What's the point of Psychiatrists?

[W19]

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

This is a serious matter because people lives can be at risk here... I think the AMA should step up their games...

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[W19]

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.

Is that a state law or your hospital that decided they are not equip to practice independently?

 

[smalltownpsych]

Is that a state law or your hospital that decided they are not equip to practice independently?

The state will allow them but our hospital sides with the AMA on this. I was invited to consult at the executive meeting last week regarding an NP they would be hiring for a specialized role and they made it very clear that they would be practicing with an MD who had experience in that arena. I don't know what the specifics of that "guidance' are, but am glad that is their position.

 

[W19]

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

But their ego won't let them to make that rational decision... I even called my cousin the other day who is an IM doc to ask him why he never hires an NP/PA, his answer was: 'when they kill someone, it will be on me'... He even went further by saying that NPs particularly have no business in practicing medicine at all--even with supervision. I thouht he was kind of over zealous with that last statement...

 

[Extralong]

I think physician extenders(NPs PAs, etc) are good when they stay within the proper realm of education and not in the realm of what the law thinks is proper. Sadly, whenever a patient has a sentinel event, or even a near miss, the law tries to hunt down the physician involved, regardless if it was their fault or not; so, we have to be careful and do our due-diligence and work with our hospital systems to make sure that physician extenders practice as physician extenders and not as physicians. Some hospital administrators are RNs, so that becomes tricky. Now as psychologists prescribing meds, that's a whole topic in itself. Did you know its the minority that what to prescribe meds and its the minority that are pushing for legalization.

 

[softballtennis]

If psychiatrists are useless, why do you see one?

My primary care doc doesn't want to prescribe me psych meds because "I'm too young".

 

[Mad Jack]

But their ego won't let them to make that rational decision... I even called my cousin the other day who is an IM doc to ask him why he never hires an NP/PA, his answer was: 'when they kill someone, it will be on me'... He even went further by saying that NPs particularly have no business in practicing medicine at all--even with supervision. I thouht he was kind of over zealous with that last statement...

NPs get around 600 hours of clinical training at the advanced level, as compared to 14,000 for physicians. Couple that with the fact that most of their courses are fluff, so they don't even have a solid foundation to know just how much they don't know, and you've got a disastrous recipe for dangerous providers.

This is a serious matter because people lives can be at risk here... I think the AMA should step up their games...

Politicians care about their careers, not people's lives.

 

[PikminOC]

But their ego won't let them to make that rational decision... I even called my cousin the other day who is an IM doc to ask him why he never hires an NP/PA, his answer was: 'when they kill someone, it will be on me'... He even went further by saying that NPs particularly have no business in practicing medicine at all--even with supervision. I thouht he was kind of over zealous with that last statement...

Wait until it's your license and malpractice on the line. United States of attorneys.

 

[PikminOC]

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?

The nurses have alot more lobbyists.

 

[DermViser]

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?

You're right bc state legislatures should dictate medical education.

 

[PikminOC]

My primary care doc doesn't want to prescribe me psych meds because "I'm too young".

I will refrain from making a biting comment.

 

[EMDO2018]

Oh god, I remember in college when a PCP put me on 50mg of Zoloft, then every couple weeks increased my dosage by 50mg until I was at 200mg. If I said to him " I still don't feel very motivated" then his plan was to UP THE DOSAGE!!!! I was taking so much Zoloft in such a short period of time I started getting brain zaps. Thinking back to that now, the guy had no f'ing Idea what he was doing, why was he allowed to treat me like that.

 

[Ceke2002]

My primary care doc doesn't want to prescribe me psych meds because "I'm too young".

So you complain that Psychiatrists do nothing but write meds, but then you complain that your PCP won't prescribe meds. Maybe you don't actually need meds, maybe the type of meds you're asking for aren't indicated in your particular case - or maybe you're just annoyed that so far no one has pulled out a magic wand, and made everything better, without you needing to put any effort in yourself.

 

[michaelrack]

You're right bc state legislatures should dictate medical education.

Yes, they should (along with the state governors). I trust the elected representatives of the great state of Mississippi to determine the educational requirements for their doctors.

 

[DermViser]

Yes, they should (along with the state governors). I trust the elected representatives of the great state of Mississippi to determine the educational requirements for their doctors.

