Psych NPs - Threat or Asset?

[Leo Aquarius]

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Psych NPs open a box of questions for us. Do Psych NPs present a workforce that will help solve the psychiatrist shortage, and if so is it a dependable and safe option for patients? Are Psych NPs a threat in that they are cheaper to hire and will replace many psychiatrist jobs? Does the public even care whether they see a psychiatrist or psych NP?

 

[PikminOC]

The public does care. At least the public I deal with.

 

[F0nzie]

The public does care. At least the public I deal with.

I am thinking back to when I was a kid. Who did I go see when I was sick? The doctor. Now 20 years later I feel entitled to see one because I trust their expertise.

The next generation will be seen predominantly by NPs. I can imagine when this next generation grows up, they will expect an NP to address their healthcare needs, not a doctor.

 

[F0nzie]

As I am setting up my private practice and looking to network with other physicians around my area, I am noticing that specialty groups are hiring psych NPs to handle the psychiatric component. For example, neurology groups (pediatric and adult) are tightening their circles of referrals and creating 1 stop shops by hiring Psych NPs in the masses, essentially leaving us out of the equation.

 

[F0nzie]

Also, as I mentioned in another thread, in states where independent prescribing privileges are permitted, large groups are hiring NPs instead of psychiatrists. They are taking advantage of their low cost and independence by giving them the same responsibilities of a fully trained Psychiatrist.

Oh yea and Medicare threatening to freeze our rates for the next 10 years is bad news too.

Leo Aquarius....Loving this thread.

 

[PikminOC]

Leo Aquarius....Loving this thread.

😛

And I am speaking from about 6 years of experience after residency. So I am a relatively new grad. Just telling you what I see.

 

[F0nzie]

Ok well I have been in residency for 4 years and barely any patient I have met knows that a psychiatrist is a doctor. Are you in Silicon Valley Grover?

 

[st2205]

Oh yea and Medicare threatening to freeze our rates for the next 10 years is bad news too.

There's a silver lining in there of you look.

 

[BobA]

Psych NPs open a box of questions for us. Do Psych NPs present a workforce that will help solve the psychiatrist shortage, and if so is it a dependable and safe option for patients? Are Psych NPs a threat in that they are cheaper to hire and will replace many psychiatrist jobs? Does the public even care whether they see a psychiatrist or psych NP?

Probably they are a financial threat - but remember that supply and demand doesn't always work in medicine. In medicine, sometimes increased supply creates more demand (from referrals, etc). For instance, one could envision a scenario where Psych NP's increased the rates of psych rx's written, which would in turn increase the public's acceptance of taking psych meds, and increase overall demand. I think it's more likely they decrease Psych MD salaries, but maybe not.

Are they a good thing? Most likely. I'd go so far as the say that the top 10% of psych NP's are better clinicians than the bottom 10% of Psychiatrists. There are some horrendous psychiatrists out there. There's no need to make patients wait forever to see a psychiatrist when a full MD or residency training isn't required to handle that issue. If these patients weren't going to psych NPs they'd be going to Family Docs and Internists who have even less psychiatric training than most Psych NPs (of course, there's variety here too).

I could see this thread devolving into a bunch of arguing of nothing, and I just want to be the first to say "stop it" before it even starts.

Pretty tired tonight - getting killed moonlighting, so forgive me if I'm a little out of it.

 

[F0nzie]

There's a silver lining in there of you look.

nice. Found a playbook.

 

[billypilgrim37]

i just want to be the first to say "stop it" before it even starts.

second!!!

 

[BobA]

second!!!

Here's a great about psych NPs vs. MDs: read this

. . . oops!

 

[NJWxMan]

One advantage of being a CAP...Psych NP's normally don't get involved in child psychiatry (some will see adolescents, say 16 years old +).

 

[PikminOC]

Ok well I have been in residency for 4 years and barely any patient I have met knows that a psychiatrist is a doctor. Are you in Silicon Valley Grover?

My patients may confuse psychologist and psychiatrist. But they know I am not a nurse. I am not in Silicon Valley. And you are still in residency. You don't think I may have a little more wordly experience? Just a little? Can't learn from an older doc?

Oh well. Sorry I came back to sdn then.

