their ultimate demise. PA's in particular are a threat to NP's and their nurse doctor ambitions and, in my opinion, should ( and I think logically will) be preferred by physicians in a position to set policy and hire midlevels.

I’m an NP and I also don’t agree with the DNP movement as I thought the original intent was to have more clinical training and not more business-related courses. We’ve already had MSN/MBA degrees and I already have an MBA. However, many of these grads will be setting up needed programs in healthcare.

I’ve heard that physicians are swinging more towards NPs. When I worked in NM, many of the physicians were upset at my medical director as she never had to sign off on any of my work since NM is an independent practice state. In contrast, the other docs spent a lot of time reviewing and signing off PA notes.

They have more standardized, rigorous educations--- not this online Dr. McFakey nursing stuff. I also think the idea of PA --> MD is great and more doable than NP --> MD (or NP --> fake nurse doctor). This allows an experienced midlevel who thirsts for independence a means to gain a full MD education and do a real medical residency while recognizing their experience and training. I hope this is the trend that we see pick up and it seems like the logical progression of things given the changes in healthcare that should involve more cost cutting (not paying midlevels large sums of money), oversight, and quality control (standardized practices, standardized education).

If you espouse EBM then maybe you’ll look at the distance education peer-reviewed journals so you won’t look like you are very ill-informed on the subject. I went to that po-dunk university called Rush University in Chicago and had distance education courses. Also, having an MBA, and being much more efficient and cost-conscious than you, I realize much of brick and mortar education is like using a walkman vs an ipod...very inefficient and a waste of my time and money. Granted, there are both good and bad distance ed and brick and mortar schools. (I have a masters in psych nursing from a traditional program and one from a distance ed program, plus MBA from traditional program so I have experience in this regard.) Take one course for example, physical exam. We had to initially video tape exams of family members and send them in. I was living in Bangkok at the time. Then we had to show up for a few days to actually do exams under supervision. I had them down by then as part of our course assignment was to review PE online videos put out by MEDICAL SCHOOLS. Much of our other reference materials came via the net from medical schools. With videos I could review to my hearts content vs listening to a lecture once and trying to remember it. When I showed up at a navy hospital in Okinawa for clinical, my psychiatrist told me I could tone my physical exams down “for the real world.”

All of these lofty future predictions and assumptions aside lets not forget that medicine, and psychiatry in particular, is an art and MD's are the real artists. This is an undeniable truth that you simply recognize if you work with both an MD and NP. Also, let me state the obvious-- MD's are on average much brighter, more articulate people and the average person recognizes that 100% of the time. Yes, people recognize that and I find it hard to imagine NP's making some power move on psychiatry or any field of medicine for that matter. It just won't jive with patient expectations and demands (Psych NP's have existed since the early 80's after all, around the time of my birth). So, lets be confident and determined to pave the future of medicine, keeping in mind our long history of superior training and intellect, eh?😀

You’re full of it aren’t you? Psychiatry is more of an art (barely) than the rest of medicine, which is rumored to be a hard science. Memorizing facts on top of facts is an art? I’ve studied other systems of medicine and Western medicine is considered to be the bottom rung of the ladder. If you think your course work is difficult and you are the top dog, I’ll try to find the link from the physician who said her BS in physics was much more difficult than medical school. I also don’t think you’re as bright as you think you are since you obliviously are ignorant about distance education. I work with 6 physicians and none of them are egoistical like you.

I can't believe I've wasted time with you that I'll never get back.

 

[JourneyAgent]

I’m an NP and I also don’t agree with the DNP movement as I thought the original intent was to have more clinical training and not more business-related courses. We’ve already had MSN/MBA degrees and I already have an MBA. However, many of these grads will be setting up needed programs in healthcare.

I’ve heard that physicians are swinging more towards NPs. When I worked in NM, many of the physicians were upset at my medical director as she never had to sign off on any of my work since NM is an independent practice state. In contrast, the other docs spent a lot of time reviewing and signing off PA notes.






If you espouse EBM then maybe you’ll look at the distance education peer-reviewed journals so you won’t look like you are very ill-informed on the subject. I went to that po-dunk university called Rush University in Chicago and had distance education courses. Also, having an MBA, and being much more efficient and cost-conscious than you, I realize much of brick and mortar education is like using a walkman vs an ipod...very inefficient and a waste of my time and money. Granted, there are both good and bad distance ed and brick and mortar schools. (I have a masters in psych nursing from a traditional program and one from a distance ed program, plus MBA from traditional program so I have experience in this regard.) Take one course for example, physical exam. We had to initially video tape exams of family members and send them in. I was living in Bangkok at the time. Then we had to show up for a few days to actually do exams under supervision. I had them down by then as part of our course assignment was to review PE online videos put out by MEDICAL SCHOOLS. Much of our other reference materials came via the net from medical schools. With videos I could review to my hearts content vs listening to a lecture once and trying to remember it. When I showed up at a navy hospital in Okinawa for clinical, my psychiatrist told me I could tone my physical exams down “for the real world.”




