Psych NPs - Threat or Asset?

[zenman]

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You're wrong and you will never be able to see it. I'm sorry. You offer straw men in response to very valid criticisms of your training. At least fight fire with fire. Your response to the argument that NPs don't have rigorous enough training to competently practice medicine is to say "you all make people fat." That's really weak sauce.

Right man syndrome here, eh?

 

[xlithiumx]

Lately I'm getting hip to the notion proposed by splik and others on here. That it's time we went the other way with it. And studied like her majesty's psychiatry consultants. The comprehensive expert model is what we should emulate. More medicine. More therapy. Long rigorous residency training.
QUOTE]

This would only make us less competitive(relative to psych nps in the future) to the people who hire us(cmhcs, hospitals, VAs, agencies) and pay us(mostly insurers).......

Right. Better training. Greater expertise. Less competitive. 👎
Your view of healthcare finance is kind of myopic and essentially entirely focused on the question of revenue vs. cost for any given provider. What you fail to see is that an effective psychiatrist who provides good care draws sick people to that healthcare system. The psychiatrically ill are, almost by definition, more medically ill than the general population. Those people also tend to receive substandard medical care. A psychiatrist who effectively treats an SPMI population also gets them medical care within the system, which is many times interventional in nature and very lucrative. A good psychiatrist is an excellent "loss leader."

The other thing you forget is that for hospital based clinics, the system collects 2 fees, the professional fee and the facility fee. They may run a slight deficit on the professional fees but more than make up for it with the facility fee. Seriously. This is kindergarten stuff. I'm so tired of you saying, "How are you ever going to bring in enough revenue to cover your salary?" The situation is vastly more complex than that, and again you are unwilling or unable to see it.

 

[zenman]

unfortunately, I see a ton of psych np's prescribe the same polypharmacy nonsense that so many psychs prescribe.

Honestly, I can't tell much of a difference between the prescribing patterns of psychs and psych nps. And thats not a compliment to either group.

Which is what I try to keep in mind every day.

The biggest advantage good psychiatrists have on psych nps is that psych nps don't have therapy training(or really any decent training) and usually arent skilled in it. Now a lot of psychs dont either. And most of the ones that do don't actually practice in a setting where they can use it. But still, that is a big difference...

Many psych NPs are lamenting the demise of the psych CNS programs which focused on therapy. Luckily, I completed such a 2 yr program back in the 80's, then did 2 more years for psych NP. I actually prefer therapy to meds. Effecting change just by words is way up there in my book. I currently train with Bradford Keeney and will be entering a 2 yr program with him next year. A couple weeks ago I spent 30 hrs with him, not a couple hrs a day then spending the rest of the time at the beach, but 6 hrs a day. He trained with all the top family therapists and now, for God's sake, is also a well-known shaman dude, lol!

 

[zenman]

I am a huge supporter of psychiatry.....my support just takes a somewhat different form than yours.

I agree with you and think we should always tear down our professions in order to ID weak areas and make it stronger.

 

[zenman]

Nah. Nursing political strategy is tight. Their unions have bowling ball sized nuts. They run health care. They take ground and hold it. F@ck around, they do not. Psychologists are a sidebar to a footnote in healthcare politics. Social workers who can do therapy are much better positioned to do more of our scope or theirs.

And I think you're non-medical argument for psychiatry is weak and unattractive to most of them or us.

Our salaries will be sizzling pork fat to hungry ax men with mba's no doubt. But I think making the training even more lopsided and allowing them to proliferate is a fine strategy for engineering our own scarcity and maintaining the level of game I want to strive for. The sort of practice I am only satisfied striving for.

I have some guarded optimism about the public pendulum swinging back the other way. To help that momentum I like the notion of doing what we do and doing it better.

And just for the record Nevada just gave full independent practice rights to NPs.

 

[JourneyAgent]

I won't support independent practice for any one but physicians for my community's sake. I won't accept anything but expert training for my own sake. Wherever the cards fall is fine with me.

