Psychiatric NP vs. Psychiatrist

[Sunny in Psych]

Is this a question? Psychiatrists have a medical degree. They then have a 4 year residency in psychiatry, making them the expert in both psychiatric and medical issues with the patient (to a degree, they still refer as a PMHNP does). A PMHNP is a different discipline. Not a physician, but a nurse who then earn masters or PhD in psychiatry (in my case 2 masters degrees). We are able to work independently and serve those with mental illness in the community. Both MDs and PMHNPs are trained in various forms of psychotherapy.

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[aim-agm]

You are making a statement to try and protect your identity. Specifically, you are trying to protect against a sense of inferiority and it's implications by asserting non-inferiority through non-comparability. What you are seeking will not be found in a statement or argument on an anonymous forum. Instead, ask yourself a question: Are you satisfied and fulfilled by what you do? If the answer is yes, then don't bother yourself with what other people who have no real influence over you think. If it is no, stop trying to escape the hard work of fixing the situation by trolling on SDN.

 

[splik]

PMHNPs don't earn a masters in psychiatry, which is a medical specialty, but psychiatric/mental health nursing. similarly there is no such a thing as a PhD in psychiatry in the US (they exist in europe for medical doctors doing research in psychiatry) and nurse practitioners don't usually have PhDs, they may have their fake doctoral degrees (i.e. the DNP) which is a professional degree, again in nursing, and does not have the rigors of a PhD, and is abused by NPs who wish to confuse patients by inappropriately referring to themselves as "dr." in the clinical setting. I am quite happy to work with NPs in certain settings. The good ones are the ones who've had years of experience as RNs, realize how crappy their NP training is, know the limits of their abilities, and actively seek out additional training and supervision following their formal education. The bad ones have little/no RN experience, have enormous chips on their shoulders, drink the kool aid they learn in school about they can do everything a physician can (and more), have no insight into the limits of their expertise, and mislead patients.

 

[DisorderedDoc417]

PMHNPs don't earn a masters in psychiatry, which is a medical specialty, but psychiatric/mental health nursing. similarly there is no such a thing as a PhD in psychiatry in the US (they exist in europe for medical doctors doing research in psychiatry) and nurse practitioners don't usually have PhDs, they may have their fake doctoral degrees (i.e. the DNP) which is a professional degree, again in nursing, and does not have the rigors of a PhD, and is abused by NPs who wish to confuse patients by inappropriately referring to themselves as "dr." in the clinical setting. I am quite happy to work with NPs in certain settings. The good ones are the ones who've had years of experience as RNs, realize how crappy their NP training is, know the limits of their abilities, and actively seek out additional training and supervision following their formal education. The bad ones have little/no RN experience, have enormous chips on their shoulders, drink the kool aid they learn in school about they can do everything a physician can (and more), have no insight into the limits of their expertise, and mislead patients.

And... place my patient, with prior history of SUD and SA by OD, on vyvanse to treat the trouble concentrating, scheduled clonazepam BID to bring them back down to Earth (also a little resostoril scheduled at bed to get to sleep), a SNRI for the depression, and a TCA for migraines. How I wish I was kidding.

 

[hamstergang]

And... place my patient, with prior history of SUD and SA by OD, on vyvanse to treat the trouble concentrating, scheduled clonazepam BID to bring them back down to Earth (also a little resostoril scheduled at bed to get to sleep), a SNRI for the depression, and a TCA for migraines. How I wish I was kidding.

And the TCA coild have treated the migraines, depression, anxiety, insomnia, and ADHD all on its own! Though I've never actually gotten a med to multipurpose like that.

 

[675015]

What is the psychotherapy training for an NP? At my residency we get two years of significant training (and still have med only patients, ER call, various other things smattered in) and talking to my peers at other places my program is on the heavy side... yet I still feel pretty humble about the depth of my therapy skills.

 

[thoffen]

Is this a question?

That is, but the rest isn't. If you want to ask something, I think we could respond appropriately. We're on the same team.

