What's the point of Psychiatrists?

[softballtennis]

I guess psych has always been a big interest, but now I am thinking what is the point of psychiatrists? I guess psych has been watered down, psychiatrists no longer do therapy but only medication management. I was just thinking what is the point of that a PCP could just write a script and learn about all the side effects of the meds. Also the APA is not supporting the offer of integrated care. So now I'm left wondering if psych is all about meds, why isn't the residency an internal med residency and then a 1 year psych fellowship?

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[splik]

For better or for worse there is a massive demand for psychiatric services and in general the people want to be drugged and are far less interested in psychotherapy. Psychiatry is going nowhere because I can tell you no one wants to do the job of a psychiatrist (most psychiatrists don't even want to do it!) which is to say looking after severely mentally ill people. In fact most psychiatrists don't look after patients with serious psychiatric illness/psychosis. Nobody wants to manage the significant risk involved in dealing with self-injurious, suicidal, violent and homicidal individuals. PCPs do not have the time or inclinication to do more than cursory prescribing. For straightforward neurotic disorders, the PCP will do just as good a job as a psychiatrist, but many patients have more complex comorbidities and PCPs are ill-equipped with this sort of thing. Sure PCPs are happy shelling out benzos, antidepressants, and atypical antipsychotics. But it would be a brave PCP that would be keen using typical neuroleptics, clozapine, lithium, high dose TCAs, MAOIs, stimulants (though some are branching out onto the latter). Psychiatrists in private practice or academics can do private practice, and alot of dynamic psychotherapy and psychoanalysis is still done by psychiatrists in particular markets. Sure in community mental health or HMO settings psychiatrists cant do psychotherapy (it's not cost-effective) but there is nothing stopping them doing it if they want to do so. Medication management is a derisory term and I don't even know what it means but we're moving away from using the term. I offer thoughtful evaluations of complex patients with multiple comorbidities, complex trauma histories, adverse psychosocial circumstances, medical illness, and ethical and legal challenges, and develop formulations to best manage these patients including management of risk of suicidality and dangerousness. That is what a decent psychiatrist does and is is not something a PCP, NP or psychologist can do or wants to do.

I am not sure where you go it that APA is not supporting intergrated care - they have a whole council devoted to this issue and integration of psychiatric services into medicine is really the thing Paul Summergrad (current APA president) keeps harping on about. many psychiatrists are against integrated care because they don't like the idea of a psychiatrist not seeing all the patients and feel the role of the psychiatrist is too peripheral, but it is a waste of time and not practical for every one whose a bit depressed or anxious to see a psychiatrist and only the more complicated cases need to actually be seen by a psychiatrist with the psychiatrist providing guidance to the behavioral health worker in most instances.

I have to laugh as "psych has alwasy been a big interest" - what are you- like 15?

 

[hamstergang]

Psychiatrists do do therapy so it's not all about the meds.

But even if we just stick to medication management, there's too much for PCPs to learn well enough. They do handle the simple cases, but they have to refer to psychiatrists when that doesn't work.

You might as well ask why there are any specialties -- can't the IM or FM docs just learn how to fully manage everything? The answer is no, there's just too much. Specialists are needed.

 

[shan564]

I guess psych has always been a big interest, but now I am thinking what is the point of psychiatrists? I guess psych has been watered down, psychiatrists no longer do therapy but only medication management. I was just thinking what is the point of that a PCP could just write a script and learn about all the side effects of the meds. Also the APA is not supporting the offer of integrated care. So now I'm left wondering if psych is all about meds, why isn't the residency an internal med residency and then a 1 year psych fellowship?

You could say the same things about neurology, dermatology, etc.

 

[Ceke2002]

I guess psych has always been a big interest, but now I am thinking what is the point of psychiatrists? I guess psych has been watered down, psychiatrists no longer do therapy but only medication management. I was just thinking what is the point of that a PCP could just write a script and learn about all the side effects of the meds. Also the APA is not supporting the offer of integrated care. So now I'm left wondering if psych is all about meds, why isn't the residency an internal med residency and then a 1 year psych fellowship?

