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- Jul 25, 2021
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When I began, we would give patients their anti-psychotic medication from elixirs into orange juice, (for example), 1 cc = 10 mg of the drug. Mellaril and Thorazine were the most commonly used hospital anti-psychotics, and Librium and Tranxene were commonly used benzos. Pamelor and Doxepin were the most commonly used anti-depressants (no SSRI's until 1987 and Prozac). Private psychiatrists made rounds daily... no such things as psychiatric hospitalists back then. When the MD came onto the unit, as nurses, if there was no place for him to sit (very few women in psychiatry back then), you were expected to get up and give him your seat at the nurses station.
I started in the mid-1980s with a “real” graduate degree in psychiatric nursing from a very respected, private university. My first few jobs were staff nursing jobs in big hospitals in the Midwest. I learned a lot there, and worked with many good physicians, and some really bad ones. I assisted in ECT, many times which we did back then, right in the patient’s room. I one time worked with a psychiatrist who zapped the patient with five consecutive seizures within five minutes. I did not report him, as I would’ve been fired, as he filled beds and I did not.
I then joined the military and that was a great experience. With the move towards NP’s, I got certified and jumped through all the hoops to get my DEA, and I work now in an independent practice state, in private practice, and am “cash only”. It amazes me how many patients come in and seem to have forgotten their credit card or checkbook! Getting paid and frequent calls from needy patients he has been a real pain. Still, it is very rewarding when you have helped somebody, and I would say 75% of the patients are great.
I cannot believe how psychiatry and medicine has changed since I began. The worst change is the demand from whomever you work for to see more patients. I was recently with an agency that gave us one hour for an intake, and 30 minutes for follow ups. Well they decided that if they cut our time to 20 minutes for a follow up, we could see 50% more patients, and thus generate 50% more revenue for the agency. Of course none of the providers got any sort of raise for the extra work. It worked out well for them, as they got the extra revenue, but it was very hard to see that many patients, working in the inner-city clinic where I was seeing many hard-core, chronic patients with many comorbidities. I would come home, and fall asleep in my living room chair, due to shear mental exhaustion.
Our agency began with five MDs and two NP's, and when I left, there were five NP’s, and two MDs. This move was again done as a revenue maker, as they paid NP’s about 35% less.
Physicians probably wonder how so many inexperienced NPs make their way into treating patients, sometimes in states with no physician collaboration. Never forget how strong the nurses’ lobby is, due to their huge numbers, especially in more liberal states. Politicians like big groups and big unions. They often will set legislation based on the power of these unions.
As I retire, the two concerns that I have are these. First, poorly trained NP’s….. NP’s with lots of hospital experience and legitimate graduate degrees from real universities, not these online things tend to be very good providers. The ones who quickly go and get their masters from some online, fly-by-night school, and somehow get certified, are horrible. I preceptored a good number of NP students, and most of the ones with little or no psych nursing inpatient experience, who become NP’s, are dangerous.
The second thing that has really created problems for all, and why I left a regular job, is the constant demand from management to see more patients. 20 minutes to see a patient, order medication and tests, and chart is virtually impossible. I began to hate what I was doing. I opened a private practice, and have been cash only, in an underserved area, and it has not been nearly as rewarding as I thought it would be, and I plan on closing the practice at the end of the year.
These are just my thoughts….I hope you have found them of some interest. There are plenty of jobs for psychiatrists, but my advice would be to work for a large practice or agency, and avoid solo private practice, but only work for the agency if they give you an appropriate time to see each patient. Another thing which many psychiatrists and NP’s seem to enjoy is doing tele-psych. Locums can be very good, as the employers treat you very well, and you’re not there long enough to get tangled into any office politics!
Military medicine is also very good, as there is not that constant obsession with revenue and seeing more patients. Honestly, it was probably the best job I had in my 35 year career, so if you would like to do something a little bit different, sign up for a three-year hitch! You will be glad you did, and the benefits will last a lifetime, along with the many friendships you will make.
I started in the mid-1980s with a “real” graduate degree in psychiatric nursing from a very respected, private university. My first few jobs were staff nursing jobs in big hospitals in the Midwest. I learned a lot there, and worked with many good physicians, and some really bad ones. I assisted in ECT, many times which we did back then, right in the patient’s room. I one time worked with a psychiatrist who zapped the patient with five consecutive seizures within five minutes. I did not report him, as I would’ve been fired, as he filled beds and I did not.
I then joined the military and that was a great experience. With the move towards NP’s, I got certified and jumped through all the hoops to get my DEA, and I work now in an independent practice state, in private practice, and am “cash only”. It amazes me how many patients come in and seem to have forgotten their credit card or checkbook! Getting paid and frequent calls from needy patients he has been a real pain. Still, it is very rewarding when you have helped somebody, and I would say 75% of the patients are great.
I cannot believe how psychiatry and medicine has changed since I began. The worst change is the demand from whomever you work for to see more patients. I was recently with an agency that gave us one hour for an intake, and 30 minutes for follow ups. Well they decided that if they cut our time to 20 minutes for a follow up, we could see 50% more patients, and thus generate 50% more revenue for the agency. Of course none of the providers got any sort of raise for the extra work. It worked out well for them, as they got the extra revenue, but it was very hard to see that many patients, working in the inner-city clinic where I was seeing many hard-core, chronic patients with many comorbidities. I would come home, and fall asleep in my living room chair, due to shear mental exhaustion.
Our agency began with five MDs and two NP's, and when I left, there were five NP’s, and two MDs. This move was again done as a revenue maker, as they paid NP’s about 35% less.
Physicians probably wonder how so many inexperienced NPs make their way into treating patients, sometimes in states with no physician collaboration. Never forget how strong the nurses’ lobby is, due to their huge numbers, especially in more liberal states. Politicians like big groups and big unions. They often will set legislation based on the power of these unions.
As I retire, the two concerns that I have are these. First, poorly trained NP’s….. NP’s with lots of hospital experience and legitimate graduate degrees from real universities, not these online things tend to be very good providers. The ones who quickly go and get their masters from some online, fly-by-night school, and somehow get certified, are horrible. I preceptored a good number of NP students, and most of the ones with little or no psych nursing inpatient experience, who become NP’s, are dangerous.
The second thing that has really created problems for all, and why I left a regular job, is the constant demand from management to see more patients. 20 minutes to see a patient, order medication and tests, and chart is virtually impossible. I began to hate what I was doing. I opened a private practice, and have been cash only, in an underserved area, and it has not been nearly as rewarding as I thought it would be, and I plan on closing the practice at the end of the year.
These are just my thoughts….I hope you have found them of some interest. There are plenty of jobs for psychiatrists, but my advice would be to work for a large practice or agency, and avoid solo private practice, but only work for the agency if they give you an appropriate time to see each patient. Another thing which many psychiatrists and NP’s seem to enjoy is doing tele-psych. Locums can be very good, as the employers treat you very well, and you’re not there long enough to get tangled into any office politics!
Military medicine is also very good, as there is not that constant obsession with revenue and seeing more patients. Honestly, it was probably the best job I had in my 35 year career, so if you would like to do something a little bit different, sign up for a three-year hitch! You will be glad you did, and the benefits will last a lifetime, along with the many friendships you will make.
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