 

[boogaaloo]

PMHNPs don't earn a masters in psychiatry, which is a medical specialty, but psychiatric/mental health nursing. similarly there is no such a thing as a PhD in psychiatry in the US (they exist in europe for medical doctors doing research in psychiatry) and nurse practitioners don't usually have PhDs, they may have their fake doctoral degrees (i.e. the DNP) which is a professional degree, again in nursing, and does not have the rigors of a PhD, and is abused by NPs who wish to confuse patients by inappropriately referring to themselves as "dr." in the clinical setting. I am quite happy to work with NPs in certain settings. The good ones are the ones who've had years of experience as RNs, realize how crappy their NP training is, know the limits of their abilities, and actively seek out additional training and supervision following their formal education. The bad ones have little/no RN experience, have enormous chips on their shoulders, drink the kool aid they learn in school about they can do everything a physician can (and more), have no insight into the limits of their expertise, and mislead patients.

Good post.

 

[deleted480308]

What is even happening in this thread?

 

[boogaaloo]

What is even happening in this thread?

OP is trolling.

 

[Sunny in Psych]

You are making a statement to try and protect your identity. Specifically, you are trying to protect against a sense of inferiority and it's implications by asserting non-inferiority through non-comparability. What you are seeking will not be found in a statement or argument on an anonymous forum. Instead, ask yourself a question: Are you satisfied and fulfilled by what you do? If the answer is yes, then don't bother yourself with what other people who have no real influence over you think. If it is no, stop trying to escape the hard work of fixing the situation by trolling on SDN.

I've been happy for 1

That is, but the rest isn't. If you want to ask something, I think we could respond appropriately. We're on the same team.

PMHNPs don't earn a masters in psychiatry, which is a medical specialty, but psychiatric/mental health nursing. similarly there is no such a thing as a PhD in psychiatry in the US (they exist in europe for medical doctors doing research in psychiatry) and nurse practitioners don't usually have PhDs, they may have their fake doctoral degrees (i.e. the DNP) which is a professional degree, again in nursing, and does not have the rigors of a PhD, and is abused by NPs who wish to confuse patients by inappropriately referring to themselves as "dr." in the clinical setting. I am quite happy to work with NPs in certain settings. The good ones are the ones who've had years of experience as RNs, realize how crappy their NP training is, know the limits of their abilities, and actively seek out additional training and supervision following their formal education. The bad ones have little/no RN experience, have enormous chips on their shoulders, drink the kool aid they learn in school about they can do everything a physician can (and more), have no insight into the limits of their expertise, and mislead patients.

I understand that this is the stance that some of you take. First, I'm not posting bc I feel inferior but quite the opposite, I feel some of you are very misinformed. Second, I own a psychiatric practice with over 1000 patients, about 70% are SMIs. How am I not not practicing psychiatry? My title includes that word. I agree that some programs are better than others. I graduated from the #5 university nationwide. But these online programs are only hurting us. I felt prepared as a new grad and after a few years of practice, confident enough to open a practice, but not all programs prepare this well and I agree with that. Third, I have never mislead a patient. In fact, if they even. All me their "doc" affectionately, I correct them. Please don' assume we are misleading. The 1000 patients on my panel are well aware that I am a PMHNP and not a physician. They should have the choice in who they see for treatment.

 

[VA Hopeful Dr]

How am I not not practicing psychiatry?

Because you're not a psychiatrist.

If I give a patient Lexapro, I'm not practicing psychiatry just because its a psychiatric drug - I'm practicing family medicine because I'm a family doctor.

 

[deleted480308]

I've been happy for 1




I understand that this is the stance that some of you take. First, I'm not posting bc I feel inferior but quite the opposite, I feel some of you are very misinformed. Second, I own a psychiatric practice with over 1000 patients, about 70% are SMIs. How am I not not practicing psychiatry? My title includes that word. I agree that some programs are better than others. I graduated from the #5 university nationwide. But these online programs are only hurting us. I felt prepared as a new grad and after a few years of practice, confident enough to open a practice, but not all programs prepare this well and I agree with that. Third, I have never mislead a patient. In fact, if they even. All me their "doc" affectionately, I correct them. Please don' assume we are misleading. The 1000 patients on my panel are well aware that I am a PMHNP and not a physician. They should have the choice in who they see for treatment.

you just implied you are practicing psychiatry and then denied misleading people....in the same post

 

[Sunny in Psych]

you just implied you are practicing psychiatry and then denied misleading people....in the same post

The word psychiatry is not owned by physicians. My title is a Psychiatric Nurse Practitioner by license and board cert. I cannot use the title I have earned without misleading people. I' afraid you are wrong.

