Psychiatric NP/PA scope of practice

[brightness]

I've been thinking of doing a PhD in psychology, but I really want to learn about medications and prescribe them. I've thought about going to medical school, and I'm still thinking about that, but I'm also thinking about being a mid level clinician- but I think I would want to specialize in psychiatry. I am not sure how possible this is, or if in your opinion, midlevels are competent enough for psychiatry as a specialty. I am NOT trying to insult midlevels- I'm just not sure how often midlevels specialize in psychiatry, or to what degree they are able to prescribe psychiatric drugs. I would like some more information on this topic.
Thank you!!

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[deleted6669]

psych is a required rotation in pa school so all pa's do get some exposure to the specialty.
pa's in most states have unrestricted prescribing rights so if a pa worked in psych they could write for all of the standard psych meds.
there are 2 postgrad residencies for pa's in psych for those who are interested in greater exposure.
http://www.appap.org/prog_specialty.html
there is also a psych specialty society:
http://www.psychpa.com/

a lot of psych pa's work at v.a. medical centers or on indian reservations although there are opportunities for psych pa's in other settings. hope that helps

 

[johankriek]

there is no way you can understand psychiatric illnesses fully without doing a psychiatric residency..

 

[core0]

I've been thinking of doing a PhD in psychology, but I really want to learn about medications and prescribe them. I've thought about going to medical school, and I'm still thinking about that, but I'm also thinking about being a mid level clinician- but I think I would want to specialize in psychiatry. I am not sure how possible this is, or if in your opinion, midlevels are competent enough for psychiatry as a specialty. I am NOT trying to insult midlevels- I'm just not sure how often midlevels specialize in psychiatry, or to what degree they are able to prescribe psychiatric drugs. I would like some more information on this topic.
Thank you!!

Another area for PA's in psychiatry is medical management of psychiatric patients.

David Carpenter, PA-C

 

[50960]

there is no way you can understand psychiatric illnesses fully without doing a psychiatric residency..

This is really hilarious. Some of the worst understanders of 90% of the psych illnesses a PA/Np would see are those with a psychiatric residency under their belts. They are well trained to treat serious psych issues, and poorly trained to treat the rest...that is one reason why primray care providers write 80% of the scripts for depression, anxiety etc...

 

[chimichanga]

Psisci is right on...

Let's expand the discussion further:

The PhDs, nurses, and the techs do 90% of the work, relate to the patient, spend FAR more time with the pt, and know the pt far more intimately than the psychiatrist...

I'm soooo impressed that you better understand the biological "whys" behind the presenting behaviors and thought processes...

I'm not discounting the attending, just asking for his appreciation for all on the team...

And he's also right about the initial (and ongoing) prescribing provider...

Pediatricians initially prescribing psychotropics and stimulants to 5 year olds...Yea, THAT'S a good plan...

 

[silas2642]

I've been thinking of doing a PhD in psychology, but I really want to learn about medications and prescribe them. I've thought about going to medical school, and I'm still thinking about that, but I'm also thinking about being a mid level clinician- but I think I would want to specialize in psychiatry. I am not sure how possible this is, or if in your opinion, midlevels are competent enough for psychiatry as a specialty. I am NOT trying to insult midlevels- I'm just not sure how often midlevels specialize in psychiatry, or to what degree they are able to prescribe psychiatric drugs. I would like some more information on this topic.
Thank you!!

Where I'm from, there's such a severe shortage of psychiatrists that NPs/PAs are picking up a significant portion of the slack... supposedly they are working under the supervision of a MD, though-- none of our mid-levels practice independently because of liability concerns.

DO NOT take med school lightly. If you are going to go for it, make damn sure that this is what you want-- this is no easy undertaking. Shadow mid-levels and psychiatrists, and see if you would be happy being a PA or NP. If you can picture yourself being satisfied as an NP or PA, for God's sake, go for that because that road is going to be so much easier-- no med school + no residency= much less hell. (I know I'm about to get flamed from just about everyone who is going to shout out and say, "our classes are just the same as yours and we learn everything that you do!" but I'm just calling it the way I see it).

Good luck with your decision.

 

[brightness]

I know that being a doctor and being a NP/PA is very different. Its been difficult for me to decide which one I wanted to do, only because I wasn't sure if I wanted to devote so much time to school and career- family is also very important to me. Its a trade off. In terms of psychology/psychiatry, I'm interested in learning medicine and medical management, but also being able to do therapy and be good at related to all types of patients, from severe psychopathology to the anxiety and depression, more common stuff. I'm not sure what field of medicine would lend itself to this goal. I thought that maybe as a psychiatric NP/PA I would be able to accomodate this goal, but I also think that I would like to go to medical school and even think about doing other types of medicine. I am learning towards medical school right now, but I still have some thinking to do.