You’re full of it aren’t you? Psychiatry is more of an art (barely) than the rest of medicine, which is rumored to be a hard science. Memorizing facts on top of facts is an art? I’ve studied other systems of medicine and Western medicine is considered to be the bottom rung of the ladder. If you think your course work is difficult and you are the top dog, I’ll try to find the link from the physician who said her BS in physics was much more difficult than medical school. I also don’t think you’re as bright as you think you are since you obliviously are ignorant about distance education. I work with 6 physicians and none of them are egoistical like you.

I can't believe I've wasted time with you that I'll never get back.

You make some good points. Particularly the brick and mortar myth. I taught myself all the m1 and m2 material. The tenured phd model is not responsive to students needs and learning styles. Long lectures for learning a body of facts is wasteful.

While I consider myself a proponent of team healthcare and think the mid level role makes a lot of sense. The utility of our model does not lie in the bricks of our lecture halls but in the thousands of hours spent working in our fields and in general medicine under the watchful eye of our supervisors being slowly given more and more decision making responsibility. Without that and therefore without us it's all dangerous reindeer games.

A new NP without one of our experienced to shelter them before they widen their practice scope would be insane. Since that notion capitalizes on the false similitude and trust that we've earned through the consistency of training in a way that is insidious and disingenuous at best. I would say more accurately deliberately deceptive and criminal. Like a mob seizing control of territory with lies to an unaware public.

At some point down a road of physician supervision that is essentially very much like a residency, parity seems inevitable. But the NP movement seems willfully unaware of what parity means and the proper way to achieve it. It would take a hell of a lot of 40 hour weeks to add up to residency training. Thinking otherwise is just being plain clueless.

And while I am a supporter of how alternative medicine has much to teach us about how we should be looking at the health of human beings I thinks it's foolish to imagine we're the bottom rung of the ladder. Saudi princes don't fly to Tibet to get their healthcare. When something is acutely and definitively f'd up, we're near the top of anybody's list who has the money to pay.

 

[PikminOC]

You make some good points. Particularly the brick and mortar myth. I taught myself all the m1 and m2 material. The tenured phd model is not responsive to students needs and learning styles. Long lectures for learning a body of facts is wasteful.

While I consider myself a proponent of team healthcare and think the mid level role makes a lot of sense. The utility of our model does not lie in the bricks of our lecture halls but in the thousands of hours spent working in our fields and in general medicine under the watchful eye of our supervisors being slowly given more and more decision making responsibility. Without that and therefore without us it's all dangerous reindeer games.

A new NP without one of our experienced to shelter them before they widen their practice scope would be insane. Since that notion capitalizes on the false similitude and trust that we've earned through the consistency of training in a way that is insidious and disingenuous at best. I would say more accurately deliberately deceptive and criminal. Like a mob seizing control of territory with lies to an unaware public.

At some point down a road of physician supervision that is essentially very much like a residency, parity seems inevitable. But the NP movement seems willfully unaware of what parity means and the proper way to achieve it. It would take a hell of a lot of 40 hour weeks to add up to residency training. Thinking otherwise is just being plain clueless.

And while I am a supporter of how alternative medicine has much to teach us about how we should be looking at the health of human beings I thinks it's foolish to imagine we're the bottom rung of the ladder. Saudi princes don't fly to Tibet to get their healthcare. When something is acutely and definitively f'd up, we're near the top of anybody's list who has the money to pay.

👍

 

[zenman]

You make some good points. Particularly the brick and mortar myth. I taught myself all the m1 and m2 material. The tenured phd model is not responsive to students needs and learning styles. Long lectures for learning a body of facts is wasteful.

While I consider myself a proponent of team healthcare and think the mid level role makes a lot of sense. The utility of our model does not lie in the bricks of our lecture halls but in the thousands of hours spent working in our fields and in general medicine under the watchful eye of our supervisors being slowly given more and more decision making responsibility. Without that and therefore without us it's all dangerous reindeer games.

A new NP without one of our experienced to shelter them before they widen their practice scope would be insane. Since that notion capitalizes on the false similitude and trust that we've earned through the consistency of training in a way that is insidious and disingenuous at best. I would say more accurately deliberately deceptive and criminal. Like a mob seizing control of territory with lies to an unaware public.

At some point down a road of physician supervision that is essentially very much like a residency, parity seems inevitable. But the NP movement seems willfully unaware of what parity means and the proper way to achieve it. It would take a hell of a lot of 40 hour weeks to add up to residency training. Thinking otherwise is just being plain clueless.