Granted I'm in a different country, but my Psychiatrist most certainly does do therapy, and long term therapy at that - utilising a mix of Psychodynamic Psychotherapy, Interpersonal/Inter-Relational therapy, MBCT, CBT, ACT, and some Psychoanalysis thrown in for good measure (I'm sure I'm probably missing a few modalities as well). Yes he does medication management also, but that's certainly not the main thrust of his practice. And no, he's not some old fossil from the Dinosaur age of Psychiatry either.

 

[thepoopologist]

I guess psych has always been a big interest, but now I am thinking what is the point of psychiatrists? I guess psych has been watered down, psychiatrists no longer do therapy but only medication management. I was just thinking what is the point of that a PCP could just write a script and learn about all the side effects of the meds. Also the APA is not supporting the offer of integrated care. So now I'm left wondering if psych is all about meds, why isn't the residency an internal med residency and then a 1 year psych fellowship?

-A proper residency will train you in both therapy and medication management. At this point in my training I put far more stock in therapy than I do in medications.
-The point of psychiatry is that there are degrees of mental illness that even a motivated PCP is not willing to handle, and that's where we come in.
-There are still psychiatrists who perform therapy or utilize the principles of therapy in their approach to patients. That is what theoretically distinguishes us from others practitioners. Frankly, a monkey could ask a patient the DSM criteria for X disorder and throw pills at it. If that is all you think it is, you should go into internal medicine instead.
-With that said, there seems to be a disproportionate number of bad psychiatrists compared to the good ones and I can see how the simplistic views of a crappy psychiatrist can influence your opinion of the field.
-Like all specialties, it takes a certain personality to do this job effectively

 

[SomeDoc]

The skillset of a Psychiatrist is simply different from that of an internist/PCP, or any other specialist for that matter. Three and a half years of training are unique to the training of inpatient and outpatient psychiatric skills, psychopharmacology being only part of the picture. These skills are simply not covered in other specialties, nor would I expect them to be. What is seen in the community is the effect of managed care pressures on the practice of mental health, rather than the way psychiatry residents are trained- with a focus on the combination of therapy and psychopharmacological management, which is empirically most efficacious in the treatment of the majority of psychiatric disorders.

 

[SomeDoc]

-The point of psychiatry is that there are degrees of mental illness that even a motivated PCP is not willing to handle, and that's where we come in.

Motivation and competence being mutually exclusive.

 

[Dharma]

I guess psych has always been a big interest, but now I am thinking what is the point of psychiatrists? I guess psych has been watered down, psychiatrists no longer do therapy but only medication management. I was just thinking what is the point of that a PCP could just write a script and learn about all the side effects of the meds. Also the APA is not supporting the offer of integrated care. So now I'm left wondering if psych is all about meds, why isn't the residency an internal med residency and then a 1 year psych fellowship?

Looks like you don't understand the field very well. If interested in the possible benefits (and utilization) of therapy give this a read (you may need to register but it's free): http://www.psychiatrictimes.com/psychopharmacology/psychodynamic-psychopharmacology-0/page/0/1

 

[DJspreadsheet]

Looking at the diagnoses imposed on psychiatric patients by PCPs is laughable. And the subsequent medication regimens are frightening.

You need a lot of experience interacting with mental illness to understand the presentations and how the diagnoses manifest themselves. And then there's medication management of those illnesses. It's much more involved than you seem to think.

You seem to be operating under the misconception that since we prescribe meds, our job is similar to an internists. All physicians prescribe medications as their primary intervention, with the exception of surgeons. That doesn't mean the varied subspecialties don't have very unique skill-sets and knowledge bases. An internist with a one year psych fellowship would be a trainwreck - and would make absolutely no sense from a training perspective.

