Psychiatry's image taking a hit because of lower standards to practice?

[nrmp]

I'm sure someone can give a more nuanced answer than myself.

What you are talking about is branding. Like how there is concern Tesla's brand is diluted because NIO or Xpeng or Li are now competitors. Tesla's brand only holds true in the face of those competitors as long as the engineering and finish continue to be high quality, the advances like autopilot and battery life continue to improve, and the product is appealing enough that a big cross section of the population either buys it or would like to buy it. Tesla's price doesn't have to decrease because of the competitors; although there will definitely be people who prefer Chinese knockoffs to the original thing, it doesn't mean Tesla's still don't have a place on the market. Another approach is that Tesla could pay off some Senators and make the argument that people deserve the highest quality product and that the introduction of lesser products would increase traffic fatalities by 100%, thus adding billions of dollars of liability into the system. Maybe one of those arguments about liability is the Chinese autopilot feature is a total buggy ripoff of the original. Another approach is they could sue the other companies directly of patent infringment, thus blocking their introduction into the US market. If I'm Tesla, all these avenues are worth pursuing, but the basis of each avenue still relies on the idea that Tesla is and remains the highest quality product.

People love candies (benzo, stimulants..) and not the right advise so when we try to be a bad parent (providing quality counseling "Tesla") by doing right thing they will go next door candy shop ran by NP and still get what they want at a cheaper price. What I am trying to say is that we are living in a world where quite good percentage of people are unable to identify difference between Tesla from "NIO or Xpeng or Li" so I believe it will have effect on the market in one way or another.

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[tortuga87]

People love candies (benzo, stimulants..) and not the right advise so when we try to be a bad parent (providing quality counseling "Tesla") by doing right thing they will go next door candy shop ran by NP and still get what they want at a cheaper price. What I am trying to say is that we are living in a world where quite good percentage of people are unable to identify difference between Tesla from "NIO or Xpeng or Li" so I believe it will have effect on the market in one way or another.

Lol loving the EV analogy

 

[VA Hopeful Dr]

That doesn't mean that states can't have individual laws governing who can prescribe what. States can certainly have laws that are more restrictive than federal laws.

They can, but why would they?

 

[birchswing]

As a medical student interested in psychiatry this has been an incredibly depressing read...

This is the optimistic thing I've seen about psychiatry in quite a while. Yes, there is fluff and yes the person is maybe a bit affected. And it takes a while to get to the parts that might make you optimistic. And maybe a lot of slogans and not saying things in a way you would want it to be codified. But if you watch the whole thing and don't dismiss it out of hand, I think this is maybe one of the strongest arguments I've personally experienced for skilled psychiatrists:



This is access that many don't have. A lot of psychiatry is awful, and that's why I personally don't find the NP vs MD/DO thing terribly interesting because I think for a lot of communities the difference is negligible. But this video like this forum showed me that there are psychiatrists who practice at a highly skilled level.

Watch it all the way through, even if some of it feels like a slog. I learned a lot, and this believe it or not made me impressed with the possibility of the field of psychiatry. And I have a lot of reasons to throw my regard out altogether.

 

[psychacad]

As a medical student interested in psychiatry this has been an incredibly depressing read...

I really wouldn't take my cues from this thread and take everything with a big grain of salt.

The reality right now is that the market is in great shape and psychiatry can afford flexibility few specialties can.

No one has a clue what the future holds, but as mentioned before, if the past is any indication, then the field likely isn't going to drastically change. In any case, we need people who are actually interested in becoming psychiatrists and that's the biggest defense against so-called 'mid levels'.

 

[michaelrack]

Inpatient psychiatry seems to be following the internal medicine Inpatient hospitalist model- increasing use of NP's to help with rounding and reduce but not eliminate the need of IP physicians. At least for now, an inpatient's attending needs to be a physician and not a nurse practitioner.

 

[robellis]

Inpatient psychiatry seems to be following the internal medicine Inpatient hospitalist model- increasing use of NP's to help with rounding and reduce but not eliminate the need of IP physicians. At least for now, an inpatient's attending needs to be a physician and not a nurse practitioner.

Imagine going to a psych ward as a patient and having a nurse as your provider..what the hell has the world come to..the patient is having the worst time of their entire life and he’s being treated by a nurse

 

[michaelrack]

Imagine going to a psych ward as a patient and having a nurse as your provider..what the hell has the world come to..the patient is having the worst time of their entire life and he’s being treated by a nurse

Some of my patients have the worst time of their entire lives every month or two

 

[Armadillos]

As a medical student interested in psychiatry this has been an incredibly depressing read...

Personally I don’t think you should read much into this thread. Nobody can tell you for sure what the future holds and all of medicine is getting pressure from various potential “threats” that generally are worse in the imagination of Medstudents than they are in real life.

Once your an attending your going to be worrying more about your raising your kids (or traveling or whatever) than about the “image” of your field.

 

[SARIEBELLE]

NP is a major issue. I have physician friends who run NP-focused practices: NPs have lower quality but better profit margin and are slated to expand. MDs need to innovate and have a pitch, as well as collectively bargain hard. His opinion is facilities-based publicly funded MD jobs will die out. This will affect a lot of lower-tier trained MDs. Higher tier MDs will still get hired/be partnered to do medical director oriented jobs to manage multiple NP case loads.

Commercial insurance and cash practices will still favor MDs--as a patient, if I can find and afford an MD I wouldn't go to an NP, though there is downward pressure--commercial insurance-driven practices are increasingly unable to find in-network MD providers. So most MDs will be chasing after 30-40% of the market that's cash-based.

Currently this is not affecting job market because the demand has grown astronomically, but I think in the next 20 years if you are a lower tier/DO/FMG trained at community programs, you'll be either offered a job that's not very desirable or be prepared to start your own practice. Cush state/non-profit community jobs will be very rare and tend to be reserved for prestige residency grads and will have a large admin component. Current med students who are interested in a long term sustainable career in psychiatry should plan to work hard and match into as good a residency program as possible to hedge against this. The current state where anyone with a pulse can waltz into a community job that pays 250k for 35 hours a week will end sooner than you think.

The sucky part of this is that these community psychiatry positions are where the sickest most complicated psychiatric patients reside. Unfortunately CMHC's are not physician led and only see that PA's and RNP's are cheaper. Mid levels usually do a reasonable job when it is a simple one or two drug solution and the diagnosis is similarly uncomplicated. Most of the private practice psychiatrists in my area basically just run a large stable of APRN's and provide little supervision. Having worked in both CMHC and private practice (I don't supervise APRN's or PA's) I frequently was the one who wound up with patients from these megapractices or CMHC's where multiple medications were started willy-nilly with no clear chain of reasoning or planning and a strong tendency to add on more meds and increase doses when med weren't working but never lowering doses or stopping meds. Also, there is a tendency to jump the gun on diagnosis using a checklist method without understanding the nuances of the checklist. Even our state hospital, where the sickest patients are in residence has multiple APRN's caring for the patients and the med regimens they come out on at discharge are ridiculous.
Fortunately I like treating complicated patients with multiple meds . . . .