 

[Sunny in Psych]

Because you're not a psychiatrist.

If I give a patient Lexapro, I'm not practicing psychiatry just because its a psychiatric drug - I'm practicing family medicine because I'm a family doctor.

Well, if all I did was prescribe some lexapro, you would be correct. I have over 350 schizophrenic/schizaffective patients on LAIs. I have many hundreds of brittle bipolar patients. Many with severe PDs. I am one of a couple psych providers within 60 miles that takes Medicaid. Who do you think is seeing those very sick patients? No, I don't prescribe an SSRI and consider that psychiatry.

 

[MrWonderful]

You mean to tell me that if my Proctologist prescribes me Adderall he isn't practicing Psychiatry? I want my money back.

 

[deleted480308]

The word psychiatry is not owned by physicians. My title is a Psychiatric Nurse Practitioner by license and board cert. I cannot use the title I have earned without misleading people. I' afraid you are wrong.

you mislead your patients when you pawn yourself off as interchangeable with physicians, it's inappropriate even if it is legal

 

[Sunny in Psych]

Well, if all I did was prescribe some lexapro, you would be correct. I have over 350 schizophrenic/schizaffective patients on LAIs. I have many hundreds of brittle bipolar patients. Many with severe PDs. I am one of a couple psych providers within 60 miles that takes Medicaid. Who do you think is seeing those very sick patients? No, I don't prescribe an SSRI and consider that psychiatry.

Primary care physicians refer to me because I am a specialist. I'm not sure how I am misrepresenting myself when I am trained I. Psychiatry. I am not a physician but in a completely different discipline, still trained in psychiatry. If a FP doc or proctologist felt comfortable treating SMIs and PDs and suicidal folks, they wouldn't refer to me. I' perplexed at the responses.

 

[MacDonaldTriad]

Our hospital's billing department has a psychiatric biller, but that person isn't practicing psychiatry. You are a psychiatric nurse, but you still are not a psychiatrist by definition. Psychiatrists practice psychiatry, other psychiatric professionals practice psychiatricishly.

Definition of psychiatry. plural psychiatries. : a branch of medicine that deals with the science and practice of treating mental, emotional, or behavioral disorders especially as originating in endogenous causes or resulting from faulty interpersonal relationships.

Surgical nurses and surgical nurse practitioners don't call themselves surgeons. Psychiatry is a branch of medicine and is "owned" by real physicians. You need some radical acceptance I'm afraid.

 

[thoffen]

This thread has become an enactment of something dynamic. As tantalizing as it is, it would be better explored in supervision or therapy.

 

[Sunny in Psych]

Our hospital's billing department has a psychiatric biller, but that person isn't practicing psychiatry. You are a psychiatric nurse, but you still are not a psychiatrist by definition. Psychiatrists practice psychiatry, other psychiatric professionals practice psychiatricishly.

Definition of psychiatry. plural psychiatries. : a branch of medicine that deals with the science and practice of treating mental, emotional, or behavioral disorders especially as originating in endogenous causes or resulting from faulty interpersonal relationships.

Surgical nurses and surgical nurse practitioners don't call themselves surgeons. Psychiatry is a branch of medicine and is "owned" by real physicians. You need some radical acceptance I'm afraid.

I am not handing a sureon tools while he does surgery. I own a psychiatric practice and care for severely mentally ill patients. I am practicing advanced practice nursing in psychiatry. It is semantics. Using my title, it is still clear to my patients that I am not a physician. But it is also clear that I practice psychiatry. Again, I have a panel of over 1000 patients and mostly SMIs. What am I doing if not psychiatry?

 

[Sunny in Psych]

This thread has become an enactment of something dynamic. As tantalizing as it is, it would be better explored in supervision or therapy.

As condescending as that was, I'll drop it and no longer respond to these somewhat misinformed comments. I started by trying to encourage a team approach, but it wasn' heard. I tried to educate about what we do. It sounds like more than one person here needs therapy. The insecurity is astounding.