 

[Extralong]

I guess psych has always been a big interest, but now I am thinking what is the point of psychiatrists? I guess psych has been watered down, psychiatrists no longer do therapy but only medication management. I was just thinking what is the point of that a PCP could just write a script and learn about all the side effects of the meds. Also the APA is not supporting the offer of integrated care. So now I'm left wondering if psych is all about meds, why isn't the residency an internal med residency and then a 1 year psych fellowship?

Dude wtf. I would second Dharma, in that I believe you don't understand the field at all. Can you please show the link in which states APA does not support integrative care, that might be true, but I just want to read it. You wouldn't believe how many non-psychiatry physicians very happy to consult psych when things get complicated. Lastly, internal med and family docs can do psych, but that would require them doing an additional residency, or a combined residency, though, most lean in one direction or another. Also I challenge you to explain what therapy are you talking about? MET, psychodynamic, CBT, biofeedback?

 

[Mad Jack]

Being professional villains of Scientology, for one. It's like a free perk to the job.

 

[slappy]

Being professional villains of Scientology, for one. It's like a free perk to the job.

 

[jakeislove]

Being professional villains of Scientology, for one. It's like a free perk to the job.

I'd utterly forgotten that they hate Psychiatrists.

 

[W19]

Looking at the diagnoses imposed on psychiatric patients by PCPs is laughable. And the subsequent medication regimens are frightening.

You need a lot of experience interacting with mental illness to understand the presentations and how the diagnoses manifest themselves. And then there's medication management of those illnesses. It's much more involved than you seem to think.

You seem to be operating under the misconception that since we prescribe meds, our job is similar to an internists. All physicians prescribe medications as their primary intervention, with the exception of surgeons. That doesn't mean the varied subspecialties don't have very unique skill-sets and knowledge bases. An internist with a one year psych fellowship would be a trainwreck - and would make absolutely no sense from a training perspective.

How do you explain that a NP can do it in 2 years without having the basic science knowledge that physicians have?

 

[novopsych]

The best part of psychiatry is that it is what you make of it.

I am a psychiatrist and dance therapist. I heal my patients with talk therapy, drug therapy, and dance therapy.

Can you imagine an internist dancing with his patient? It would be preposterous. But psychiatry is a blank canvas: Make it your own.

 

[splik]

How do you explain that a NP can do it in 2 years without having the basic science knowledge that physicians have?

they can't/

 

[Mad Jack]

they can't/

Beat me to it.

Just because they can legally prescribe psych meds doesn't mean they are actually competent to do so. Many people coming out of 4 year psych residencies will tell you they still don't feel fully prepared, because psychiatry is hard. Any NP can fill neurotic soccer mom's Prozac prescription, but real psychiatry is complicated stuff.

 

[W19]

they can't/

Have you worked with psych NPs? If so, have they been incompetent?

 

[splik]

Have you worked with psych NPs? If so, have they been incompetent?

I do not want to turn this into another yawnfest NP vs MD thread. the uneven distribution of psychiatrists means that there is a need for other providers to supply mental health care and this includes nurse practitioners. I find it hard to object to the existence of NPs given this (although they too are unevenly distributed and not meeting the needs of the population). I do work with psych NPs and am involved in training psych NP students. All the students are at would be regarded as one of the top schools and yet they all feel that their training does not equip them for clinical practice (with which I agree) and they wish there were more residencies for NPs (there are some additional training opportunities at the VA in particular). I don't think that NPs are good at managing risk and seem prone to admit everyone when a psychiatrist would be able to manage more challenging patients in an outpatient setting. They do not have a good grasp of descriptive psychopathology, or the ability to come up with nuanced formulations of patients. They are not good at managing patients with complex comorbidities. They are not good at managing high risk suicidal, self-injurious, violent, or homicidal patients. They are not comfortable usually dealing with pregnant patients. They are not adept often at using older treatments such as TCAs (not baby doses, real antidepressant doses), MAOIs, and often use curious polypharmacy. Many of the criticisms that could be lambasted against NPs also apply to bad psychiatrists (of which there are many). I think that NPs can work very well with good supervision from a senior psychiatrist but this is rare, and psych NPs are increasingly working completely independently or with superivision which constitutes little more than signing the charts.