And while I am a supporter of how alternative medicine has much to teach us about how we should be looking at the health of human beings I thinks it's foolish to imagine we're the bottom rung of the ladder. Saudi princes don't fly to Tibet to get their healthcare. When something is acutely and definitively f'd up, we're near the top of anybody's list who has the money to pay.

I'm all for 1-2 years of residency. I saw something the other day about a residency program but don't remember where it was. I don't think however, that NPs should be PA clones.

I see many Saudi people go to Bumrungrad Hospital in Bangkok. This place is the most efficient hospital I've ever seen in my life. My wife had a lap choley and cervical disectomy at another hospital down the street. Also excellent with an international reputation. Cost me almost a dollar after insurance and that was because I ordered an extra meal one day from the chef at the hospital kitchen.

True, with surgery and trauma Western med excels. Here's what I was talking about.

Levels of Engagement

1. Energetic – pure spirit
2. Mythic – stories, dreamtime
3. Symbolic – level of mind, lot’s of words, some knowledge
4. Physical - lot of info and knowledge (Western medicine)

 

[JourneyAgent]

I'm all for 1-2 years of residency. I saw something the other day about a residency program but don't remember where it was. I don't think however, that NPs should be PA clones.

I see many Saudi people go to Bumrungrad Hospital in Bangkok. This place is the most efficient hospital I've ever seen in my life. My wife had a lap choley and cervical disectomy at another hospital down the street. Also excellent with an international reputation. Cost me almost a dollar after insurance and that was because I ordered an extra meal one day from the chef at the hospital kitchen.

True, with surgery and trauma Western med excels. Here's what I was talking about.

Levels of Engagement

1. Energetic – pure spirit
2. Mythic – stories, dreamtime
3. Symbolic – level of mind, lot’s of words, some knowledge
4. Physical - lot of info and knowledge (Western medicine)

Hmmm. Interesting. I'm not sure what your talking about exactly. But I dig it. And on a subconscious level. I agree with you.

 

[Textbookversion]

I'm all for 1-2 years of residency. I saw something the other day about a residency program but don't remember where it was. I don't think however, that NPs should be PA clones.

I see many Saudi people go to Bumrungrad Hospital in Bangkok. This place is the most efficient hospital I've ever seen in my life. My wife had a lap choley and cervical disectomy at another hospital down the street. Also excellent with an international reputation. Cost me almost a dollar after insurance and that was because I ordered an extra meal one day from the chef at the hospital kitchen.

True, with surgery and trauma Western med excels. Here's what I was talking about.

Levels of Engagement

1. Energetic – pure spirit
2. Mythic – stories, dreamtime
3. Symbolic – level of mind, lot’s of words, some knowledge
4. Physical - lot of info and knowledge (Western medicine)

ROFL. That approach worked out great for steve jobs. Magical thinking makes my brain hurt.

 

[Futuredoc12]

I was going to make a separate thread about this, but then I saw this thread. I just have a salary question regarding Psychiatrists salaries vs Psychiatric Nurse Practitioner salaries.


In my research, I have found that Psychiatric NPs are making salaries almost comparable to that of a psychiatrist. To my knowledge, a psychiatrist's salary ranges between 170-200k being one of the lowest paying medical specialties next to Family Medicine and pediatrics.

I'm wondering: How is it that psychiatric NPs are making on average 110-120k, some even as high as 130k, while many other NPs specializing in other areas are only making 70-85k. Most Psychiatric NP new grads START at 90k. While psychiatrists are only making "a few bucks more." Maybe my research is a bit bias, as I'm sure there are psychiatrists making more than some cardiologists but I'm talking average.

How is it that their salaries are so close? Is this because they provide almost identical services (mostly medication with diagnostics and psych evaluations) and therefore get reimbursed the same? How exactly does health insurance and reimbursements work for psychiatry between psychiatrists and psychiatric nurse practitioners? How are these NPs making six figures?

Also, based on what you all know here, what have you all found to be the average salary of a psychiatrist and the average salary of a psychiatric nurse practitioner?

 

[digitlnoize]

There is a big difference in starting at 90k and starting at 180k. My friend just got an offer for 230k with 40h/wk and no call. Average I've been hearing is 180 ish for new psych grads.

 

[tobi44]

There is a big difference in starting at 90k and starting at 180k. My friend just got an offer for 230k with 40h/wk and no call. Average I've been hearing is 180 ish for new psych grads.

Agree with the above. When you compare the highest earning psychiatry nurses to the lowest earning psychiatrists then their salaries start to look similar. However, you have to work a lot harder as a psych nurse to approach the salary of a psychiatrist. And don't forget that the salary cap for a psychiatrist is a lot higher too in comparison to a psych nurse.