 

[vistaril]

I agree with you and think we should always tear down our professions in order to ID weak areas and make it stronger.

absolutely

 

[vistaril]

Right. Better training. Greater expertise. Less competitive. 👎
Your view of healthcare finance is kind of myopic and essentially entirely focused on the question of revenue vs. cost for any given provider. What you fail to see is that an effective psychiatrist who provides good care draws sick people to that healthcare system. The psychiatrically ill are, almost by definition, more medically ill than the general population. Those people also tend to receive substandard medical care. .

misguided on so many levels....the population of psych patients that are medically underserved and very sick are, in general, not a particularly profitable group. These people are unfortunately generally underserved for a reason.

 

[billypilgrim37]

I agree with you and think we should always tear down our professions in order to ID weak areas and make it stronger.

Criticizing the specialty is different than using inaccurate and over-confident generalizations based on limited experience all while misleading about credentials and qualifications to make said generalizations.

 

[xlithiumx]

Criticizing the specialty is different than using inaccurate and over-confident generalizations based on limited experience all while misleading about credentials and qualifications to make said generalizations.

Like!!👍😍

 

[JourneyAgent]

absolutely

Insanity. A half-baked notion of midlevel independent practice is crammed down the throats of anyone who stands in it's way. Bolshevik style. And it represents a superior health care delivery business model. Whereas a rigorous clinical training model developed and standardized over the last 100 years is something that needs internal turn coats and sneaky demolition specialists to elevate it's practice. You're not worth reading.

Zenman, You're often reasonable, and yet a successful state push for independence is a touchdown! rather than a responsibility captured by political strength and strategy without the structure in place to ensure even a fraction of physician competency. This isn't about you. It's about the C- students in each of our camps.

I find celebrations of these political victories from your camp without the necessary self-regulation to be evidence of unscrupulous manipulation of the public.

Which is why I'm optimistic. These types of movements always reveal themselves after they attain power and not before.

I no longer experience any cognitive dissonance with it. And see of it more as our job to attain expertise and to educate. That's the way to professional satisfaction. Shortcuts and political manipulation are shallow pursuits.

Many of us, myself included, would amenable to checks and balances to establish a safe pathway to independent practice for NP's. But Bolshevik's don't negotiate. And so it's simply an ethical matter of warning the public. Even if that's doomed to failure. And maintaining rigor with respect to our research and clinical practice. Beyond the public obligation to impede the push for independence, I feel an out of control growth, and allowing the natural malignant course of exhaustion of your public support might be our only recourse.

Eventually we'll make the same money. But your training will always be a shortcut. Meant for lazier minds and hack clinicians. That will be, in the end, the prize you have won for all the C- students in your camp. It's bigger than just you. I never understood your insistence on your own experience. This is policy.

 

[JourneyAgent]

as a comical side note. what's wrong with you people. the psych forum is the largest collection of quote errors and blunders on sdn.

 

[vistaril]

Insanity. A half-baked notion of midlevel independent practice is crammed down the throats of anyone who stands in it's way. Bolshevik style. And it represents a superior health care delivery business model. Whereas a rigorous clinical training model developed and standardized over the last 100 years is something that needs internal turn coats and sneaky demolition specialists to elevate it's practice. You're not worth reading.

Zenman, You're often reasonable, and yet a successful state push for independence is a touchdown! rather than a responsibility captured by political strength and strategy without the structure in place to ensure even a fraction of physician competency. This isn't about you. It's about the C- students in each of our camps.

I find celebrations of these political victories from your camp without the necessary self-regulation to be evidence of unscrupulous manipulation of the public.

Which is why I'm optimistic. These types of movements always reveal themselves after they attain power and not before.

I no longer experience any cognitive dissonance with it. And see of it more as our job to attain expertise and to educate. That's the way to professional satisfaction. Shortcuts and political manipulation are shallow pursuits.

Many of us, myself included, would amenable to checks and balances to establish a safe pathway to independent practice for NP's. But Bolshevik's don't negotiate. And so it's simply an ethical matter of warning the public. Even if that's doomed to failure. And maintaining rigor with respect to our research and clinical practice. Beyond the public obligation to impede the push for independence, I feel an out of control growth, and allowing the natural malignant course of exhaustion of your public support might be our only recourse.

Eventually we'll make the same money. But your training will always be a shortcut. Meant for lazier minds and hack clinicians. That will be, in the end, the prize you have won for all the C- students in your camp. It's bigger than just you. I never understood your insistence on your own experience. This is policy.