 

[pathologyDO]

Not going to lie, this thread is sort-of discouraging for me as an incoming M1 with a strong interest in psychiatry... : (

 

[JourneyAgent]

Not going to lie, this thread is sort-of discouraging for me as an incoming M1 with a strong interest in psychiatry... : (

No man. Do what you want to do. The whole health care industry is dealing with economic constraints. It's unlikely that your interests will range from surgery to a field like psychiatry or that the particular market forces in psychiatry will be a large enough factor to choose this field over another or vice versa.

We're all in competition with some feature that depresses wages. These features of our work environment will always outnumber us so long as we remain in the ever dwindling upper middle class.

 

[PikminOC]

Not going to lie, this thread is sort-of discouraging for me as an incoming M1 with a strong interest in psychiatry... : (

Funny, I thought you like PATH.

 

[F0nzie]

My patients may confuse psychologist and psychiatrist. But they know I am not a nurse. I am not in Silicon Valley. And you are still in residency. You don't think I may have a little more wordly experience? Just a little? Can't learn from an older doc?

Oh well. Sorry I came back to sdn then.

I believe I have expressed my point of view and clearly state above my avatar that I am a PGYIV. Anybody reading these forums should know (as well as you do) that residents hardly know anything about real world experience. But thank you for clarifying rank.

 

[jettavr6]

Anybody reading these forums should know (as well as you do) that residents hardly know anything about real world experience.

Vistaril would vehemently disagree with you on this.

 

[pathologyDO]

Funny, I thought you like PATH.

Yeah well, you know what they say: "don't judge a book by it's cover." But really, it's not easy to change your name on this forum. I may get around to it eventually though. Thanks for giving me a hard time about it 😛

So apparently the thought here is that all doctors (especially psychiatrists) are being undermined by the NP's in their respective specialties, and that MD/DO is a dieing profession, given that it costs so much in both time and money to become a physician, yet the wages will be lowering substantially because of the less trained, less debt-burdened NP's taking over the fields?

 

[PikminOC]

I believe I have expressed my point of view and clearly state above my avatar that I am a PGYIV. Anybody reading these forums should know (as well as you do) that residents hardly know anything about real world experience. But thank you for clarifying rank.

You are getting worked up about this. I am just telling you what I am seeing in the real world. I am optimistic and am trying to get you guys to see it too. Seems like you guys get pisd when ppl are optimistic or pessimistic.

You came off very accusatory and not receptive with your Silicon Valley comment. And you are continuing to do so.

 

[PikminOC]

Also, as I mentioned in another thread, in states where independent prescribing privileges are permitted, large groups are hiring NPs instead of psychiatrists. They are taking advantage of their low cost and independence by giving them the same responsibilities of a fully trained Psychiatrist.

Oh yea and Medicare threatening to freeze our rates for the next 10 years is bad news too.

Leo Aquarius....Loving this thread.

I try to respect ppl if they know more about something than I do regardless of 'rank'. Please tell me the states that are allowing independent nurse practice without any form of physician collaboration.

 

[PikminOC]

Vistaril would vehemently disagree with you on this.

Exactly. I respect ppl for what they know more than me regardless of age or rank or whatever.

Addressing OP, I do not see NP's as a threat at all.

 

[Leo Aquarius]

Yeah well, you know what they say: "don't judge a book by it's cover." But really, it's not easy to change your name on this forum. I may get around to it eventually though. Thanks for giving me a hard time about it 😛

So apparently the thought here is that all doctors (especially psychiatrists) are being undermined by the NP's in their respective specialties, and that MD/DO is a dieing profession, given that it costs so much in both time and money to become a physician, yet the wages will be lowering substantially because of the less trained, less debt-burdened NP's taking over the fields?

Philosophically your comment tickles my fancy. Let's play this out a bit, that one day American-trained doctors will become a thing of the past. Can you imagine a world where US MDs are a rarity, a relic of the past because, hey, who would send their kids into a profession that costs $300,000 (10 years from now) to only come out making $130,000 (hello socialized health care) which is what NPs make because, after all, the cool kids become NPs since it's a shorter path that pays as much as doctors make. Yes, I can see this becoming a reality. By then, 90% of MDs will be foreign-trained.