 

[zenman]

ROFL. That approach worked out great for steve jobs. Magical thinking makes my brain hurt.

All this means is you have a lack of knowledge outside your field. That's ok. I'm cross-trained like you won't believe. Obamacare doesn't scare me, lol!

 

[zenman]

I was going to make a separate thread about this, but then I saw this thread. I just have a salary question regarding Psychiatrists salaries vs Psychiatric Nurse Practitioner salaries.


In my research, I have found that Psychiatric NPs are making salaries almost comparable to that of a psychiatrist. To my knowledge, a psychiatrist's salary ranges between 170-200k being one of the lowest paying medical specialties next to Family Medicine and pediatrics.

I'm wondering: How is it that psychiatric NPs are making on average 110-120k, some even as high as 130k, while many other NPs specializing in other areas are only making 70-85k. Most Psychiatric NP new grads START at 90k. While psychiatrists are only making "a few bucks more." Maybe my research is a bit bias, as I'm sure there are psychiatrists making more than some cardiologists but I'm talking average.

How is it that their salaries are so close? Is this because they provide almost identical services (mostly medication with diagnostics and psych evaluations) and therefore get reimbursed the same? How exactly does health insurance and reimbursements work for psychiatry between psychiatrists and psychiatric nurse practitioners? How are these NPs making six figures?

Also, based on what you all know here, what have you all found to be the average salary of a psychiatrist and the average salary of a psychiatric nurse practitioner?

I've always made 6 figures right out of school as a psych NP. I'm right at the high figure you mentioned. However, psychiatrist contractors can make a lot more. We have opening for child psych at 300k with all kinds of sign on and retention bonuses.

 

[digitlnoize]

I've always made 6 figures right out of school as a psych NP. I'm right at the high figure you mentioned. However, psychiatrist contractors can make a lot more. We have opening for child psych at 300k with all kinds of sign on and retention bonuses.

Oooh...where is this? Can I sign up now and start when I finish fellowship? 🙂

 

[JourneyAgent]

All this means is you have a lack of knowledge outside your field. That's ok. I'm cross-trained like you won't believe. Obamacare doesn't scare me, lol!

You know that's the real power of the NP model. Light overhead. Quicker turnaround. More room for training in other modalities--yours are very interesting. Flexible and adaptable and cheaper.

If NP programs stuck to a more rigorous clinical tract and emphasized taking all the same licensing exams. They would change the game entirely. What's short sighted is that they tout their similitude without walking the walk training wise. And try to maintain their nursecentricity while at it.

Residency works at training clinicians. Exams work at making sure a safe fund of knowledge exists. Excuses and hardball politics don't cover the spread. Even if it looks good now. Sharky lawyers will come from miles when they smell blood in the water. Perceived differences would be all that matters.

I'm actually rooting for an NP model that is effective as it is efficient. Because it would force medicine to respond. Which would be good for the health of medical training. Which has been unchecked and unchallenged in its hegemony for almost 100 years now.

 

[deleted307836]

What does supervision of midlevels entail in psychiatry? It seems like it would be difficult to effectively "supervise" an np/pa when the psychiatrist him-/herself doesn't actually see or interview the patient. If psychiatrists are being pressured to sign off on the work of midlevels without direct contact with the corresponding patients, that does seem like a big liability risk.

I don't have any experience with this (as a premed) but am curious to hear about the various models that exist, the effectiveness of the physician-midlevel partnership, and the risk to physicians and patients when working within these models. Thanks for any info.

 

[kindasorta]

What does supervision of midlevels entail in psychiatry? It seems like it would be difficult to effectively "supervise" an np/pa when the psychiatrist him-/herself doesn't actually see or interview the patient. If psychiatrists are being pressured to sign off on the work of midlevels without direct contact with the corresponding patients, that does seem like a big liability risk.

I don't have any experience with this (as a premed) but am curious to hear about the various models that exist, the effectiveness of the physician-midlevel partnership, and the risk to physicians and patients when working within these models. Thanks for any info.

If the psychiatrist had direct contact with the patient, what would be the point of the midlevel? They just do chart review, like all other specialties interacting with midlevels.

 

[deleted307836]

If the psychiatrist had direct contact with the patient, what would be the point of the midlevel? They just do chart review, like all other specialties interacting with midlevels.

I think we established on an earlier thread that you are not a psychiatrist, psych resident, or med student. As for what the point of that would be, that is why I am asking this question. I am curious about how long psychiatrists spend reviewing midlevel charts, how often there are missing gaps when doing these reviews, how the psychiatrists gets this missing information, inherent liability risks, etc. And again, I'd appreciate the input of someone actually in the profession, not someone who is as equally inexperienced as I 😉.