Why does this concern you so much? If you're training is so much better than zenman's and it will lead you to be so much more effective for patients than zenman, why are you so opposed to competing with psych nps?

 

[JourneyAgent]

Why does this concern you so much? If you're training is so much better than zenman's and it will lead you to be so much more effective for patients than zenman, why are you so opposed to competing with psych nps?

Because it's patient care and not everything can be solved on the free market. I might go that route. But leaving behind patients without disposable income would haunt me.

I don't feel the need to explain my common sense to you. Carry on with your demolitions.

But congrats on successfully pressing the quote button.

 

[vistaril]

Because it's patient care and not everything can be solved on the free market. QUOTE]

sure it can......short of any safety issues that represent a real and clear danger to the public. Which clearly isn't the case(as psych nps arent going out and killing folks...even you know this)

 

[billypilgrim37]

Because it's patient care and not everything can be solved on the free market. QUOTE]

sure it can......short of any safety issues that represent a real and clear danger to the public. Which clearly isn't the case(as psych nps arent going out and killing folks...even you know this)

If you purposely messed up the quote above, you have a much better sense of humor than you get credit for.

 

[vistaril]

If you purposely messed up the quote above, you have a much better sense of humor than you get credit for.

I wish I could take credit for it, but any humor was unintentional. Not real good with grammar, spelling, writing, or following long sentences...

My point was that I just don't see psych nps as being dangerous, and those are the situations whereby licensing boards and state boards and whatnot have a duty to protect the public. It's why I can't get my gallbladder removed by my vet. So if Journey Agent believes that his skills are going to be so massive that he represents such a great value to patients over NPs....good for him. Surely they will all flock to him with their checkbooks out to be helped by them more than an np........so why the concern on his part?

 

[F0nzie]

you are still in medical school.....of course you think any model except the medical model is highly flawed. But when you actually start treating your own patients and the middle aged divorced woman with two kids with unstable affect, volatile relationships with family, and parapsychotic thinking fails to respond to Seroquel and Abilify, did 'a little better' with Lamictal initially but it wore off after awhile, didn't respond to Tegetrol or Risperdal, and is currently on Effexor and Klonopin and not getting better and having another breakdown in your office.........well, then you may start to be more openminded about other models.

You're argument about making the training even more lopsided is ridiculous.....do you honestly think excecutives with Blue cross(or the people who wrote the ACA) are sitting around saying "you know if only the difference between psychiatrists and psych nps was 15% greater than it is now we would take psych nps out of the mix"......of course not.

guarded optimism about the public pendulum swinging the other way? huh? Based on what? The question is how much can we preserve what we have with all the changes in healthcare coming......how much LSD have you been taking if you believe the changes that are going to be coming to health care are going to result in MORE expenditures, MORE costly providers, etc......read the writing on the wall- except for cash pay patients, we're entering a period where COST SAVINGS and COST EFFICIENCY is going to be numero uno. It doesn't take a rocket scientist to see that such a push is going to favor psych nps for the noncash pay population relative to psychiatrists.

I do think it's good you want to develop unique and high level clinical skills....but when you do, just stop worrying about this stuff and PUT THEM TO USE. if your skills are so solid and you do provide so much more value than a psych NP or a psychologist or an lcsw(depending on what the pt needs), then let those skills shine on the free market. If you really have skills, open up your own shop and do your cash pay thing and charge a rate in accordance with those superduper skills. Because that mindset is very different than a lot of the rhetoric I hear about wanting to squash psych nps and midlevels and such......someone who is providing such a useful and valuable product shouldn't care what psych nps are doing. After all, in a free market pt's will pick the provider that gives them the most bang for their buck....that's what it all should be about.

Epic post by Hydroxyzine.

Unless we can turn this economy around, physician salaries will continue to crumble. With rising student loan interest rates, inflation/devaluation of currency, higher taxes, reimbursement cuts and freezing rates, and mid-level encroachment...

Everyone seems to be getting screwed except my landscaper. SOB wants me to pay him $100 in cash for 30 minutes of his time. Is he paying taxes on that $100? I dunno, but that's some sweet grocery and gas money right there for trimming my bush.

 

[billypilgrim37]

I wish I could take credit for it, but any humor was unintentional. Not real good with grammar, spelling, writing, or following long sentences...