Most of psychiatry really isn't rocket science but the field is prone to fads, dumbing down, pseudoscience, and mental masturbation and a high tolerance for poor performance from its practitioners. I do think it might be reasonable to train seasoned mental health nurses to do a half-decent job in dealing with 80% of general psychiatry in 2 years but this doesn't seem to be happening.

 

[erg923]

I do not want to turn this into another yawnfest NP vs MD thread. the uneven distribution of psychiatrists means that there is a need for other providers to supply mental health care and this includes nurse practitioners. I find it hard to object to the existence of NPs given this (although they too are unevenly distributed and not meeting the needs of the population). I do work with psych NPs and am involved in training psych NP students. All the students are at would be regarded as one of the top schools and yet they all feel that their training does not equip them for clinical practice (with which I agree) and they wish there were more residencies for NPs (there are some additional training opportunities at the VA in particular). I don't think that NPs are good at managing risk and seem prone to admit everyone when a psychiatrist would be able to manage more challenging patients in an outpatient setting. They do not have a good grasp of descriptive psychopathology, or the ability to come up with nuanced formulations of patients. They are not good at managing patients with complex comorbidities. They are not good at managing high risk suicidal, self-injurious, violent, or homicidal patients. They are not comfortable usually dealing with pregnant patients. They are not adept often at using older treatments such as TCAs (not baby doses, real antidepressant doses), MAOIs, and often use curious polypharmacy. Many of the criticisms that could be lambasted against NPs also apply to bad psychiatrists (of which there are many). I think that NPs can work very well with good supervision from a senior psychiatrist but this is rare, and psych NPs are increasingly working completely independently or with superivision which constitutes little more than signing the charts.

Most of psychiatry really isn't rocket science but the field is prone to fads, dumbing down, pseudoscience, and mental masturbation and a high tolerance for poor performance from its practitioners. I do think it might be reasonable to train seasoned mental health nurses to do a half-decent job in dealing with 80% of general psychiatry in 2 years but this doesn't seem to be happening.

As a psychologist I am often shocked at NPs superficial knowledge and undestanding of the psychopathology that they are in charge of treating. Sometimes, frankly, this makes little difference. Many times it does , however.

 

[NickNaylor]

One of the things that I've been told by mentors as a student is that the fundamentals of psychiatry are not in and of themselves all that difficult to understand. This lends to the mischaracterization that psychiatry is "easy." However, almost everyone agrees that being a truly competent and effective psychiatrist is incredibly difficult. It's one reason why the training is so long for something that is supposedly "easy."

And to be honest, after seeing many patients being managed for anxiety by FM docs with Xanax, the need for psychiatrists became patently obvious to me.

 

[DJspreadsheet]

How do you explain that a NP can do it in 2 years without having the basic science knowledge that physicians have?

As splik so thoughtfully explained, they cannot. God forbid someone goes in to see them for anything more than garden variety depression. And pray your 28-year-old daughter with autoimmune encephalitis doesn't magically become a schizophrenic, thanks to your friendly neighborhood NP's nuanced medical and psychiatric training. I guess you could equally pray that your other daughter, the 19-year-old "rapid-cycling bipolar", doesn't get thrown on antipsychotics and benzos, when in reality the only intervention that will help them is diligent long-term therapy. Maybe that same NP can use their global medical expertise to resolve their iatrogenic diabetes, hypercholesterolemia, obesity, and burgeoning benzodiazepine addiction.

 

[W19]

...

 

[slappy]

I think it's important here to keep in mind that the OP is only 17, at least till next month. (So, lets not get riled up about his half-knowledge?)

And NP vs MD?

