1. The SDN iPhone App is back and free through November! Get it today and please post a review on the App Store!
    Dismiss Notice
  2. Dismiss Notice

Will nurse practitioners (NP) be a threat to Psychiatrists?

Discussion in 'Psychiatry' started by citizenbang, Jul 30, 2011.

  1. citizenbang

    Joined:
    Jul 7, 2011
    Messages:
    31
    Likes Received:
    0
    I have heard of people saying that NPs can practice independently in more and more states. I was wondering, are they a real threat? (they can increase supply in general, thus lowering wages across the board even if you are a psychiatrist and already have a job).

    Are psych NPs increasing in number or something? I don't understand why they are talked about now as being a threat but haven't been talked about to the same extent before.
     
  2. Note: SDN Members do not see this ad.

  3. Karen Shelton

    Karen Shelton DNP Student

    Joined:
    Jul 28, 2011
    Messages:
    15
    Likes Received:
    1
    Status:
    Other Health Professions Student
    I don't think I would consider myself a threat (I happen to live in AZ, one of the states that allows independent practice). The nursing model of care places an emphasis on public health and client education (I chose nursing because I wanted to work within this model...not the medical model of health care delivery). Most often PsyNp's prefer to work in settings where they are dealing with those clients who tend to be disenfranchised due to geographic location, ethnicity (in my case I am referring to Native Americans due to the large number of tribal lands in AZ) , and socio-economic status. There are some NP's in private practice but most prefer a setting where there is access to a physician for collaboration. I have most often seen PsyNP's working within the collegiate system at student health, physician owned and directed non-profits, and clinics while those in private practice are often in underserved areas where the choice would be a PsyNP or no psychiatric services at all...or worse yet a 1 to 1 1/2 hour drive to the nearest provider....who is still considered to be in a rural area.

    In addition when I went through my RN training I was the only one in a cohort of 48 who was specifically interested in psychiatry and that seems to hold true for most programs...it is not a field most nurses wish to go into for advanced education. When I got into the program I am currently attending, it was the only DNP program in psychiatry on the west coast that I know of (there were MSN programs but no DNP programs...but even those were few and far between for this specific specialty).

    Even when I checked with my own insurance for psychiatrists in my area (Scottsdale, AZ) there was a choice of 2 psychiatrist and a PsyNP...and I would not consider Scottsdale an area with a lower socio-economic population or a high needs area per se...although the state of Arizona particularly has a severe shortage of psychiatric providers in general and even more so in regards to psychiatric treatment for children and in more rural areas and on tribal lands. I may very well be close to retired or even retired before we ever catch up to the need if at all.

    The only threat I see is that many people with no money or resources will suffer needlessly in a system that can't help them resolve their mental health issues self medicating with drugs and alcohol while passing down poor coping skills to their children and exacerbating an already troubled situation with a heavier burden on society. I don't want to take your job or your livelihood or drive down your ability to earn income...I honestly just want to help people who might otherwise not receive help at all and hopefully in the long run decrease the burden on society as a whole in the process in a way that allows me to challenge my potential for personal and intellectual growth. That's it.
     
  4. citizenbang

    Joined:
    Jul 7, 2011
    Messages:
    31
    Likes Received:
    0
    Thanks for the response. Are there more and more NPs going into psychiatry? I only recently heard about psych NP, I didn't know if it was because something was changing or if it was just that I didn't hear of anything before.
     
  5. Sneezing

    Sneezing Even Bears do it!
    2+ Year Member

    Joined:
    Jan 27, 2009
    Messages:
    598
    Likes Received:
    8
    Status:
    Resident [Any Field]
    You have definitely drank the kool aid if you really believe there is a nursing model vs medical model.
     
  6. Karen Shelton

    Karen Shelton DNP Student

    Joined:
    Jul 28, 2011
    Messages:
    15
    Likes Received:
    1
    Status:
    Other Health Professions Student
    Dr. Sneezing,

    It is interesting to me that out of my entire statement that you chose to focus on my reference to the differences between the nursing model and medical model. Even more interesting is your remark regarding my "drinking the kool-aid" if I believe that there is indeed a difference between the two.