My point was that I just don't see psych nps as being dangerous, and those are the situations whereby licensing boards and state boards and whatnot have a duty to protect the public. It's why I can't get my gallbladder removed by my vet.

Agreed. I'm not opposed to having good NP colleagues at all. I think your estimates of the effect on our work force may be exaggerated, for various complicated reasons. Most people get their psychiatric care from pcps, and I imagine that much of the psych NP effect will be improving the care of patients getting psych care from pcps. The sorts of patients I see are already sick enough that most should really be seeing a psychiatrist, but I work in specialty clinics rather than general clinics. I have had relatively minimal exposure to straightforward cases, and by choice I can continue to work in that sort of environment.

 

[michaelrack]

Right man syndrome here, eh?

Better than stiff man syndrome

 

[xlithiumx]

Epic post by Hydroxyzine.

Unless we can turn this economy around, physician salaries will continue to crumble. With rising student loan interest rates, inflation/devaluation of currency, higher taxes, reimbursement cuts and freezing rates, and mid-level encroachment...

Everyone seems to be getting screwed except my landscaper. SOB wants me to pay him $100 in cash for 30 minutes of his time. Is he paying taxes on that $100? I dunno, but that's some sweet grocery and gas money right there for trimming my bush.

I find this hard to reconcile with what I see happening on the ground here in the upper midwest. When I was a 3rd year medical student 6 years ago, graduates of my current residency program were taking inpatient jobs with a starting salary of $170K. Everyone in my graduating class this year is getting a minimum of $230K for mixed inpatient/outpatient in a large metropolitan area. For those of us going outstate, it's closer to $300K.

I am sympathetic to your fears and anticipate that my first job will be the most lucrative of my career, but I just don't get how salaries have increased by a full 33% in the last 6 years. I struggle to see that inflation could account for it. An inflation calculator suggested to me that 170K in 2006 dollars would be 197K in 2012 dollars.

 

[F0nzie]

Everyone in my graduating class this year is getting a minimum of $230K for mixed inpatient/outpatient in a large metropolitan area.

The mixed inpatient/outpatient jobs I have seen are BS. Who the hell wants to see 10-14 inpatients in the AM then 15 min med checks in the afternoon and also be on overnight\call and cover weekends.

That's like getting 2 jobs and getting paid 1.5. Those numbers are nothing but tricks to make sh*tty jobs offering substandard psychiatric care more attractive. Salaries haven't gone up, MBA's have gotten better at farming us.

 

[xlithiumx]

The mixed inpatient/outpatient jobs I have seen are BS. Who the hell wants to see 10-14 inpatients in the AM then 15 min med checks in the afternoon and also be on overnight\call and cover weekends.

That's like getting 2 jobs and getting paid 1.5. Those numbers are nothing but tricks to make sh*tty jobs offering substandard psychiatric care more attractive. Salaries haven't gone up, MBA's have gotten better at farming us.

Well, let's be clear, F0nzie. My inpatient/outpatient job will be seeing 4-5 inpatients in the morning and then doing 30 minute follow-ups and 60 minute evals in the afternoon. I'm required to keep 16 hours of clinic per week, which means I'll be taking Wednesday afternoons off for my part-time teaching faculty appointment at the local medical school. I'm being paid 270K guaranteed for the entire duration of my 3 year contract for my clinical work by the hospital. My RVU conversion factor is $60 per RVU and anything I generate about 270K, I keep 100% of. I don't anticipate I'll be going over 270K, but my salary is not adjusted down for being under. The call is 1:6 weekends and 1 night a week. The inpatient unit is 20 beds. So, that is a dream job for me and not a BS job.

A colleague is being paid 230K at a tertiary referral center to be the psychiatrist for their partial hospital and day treatment programs. He will see 8-12 patients per day.

Another is being paid 230K to be embedded in a primary care clinic with some structured time for seeing her own patients and some semi-structured time to provide on the fly consultation for primary care physicians.

