3rd mid-level I've fired

[BurnENickcoles]

I'm worried that all the mid level puppy mills springing up are producing sub par clinicians. I've had to fire 3 mid-levels now due to incompetence, and one even went to Columbia! Fired the 3rd today.

Taking short-cuts, missing the 'big picture', over-testing.... it seems like it only takes about 20 or 30 patients before they really screw one up.

No more mid-levels for my practice.

---

Members don't see this ad.

 

[Paseo Del Norte]

I'm worried that all the mid level puppy mills springing up are producing sub par clinicians. I've had to fire 3 mid-levels now due to incompetence, and one even went to Columbia! Fired the 3rd today.

Taking short-cuts, missing the 'big picture', over-testing.... it seems like it only takes about 20 or 30 patients before they really screw one up.

No more mid-levels for my practice.

How is your hiring and interview process? With all the problems, you may want to look internally to your own hiring practices.

 

[zenman]

I'm worried that all the mid level puppy mills springing up are producing sub par clinicians. I've had to fire 3 mid-levels now due to incompetence, and one even went to Columbia! Fired the 3rd today.

Taking short-cuts, missing the 'big picture', over-testing.... it seems like it only takes about 20 or 30 patients before they really screw one up.

No more mid-levels for my practice.

Medical schools have also been doing the same. Listen to Paseo.

 

[sarjasy]

I'm worried that all the mid level puppy mills springing up are producing sub par clinicians. I've had to fire 3 mid-levels now due to incompetence, and one even went to Columbia!.

You mention mid-level puppy mills, but then say the last person you fired was from Columbia. Unless you think Columbia is a puppy mill, I don't understand how so-called puppy mills are causing your problem.

 

[njbmd]

I'm worried that all the mid level puppy mills springing up are producing sub par clinicians. I've had to fire 3 mid-levels now due to incompetence, and one even went to Columbia! Fired the 3rd today.

Taking short-cuts, missing the 'big picture', over-testing.... it seems like it only takes about 20 or 30 patients before they really screw one up.

No more mid-levels for my practice.

Can't imagine not having my great mid-levels in my practice. We have a strong team that has meshed together well.

How is your hiring and interview process? With all the problems, you may want to look internally to your own hiring practices.

Totally agree with this. I screened very carefully; found good people and pay them well. I also do not use NPs but only use PAs who are simply wonderful.

 

[zenman]

Totally agree with this. I screened very carefully; found good people and pay them well.

In one of my management positions, I developed a team hiring and interview system. 5-6 people would interview the person as a group, and the interviewee knew this up front. I developed questions geared to the needed position, whether it be managerial, technical, clerical, etc. At least one person on the group had to be from that same position. We would interview the person and score them. If one person had even an uneasy feeling about the person, they were dropped from consideration, no questions asked. Worked beyond our expectations.

Basically, if you are in charge, you are responsible for your own turmoils. Sorry, but that's management...or lack of it.

 

[Socrates25]

You mention mid-level puppy mills, but then say the last person you fired was from Columbia. Unless you think Columbia is a puppy mill, I don't understand how so-called puppy mills are causing your problem.

The Columbia DNP program is ABSOLUTELY a "puppy mill." Their freaking clinical training is only part time, 2-3 days of clinic or inpatient per week. The didactic is 100% online. They OPENLY ADVERTISE that you can work a full time 40 hour per week job in addition to the DNP and still graduate in 36 months.

This is supposed to be the "best of the best" DNP programs. What does that tell you about all the other third tier trash programs?

DNP education is an absolute joke.

 

[poresofkohn]

The Columbia DNP program is ABSOLUTELY a "puppy mill." Their freaking clinical training is only part time, 2-3 days of clinic or inpatient per week. The didactic is 100% online. They OPENLY ADVERTISE that you can work a full time 40 hour per week job in addition to the DNP and still graduate in 36 months.

This is supposed to be the "best of the best" DNP programs. What does that tell you about all the other third tier trash programs?

DNP education is an absolute joke.

>
>
I feel this response to the above quoted can be summed up by a scene from the classic cinematic tale, SPACEBALLS. I'll do my best:


Darkhelmet to Lonestar:
"I can't believe you fell for the oldest trick in the book! What a goof! Whats WITH YOU MAN!?! Come on! You know what?.....Here let me give it back to you. Oh look! you fell for that to...I can't believe it man!!!!

:troll:

 

[zenman]

The Columbia DNP program is ABSOLUTELY a "puppy mill." Their freaking clinical training is only part time, 2-3 days of clinic or inpatient per week. The didactic is 100% online. They OPENLY ADVERTISE that you can work a full time 40 hour per week job in addition to the DNP and still graduate in 36 months.

This is supposed to be the "best of the best" DNP programs. What does that tell you about all the other third tier trash programs?

DNP education is an absolute joke.

I want you to explain to me in a logical manner...well, you might need some help...how going part-time is a joke. Then I want you to explain to me why you fail to look at all the distance education research when you rely on research to guide your own practice.

If you don't provide a logical answer, when I graduate from my NP program here in a few months, I'm going to enrolll in a DNP program in your honor.

 

[FutureDoc4]

I want you to explain to me in a logical manner...well, you might need some help...how going part-time is a joke. Then I want you to explain to me why you fail to look at all the distance education research when you rely on research to guide your own practice.