I hope you're being facetious. My comment was more with reference to scope of practice and the actual educational curriculum.

 

[michaelrack]

I hope you're being facetious. My comment was more with reference to scope of practice and the actual educational curriculum.

If there is going to be any regulation of scope of practice, I am in favor of states determining scope of practice (as opposed to the feds). While I guess that it would be impractical for states to mandate that docs receive a specific education in medical school (it would be impractical for MS to demand that any doctor who wants to practice in MS studied cardiology for 100 hrs in med school, etc), certainly states can easily mandate some educational requirements through regulation of required CME.

 

[DermViser]

If there is going to be any regulation of scope of practice, I am in favor of states determining scope of practice (as opposed to the feds). While I guess that it would be impractical for states to mandate that docs receive a specific education in medical school (it would be impractical for MS to demand that any doctor who wants to practice in MS studied cardiology for 100 hrs in med school, etc), certainly states can easily mandate some educational requirements through regulation of required CME.

I was more talking about very specific curriculum requirements (i.e. your example of 100 hrs. of cardiology in medical school, for example). I would much rather leave that to the people actually in the profession.

 

[Shikima]

Just saw this on Doximity ---

http://news.doximity.com/entries/1527793?_ref=email&user_id=2226021

 

[W19]

Just saw this on Doximity ---

http://news.doximity.com/entries/1527793?_ref=email&user_id=2226021

More opening for NP to say: See 'patients can't even get an appointment with a psychiatrist, let us fill in that void'

 

[Frazier]

Just saw this on Doximity ---

http://news.doximity.com/entries/1527793?_ref=email&user_id=2226021

So given this quote, if representative of the country...

About one in five psychiatrists weren't accepting any new patients

...on average these guys must either be: A) content with with current level of income, or B) content with their current state of lifestyle to the point that added $$$ isn't worth it.

[This assumes that if both the above were false, then there would be more accepting new patients.]

So which, between those 2 possibilities, likely plays a larger role in the forum's opinion?

 

[nitemagi]

So given this quote, if representative of the country...


...on average these guys must either be: A) content with with current level of income, or B) content with their current state of lifestyle to the point that added $$$ isn't worth it.

[This assumes that if both the above were false, then there would be more accepting new patients.]

So which, between those 2 possibilities, likely plays a larger role in the forum's opinion?

Or they have a full practice.

 

[Frazier]

Or they have a full practice.

Yeah, that was the underlying idea to what I said earlier.

A) I make 200k. I'm happy with that. Therefore, "Practice full".

B) I work 45 hours per week. I'm happy with that. Therefore "Practice full".

Yeah, there are only so many hours in a day...in a week... but I doubt the 1 in 5 are pushing 80+ hour work weeks. To where there is truly "no time to see another patient".

So my question, in forum's opinion, which facet from earlier post is playing more of a role?

 

[nitemagi]

Yeah, that was the underlying idea to what I said earlier.

A) I make 200k. I'm happy with that. Therefore, "Practice full".

B) I work 45 hours per week. I'm happy with that. Therefore "Practice full".

Yeah, there are only so many hours in a day...in a week... but I doubt the 1 in 5 are pushing 80+ hour work weeks. To where there is truly "no time to see another patient".

So my question, which facet from earlier post is playing more of a role in forum's opinion?

Yes, most psychiatrists don't define a full practice as "80+ hours a week."

 

[Frazier]

Yeah, that was the underlying idea to what I said earlier.

A) I make 200k. I'm happy with that. Therefore, "Practice full".

B) I work 45 hours per week. I'm happy with that. Therefore "Practice full".

Yeah, there are only so many hours in a day...in a week... but I doubt the 1 in 5 are pushing 80+ hour work weeks. To where there is truly "no time to see another patient".

So my question, in forum's opinion, which facet from earlier post is playing more of a role?

Yes, most psychiatrists don't define a full practice as "80+ hours a week."

So if you had to theorize...which plays a larger role in dictating that: satisfaction with what they make without packing in the extra couple sessions per day, or satisfaction with being able to leave the office at ~5PM?

 

[nitemagi]

So if you had to theorize...which plays a larger role in dictating that: satisfaction with what they make without packing in the extra couple sessions per day, or satisfaction with being able to leave the office at ~5PM?

We've all had to work 80 hours a week at some point in our training.