 

[MacDonaldTriad]

This thread has become an enactment of something dynamic. As tantalizing as it is, it would be better explored in supervision or therapy.

This will likely take a second analysis.

 

[thoffen]

As condescending as that was, I'll drop it and no longer respond to these somewhat misinformed comments. I started by trying to encourage a team approach, but it wasn' heard. I tried to educate about what we do. It sounds like more than one person here needs therapy. The insecurity is astounding.

I will discuss it in my therapy, personally. The recommendation goes for everyone who participated in the enactment.

 

[Sunny in Psych]

What is the psychotherapy training for an NP? At my residency we get two years of significant training (and still have med only patients, ER call, various other things smattered in) and talking to my peers at other places my program is on the heavy side... yet I still feel pretty humble about the depth of my therapy skills.

I believe most NP programs concentrate on CBT, mindfulness, DBT, motivational interviewing. We don' have as many hours but do take many courses and must have hundreds of hours under our belt before graduation. I felt more comforable with practice, of course. And continued education.

 

[MrWonderful]

A PhD in Clinical Psychology practices Clinical Psychology, not Psychiatry.
A PsyD in Clinical Psychology practices Clinical Psychology, not Psychiatry.
An LPC in Mental Health Counseling practices counseling, not Psychiatry.
An MSW in Social Work practices social work, not Psychiatry.

Caring for the mentally ill, with a specialized 'mental health' degree, even in an anecdotally successful practice, does not mean you are practicing Psychiatry. Accept it.

 

[VA Hopeful Dr]

I am practicing advanced practice nursing in psychiatry.

Good, so we're in agreement. You're not practicing psychiatry, you're practicing nursing. There's nothing wrong with that.

 

[hamstergang]

Again, I have a panel of over 1000 patients and mostly SMIs. What am I doing if not psychiatry?

Psychiatric nursing. You have a nursing degree and a nursing license, so how can your work be anything other than nursing?

 

[VA Hopeful Dr]

Primary care physicians refer to me because I am a specialist. I'm not sure how I am misrepresenting myself when I am trained I. Psychiatry. I am not a physician but in a completely different discipline, still trained in psychiatry. If a FP doc or proctologist felt comfortable treating SMIs and PDs and suicidal folks, they wouldn't refer to me. I' perplexed at the responses.

We refer to you because a) our patients can't get in anywhere else anytime soon b) their insurance is accepted at your office c) we don't have time to deal with their issues properly.

None of that is specific to you. While I have favorite psych people in town, I send my patients to whoever can get them in in a reasonable time and who accept their insurance.

 

[Ahamis]

How are the regulations of NP in other countries? Can they work independently?

 

[smalltownpsych]

 

[Sunny in Psych]

Psychiatric nursing. You have a nursing degree and a nursing license, so how can your work be anything other than nursing?

I never claimed to have a degree in anything other than nursing. I am an advanced practice nurse who is trained in psychiatry. It is that simple.

 

[MacDonaldTriad]

This will probably take three analyses.
You will never be eligible to become board certified in psychiatry. Without our type of training, you are not doing the same thing.
You claim 6 of us need to work on our insecurity in therapy but me thinks it is only one of us who needs to get a clue.
Smalltownpsych would never tell anyone he is practicing psychiatry.

 

[Sunny in Psych]

We refer to you because a) our patients can't get in anywhere else anytime soon b) their insurance is accepted at your office c) we don't have time to deal with their issues properly.

None of that is specific to you. While I have favorite psych people in town, I send my patients to whoever can get them in in a reasonable time and who accept their insurance.

It is not specific to me, personally, it is that I am accepted for what I do in my community. I get at least 5 referrals from psychiatrists discharging inpatients every day. It took time, but we work together respectfully now. I suggest you do the same with your PMHNPs. You could look at my reviews and see that folks are happy with my patient care. I'm not being defensive, not even sure what to say here... you sound very begrudging. I hope you will educate yourself rather than feeling so bitter.

I'd leave a link here, but it won't let me.