    So, are you making reference to the 1960's connotation taken from the book written by Tom Wolfe entitled "The Electric Kool-Aid Acid Test" based on the activities of Ken Kesey and the Merry Pranksters? Or, are you referring instead to the 1978 Jonestown Massacre? In which case I would then be drinking the proverbial Flavor-Aid...not Kool-Aid.

    And, I am assuming you are suggesting that I am blindly and uncritically accepting that there is a difference between the nursing model of care and the medical model of care and meaning to do so in a derogatory sense? Rather than say the currently accepted meaning (as of the 1990's) of the phrase which implies an acceptance of or enthusiasm for a certain belief or philosophy? Not sure?

    Hmmm....I am suddenly thirsty...think I will have a chocolate martini...heavy on the syrup and light on the cyanide...sheesh... ;-)
     
  7. Karen Shelton

    Karen Shelton DNP Student

    Joined:
    Jul 28, 2011
    Messages:
    15
    Likes Received:
    1
    Status:
    Other Health Professions Student
    Honestly, I could not say as that would just be based on my personal experience and not in true numbers. I do know some Psych NP programs have actually closed and I am assuming it is due to lack of interest. And, thank you for having an honest conversation with me in the interest of true discourse which I believe to be an indication of real professionalism...rather than making inferences that I enjoy drinking cyanide laced Kool-Aid...sigh. :laugh:
     
  8. billypilgrim37

    billypilgrim37 Unstuck in Time
    Physician Faculty 7+ Year Member

    Joined:
    Apr 21, 2007
    Messages:
    2,387
    Likes Received:
    115
    Status:
    Attending Physician
    You clearly don't watch enough Fox News... ;)
     
  9. whopper

    whopper Former jolly good fellow
    Physician Faculty 10+ Year Member

    Joined:
    Feb 8, 2004
    Messages:
    6,691
    Likes Received:
    1,399
    Status:
    Attending Physician
    It's always possible, but I don't think it would happen.

    Never say never. Anything is always possible, but you can't live your life in fear of getting struck by lightening.

    If one wants to play a turf war, and start gunning against competitors, with complete disregard that there is a shortage of psychiatrists and plenty in need of mental health treatment that aren't getting it, then the biggest enemy (if you want to look at it that way) are primary care doctors. If you want to worry about the next biggest threat it'd be the local psychiatrists in your area, not an NP.
     
  10. Karen Shelton

    Karen Shelton DNP Student

    Joined:
    Jul 28, 2011
    Messages:
    15
    Likes Received:
    1
    Status:
    Other Health Professions Student
    Clearly :)
     
  11. sunlioness

    sunlioness Fierce. Proud. Strong
    Physician 10+ Year Member

    Joined:
    Feb 23, 2007
    Messages:
    1,535
    Likes Received:
    765
    Status:
    Attending Physician
    Exactly. When we set our inpatients up with follow-up appointments upon discharge, we are routinely having to wait 3 months before they can get in somewhere. This is for people who are sick enough to have required hospitalization. And here I am having to write for a three month supply of meds for these acutely ill folks, many of whom just overdosed on meds. (Yes, I do write them for short supplies with refills, but it's just not ideal on so many levels.) We need more psychiatrists for sure. But if NPs can help ease that burden, then I'm all for it. I don't think we're going to be out-competed any time soon.

    I also had one of my old outpatients call me recently to ask if I had gone back into private practice. She didn't think I had, but she was getting desperate. In the 9+ months since I closed my practice, she hadn't managed to get in anywhere. She's on waiting lists at a couple of mental health centers and her PCP has continued to write what she was getting from me, but she hasn't seen a psychiatrist in over 9 months. And this is a chronically ill patient. And this isn't rural America either. It's in a metropolitan area famous for its health care with a top 10 psychiatric hospital.
     