 

[pathologyDO]

Philosophically your comment tickles my fancy. Let's play this out a bit, that one day American-trained doctors will become a thing of the past. Can you imagine a world where US MDs are a rarity, a relic of the past because, hey, who would send their kids into a profession that costs $300,000 (10 years from now) to only come out making $130,000 (hello socialized health care) which is what NPs make because, after all, the cool kids become NPs since it's a shorter path that pays as much as doctors make. Yes, I can see this becoming a reality. By then, 90% of MDs will be foreign-trained.

Anybody care to offer counter-points on this discussion? I'm yearning for some optimism.

 

[BS81]

Color coded map for scope of practice rights for NPs:
http://www.aanp.org/images/documents/state-leg-reg/stateregulatorymap.pdf
http://www.aanp.org/legislation-regulation/state-practice-environment

My experiences are mostly in a "red state" with restricted NP practice and I don't really see any of these doomsday scenarios on the near horizon. Are any of you in one of these "yellow" or limited practice states that are seeing direct head to head competition? Or are the people complaining all in the states where there are no restrictions on NP practice?

 

[benjee]

Psych NPs open a box of questions for us. Do Psych NPs present a workforce that will help solve the psychiatrist shortage, and if so is it a dependable and safe option for patients? Are Psych NPs a threat in that they are cheaper to hire and will replace many psychiatrist jobs? Does the public even care whether they see a psychiatrist or psych NP?

No, Nps won't solve the psychiatrist shortage . It's like plasma and blood, the rules and regulation is trying to substitute blood with plasma which does not carry oxygen with the thought that can save lots of money. However, Np will request more and more reimbursement even higher than psychiatrist , once they are allowed to practice medicine independently as they would claim they are the same as or even better than MDs performing same thing. For those underserved areas, still in shortage.
Eventually, there is still shortage no matter what. Government can make laws and regulations to allow anyone not just Nps, PA,..etc to practice medicine independently so to keep budget low. But at the same time, many lawsuits will be happening more frequently.

 

[zenman]

One advantage of being a CAP...Psych NP's normally don't get involved in child psychiatry (some will see adolescents, say 16 years old +).

Wrong. The Adult Psych NP is now changing to Family Psych NP. Luckily, I finished before this came into affect. As an Adult Psych NP I can see ages 13 and up only. Fortunately, since I don't like kids, my current patients are 18 yrs and above...and soldiers.

 

[michaelrack]

I outrank everyone on this thread (so far) in years post-residency and years in private practice, but probably not in time spent actually practicing the specialty of psychiatry.

In my neck of the woods, psych NP's practice predominantly under psychiatrists, often in state hospitals but there are some in a private practice setting.

In Mississippi, it is in the area of primary care that NP's are practicing practically on their own.

I do collaborate with a family practice (that may not be the official title, it may be adult) NP who helps me out in my sleep clinic.

 

[st2205]

As psych NPs continue to grow, I'd like to see, on one hand or the other, change to the dichotomous view of it being unconscionable for an adult psychiatrist to see children but kosher for a psych NP to do so.

 

[BS81]

Wrong. The Adult Psych NP is now changing to Family Psych NP. Luckily, I finished before this came into affect. As an Adult Psych NP I can see ages 13 and up only. Fortunately, since I don't like kids, my current patients are 18 yrs and above...and soldiers.

As psych NPs continue to grow, I'd like to see, on one hand or the other, change to the dichotomous view of it being unconscionable for an adult psychiatrist to see children but kosher for a psych NP to do so.

Maybe we should just change the name adult psychiatry to FAMILY psychiatry and that will make everything ok! We should start embracing these shortcuts like the NPs are! 😉

 

[vistaril]

Philosophically your comment tickles my fancy. Let's play this out a bit, that one day American-trained doctors will become a thing of the past. Can you imagine a world where US MDs are a rarity, a relic of the past because, hey, who would send their kids into a profession that costs $300,000 (10 years from now) to only come out making $130,000 (hello socialized health care) which is what NPs make because, after all, the cool kids become NPs since it's a shorter path that pays as much as doctors make. Yes, I can see this becoming a reality. By then, 90% of MDs will be foreign-trained.

NP's aren't a threat to a lot of fields....not every specialty experiences anywhere near the same type of midlevel threat.