 

[W19]

I think it's important here to keep in mind that the OP is only 17, at least till next month. (So, lets not get riled up about his half-knowledge?)

And NP vs MD?

What? What a 17 year old is doing in a psychiatrist forum... I am not even allowed to be here as a med student...

 

[michaelrack]

You could say the same things about neurology, dermatology, etc.

These could be 2-3 yr fellowships after IM (probably not 1 year). It is historical accident that they aren't (and things like pulm are)

 

[smalltownpsych]

As splik so thoughtfully explained, they cannot. God forbid someone goes in to see them for anything more than garden variety depression. And pray your 28-year-old daughter with autoimmune encephalitis doesn't magically become a schizophrenic, thanks to your friendly neighborhood NP's nuanced medical and psychiatric training. I guess you could equally pray that your other daughter, the 19-year-old "rapid-cycling bipolar", doesn't get thrown on antipsychotics and benzos, when in reality the only intervention that will help them is diligent long-term therapy. Maybe that same NP can use their global medical expertise to resolve their iatrogenic diabetes, hypercholesterolemia, obesity, and burgeoning benzodiazepine addiction.

I have seen the same difficulties when working with more complex cases and inappropriate medication regimens. Unfortunately, I have seen bad psychiatrists and over-reaching family med docs make the same errors. There is one big difference that I have experienced and that is that the NPs are willing to listen to alternative perspectives and actually shift their tx plan accordingly. It's much more difficult to get the average MD to shift because they believe that they know so much more about everything than anyone else. "I didn't misdiagnose psychosis as opposed to delirium on that elderly woman with a UTI, she was exaggerating her symptoms for secondary gain." Serious conversation I had with an IM doc. I love how they pick up some lingo and throw it around like they know what it means. By the way, she has returned to her pre-morbid level of high functioning after course of antibiotics, rest, and fluids.

 

[Leo Aquarius]

I guess psych has always been a big interest, but now I am thinking what is the point of psychiatrists? I guess psych has been watered down, psychiatrists no longer do therapy but only medication management. I was just thinking what is the point of that a PCP could just write a script and learn about all the side effects of the meds. Also the APA is not supporting the offer of integrated care. So now I'm left wondering if psych is all about meds, why isn't the residency an internal med residency and then a 1 year psych fellowship?

We don't need neurologists, because we can teach neurosurgeons all there is to know about the brain.

We don't need psychiatrists, because we can teach hospitalists how to work up delirium, and internists how to manage depression and anxiety and the occasional psychosis.

I also don't think we need radiologists because every surgeon should be trained how to read his or her own films.

If really pushed, we could pay doctors 1.5 times their pay to cover the emergency room in shifts which is what we did before emergency doctors existed. So we actually don't really need emergency physicians. It will just mean the rest of us must be willing to serve in the ERs.

I'm trying to think what other doctors are redundant...

 

[DermViser]

I guess psych has always been a big interest, but now I am thinking what is the point of psychiatrists? I guess psych has been watered down, psychiatrists no longer do therapy but only medication management. I was just thinking what is the point of that a PCP could just write a script and learn about all the side effects of the meds. Also the APA is not supporting the offer of integrated care. So now I'm left wondering if psych is all about meds, why isn't the residency an internal med residency and then a 1 year psych fellowship?

Sees status --> Pre-Medical -->

 

[DermViser]

How do you explain that a NP can do it in 2 years without having the basic science knowledge that physicians have?

Please tell me you're kidding.

 

[W19]

Please tell me you're kidding.

I like to think that the people who are expanding NP scope put a lot of thoughts into that... I like to see the good side of things...

 

[DermViser]

I like to think that the people who are expanding NP scope put a lot of thoughts into that... I like to see the good side of things...

You're right. Bc it's not like state laws that are passed are affected by lobbying, bribes, or anything. Nope - they've thought long and hard on the ramifications of their actions.

