I actually get many of my patients (cash only) that come from being treated by a NP that has no idea what is going on.
Which I think is the biggest thing psychiatrists have going over many other medical fields. A rash or cold gets mismanaged in the FM clinic by an NP, and it usually resolves itself anyway. Bipolar or schizophrenia gets mismanaged by a psych NP and psychiatrists get to clean up the eventual fallout. Even if NPs start to take over, the psych NPs I've met (other than one who was legitimately fantastic) are so incompetent that I'm not too worried about difficulties finding employment anytime soon. I'll also be doing residency in a state adamantly against mid-level independence though, so that helps.
Wait wait wait. I don't know any of the lingo here, but each patient/family was charged 2500 a month to see this person?
Concierge medicine is essentially like being on retainer, so basically you charge a fee and make yourself available to your patients 24/7 as they need you (at least in a true concierge model). DPC (direct primary care) is a similar model, except you charge a monthly fee and patients can see you anytime during allotted office hours. So if something comes up and they need to see you, they make an appointment on short notice. In both models you're basically charging a "membership fee" in exchange for you being more available to the patient than a normal physician would be. This is typically successful because these physicians, I guess providers if NPs are also doing it, have limit their patient pools which remain relatively small and do not take new patients unless spots open up. It's somewhat advantageous because it provides a consistent and predictable monthly income (even if you don't see patients) for the physician, a smaller more manageable patient load, and allows the patient to have better/easier access to their doctor.
In the given example, the family was probably being charged $2,500/mo so they could have (nearly) unlimited access to care whenever necessary. For a model like that to work with that kind of price tag you've either got to have patients coming from very wealthy families, patients whose care requirements are significant enough that $2,500 actually saves them money, or just patients so pathological that they'll pay that much to have their hands held and have smoke blown up their a$$ about how they're "doing so well" with that provider.
Any reason for profit-driven entity to hire psychiatrists over NPs? Doesn't insurance reimburse 80% for NPs? If so, why not just hire 2 NPs instead of 1 psychiatrist and make profit through volume? Any penalties legally for having NPs and no psychiatrists?
In states with supervision requirements they obviously have to pay a physician to supervise. In the states with independent practice rights for NPs, there are potential reasons. Increased malpractice risks, increased admits from outpatient clinics, increased re-admission rates due to improper care (which leads to penalties and decreases reimbursement from the gov), and patients who refuse to be seen by non-physicians are just a few. Some of those haven't happened en masse yet in many places, but I'd be willing to bet that once they do (like the post above me suggests) you won't be seeing hospitals or practices which don't at least have physicians on staff as supervisors.
Getting back on track to the initial question though...
From what I've heard, addiction is one of the lower paying areas of psychiatry. Anybody have any ideas about how the whole "opioid epidemic" may or may not impact the field? The few physicians I've talked to about it (not psychiatrists) seem to think that we'll see addiction medicine income skyrocket in the next few years thanks to all the attention, but I don't really see how given that most addiction/rehab programs near my city are already constantly full. Any thoughts on that as I'm actually somewhat interested in that area.