 

[vistaril]

As I am setting up my private practice and looking to network with other physicians around my area, I am noticing that specialty groups are hiring psych NPs to handle the psychiatric component. For example, neurology groups (pediatric and adult) are tightening their circles of referrals and creating 1 stop shops by hiring Psych NPs in the masses, essentially leaving us out of the equation.

yep...I'm starting to hear of the same trend. And it makes sense. We do a very poor job(for the most part) of meeting the needs of referring outpt physicians. A lot of outpt psychiatrists can't get someone very soon who needs to be seen because they prefer to refill some girls vyvance 70 who has been 'stable' for 4 years now. What do you think others are going to do? Of course they are going to do an end around, as they should....

 

[vistaril]

One advantage of being a CAP...Psych NP's normally don't get involved in child psychiatry (some will see adolescents, say 16 years old +).

hehe....maybe a lot of the medicaid train wrecks that are complicated, difficult to effectively treat, and don't pay anything. You're kidding yourself if you think the middle class and upper middle class adderall refill kids(which pay the bills) aren't out there for the taking/competition....

 

[vistaril]

My patients may confuse psychologist and psychiatrist. But they know I am not a nurse. I am not in Silicon Valley. And you are still in residency. You don't think I may have a little more wordly experience? Just a little? Can't learn from an older doc?

Oh well. Sorry I came back to sdn then.

ummm, your last few jobs you've also been let go and/or quit because you couldn't effectively work within the system for various reasons. that seems like a trend. Meanwhile, fonzie has successfully worked effectively in different settings outside of residency(and made nice coin doing so).....so I wouldnt go down that road if I were you. I wasn't going to bring that up, but you started it in this case by going after him.

 

[vistaril]

Vistaril would vehemently disagree with you on this.

depends on how much real world experience in different settings outside of residency they have. Some people ten years out of residency have only wored in one system(the same academic hospital) their whole career....

 

[vistaril]

Color coded map for scope of practice rights for NPs:
http://www.aanp.org/images/documents/state-leg-reg/stateregulatorymap.pdf
http://www.aanp.org/legislation-regulation/state-practice-environment

My experiences are mostly in a "red state" with restricted NP practice and I don't really see any of these doomsday scenarios on the near horizon. Are any of you in one of these "yellow" or limited practice states that are seeing direct head to head competition? Or are the people complaining all in the states where there are no restrictions on NP practice?

looking at the issue this way doesn't allow for full understanding......large numbers of psychiatrists are now employed in settings like VAs, community mental healths, and other salaried positions. Increasing numbers of psych nps, even in fairly restricted states, decreases the number of psychs employed in these settings....which puts more supply pressure on the system as a whole. Which drives down salaries as a whole.

Also, over the next ten years a lot of those states with more restrictions now are going to see resctrictions loosen a lot

 

[vistaril]

One advantage of being a CAP...Psych NP's normally don't get involved in child psychiatry (some will see adolescents, say 16 years old +).

hehe...maybe the train wreck medicaid pt population that doesn't pay anything and have poor outcomes overall. But the middle class and upper middle class stimulant kids....those are definately up for grabs in the future and you're delusional if you think midlevels won't be competing for those.

 

[BS81]

Psych is still fairly unpopular for NPs and as more specialty NP programs start to appear the pmhnp will continue to be unpopular. On one of the nursing forums (all nurses) there is a fairly large thread about how unpopular psych is for NPs as the nursing faculty look down on psych nursing a lot more than the MDs. The number of psych NP programs is actually decreasing as many are shutting down due to lack of interest.
But that info might be as exaggerated as anything else on SDN. I tried to find the hard numbers on how many psych NP programs graduates, or current practitioners are out there but can't so who knows what the truth is.

 

[vistaril]

Psych is still fairly unpopular for NPs and as more specialty NP programs start to appear the pmhnp will continue to be unpopular. On one of the nursing forums (all nurses) there is a fairly large thread about how unpopular psych is for NPs as the nursing faculty look down on psych nursing a lot more than the MDs. The number of psych NP programs is actually decreasing as many are shutting down due to lack of interest.
But that info might be as exaggerated as anything else on SDN. I tried to find the hard numbers on how many psych NP programs graduates, or current practitioners are out there but can't so who knows what the truth is.