 

[zenman]

Better than stiff man syndrome

I still have that at my age...good genes somewhere

 

[vistaril]

Well, let's be clear, F0nzie. My inpatient/outpatient job will be seeing 4-5 inpatients in the morning and then doing 30 minute follow-ups and 60 minute evals in the afternoon. I'm required to keep 16 hours of clinic per week, which means I'll be taking Wednesday afternoons off for my part-time teaching faculty appointment at the local medical school. I'm being paid 270K guaranteed for the entire duration of my 3 year contract for my clinical work

If you are getting 270k right out of residency to see 4 inpatients in the morning and then do 16 hours of outpt work per week and you get 30 minute followups to fill those 16 hours per week......then yeah, that seems like a dream job.

The mix of community hospital inpt/outpt jobs I see people taking expect more like 9-10 inpatients per day + 20-24 hrs of outpt work, and they expect a minimum of 3 patients per hour(but usually 4...15 minute appts). Or 30 minute intakes. Or basically having social workers see your intakes and you quickly sign off on treatment plans. Oh and for all these inpatients + the 65 or so outpts per week they pay about 220k.

 

[vistaril]

The mixed inpatient/outpatient jobs I have seen are BS. Who the hell wants to see 10-14 inpatients in the AM then 15 min med checks in the afternoon and also be on overnight\call and cover weekends.
.

yep....this is the model I mostly see people taking and working(for those that dont want to work in academia). However, often the facility will bring in outsiders to cover weekends so there is at least that.

 

[OldPsychDoc]

yep....this is the model I mostly see people taking and working(for those that dont want to work in academia). However, often the facility will bring in outsiders to cover weekends so there is at least that.

I think that what xlithiumx is saying is "lift up your eyes and expand your horizons"--because the "model you mostly see" isn't what many of us are seeing at all.

 

[vistaril]

I think that what xlithiumx is saying is "lift up your eyes and expand your horizons"--because the "model you mostly see" isn't what many of us are seeing at all.

I dunno I think what I see and the people I know is sorta in line with what Fonzie, michael rack, and some others are reporting what they see in their area. I also think a lot of the difference is academic vs nonacademic. A lot of people just aren't interested in working within an academic medical center, and it seems as if a lot of the attendings that post on these forums(not just in psychiatry but other forums as well) are disproportionally in academics.....how many people with > 6-8 years experience outside of an academic center post in this forum now? Any?

 

[michaelrack]

However, often the facility will bring in outsiders to cover weekends so there is at least that.

And I am happy to be one of those outsiders who is occasionally brought in.

 

[billypilgrim37]

how many people with > 6-8 years experience outside of an academic center post in this forum now? Any?

why would they? they can't bill for posting on here. we can't all whack and stack posts like you do.

 

[michaelrack]

why would they? :

I think it would take years of psychoanalysis to figure that out

 

[michaelrack]

I dunno I think what I see and the people I know is sorta in line with what Fonzie, michael rack, and some others are reporting what they see in their area. I also think a lot of the difference is academic vs nonacademic. A lot of people just aren't interested in working within an academic medical center, and it seems as if a lot of the attendings that post on these forums(not just in psychiatry but other forums as well) are disproportionally in academics.....how many people with > 6-8 years experience outside of an academic center post in this forum now? Any?

I generally agree with Vistaril on this. There are some cush psych jobs in the 150-200k range, but above that you usually need to work hard.
I wish all those residents who are finding high-paying jobs good luck. Be sure and get a lawyer to look over any salary-guarantees and non-competes. Let us know in 2-3 years (when the guarantee runs out) how things are working out.

 

[xlithiumx]

I generally agree with Vistaril on this. There are some cush psych jobs in the 150-200k range, but above that you usually need to work hard.
I wish all those residents who are finding high-paying jobs good luck. Be sure and get a lawyer to look over any salary-guarantees and non-competes. Let us know in 2-3 years (when the guarantee runs out) how things are working out.

I appreciate your skepticism. The hospital practice I'm joining has had the same physicians for several years and each time they renegotiate their contracts, the guarantee continues and the salary goes up. When I signed 2 years ago, the pay was 230K. In the interval 2 years, it went up to 270K when my colleagues renegotiated. One of my future colleagues sees all of his patients for 40 minute appointments on the outpatient side. The market for psychiatrists in my neck of the woods is extremely tight. That said, I'm in a city with 100K population and a service area closer to 200K population. There is a university, a symphony orchestra, a productive theater company, a good local music scene, minor league sports teams, and access to some of the best outdoor activity to be had in the country.