 

[qwerty1]

there is no way you can understand psychiatric illnesses fully without doing a psychiatric residency..

There is a better training program to more completely understand mental illness.

It's called the Ph.D. / Psy.D. educated psychologist.

Why do I say this?

Consider the training.

Minimal psychological training for future physician-psychiatrists in undergrad years, minimal training in medical school, minimal training in internship and a 3-4 year residency in psychiatry.

Compare and contrast to a heavily weighted undergrad psych program, a dedicated master's level of 2 years and 3-4+ year doctoral program in psychology.

I'm certainly not saying M.D. / D.O. psychiatrists aren't able to treat these patients very well... but I believe Ph.D. / Psy. D. psychologists have a somewhat deeper understanding of mental illness. However, they lack the prescribing authority so often needed.

One state has permitted limited prescribing authority for the most commonly needed drugs.

 

[brightness]

I REALLY wish that training in a clinical PhD or Psy D was expanded to include prescription privilige. I know a lot of people feel that would be less than acceptable, psychologists shouldn't prescribe meds, ect., but I do feel that psychologists get a good training in diagnosis and therapy, but need more involvement in the biological aspects of behavior. So...I've sort of been lamenting the fact that psychologists can't prescribe, but only because I am interested in learning more about the biological determinants of behavior than I feel a PhD/Psy D. can give me.

 

[alpha62]

there is no way you can understand psychiatric illnesses fully without doing a psychiatric residency..

.... and I've never understood how you could practice psych in this country and not be a native of this country.

I always thought it funny to sit there and watch a psych. from Bangladesh try and have a conversation with some whacked out gang banger on pcp from the inner city that was conversing in some type of street slang jibberish.

If I took that psych and put him in the that pts neighborhood, he'd probably be thought of as crazy.... if he weren't dead already.

 

[zenman]

.... and I've never understood how you could practice psych in this country and not be a native of this country.

I always thought it funny to sit there and watch a psych. from Bangladesh try and have a conversation with some whacked out gang banger on pcp from the inner city that was conversing in some type of street slang jibberish.

If I took that psych and put him in the that pts neighborhood, he'd probably be thought of as crazy.... if he weren't dead already.

Very good point, however even here in Bangladesh there are quite a few American trained physicians. Actually, it's kinda funny to see a Harvard trained physician in his cramped little chamber inside a pharmacy, but I guess you got to bless them for coming back home to practice. But, you're right...culture runs deep.

 

[Dr_Feelgood]

.... and I've never understood how you could practice psych in this country and not be a native of this country.

I always thought it funny to sit there and watch a psych. from Bangladesh try and have a conversation with some whacked out gang banger on pcp from the inner city that was conversing in some type of street slang jibberish.

If I took that psych and put him in the that pts neighborhood, he'd probably be thought of as crazy.... if he weren't dead already.

Do you think that someone who was born in the suburbs with a silver spoon in his/her mouth would understand either? Heck, I think that most of the B.S. psych theories come from rich people evaluating poor people b/c they don't understand them.

A psych from Bangladesh that maybe poor and raised in a gang filled area would understand the guy tripping on angel dust a lot better than a rich American.

 

[alpha62]

Do you think that someone who was born in the suburbs with a silver spoon in his/her mouth would understand either? Heck, I think that most of the B.S. psych theories come from rich people evaluating poor people b/c they don't understand them.

A psych from Bangladesh that maybe poor and raised in a gang filled area would understand the guy tripping on angel dust a lot better than a rich American.

I'm not even sure somebody from the south ought to be treating a pt from New York City. I've seen a few fast talking yankees down here medicated for " rapid, pressured, speech consistent with hypomania" by a slow talking bubba from Alabama.

Also seen a few yanks medicated for yelling at somebody in the walmart parking lot " hey, ya sonabitch, I'm walkin here ! " Like that must happen 1000 times a day up north and so far, I haven't seen a run on Zyprexa up there.

 

[deleted6669]

"slow talking bubba from Alabama"

also diagnostic. they need amphetamine supplementation until words/min > 20

we had a doc like that who worked in my ed until a few yrs ago.
he would say that anyone who talked more slowly than he did needed to be intubated.....

 

[zenman]

"slow talking bubba from Alabama"

also diagnostic. they need amphetamine supplementation until words/min > 20

we had a doc like that who worked in my ed until a few yrs ago.
he would say that anyone who talked more slowly than he did needed to be intubated.....