I know the hospital I'm affiliated with has pumped out several psych np grads in the last several years. And all of them are now working in outpt salaried settings(several at the VA) seeing the same pts that psychiatrists saw a few years ago......they were hired in place of hiring more psychiatrists.

As to the popularity of the psych np programs, I think they will become even more popular as people realize what the opportunities to practice are relative to psychiatrists. And the salaries are generally pretty good.

 

[AnnoyedByFreud]

yup. The reality is that in psych there will be plenty of work for everyone, since it's pretty unpopular across the board for all healthcare workers. It is true, however, that from about 2014 forward all psych NPs will have to sit for the family psych NP exam (not adult only) and will be licensed to see the entire age spectrum.

 

[jettavr6]

depends on how much real world experience in different settings outside of residency they have. Some people ten years out of residency have only wored in one system(the same academic hospital) their whole career....

Seven posts back to back?? The "real world" may not offer you this amount of internet time.

 

[vistaril]

Are they a good thing? Most likely. I'd go so far as the say that the top 10% of psych NP's are better clinicians than the bottom 10% of Psychiatrists. There are some horrendous psychiatrists out there. QUOTE]

I think it's more like 25-30% on both ends.

 

[jettavr6]

I think it's more like 25-30% on both ends.

Can you post a website link to substantiate this? Have you cross-referenced this from a search of NP test scores or patient satisfaction data from each state nursing board? 😉

 

[vistaril]

Can you post a website link to substantiate this? Have you cross-referenced this from a search of NP test scores or patient satisfaction data from each state nursing board? 😉

seeing as how I stated "I think........".........no, I haven't.

Words. They matter.

Along this same line, I think people who train at the more competitive programs don't understand the quality of 'candidates' at many programs. Maybe only the 10% of psych nps are better than the bottom 10% of psychiatrists.....who trained at Columbia or whatever. But there is no way the bottom quarter of East Carolina grads are better than the top 10% of psych nps....in fact I would say they arent even close.

 

[jettavr6]

Words. They matter.

Of course words matter. So does punctuation, spelling and grammar. At least use the spelling and grammar check - the damn system corrects it for you.

Along this same line, I think people who train at the more competitive programs don't understand the quality of 'candidates' at many programs. Maybe only the 10% of psych nps are better than the bottom 10% of psychiatrists.....who trained at Columbia or whatever. But there is no way the bottom quarter of East Carolina grads are better than the top 10% of psych nps....in fact I would say they arent even close.

"I think" aside, don't you even feel the urge to run a couple of web queries here? Maybe you can check the top 10% of Psych NP's with missing limbs and compare it to Dermatology NP's who can suture with two fingers... Just think chi-squared analysis or ANOVA!

 

[BobA]

I am very happy that Jetta joined back up with our discussion as he's got a lot to offer with his pain training and I know a lot of people will find his advice extremely helpful.

However, while he was gone he may have missed the many morass-like forum debates that people have found themselves in with V.

I would instead like the change the discussion topic.

How about a discussion over whether Rylie the mixed breed cuter than the Labrador Mix?

 

[billypilgrim37]

How about a discussion over whether Rylie the mixed breed cuter than the Labrador Mix?

You're a genius.

Rylie seems to edge it out by just a bit.

 

[vistaril]

Of course words matter. So does punctuation, spelling and grammar.

well in a forum like this, not nearly as much......we can communicate just fine(and vice versa) with a certain number of spelling and grammar mistakes. But the same can't be said when words are disregarded.

Back to psych np....not really interested in any such data. It's obviously not very practical.

 

[PikminOC]

ummm, your last few jobs you've also been let go and/or quit because you couldn't effectively work within the system for various reasons. that seems like a trend. Meanwhile, fonzie has successfully worked effectively in different settings outside of residency(and made nice coin doing so).....so I wouldnt go down that road if I were you. I wasn't going to bring that up, but you started it in this case by going after him.

Not sure what that has to do with this thread.
I work solo, as many docs do for various reasons including the ones cited above.
And I don't see NP's as a threat.
You all doing well in other settings does not change my opinion re NP's.

I'm not in Silicon Valley which was the original fork in my side.
I gave my opinion.
So my opinion doesn't count as I didn't learn anything from the other places I worked in?
You know nothing about my residency experience either.

Thanks SDN.