    #10 sunlioness, Aug 1, 2011
    Last edited: Aug 1, 2011
  12. zenman

    zenman Senior Member
    7+ Year Member

    Joined:
    Apr 1, 2004
    Messages:
    2,183
    Likes Received:
    14
    I think there's plenty to go around. I'm in New Mexico and I've been extended twice now in my locums job. Feel free to come relieve me so I can head up to Northern New Mexico or next door to Arizona.:D

    The only reason I'm considering private practice is to combine psych and shamanism. And then a locums shrink shows up who has also trained in shamanism. This town ain't big enough for both of us. No worries as I'm looking for a place with more population and things to do.
     
    #11 zenman, Aug 1, 2011
    Last edited: Aug 1, 2011
  13. Karen Shelton

    Karen Shelton DNP Student

    Joined:
    Jul 28, 2011
    Messages:
    15
    Likes Received:
    1
    Status:
    Other Health Professions Student
    Zenman,

    I find the combination of psychiatry with shamanism to be an interesting combination and one that would uniquely position you to deal with the specific cultural aspects of care within the Native American population (which I am sure is just as prevalent in New Mexico as it is in Arizona).

    How has this influenced your personal philosophy in the delivery of care both personally and professionally? I am part Cherokee but sadly have no "roots" in my own culture and my knowledge regarding shamanism is severely lacking and based mostly on pop culture and exposure to films (which we all know are good representations of these sorts of things...not).

    And, I would love to see New Mexico and "relieve" you in the future. :)
     
  14. zenman

    zenman Senior Member
    7+ Year Member

    Joined:
    Apr 1, 2004
    Messages:
    2,183
    Likes Received:
    14
    My training in shamanism as well as Asian medicine allows me to look at a person from several different viewpoints. This is beneficial because if one doesn't work, the others might.

    I'm not impressed with Southern New Mexico, however I recently went to Santa Fe and could park myself there. Still want to check out AZ though. I'm licensed there and about to get credentialed with Megellan.
     
  15. Sneezing

    Sneezing Even Bears do it!
    2+ Year Member

    Joined:
    Jan 27, 2009
    Messages:
    598
    Likes Received:
    8
    Status:
    Resident [Any Field]
    I have a hard time believing shamanism has a role of being integrated with psychiatry. Other than being aware of cultural values to better understand a local population I fail to see how anyone presenting themselves as a professional can advocate shamanistic treatment.
     
  16. whopper

    whopper Former jolly good fellow
    Physician Faculty 10+ Year Member

    Joined:
    Feb 8, 2004
    Messages:
    6,691
    Likes Received:
    1,399
    Status:
    Attending Physician
    While I agree with you (I think) Sneezing, I think many who want a psychiatrist to be at least open to something like shamanism would be shunned or at least find a psychiatrist who didn't know much about it.

    So if a psychiatrist mentions he has an interest in it, it could be enough for someone with a similar interest in need of a psychiatrist to look to that psychiatrist first.
     
  17. nitemagi

    nitemagi Senior Member
    Physician Faculty 10+ Year Member

    Joined:
    Oct 15, 2001
    Messages:
    2,820
    Likes Received:
    859
    Status:
    Attending Physician
    These threads about whether Psychologists, RxP's, NP's, and neurologists will make psychiatry obsolete are getting tired.
     
  18. sunlioness

    sunlioness Fierce. Proud. Strong
    Physician 10+ Year Member

    Joined:
    Feb 23, 2007
    Messages:
    1,535
    Likes Received:
    765
    Status:
    Attending Physician
    I actually do find it fascinating and have read about it, but don't think my psychiatric training qualifies me to be one. Not that anyone is saying it does. But given how "shamans" (that term actually is generally not how indigenous healers refer to themselves) are such an integrated part of their cultures, I don't really understand how people not of the culture can learn the practices in any sort of meaningful way. I'm kinda wary of the "plastic shaman" phenomenon where people think they can gain mystic healing powers by attending a few weekend workshops, or doing a few hallucinogenic drugs, or by building a sweat lodge in their backyards. Am I saying that every person not raised in a culture where this is an accepted and respected role is a quack (even if an unknowing one who genuinely believes in what they're doing)? No, I don't know that. But I think you have to be really really careful.