 

[VA Hopeful Dr]

It is not specific to me, personally, it is that I am accepted for what I do in my community. I get at least 5 referrals from psychiatrists discharging inpatients every day. It took time, but we work together respectfully now. I suggest you do the same with your PMHNPs. You could look at my reviews and see that folks are happy with my patient care. I'm not being defensive, not even sure what to say here... you sound very begrudging. I hope you will educate yourself rather than feeling so bitter.

I'd leave a link here, but it won't let me.

I'm not bitter at all, and I'm sure you do fine work. But that work is nursing, psychiatric nursing specifically, but not psychiatry.

 

[Sunny in Psych]

This will probably take three analyses.
You will never be eligible to become board certified in psychiatry. Without our type of training, you are not doing the same thing.
You claim 6 of us need to work on our insecurity in therapy but me thinks it is only one of us who needs to get a clue.
Smalltownpsych would never tell anyone he is practicing psychiatry.

I am on a medical student board. Would you like to pose your position on my board of 4,000 PMHNPs and see if your opinion is outnumbered?

 

[clausewitz2]

I am on a medical student board. Would you like to pose your position on my board of 4,000 PMHNPs and see if your opinion is outnumbered?

"It is difficult to get a man to understand something, when his salary depends on his not understanding it"
-Upton Sinclair

 

[Sunny in Psych]

I'm not bitter at all, and I'm sure you do fine work. But that work is nursing, psychiatric nursing specifically, but not psychiatry.

Yes, and to be more correct, it is Advanced Practice Nursing, which is different from being an RN. If your biggest concern is semantics over whether or not we practice psychiatry, we don't have much to talk about. I'm not sure how you would categorize what I do, but I am a Psychiatric Nurse Practitioner and I own a Psychiatric private practice. The rest is, well.... whatever you want to call it.

 

[Sunny in Psych]

"It is difficult to get a man to understand something, when his salary depends on his not understanding it"
-Upton Sinclair

A PhD in Clinical Psychology practices Clinical Psychology, not Psychiatry.
A PsyD in Clinical Psychology practices Clinical Psychology, not Psychiatry.
An LPC in Mental Health Counseling practices counseling, not Psychiatry.
An MSW in Social Work practices social work, not Psychiatry.

Caring for the mentally ill, with a specialized 'mental health' degree, even in an anecdotally successful practice, does not mean you are practicing Psychiatry. Accept it.

See my post below. Again, I am a Psychiatric Nurse Practitioner. I own a psychiatric private practice. And unlike any of your above mentioned disciplines, I evaluate, diagnose, provide both therapy and medications to my patients. That is psychiatry. If using that word bothers you, that is up to you, however, your argument seems rather childish. I originally posted to encourage collaboration between these two disciplines, but I see that won't happen on this forum.

 

[deleted480308]

See my post below. Again, I am a Psychiatric Nurse Practitioner. I own a psychiatric private practice. And unlike any of your above mentioned disciplines, I evaluate, diagnose, provide both therapy and medications to my patients. That is psychiatry. If using that word bothers you, that is up to you, however, your argument seems rather childish. I originally posted to encourage collaboration between these two disciplines, but I see that won't happen on this forum.

psychologists do all of those activities in some jurisdictions too......do propose that they are now practicing psychiatry?

 

[MrWonderful]

See my post below. Again, I am a Psychiatric Nurse Practitioner. I own a psychiatric private practice. And unlike any of your above mentioned disciplines, I evaluate, diagnose, provide both therapy and medications to my patients. That is psychiatry. If using that word bothers you, that is up to you, however, your argument seems rather childish. I originally posted to encourage collaboration between these two disciplines, but I see that won't happen on this forum.

Edit -- not feeding the troll

 

[675015]

I believe most NP programs concentrate on CBT, mindfulness, DBT, motivational interviewing. We don' have as many hours but do take many courses and must have hundreds of hours under our belt before graduation. I felt more comforable with practice, of course. And continued education.

You felt better with practice or ongoing supervision?

 

[smalltownpsych]

This will probably take three analyses.
You will never be eligible to become board certified in psychiatry. Without our type of training, you are not doing the same thing.
You claim 6 of us need to work on our insecurity in therapy but me thinks it is only one of us who needs to get a clue.
Smalltownpsych would never tell anyone he is practicing psychiatry.