Each person then goes on to define a balance, for quality of life, that is individualized. Would more sessions add to my quality of life (either via money or satisfaction of helping others), or would it take away from my QoL (time could be spent with family/friends, or added exhaustion).

 

[PikminOC]

If there is going to be any regulation of scope of practice, I am in favor of states determining scope of practice (as opposed to the feds). While I guess that it would be impractical for states to mandate that docs receive a specific education in medical school (it would be impractical for MS to demand that any doctor who wants to practice in MS studied cardiology for 100 hrs in med school, etc), certainly states can easily mandate some educational requirements through regulation of required CME.

Illinois 150 cme in 3 years. Wisconsin 30 in 2 years..

 

[michaelrack]

I was more talking about very specific curriculum requirements (i.e. your example of 100 hrs. of cardiology in medical school, for example). I would much rather leave that to the people actually in the profession.

The state of MS mandates 5 hrs CME (I am not sure if it is yearly or every 2 yrs) in the area of proper prescription of controlled substances. Mandating specific CME requirements is a way for states to control, to some extent, medical education of their doctors without trying to micromanage medical schools.

There are a lot of possibilities out there. For example, if a state thought that identifying child abuse was important, it could mandate CME in this area for all physicians or possibly for all physicians who treated a certain age range of patients.

If doctors in a state disagreed with the requirements, they could lobby their legislatures.

 

[milesed]

I have NP's working with me under a collaborative agreement and they all need guidance at times. EVERY NP we have calls me at least 1x/week with questions or a need to totally xfer a patient to me due to the level of complexity.

 

[smalltownpsych]

I have NP's working with me under a collaborative agreement and they all need guidance at times. EVERY NP we have calls me at least 1x/week with questions or a need to totally xfer a patient to me due to the level of complexity.

That is one good answer to the thread title, one point of a psychiatrist is to be the expert at the medical aspects of treatment of mental illness. That is similar to how I conceptualize my role as a psychologist. I really wish there was not as much independent practice of mid-levels when it comes to psychotherapy as my experience with mid-levels has been analogous to your own.

 

[DermViser]

Oh god, I remember in college when a PCP put me on 50mg of Zoloft, then every couple weeks increased my dosage by 50mg until I was at 200mg. If I said to him " I still don't feel very motivated" then his plan was to UP THE DOSAGE!!!! I was taking so much Zoloft in such a short period of time I started getting brain zaps. Thinking back to that now, the guy had no f'ing Idea what he was doing, why was he allowed to treat me like that.

All psychotropics have side effects and risk benefit profiles. They are not all good with no bad (side effects). You have no idea the thinking behind his management.

 

[smalltownpsych]

All psychotropics have side effects and risk benefit profiles. They are not all good with no bad (side effects). You have no idea the thinking behind his management.

Really? Why would a patient have no idea what a doctors plan of treatment is? Do you really think that patients don't understand side effects and are unable to weigh risks and benefits or is it more about resistance and looking for a quick fix? If so, then that just makes the case for why a psychiatrist should be managing these medications as opposed to a GP or an NP. It is bad enough when modern medicine is ignorant of or dismissive of the psychological factors that are integrated with more purely "physical" ailments, but when depression or anxiety are viewed and treated in the same way, then we're in trouble.

 

[DermViser]

Really? Why would a patient have no idea what a doctors plan of treatment is? Do you really think that patients don't understand side effects and are unable to weigh risks and benefits or is it more about resistance and looking for a quick fix? If so, then that just makes the case for why a psychiatrist should be managing these medications as opposed to a GP or an NP. It is bad enough when modern medicine is ignorant of or dismissive of the psychological factors that are integrated with more purely "physical" ailments, but when depression or anxiety are viewed and treated in the same way, then we're in trouble.

Read again what I wrote. His psychiatrist INCREASED his dose. He has no idea the thinking behind why his psychiatrist increased his dose. No, I don't think psychiatric patients a lot of times have insight into their condition - that's why many of them stop taking it, bc they "feel better". I realize however, you're a psychologist, not an actual psychiatrist.

 

[smalltownpsych]

Read again what I wrote. His psychiatrist INCREASED his dose. He has no idea the thinking behind why his psychiatrist increased his dose. No, I don't think psychiatric patients a lot of times have insight into their condition - that's why many of them stop taking it, bc they "feel better". I realize however, you're a psychologist, not an actual psychiatrist.