 

[kindasorta]

I think we established on an earlier thread that you are not a psychiatrist, psych resident, or med student. As for what the point of that would be, that is why I am asking this question. I am curious about how long psychiatrists spend reviewing midlevel charts, how often there are missing gaps when doing these reviews, how the psychiatrists gets this missing information, inherent liability risks, etc. And again, I'd appreciate the input of someone actually in the profession, not someone who is as equally inexperienced as I 😉.

Oh did we? I'm a current applicant for psych residency.

Looks like you would suck at chart review. 😉

 

[deleted307836]

Oh did we? I'm a current applicant for psych residency.

Looks like you would suck at chart review. 😉

I made an assumption from your silence that I shouldn't have. Sorry. 🙂

I'm still interested in getting some feedback if anyone here cares to share.

 

[AnnoyedByFreud]

You know that's the real power of the NP model. Light overhead. Quicker turnaround. More room for training in other modalities--yours are very interesting. Flexible and adaptable and cheaper.

If NP programs stuck to a more rigorous clinical tract and emphasized taking all the same licensing exams. They would change the game entirely. What's short sighted is that they tout their similitude without walking the walk training wise. And try to maintain their nursecentricity while at it.

Residency works at training clinicians. Exams work at making sure a safe fund of knowledge exists. Excuses and hardball politics don't cover the spread. Even if it looks good now. Sharky lawyers will come from miles when they smell blood in the water. Perceived differences would be all that matters.

I'm actually rooting for an NP model that is effective as it is efficient. Because it would force medicine to respond. Which would be good for the health of medical training. Which has been unchecked and unchallenged in its hegemony for almost 100 years now.

I am all for more rigorous training for NPs. Once I realized that clinical psychology was not for me, I looked at both the psychiatry and psych NP routes. I chose psych NP because the salary seems pretty great for a 2-3 year degree compared with 10+ years for medical school (including premed, residency, etc.), even though the rewards are clearly far higher for psychiatry longterm. In my area, psych NPs start around 100-110k (though I live in an extremely high cost area with a strong nursing lobby.)

Anyway, I'm all for better training. I do think the nursing model has some pluses (basically an emphasis on the biopsychosocial model), however, I hate the lack of standardization in this field. I do like my program, then again, I'm at one of the best schools in the country at an extremely well regarded medical center. I have no idea what it's like to train at a podunk university (or even more scary - online at a for profit school that's not even part of a real university!) Here the NP students round alongside a big team of med students, interns, residents, and NPs. I decided if I was going to go into nursing, I was damn well going to go to a top school so I could eventually pursue a leadership position and try to change the field for the better (this is my fantasy, we'll see if it ever happens).

eta: As far as psychiatrists collaborating (or supervising) NPs - I think that depends entirely on the state and the policy of the institution.

 

[JourneyAgent]

I am all for more rigorous training for NPs. Once I realized that clinical psychology was not for me, I looked at both the psychiatry and psych NP routes. I chose psych NP because the salary seems pretty great for a 2-3 year degree compared with 10+ years for medical school (including premed, residency, etc.), even though the rewards are clearly far higher for psychiatry longterm. In my area, psych NPs start around 100-110k (though I live in an extremely high cost area with a strong nursing lobby.)

Anyway, I'm all for better training. I do think the nursing model has some pluses (basically an emphasis on the biopsychosocial model), however, I hate the lack of standardization in this field. I do like my program, then again, I'm at one of the best schools in the country at an extremely well regarded medical center. I have no idea what it's like to train at a podunk university (or even more scary - online at a for profit school that's not even part of a real university!) Here the NP students round alongside a big team of med students, interns, residents, and NPs. I decided if I was going to go into nursing, I was damn well going to go to a top school so I could eventually pursue a leadership position and try to change the field for the better (this is my fantasy, we'll see if it ever happens).

eta: As far as psychiatrists collaborating (or supervising) NPs - I think that depends entirely on the state and the policy of the institution.

Yeah we're on the same page. And the decision was tough for me. I thought I wanted ED and the NP markets were saturated where I was living and want to end up. I want a synthesis of both models for a shorter route to practice with more clinical training and a separate academic tract for physician researchers. We spend entirely too much time messing around with phd's and specialist attendings that have forgotten how much they've forgotten about what's needed to effectively engage their field that we're never going into.

I rotated with a PA student. Sharp as tack. She was one of us, no different. Just getting to the end point sooner.

Really the PA model with an extra year of rotations plus a residency might be a good synthesis. Because as you say....NP education is all over the map.

But you know. Just like medical students who come from different backgrounds of knowledge, we will all end up where our conscientiousness takes us in the quality of our practice. It's just we need the best way to ensure every one gets passed the reigns safely.

The amount of money it takes to become a doctor is also very problematic. There's no restraint on the ballooning costs now.

Something will have to give.