There is a non-compete with the competing health system in town. I am from this city and would not work for the competition based on how I know they do business. I intend to keep this job for 4 years and then relocate to the larger metropolitan area in my state, where my wife is originally from and where we'd like to raise our child. The guarantee, as well as the $80K signing bonus that I received have no contingencies other than showing up for the first day of work. There is no penalty for leaving early. They cover my full tail malpractice from day 1. I get that you don't see this kind of contract in the south, but it doesn't mean I was fooled. It means I practice in a state that reimburses psychiatrists well and got an exceptionally good deal, even for this state.

 

[vistaril]

I appreciate your skepticism. The hospital practice I'm joining has had the same physicians for several years and each time they renegotiate their contracts, the guarantee continues and the salary goes up. When I signed 2 years ago, the pay was 230K. In the interval 2 years, it went up to 270K when my colleagues renegotiated. One of my future colleagues sees all of his patients for 40 minute appointments on the outpatient side. The market for psychiatrists in my neck of the woods is extremely tight. That said, I'm in a city with 100K population and a service area closer to 200K population. There is a university, a symphony orchestra, a productive theater company, a good local music scene, minor league sports teams, and access to some of the best outdoor activity to be had in the country.

There is a non-compete with the competing health system in town. I am from this city and would not work for the competition based on how I know they do business. I intend to keep this job for 4 years and then relocate to the larger metropolitan area in my state, where my wife is originally from and where we'd like to raise our child. The guarantee, as well as the $80K signing bonus that I received have no contingencies other than showing up for the first day of work. There is no penalty for leaving early. They cover my full tail malpractice from day 1. I get that you don't see this kind of contract in the south, but it doesn't mean I was fooled. It means I practice in a state that reimburses psychiatrists well and got an exceptionally good deal, even for this state.

the national surveys I see show the south paying pretty well relative to the rest of the nation.

 

[xlithiumx]

the national surveys I see show the south paying pretty well relative to the rest of the nation.

Well, in terms of actual dollars, the upper midwest/great lakes can't be beat for salary. However, probably when you adjust for cost of living, the south is probably where its at.

 

[michaelrack]

I appreciate your skepticism. The hospital practice I'm joining has had the same physicians for several years and each time they renegotiate their contracts, the guarantee continues and the salary goes up. When I signed 2 years ago, the pay was 230K. In the interval 2 years, it went up to 270K when my colleagues renegotiated. One of my future colleagues sees all of his patients for 40 minute appointments on the outpatient side. The market for psychiatrists in my neck of the woods is extremely tight. That said, I'm in a city with 100K population and a service area closer to 200K population. There is a university, a symphony orchestra, a productive theater company, a good local music scene, minor league sports teams, and access to some of the best outdoor activity to be had in the country.

There is a non-compete with the competing health system in town. I am from this city and would not work for the competition based on how I know they do business. I intend to keep this job for 4 years and then relocate to the larger metropolitan area in my state, where my wife is originally from and where we'd like to raise our child. The guarantee, as well as the $80K signing bonus that I received have no contingencies other than showing up for the first day of work. There is no penalty for leaving early. They cover my full tail malpractice from day 1. I get that you don't see this kind of contract in the south, but it doesn't mean I was fooled. It means I practice in a state that reimburses psychiatrists well and got an exceptionally good deal, even for this state.

sounds like things will work out for you. I am interested, if you are willing, in getting a detailed update after you have been on the job for 6 months. Good luck to you.

 

[michaelrack]

Well, in terms of actual dollars, the upper midwest/great lakes can't be beat for salary. However, probably when you adjust for cost of living, the south is probably where its at.

I agree. One thing that is expensive in the South, however, is the best private schools (K-12).

 

[OldPsychDoc]

I agree. One thing that is expensive in the South, however, is the best private schools (K-12).

Possibly because the bluer states of the North have fewer qualms about paying the taxes to have strong public schools!

 

[vistaril]

Possibly because the bluer states of the North have fewer qualms about paying the taxes to have strong public schools!

oh jeeez I'm not even going to touch this bait...(well I guess I sorta did)

 

[billypilgrim37]

oh jeeez I'm not even going to touch this bait...(well I guess I sorta did)

You're right. It's obviously because the North is genetically superior to the South and thus requires fewer resources.


/says the bourbon-soaked boy with the thick drawl.