He wrote PCP which in my mind means Primary Care Physician. Patients with schizophrenia struggle with insight, others have varying degrees and for many it is the denial around substance abuse more than poor insight. That's a whole different ball game. Obviously, as a psychologist, I don't spend a lot of time understanding the details of the specific mechanisms of the various medications, half-lifes, and receptors targeted, but trust me I understand why my patients discontinue medications and often it is because the doc doesn't take the time to educate.

 

[DermViser]

He wrote PCP which in my mind means Primary Care Physician. Patients with schizophrenia struggle with insight, others have varying degrees and for many it is the denial around substance abuse more than poor insight. That's a whole different ball game. Obviously, as a psychologist, I don't spend a lot of time understanding the details of the specific mechanisms of the various medications, half-lifes, and receptors targeted, but trust me I understand why my patients discontinue medications and often it is because the doc doesn't take the time to educate.

Yes, obviously.

 

[smalltownpsych]

Read again what I wrote. His psychiatrist INCREASED his dose.

His PCP increased his dose not his psychiatrist. Read the title of the thread. You are actually reinforcing the stereotype of the MD who doesn't listen because he is already right and then being condescending. I usually am more understanding of other's perspectives and less condescending (occupational hazard), but you are really bringing it out in me today!

Yes, obviously.

 

[DermViser]

His PCP increased his dose not his psychiatrist. Read the title of the thread. You are actually reinforcing the stereotype of the MD who doesn't listen because he is already right and then being condescending. I usually am more understanding of other's perspectives and less condescending (occupational hazard), but you are really bringing it out in me today!

My point is regardless of whether it's a PCP or Psychiatrist, he doesn't understand the reasoning behind increasing his dose.

 

[Armadillos]

Gotta love SDN sometimes, a psychiatrist forum under the [Physicians / Residents] tab with a thread started by a high school kid ultimately leading to a dermatologist and a psychologist going at each other.

 

[Ceke2002]

Why would a patient have no idea what a doctors plan of treatment is? Do you really think that patients don't understand side effects and are unable to weigh risks and benefits or is it more about resistance and looking for a quick fix?

Or there's another option, and that is the patient has been raised with the idea that a Doctor, by virtue of their profession and title, is of a higher station in life and must be shown due deference at all times (which also typically means they're taught that to question a Doctor's medical decisions or prescribing practices is the absolute height of disrespect). I know that was certainly the case with my upbringing. It's really only been in the last ten years or so that I've learnt to advocate for myself as a healthcare consumer, and even now my Psychiatrist has to remind me every so often that it's okay to both question and disagree with him.

Unfortunately there does seem to be a certain quotient of Doctors who hold the same, or at least a similar viewpoint in regards to the sacrosanctity of their own (perceived) status and will tend to behave in accordance with that when it comes to how they treat patients (failing to explain the risk/benefit ratio of different treatments, not bothering to engage themselves in patient education for example).

These days I tend to view the relationship between Doctor and patient to be more that of an alliance. To me the onus should be on both parties to not only speak up and be prepared to question if and when necessary, but to also provide adequate explanation and guidance (imho).

 

[Frazier]

Gotta love SDN sometimes, a psychiatrist forum under the [Physicians / Residents] tab with a thread started by a high school kid ultimately leading to a dermatologist and a psychologist going at each other.

Variety is the spice of strife.

 

[smalltownpsych]

Gotta love SDN sometimes, a psychiatrist forum under the [Physicians / Residents] tab with a thread started by a high school kid ultimately leading to a dermatologist and a psychologist going at each other.

My main reason for participating in this thread is that I appreciate the specialty of psychiatry and see first hand the difficulties that are created when other doctors try to treat psychiatric conditions. I do believe that it is important to educate patients and the "psych patients don't have insight" or "psych patients manipulate" or "psych patients lie" leads to poor care and when I see this dynamic -I will call it out. After all, the knowledge and awareness of interpersonal dynamics is right smack in the middle of my own scope of practice.

 

[endrun]

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

Gotta love SDN sometimes, a psychiatrist forum under the [Physicians / Residents] tab with a thread started by a high school kid ultimately leading to a dermatologist and a psychologist going at each other.

The better to have more SKIN IN THE GAME, my dear.....