 

[michaelrack]

If the psychiatrist had direct contact with the patient, what would be the point of the midlevel? .

For a patient with chronic mental illness that comes in periodically, the psychiatrist could see him for a % of visits (every 4th visit, for example), with the NP seeing him for the other visits. That is one model of physician/NP collaboration

 

[AnnoyedByFreud]

I should mention that I'm also female and in my mid-20s. I know that people on the medical path pop out kids all the time, however, it sounds like it is very difficult. I'm not very good at balancing my life and I know it would be extremely challenging for me to be inundated with medical education and also attempting to become a parent. That was a serious concern of mine. I'll still be in my 20s when I graduate NP school (plenty of time to start a family), as opposed to ~36 (things starting to look dicey), had I pursued medicine.

The problem with PA (for me, personally) was that their psych training is pretty minimal compared to psych NP. They don't take any extra psych courses, receive no training in therapy, and do they even take a class on psychiatric assessment specifically? I'm not so sure, but it didn't appeal. Plus there are more opportunities for growth in nursing (just my opinion). I would love to have a residency attached to my NP education. That would be perfect. I know they're starting to move in that direction (I believe a few psych PA residencies accept NPs, so that might be something I pursue). I also know some new grads who got jobs that offer ~6 months of close supervision, almost like a mini residency. Finding a job like that when I graduate would be ideal.

Anyway, in the end I'm very pleased with my choice. I know it will be an uphill battle in some respects, but I'm willing to put up with it considering the other advantages associated with this path.

 

[deleted307836]

For a patient with chronic mental illness that comes in periodically, the psychiatrist could see him for a % of visits (every 4th visit, for example), with the NP seeing him for the other visits. That is one model of physician/NP collaboration

This is interesting, and I can see how this type of setup would be particularly useful in areas where there is a shortage of psychiatrists. Thanks 👍

 

[JourneyAgent]

I should mention that I'm also female and in my mid-20s. I know that people on the medical path pop out kids all the time, however, it sounds like it is very difficult. I'm not very good at balancing my life and I know it would be extremely challenging for me to be inundated with medical education and also attempting to become a parent. That was a serious concern of mine. I'll still be in my 20s when I graduate NP school (plenty of time to start a family), as opposed to ~36 (things starting to look dicey), had I pursued medicine.

The problem with PA (for me, personally) was that their psych training is pretty minimal compared to psych NP. They don't take any extra psych courses, receive no training in therapy, and do they even take a class on psychiatric assessment specifically? I'm not so sure, but it didn't appeal. Plus there are more opportunities for growth in nursing (just my opinion). I would love to have a residency attached to my NP education. That would be perfect. I know they're starting to move in that direction (I believe a few psych PA residencies accept NPs, so that might be something I pursue). I also know some new grads who got jobs that offer ~6 months of close supervision, almost like a mini residency. Finding a job like that when I graduate would be ideal.

Anyway, in the end I'm very pleased with my choice. I know it will be an uphill battle in some respects, but I'm willing to put up with it considering the other advantages associated with this path.

Cool. Good luck. I agree that parenting in medical school is like one of those things nobody tells you the real dirt on. Nobody will say their kids suck once they have them. But I'm convinced regardless of what people say. Residency and young kids is like living dog years. You'll come out of it wore the F out and still say lovely things about it.

Lets put it this way. I've worked in peds for a couple of years. New parents look like interns. And interns look like ****. The math is additive. And easy to surmise. Even with the inexplicable Stockholm syndrome reporting of its survivors.

 

[PikminOC]

There is a big difference in starting at 90k and starting at 180k. My friend just got an offer for 230k with 40h/wk and no call. Average I've been hearing is 180 ish for new psych grads.

That's pretty amazing. I have never seen an employed position that was really only 40 hours a week and not full a bunch of other, nonclinical, annoying crap.

 

[zenman]

I should mention that I'm also female and in my mid-20s. I know that people on the medical path pop out kids all the time, however, it sounds like it is very difficult. I'm not very good at balancing my life and I know it would be extremely challenging for me to be inundated with medical education and also attempting to become a parent. That was a serious concern of mine. I'll still be in my 20s when I graduate NP school (plenty of time to start a family), as opposed to ~36 (things starting to look dicey), had I pursued medicine.

The problem with PA (for me, personally) was that their psych training is pretty minimal compared to psych NP. They don't take any extra psych courses, receive no training in therapy, and do they even take a class on psychiatric assessment specifically? I'm not so sure, but it didn't appeal. Plus there are more opportunities for growth in nursing (just my opinion). I would love to have a residency attached to my NP education. That would be perfect. I know they're starting to move in that direction (I believe a few psych PA residencies accept NPs, so that might be something I pursue). I also know some new grads who got jobs that offer ~6 months of close supervision, almost like a mini residency. Finding a job like that when I graduate would be ideal.