 

[vistaril]

You're right. It's obviously because the North is genetically superior to the South and thus requires fewer resources.


/says the bourbon-soaked boy with the thick drawl.

in all seriousness, what we know about public education is this: funding isn't so important. geography isn't so important. teacher qualifications or standards or whatever aren't so important. Give anyone two numbers...income level(region adjusted even better) and the racial makeup of the school/district. With those two pieces of info alone one can usually guess very close to what that school's performance is. Throw in average parent education level if I had to pick a third data point I'd want.....

All the other stuff(funding, standards, teacher training, etc) is just a bunch of noise.

 

[notdeadyet]

in all seriousness, what we know about public education is this: funding isn't so important. geography isn't so important. teacher qualifications or standards or whatever aren't so important. Give anyone two numbers...income level(region adjusted even better) and the racial makeup of the school/district. With those two pieces of info alone one can usually guess very close to what that school's performance is.

Ugh... You really seem to make this stuff up on the fly but I'll grant that you always have great confidence, particularly when you're wrong.

The race card is smoke and this has been born out in studies. Schools more predominantly of one race vs another do tend to perform differently. There is a.... movement... that likes to pretend this says something about race. But it's confounded because predominantly minority schools tend to have poorer funding and support than predominantly white schools. Exceptions to this are often districts that struggled so long they've given boluses of money to play catch up which can be disastrous if not well-managed and as these districts often have trouble keeping quality people, it's often not-well managed. This is further confounded by testing still having a long way to go to reduce racial bias. I still remember looking over some of the testing that had logic questions involving tennis. Oi....

And the proximity income level is also not a strict indicator. You can find many municipalities that have poor neighborhoods with decent school performance. You also have the inverse in which districts/municipalities have high income levels and poor public school performance. San Francisco is a great example of one of the highest income cities in the country but a public school system that's very poor.

I'm checking out. One thing I've noticed is that logic and facts have never budged you from your initial declaration in an argument on this forum, V, which makes any kind of actual conversation a struggle. But as a prior career teacher who has some experience in this stuff, I had to cry foul. Throwing money blindly at struggling schools does not work, but to pretend that a school district's budget (which controls class size, programs for at-risk students, daycare programs, security, textbook availability, literacy services, etc.) does not play a role in performance is just silly. And pinning student performance to race and income of the parents is a throwback 50 years and hasn't been born out since.

Ugh... I'm out. I had to deal with parents like this and it made my transition out of education a lot easier.

 

[vistaril]

Ugh... You really seem to make this stuff up on the fly but I'll grant that you always have great confidence, particularly when you're wrong.

The race card is smoke and this has been born out in studies. Schools more predominantly of one race vs another do tend to perform differently. There is a.... movement... that likes to pretend this says something about race. But it's confounded because predominantly minority schools tend to have poorer funding and support than predominantly white schools. Exceptions to this are often districts that struggled so long they've given boluses of money to play catch up which can be disastrous if not well-managed and as these districts often have trouble keeping quality people, it's often not-well managed. This is further confounded by testing still having a long way to go to reduce racial bias. I still remember looking over some of the testing that had logic questions involving tennis. Oi....

And the proximity income level is also not a strict indicator. You can find many municipalities that have poor neighborhoods with decent school performance. You also have the inverse in which districts/municipalities have high income levels and poor public school performance. San Francisco is a great example of one of the highest income cities in the country but a public school system that's very poor.

I'm checking out. One thing I've noticed is that logic and facts have never budged you from your initial declaration in an argument on this forum, V, which makes any kind of actual conversation a struggle. But as a prior career teacher who has some experience in this stuff, I had to cry foul. Throwing money blindly at struggling schools does not work, but to pretend that a school district's budget (which controls class size, programs for at-risk students, daycare programs, security, textbook availability, literacy services, etc.) does not play a role in performance is just silly. And pinning student performance to race and income of the parents is a throwback 50 years and hasn't been born out since.

Ugh... I'm out. I had to deal with parents like this and it made my transition out of education a lot easier.

I'm going to take issue with a few things...mainly the comment 'pretend this says something about race'. I'm not saying that. In fact, I don't really care what it means. What I'm saying is that if you give me the demographics of a school and the income of the parents of the actual students in the school, it's going to track unbelievably closely with how 'good' that school is. That's been the case in every single area I have lived(many).