 

[W19]

You're right. Bc it's not like state laws that are passed are affected by lobbying, bribes, or anything. Nope - they've thought long and hard on the ramifications of their actions.

We are talking about life and death stuff here... Maybe I am too naive!

 

[DermViser]

We are talking about life and death stuff here... Maybe I am too naive!

Yes, you are.

 

[milesed]

The alternative to seeing me as their kid's child psychiatrist here, is seeing a local pediatrician who diagnoses everyone with defiance or irritabilty as Bipolar and puts them all on risperdal and lamictal at the first visit- no labs, no warnings about rashes, no therapy.

 

[softballtennis]

I want to apologize to everyone for this topic. I do aprreciate the work of psychiatrists I think most of you guys are great. Although I have meet a few crappy ones. I consider my current one a complete bitch most of the time but I just let my emotions get the better of me. I should just tell her this because it's important. I just hate how she invalidates me and always says talk to your therapist about that. Sorry she just makes me angry but I guess I need to tell her that.

 

[Nasrudin]

You're a bit creepy. And this is not the venue for your issues.

 

[Ceke2002]

I want to apologize to everyone for this topic. I do aprreciate the work of psychiatrists I think most of you guys are great. Although I have meet a few crappy ones. I consider my current one a complete bitch most of the time but I just let my emotions get the better of me. I should just tell her this because it's important. I just hate how she invalidates me and always says talk to your therapist about that. Sorry she just makes me angry but I guess I need to tell her that.

Sometimes a particular Psychiatrist can be a perfectly adequate physician, but for whatever reason you simply don't connect with them, or you feel like they're not really the Doctor for you. If you're really that unhappy with her, then why don't you look at transferring to someone else? There's no need to throw the baby out with the bathwater by coming down on the profession as a whole, based on a few unsatisfactory experiences.

 

[PikminOC]

I have seen the same difficulties when working with more complex cases and inappropriate medication regimens. Unfortunately, I have seen bad psychiatrists and over-reaching family med docs make the same errors. There is one big difference that I have experienced and that is that the NPs are willing to listen to alternative perspectives and actually shift their tx plan accordingly. It's much more difficult to get the average MD to shift because they believe that they know so much more about everything than anyone else. "I didn't misdiagnose psychosis as opposed to delirium on that elderly woman with a UTI, she was exaggerating her symptoms for secondary gain." Serious conversation I had with an IM doc. I love how they pick up some lingo and throw it around like they know what it means. By the way, she has returned to her pre-morbid level of high functioning after course of antibiotics, rest, and fluids.

"The lingo"??
So all that medical school, residency, 3 Board exams, possible board certification...but it's just lingo right?

What about all those psyd, phd, and social workers recommending meds to patients when they have NO training in it. Is that "lingo"?

 

[PikminOC]

I want to apologize to everyone for this topic. I do aprreciate the work of psychiatrists I think most of you guys are great. Although I have meet a few crappy ones. I consider my current one a complete bitch most of the time but I just let my emotions get the better of me. I should just tell her this because it's important. I just hate how she invalidates me and always says talk to your therapist about that. Sorry she just makes me angry but I guess I need to tell her that.

If psychiatrists are useless, why do you see one?

 

[PikminOC]

How do you explain that a NP can do it in 2 years without having the basic science knowledge that physicians have?

There's many thing NP's and PA's say they can do with their short training in addition to psychiatry.

 

[W19]

There's many thing NP's and PA's say they can do with their short training in addition to psychiatry.

I looked a few NP curricula of some good universities and after taking a look at them, I conclude that either US physicians are over 'educated' or NPs have no business in practicing medicine... I don't really know which one is it since I am a MS1.

 

[Ceke2002]

II was just thinking what is the point of that a PCP could just write a script and learn about all the side effects of the meds.

Because, as others have so rightly pointed out, a PCP or GP here in Australia, would simply not have the training to deal with more complex presentations of Psychiatric illness, beyond your garden variety depression and anxiety.