    So I wouldn't ever call myself a shaman. I have no interest in trying to become one. I wouldn't refer to a shaman (don't really feel qualified to do that either and would want to see hard data as to its efficacy before recommending it), but I think I'd be an open-minded listener if my patients wanted to talk/ask about it.
     
    #17 sunlioness, Aug 10, 2011
    Last edited: Aug 10, 2011
  19. Karen Shelton

    Karen Shelton DNP Student

    Joined:
    Jul 28, 2011
    Messages:
    15
    Likes Received:
    1
    Status:
    Other Health Professions Student
    Dr. Sneezing,

    Sigh...I would say more but I am engaging my mouth edit. Where did that "easy" button go?!
     
  20. Karen Shelton

    Karen Shelton DNP Student

    Joined:
    Jul 28, 2011
    Messages:
    15
    Likes Received:
    1
    Status:
    Other Health Professions Student
    agreed...
     
  21. zenman

    zenman Senior Member
    7+ Year Member

    Joined:
    Apr 1, 2004
    Messages:
    2,183
    Likes Received:
    14
    You are wise to have a jaundiced eye as there are tricksters everywhere. But it's not one culture. People all over the world, without benefit of chatting with each other, came up with the core principles. it may be awhile before you see any hard data, although there are a few people, Dr. Gob at UCLA for example, who is working with psychedelics, including ayahuasca. I do have a lot of graduate papers on the integration of psychology and shamanism.

    This may also explain why you may not see any hard data: http://www.salkawind.com/Writings/TheRealHeart.pdf

    I was blown away by the number of physicians and mental health people involved in shamanism. There may be one next to you, lol.

    Let's see...Roger Walsh, M.D. has written a few books...Rick Strassman, M.D.. Bradford Keeney, Ph.D., famous psychologist, is a full blown shaman who trained with Kalahari bushmen.

    Here's a couple more links if you wish:

    http://www.kittyfarmer.com/donald.html

    http://www.shamansociety.org/directors.html

    http://www.woodfish.org/about.html

    http://www.dralcorn.us/index.htm

    http://www.healing-arts.org/mehl-madrona/index.htm#intro

    http://www.davidcumes.com/

    I'll be in the Amazon with Shipibo shamans most of this December if you want to have some fun!

    Here, I'll add this on ayahuasca..http://iceers.org/ethnobotanicals/ayahuasca/sources.html
     
    #20 zenman, Aug 10, 2011
    Last edited: Aug 10, 2011
  22. sunlioness

    sunlioness Fierce. Proud. Strong
    Physician 10+ Year Member

    Joined:
    Feb 23, 2007
    Messages:
    1,535
    Likes Received:
    765
    Status:
    Attending Physician
    Hi Zenman,

    Thanks for the links. We should probably start a new thread if anyone is interested in discussing this further. I've actually read Walsh's book and found it really interesting. Especially how he debunks the whole mental illness = shaman in other cultures thing. I've also read Harner and Ingerman and while I found their writings interesting, I do have some doubts about "Core Shamanism" having any real meaning on its own outside of a specific cultural context. I've read Eliade, too, but that was slow going and I don't really remember a lot about it. I also find things like this concerning: http://puffin.creighton.edu/lakota/war.html

    Anyway, I will try to check out those links when I have time. One thing I've always wondered though about psychiatrists and therapists who incorporate this kind of work into their practices is if it limits their ability to have affordable liability insurance. I know that insurers do ask about alternative practices.

    Thanks again for the info!
     
  23. zenman

    zenman Senior Member
    7+ Year Member

    Joined:
    Apr 1, 2004
    Messages:
    2,183
    Likes Received:
    14
    Maybe a mod can move these posts over to a new thread. Core shamanism is from Harner's group and is a collection of techniques. I'm from Villoldo's camp. He has the techniques also, some created to mesh more with modern society, but primary difference is we are given direct lineage from the Q'ero Indians. They had visions the new shamans would come from the West so they came down out of the mountains to teach. They were untouched by the Spanish invaders. But "techniques" are just that. Some I use; some I don't. Sometimes I'm guided to do something else.

    I see you have a lion avatar. But are you surrounded by regular cats?
     

Share This Page