What can a Psychiatrist do that an Psych NP can't?

[moto_za]

I see online a bunch of Psych NPs practicing independently and have opened up their own private practice doing it all. What makes us stand out from an NP that has everything listed on their website that they treat and charge pretty highly for it.

---

Members don't see this ad.

 

[Cath Up]

People post here all the time about the egregious mismanagement they see psych NPs making. A psychiatrist can fix those.

A psychiatrist can use various psychotherapies that are standardized in training.

A psychiatrist will have a better understanding of concomitant medical problems and medications alongside the psychiatric treatment.

A psychiatrist typically has far higher ability to juggle multiple patients and see pts more efficiently.

A psychiatrist may access medical fellowships within psychiatry as well as pain, palliative.

A psychiatrist can do procedural stuff like ECT, ketamine, TMS.

A psychiatrist may oversee midlevels and earn additional income from them.

I am sure psych NPs have done some of what I list above but my understanding is these are generally true.

Most importantly in my eyes- psychiatrists have pursued the path of maximum study and experience in order to properly treat patients. Psych NPs have to convince themselves and their patients that 15,000 hours+ More of training is of negligible benefit and they pursued a career that would make them money/ improve work/life balance while possibly sub-optimally treating patients due to unknown unknowns that were skipped in their non-biopsychosocial model of training. I do acknowledge that “fit” is important as is effort and there is certainly overlap in the quality of care between the two due to laziness/negligence and exceptional hard work on either side of things. They also have to reckon with the fact that they by and large exist to make hospitals/healthcare systems money. The ones that escape into private practice appear to be an enterprising minority.

 

[Ludwig2000]

Psychiatrists can [should] treat diagnoses rather than symptoms. By that I mean, (1) maintaining a differential that includes medical, neurologic, pharmacological causes of symptoms - and doing something about those causes. And (2) using a similar kind of strategy, learned in medical training, even when the illness IS “purely psychiatric.”

Regards to (1)
In my experience NPs don’t often consider that a medication (whether it’s one they had prescribed or not) might be the cause of a symptom, and they reflex to adding another medication. I’m less sure how often they work up basic medical causes of symptoms, e.g. hypothyroidism. I think it’s very unlikely that they would think of something like anti-NMDA encephalitis in a 40yo with new psychosis and facial twitching, and would just prescribe an antipsychotic rather than arranging for the LP per Neuro.

Regards to (2)
If you’re keeping an open psych differential you might find that after 8-10 outpatient appointments, what you thought was MDD because of the SI and reported low mood, was really Avoidant Personality Disorder all along, where the SI is a chronic, escapist fantasy as a coping mechanism, and the low mood (which was never really evident by their affect in the first place, you realize) is really what they were calling the effects of their anxious attachment style on their life circumstances. This changes management.
But this does not happen when treatment is guided essentially by self report symptom surveys.

 

[Ludwig2000]

Psychiatrists can [should] treat diagnoses rather than symptoms. By that I mean, (1) maintaining a differential that includes medical, neurologic, pharmacological causes of symptoms - and doing something about those causes. And (2) using a similar kind of strategy, learned in medical training, even when the illness IS “purely psychiatric.”

Regards to (1)
In my experience NPs don’t often consider that a medication (whether it’s one they had prescribed or not) might be the cause of a symptom, and they reflex to adding another medication. I’m less sure how often they work up basic medical causes of symptoms, e.g. hypothyroidism. I think it’s very unlikely that they would think of something like anti-NMDA encephalitis in a 40yo with new psychosis and facial twitching, and would just prescribe an antipsychotic rather than arranging for the LP per Neuro.

Regards to (2)
If you’re keeping an open psych differential you might find that after 8-10 outpatient appointments, what you thought was MDD because of the SI and reported low mood, was really Avoidant Personality Disorder all along, where the SI is a chronic, escapist fantasy as a coping mechanism, and the low mood (which was never really evident by their affect in the first place, you realize) is really what they were calling the effects of their anxious attachment style on their life circumstances. This changes management.
But this does not happen when treatment is guided essentially by self report symptom surveys.

I guess what I’m really saying is… What can a psychiatrist do that a psych np can’t? Be a doctor.

 

[TexasPhysician]

Well answered. Locking thread before it goes the wrong direction.