Anyway, in the end I'm very pleased with my choice. I know it will be an uphill battle in some respects, but I'm willing to put up with it considering the other advantages associated with this path.

Agree with you. One of the reasons I didn't do primary care was because I didn't think there were enough hours to learn a little something about everything. I had already completed a CNS program which was all geared to psychotherapy and just added the psych NP to that.

 

[ReInventor]

I should mention that I'm also female and in my mid-20s. I know that people on the medical path pop out kids all the time, however, it sounds like it is very difficult. I'm not very good at balancing my life and I know it would be extremely challenging for me to be inundated with medical education and also attempting to become a parent. That was a serious concern of mine. I'll still be in my 20s when I graduate NP school (plenty of time to start a family), as opposed to ~36 (things starting to look dicey), had I pursued medicine.

Word. This is a big reason I'm pursuing NP school rather than med school. I thought long and hard about doing the whole post-bac --> med school thing after my psych BA, but I don't think it will mesh with other things I want to do in my life. I think it will be the right decision for me.

Let me start off by saying that I honestly appreciate a good midlevel-- NP or PA-- they're valuable and are reimbursed well and on par with their education (some of them make a **** load of money). I also, like most physicians that haven't lost their damn minds, don't appreciate the Dr. Fake NP movement and all the garbage put forth on SDN and other anonymous web forums, or the repeated attempts at legislating by nurses to try to take scope of practice from doc's (see recent attempt to practice pain medicine).

We live in a funny time in medicine where midlevels are trying to demand more and more-- actually, mostly NP's and their whole "nurse doctor" movement. Like has already been said, their invention was to decrease costs and act as physician extenders, not create independent pseudo-doc's that are equally reimbursed with less training and less standardized training. While I often see doomsday venting about many things on SDN, including midlevels, I tend to think that the threat is less legitimate.

As far as NP's are concerned, I think their nurse doctor movement is increasingly on the radar of physicians (especially younger physicians) who are being increasingly pissed off by it and who, in many cases, are the ones who do/will hire mid-levels and/or be involved in midlevel training. This could lead to their ultimate demise. PA's in particular are a threat to NP's and their nurse doctor ambitions and, in my opinion, should ( and I think logically will) be preferred by physicians in a position to set policy and hire midlevels. They have more standardized, rigorous educations--- not this online Dr. McFakey nursing stuff. I also think the idea of PA --> MD is great and more doable than NP --> MD (or NP --> fake nurse doctor). This allows an experienced midlevel who thirsts for independence a means to gain a full MD education and do a real medical residency while recognizing their experience and training. I hope this is the trend that we see pick up and it seems like the logical progression of things given the changes in healthcare that should involve more cost cutting (not paying midlevels large sums of money), oversight, and quality control (standardized practices, standardized education).

All of these lofty future predictions and assumptions aside lets not forget that medicine, and psychiatry in particular, is an art and MD's are the real artists. This is an undeniable truth that you simply recognize if you work with both an MD and NP. Also, let me state the obvious-- MD's are on average much brighter, more articulate people and the average person recognizes that 100% of the time. Yes, people recognize that and I find it hard to imagine NP's making some power move on psychiatry or any field of medicine for that matter. It just won't jive with patient expectations and demands (Psych NP's have existed since the early 80's after all, around the time of my birth). So, lets be confident and determined to pave the future of medicine, keeping in mind our long history of superior training and intellect, eh?😀

So I don't usually like to respond to the really negative posts about NPs on this board (I mean, wouldn't it be better for MDs and NPs to collaborate and get along!? Sure there are some obnoxious NPs [cough DNP movement cough] out there but dang they aren't all bad), but that little jab really pissed me off. I graduated summa cum laude, Phi Beta Kappa, and I was a Fulbright grant finalist, and I am going to be an NP. So kiss my behind if you don't think I'm as intelligent as the average medical student. 😀 I think more and more bright young people are realizing that med school can be a pretty rough road and making the choice to become an NP/PA instead.

 

[surftheiop]

Word. This is a big reason I'm pursuing NP school rather than med school. I thought long and hard about doing the whole post-bac --> med school thing after my psych BA, but I don't think it will mesh with other things I want to do in my life. I think it will be the right decision for me.



So I don't usually like to respond to the really negative posts about NPs on this board (I mean, wouldn't it be better for MDs and NPs to collaborate and get along!? Sure there are some obnoxious NPs [cough DNP movement cough] out there but dang they aren't all bad), but that little jab really pissed me off. I graduated summa cum laude, Phi Beta Kappa, and I was a Fulbright grant finalist, and I am going to be an NP. So kiss my behind if you don't think I'm as intelligent as the average medical student. 😀

The fact that you even find this worth mentioning shows your probably way more academically inclined than your average NP classmate, while you would probably be average in a medschool.