To give an example: I'm one of a couple of patients that frequent this board (and who might end up getting off her ar5e and returning to some form of Healthcare studies one of these days, but I digress). I'm considered somewhat of a complex case, because I'm diagnosed with Major Depressive Disorder with Psychotic features, but I also have some other conditions that can cause 'soft' or 'pseudo' hallucinations (Some remnants of an Axis II presentation, high levels of anxiety, etc). My Psychiatrist needs to be able to tease out which hallucinatory experiences et al, that I may be having, are a result of the MDD with Psychotic fx, and which can be attribute to other causes - because depending on the cause the treatment is going to differ. If the hallucinations are due to Psychotic Depression he also needs to ascertain at which point we can just keep an eye on things, and when he needs to be looking at recommending that (re) start medication, as well as which medication at what dosage is going to be the most efficacious.

Contrast that with a GP I was seeing several years ago, who, upon hearing words like 'Anxiety', 'Insomnia' and 'Hallucinations', promptly put me on Seroquel, and then rapidly titrated me up to 1200 mgs per day, causing excessive binge eating along with a (close to) 40 pound weight gain within less than 6 months, and which eventually lead to the onset of Extra Pyramidal symptoms along with what was potentially the start of Tardive Dyskinesia - at which point he pulled me off the medication, which then sent me into a 4-6 week period of what were some of the most bizarre hallucinations I have ever experienced in my life (ever seen an Apatosaurus casually strolling down the middle of a street? 'Cause I have).

So all things considered I think I'd much rather stick with my Psychiatrist than to trust a PCP/GP to manage my symptoms ever again.

 

[smalltownpsych]

"The lingo"??
So all that medical school, residency, 3 Board exams, possible board certification...but it's just lingo right?

What about all those psyd, phd, and social workers recommending meds to patients when they have NO training in it. Is that "lingo"?

I wasn't talking about a psychiatrist. I was referring to someone practicing outside their scope which seems to be rampant within our field. When it comes to human behavior, everyone has an opinion and isn't afraid to voice it. I don't see that as much the other way. "Based on the symptoms, I was thinking that this patient has stage 4 melanoma and needs xyz treatment plan". Oh and I hate the dynamic of recommending meds from the people you mentioned because it is usually bad "therapy" along the lines of, "This patient is not doing what I tell them so they must need meds." I take a lot of pride in how much I can accomplish without relying on medication interventions.

 

[PikminOC]

I looked a few NP curricula of some good universities and after taking a look at them, I conclude that either US physicians are over 'educated' or NPs have no business in practicing medicine... I don't really know which one is it since I am a MS1.

You are a tadpole. We aren't overeducated. The more you learn, the more you realize you don't know..

 

[W19]

You are a tadpole. We aren't overeducated. The more you learn, the more you realize you don't know..

I know, but I think it is crazy that state legislatures are letting these people practice medicine independently--unless a lot of these stuff I am learning now are useless (which I think it's not the case)... What is the AMA position in all of this?

 

[Mad Jack]

I like to think that the people who are expanding NP scope put a lot of thoughts into that... I like to see the good side of things...

They put a lot of thought into how much money it would save them and how good it would look for their political careers.

 

[smalltownpsych]

I know, but I think it is crazy that state legislatures are letting these people practice medicine independently--unless a lot of these stuff I am learning now are useless (which I think it's not the case)... What is the AMA position in all of this?

Our hospital doesn't let them practice independently. They have to be under the direct guidance of an MD, except for the psychiatric NP who has no one to guide her. I can help with some of the diagnostic questions, but she is on her own when it comes to medications. I agree that this is not good but we couldn't find a psychiatrist willing to move to our area.

 

[Mad Jack]

I know, but I think it is crazy that state legislatures are letting these people practice medicine independently--unless a lot of these stuff I am learning now are useless (which I think it's not the case)... What is the AMA position in all of this?

That they shouldn't practice independently because it's absolutely insane for them to do so.