To the degree that you do get results outside of what is expected from district to district(or even school to school) based on these two things, it's almost always not a real or meaningul result(but rather than exceptionally poor and useless metric like ARP)

 

[billypilgrim37]

What I'm saying is that if you give me the demographics of a school and the income of the parents of the actual students in the school, it's going to track unbelievably closely with how BIG OF A BUDGET FROM PROPERTY TAXES THAT SCHOOL HAS. That's been the case in every single area I have lived(many).

Fixed that for you.

 

[vistaril]

Fixed that for you.

well sure, but property tax is also going to vary on a lot of other factors.....does the state have a state income tax(and what is it) being one.

My point was obsessing with funding issues for crappy schools is a dead end. It's a recipe for continued failure. Yes, there are a lot of crappy public schools that don't have high per pupil annual expenditures. But there are also a lot of crappy public schools that have moderate and even super high annual expenditures when adding up all the different funding sources. It's not the data point I care to look at.

 

[gabafan]

There is really no need for psychiatrists to feel threatened by NP's. The savvy MD will understand that he can make a lot of money by having NP's in his employ, and providing supervision to them.

Just like there are many incompetent MD's, there are many NP's with poor practices. I've seen several psychiatrists who prescribe their anxious patient Xanax 2 mg tid or qid... for years. And of course, the patient continues to have anxiety.

I have never attended medical school. Is there any training on therapeutic communication? I've witnessed so many physician (and nursing) interactions where the patient's concerns are ignored or misinterpreted. It's of primary importance for all of us to listen to our patient's concerns, not just throw meds at them based on our vast knowledge of psychopharm.

 

[Leo Aquarius]

There is really no need for psychiatrists to feel threatened by NP's. The savvy MD will understand that he can make a lot of money by having NP's in his employ, and providing supervision to them.

And that's exactly what I plan to do, build a practice that includes a super duper psych NP and psychologist. I've seen it done, and it works really well for patients and staff.

 

[vistaril]

And that's exactly what I plan to do, build a practice that includes a super duper psych NP and psychologist. I've seen it done, and it works really well for patients and staff.

by the time you finish training and then spend some time establishing yourself in the pp world(if that is what your goals are), psych nps arent going to need to work *for* you in any states. Things are shifting.....many/most(?) psych nps dont work for psychiatrists now in pp depending on the state. Why in the world would a psych np want to let you collect most of their billings and out them on salary(unless their salary was a good % of their billings).....

And not even sure where the psychologist comment came from. *good* psychologists(which Im guessing you would want to work with) don't work *for* us.......

 

[vistaril]

There is really no need for psychiatrists to feel threatened by NP's. The savvy MD will understand that he can make a lot of money by having NP's in his employ, and providing supervision to them.

Just like there are many incompetent MD's, there are many NP's with poor practices. I've seen several psychiatrists who prescribe their anxious patient Xanax 2 mg tid or qid... for years. And of course, the patient continues to have anxiety.

shifting into clinical mode for a sec....let's say that pt has already been on(by pcp or psych) 250mg Zoloft which didnt work, and then a noncontrolled med combo for GAD(or SAD or PD or whatever) in the algorithm as well(which any tool can look up) with no resolution in subjective symptoms.....where do you go from there? Is there some magic med I'm not aware of that psychiatrists are using?

I see a lot of complaining about how pcps are (pharmacologically) treated anxiety d/os......but do we have some special drugs they don't have?

 

[Leo Aquarius]

by the time you finish training and then spend some time establishing yourself in the pp world(if that is what your goals are), psych nps arent going to need to work *for* you in any states. Things are shifting.....many/most(?) psych nps dont work for psychiatrists now in pp depending on the state. Why in the world would a psych np want to let you collect most of their billings and out them on salary(unless their salary was a good % of their billings).....

And not even sure where the psychologist comment came from. *good* psychologists(which Im guessing you would want to work with) don't work *for* us.......

You idiot. Why do you twist things? You have a warped, dramatized understanding of anything and everything people say. Get out of medicine. I never meant that people would NEED to work for me you stupid ass.

Don't you ever put words into my mouth again that I never said. I hate people like you. I hope you get sued the first year you enter practice.