You got that right. I didn't go through all this schooling and training in order to try to do something that I didn't develop expertise. Not that there's anything wrong with being a psychiatrist, I just prefer being a psychologist myself. There is also nothing wrong with being a midlevel practitioner whether it is an NP, PA, LCSW, MFT, or LPC. They are just not psychiatrists or psychologists. Some midlevels are better at the job than us. One of the best therapists I ever worked with was an LPC who worked for em and I supervised him for licensure. He didn't have some of my skills, mainly due to lack of training in these areas (diagnostic, conceptualizations, asessements, knowledge of literature and legal and ethical issues), but as far as implementing interventions, the guy was clearly one of the best.

 

[VA Hopeful Dr]

Yes, and to be more correct, it is Advanced Practice Nursing, which is different from being an RN. If your biggest concern is semantics over whether or not we practice psychiatry, we don't have much to talk about. I'm not sure how you would categorize what I do, but I am a Psychiatric Nurse Practitioner and I own a Psychiatric private practice. The rest is, well.... whatever you want to call it.

Fair enough, advanced practice nursing it is.

And yes, my entire point in this whole thread was that you aren't practicing psychiatry but are in fact practicing advanced practice nursing. That's literally my only point here.

 

[Sunny in Psych]

Fair enough, advanced practice nursing it is.


And yes, my entire point in this whole thread was that you aren't practicing psychiatry but are in fact practicing advanced practice nursing. That's literally my only point here.

The whole point of my original post, before it turned into semantics about the word psychiatry, was about the two disciplines working together with mutual respect bc all I read on here is negativity about PMHNPs. It wasn't meant to be about whether or not I practice psychiatry... although I just had a drink with 3 psychiatrists who laughed and said I absolutely practice psychiatry... guess it depends on the audience. It doesn' bother me. As for someone's remark about supervision, I've been practicing for 14 years... supervision is not necessary. I'm going to sign out here. I'm not a troll, but had a different and more meaningful discussion in mind. Not bullies picking a word and defending their insecurities with nonsense. I wish you all the best in ypur studies and in your careers. "Psychiatry" is a challenging and fulfilling specialty!

 

[deleted480308]

The whole point of my original post, before it turned into semantics about the word psychiatry, was about the two disciplines working together with mutual respect bc all I read on here is negativity about PMHNPs. It wasn't meant to be about whether or not I practice psychiatry... although I just had a drink with 3 psychiatrists who laughed and said I absolutely practice psychiatry... guess it depends on the audience. It doesn' bother me. As for someone's remark about supervision, I've been practicing for 14 years... supervision is not necessary. I'm going to sign out here. I'm not a troll, but had a different and more meaningful discussion in mind. Not bullies picking a word and defending their insecurities with nonsense. I wish you all the best in ypur studies and in your careers. "Psychiatry" is a challenging and fulfilling specialty!

I would propose those docs might have offered you a neutered response for the purpose of not upsetting someone in person

 

[VA Hopeful Dr]

I'm not a troll

Agree to disagree

 

[Sunny in Psych]

I would propose those docs might have offered you a neutered response for the purpose of not upsetting someone in person

And I would propose that they wouldnt have laughed, made jokes about how big headed med students can be, if it were a neutered response. They wouldn't have said, "As a scientist, just like we are..." They have known me over a decade. They refer to me and invite me for a drink with them. It is disappointing that your response is so juvenile.

 

[deleted480308]

And I would propose that they wouldnt have laughed, made jokes about how big headed med students can be, if it were a neutered response. They wouldn't have said, "As a scientist, just like we are..." They have known me over a decade. They refer to me and invite me for a drink with them. It is disappointing that your response is so juvenile.

You equate being friendly with someone as an endorsement of professional interchangeability?

And we know everyone busts on med students, everyone. It’s not a big deal because we know our place in the hierarchy. The only embarassment is when someone doesn’t

 

[deleted480308]

And I would propose that they wouldnt have laughed, made jokes about how big headed med students can be, if it were a neutered response. They wouldn't have said, "As a scientist, just like we are..." They have known me over a decade. They refer to me and invite me for a drink with them. It is disappointing that your response is so juvenile.

Please don’t pm me any more, I don’t debate in my inbox