Thant being said this is not a useful discussion at all, the average clinical psychology PhD is going to be more intelligent than the average psychiatrist, the average biostatistics PhD is going to be smarter than the average clinical psychologist. But this has nothing to do with who I would most trust to prescribe medications.

 

[ReInventor]

The fact that you even find this worth mentioning shows your probably way more academically inclined than your average NP classmate, while you would probably be average in a medschool.

Thant being said this is not a useful discussion at all, the average clinical psychology PhD is going to be more intelligent than the average psychiatrist, the average biostatistics PhD is going to be smarter than the average clinical psychologist. But this has nothing to do with who I would most trust to prescribe medications.

I agree, that it is a pretty normal profile for a med student. But I just said it to show that it's not fair to assume degree = intelligence, I was irritated by the assumption in the post I was responding to. So basically I agree with you.

 

[JourneyAgent]

I agree, that it is a pretty normal profile for a med student. But I just said it to show that it's not fair to assume degree = intelligence, I was irritated by the assumption in the post I was responding to. So basically I agree with you.

Yeah that kind of bullying just makes us look bad. Which is our problem. We have failed the public relations aspect. Maybe because we haven't had much competition until recently.

But what we--those of us interested in safe clinical practice need--is for smart people like yourself to push from within for mor standardized training with mandatory residency and only independent practice where shortages exist.

We have completely irresponsible twits among us. But we ensure that they have to have a minimum level of their **** together. And we've been doing this long enough to figure out what works.

Nursing coursework followed by no residency is predicated on the fact that we're responsible for your safe practice.

So the fact that your political bodies--the standard rank and file consensus, not just the DNP academicians--are constantly pushing for independent practice should rightly be taken as slight of hand trick on the public at our expense.

Your profession has yet to transform with its own Flexner report. It will. And all the public support your profession has garnered through offering cheaper option will wilt if they can get a lawyer to get themselves a pay out. They'll always be just as stupid as they need to be.

What seems hostile form at least the non-bullies in our camp is better taken as a charge to know the same amount, to take the same rigorous exams, to carry the pager 70 plus hours a week for a year at least, and in so doing help us to push back at our own inefficiencies. So that we have a system that makes sense for everyone. Us with our debt loads and level of investment, you with yours, and the public with its health services bills to pay.

 

[Leo Aquarius]

Thant being said this is not a useful discussion at all, the average clinical psychology PhD is going to be more intelligent than the average psychiatrist, the average biostatistics PhD is going to be smarter than the average clinical psychologist. But this has nothing to do with who I would most trust to prescribe medications.

Your point being that you can't stereotype intelligence. I agree up to a point. I am biased and believe medical education in this country is designed to admit top performing college students, those who not only pass but get strong grades in organic chemistry and biochemistry and very difficult classes of those sorts which require decent doses of intelligence. There's nothing wrong saying the doctors in America are generally very smart, more so than others. We'd be in trouble if this were untrue. So yes I do believe the average MD intelligence >> your average anybody else. I'm biased and recognize this.

Working every day in a very busy hospital I thank my lucky stars for great nurses. I love nurses!

 

[dozitgetchahi]

Your point being that you can't stereotype intelligence. I agree up to a point. I am biased and believe medical education in this country is designed to admit top performing college students, those who not only pass but get strong grades in organic chemistry and biochemistry and very difficult classes of those sorts which require decent doses of intelligence. There's nothing wrong saying the doctors in America are generally very smart, more so than others. We'd be in trouble if this were untrue. So yes I do believe the average MD intelligence >> your average anybody else. I'm biased and recognize this.

Working every day in a very busy hospital I thank my lucky stars for great nurses. I love nurses!

Word.

Some really crazy stuff has come out in this thread. Western medicine is the 'bottom rung of the ladder?' I nearly sprayed coffee everywhere when I read that. NPs bashing PAs? That's uncalled for...and absurd to boot. PA students are 'right where we are' as medical students? Maybe you worked with one that was, but the ones I've rotated with haven't been.

Normally I'd just read a thread like this and be on my merry way - after all, the SDN forums are home to a lot of silly and just plain incorrect information (don't take it the wrong way)...but lately I've been paying more attention to stuff like this because it seems like this is the type of thinking that's taking hold in the profession. I don't know what to make of it.

 

[ReInventor]

Word.
NPs bashing PAs? That's uncalled for...and absurd to boot.

Where was this bashing in the thread? When AnnoyedByFreud said PAs had weak training in psych? I don't think that's bashing, I think it's just truthful, it's not a big emphasis in PA training (at least based on what I have been told by practicing PAs and PA students). But generally I agree PA training is stronger than NP training, except maybe for psych.