If you don't provide a logical answer, when I graduate from my NP program here in a few months, I'm going to enrolll in a DNP program in your honor.

This was bating me so much I just had to bite. I will try to keep it short so people may actually read it:

Research shows that you need 10,000 hours of work to "master" something (I mean to truly be independent and master a field). Largely, this is what residency length of training was based on (does not even consider the time in medical school).

80 hrs a week x 52 weeks a year x 3-4 years (depending on specialty) = >10,000 hrs (this to guarantee competence in independent practice)

To logically explain why these programs are a joke you can look at a few factors:

1) The hours (whether full or part time), come no where close to 10,000 in training.

2) Although many subjects like biochemistry and anatomy may be learned through online coursework (I stress maybe--though there is a pushback against this... nothing can replace dissecting a cadevor for yourself to learn anatomy---hence, most reputable medical schools have not moved away to "technologically teaching of anatomy"). Hours in the clinical or hours in small groups working with preceptors on physical exam/hx taking skill cannot be replaced by online course work.

3) Now, the counterargument that is usually made is:

"Well, us nurses have lots of clinical hours of experience.... We have a masters before hand, and work in the hospital while we take classes part time."

The counter to this is very straight forward: Most nurses (not in a DNP program) will argue that nursing is SEPARATE from medicine. And they are proud of that fact (and they should be)--for example, the NANDA and nursing diagnosis. That training and experience isn't in medicine... it's in nursing.... two separate, albeit important fields. So, hours nursing are not/should not be "counted" towards time learning medicine.

Now, if you are going to argue that you were "practicing" medicine while you were nursing than I can't help you understand.

But, I am sure some of your physician preceptors would love to hear about that..... along with some lawyers who would be very "interested" in hearing how you practiced medicine without a license.

Okay, this was as short as I can keep it. There is more but I wanted to not overload people.

 

[AnnoyedByFreud]

This was bating me so much I just had to bite. I will try to keep it short so people may actually read it:

Research shows that you need 10,000 hours of work to "master" something

Cite.

 

[AegriSomnia]

http://74.125.155.132/scholar?q=cac...com/+10000+hours+expert&hl=en&as_sdt=40000000

http://ecmaj.ca/cgi/content/full/180/12/1272

 

[FutureDoc4]

Thanks AegriSomnia for doing my work for me

P.S. I am waiting for zenman to respond... and if he/she doesn't provide a logical answer.... well, actually, I am not expecting a logical answer.... just more "buzzwords" and propaganda.

 

[deleted6669]

I agree about the 10,000 hr concept in practice.
what about the residencies that are like this:
80hrs/week yr 1
70 hrs/week yr 2
50-60 hrs/week yr 3.

not uncommon.

are these folks not ready to practice when they graduate?

 

[FutureDoc4]

Well: with your numbers

80 x 52 x 1 = 4160
70 x 52 x 1 = 3640
60 x 52 x 1= 3120

= 10, 920 hrs

P.S. Even if you low balled 3rd year at 50 hrs a week (which I dont see many doing):
50 x 52 x 1 = 2600 (instead of 3120)

Total hrs = 10,400

This does not count 3rd or 4th year of medical school.

 

[zenman]

This was bating me so much I just had to bite. I will try to keep it short so people may actually read it:

Research shows that you need 10,000 hours of work to "master" something (I mean to truly be independent and master a field). Largely, this is what residency length of training was based on (does not even consider the time in medical school).

80 hrs a week x 52 weeks a year x 3-4 years (depending on specialty) = >10,000 hrs (this to guarantee competence in independent practice)

To logically explain why these programs are a joke you can look at a few factors:

1) The hours (whether full or part time), come no where close to 10,000 in training.

2) Although many subjects like biochemistry and anatomy may be learned through online coursework (I stress maybe--though there is a pushback against this... nothing can replace dissecting a cadevor for yourself to learn anatomy---hence, most reputable medical schools have not moved away to "technologically teaching of anatomy"). Hours in the clinical or hours in small groups working with preceptors on physical exam/hx taking skill cannot be replaced by online course work.

3) Now, the counterargument that is usually made is:

"Well, us nurses have lots of clinical hours of experience.... We have a masters before hand, and work in the hospital while we take classes part time."

The counter to this is very straight forward: Most nurses (not in a DNP program) will argue that nursing is SEPARATE from medicine. And they are proud of that fact (and they should be)--for example, the NANDA and nursing diagnosis. That training and experience isn't in medicine... it's in nursing.... two separate, albeit important fields. So, hours nursing are not/should not be "counted" towards time learning medicine.

Now, if you are going to argue that you were "practicing" medicine while you were nursing than I can't help you understand.

But, I am sure some of your physician preceptors would love to hear about that..... along with some lawyers who would be very "interested" in hearing how you practiced medicine without a license.

Okay, this was as short as I can keep it. There is more but I wanted to not overload people.

Well you might need 10,000 hrs in your case since we weren't talking about number of hours but "part-time" and "distance education."

1. Two people have to do 60 hours of clinical. One has to do it in one week. The other can do it part-time in two weeks. Does one have an advantage over the other?

2. Re distance ed, perhaps medical schools should look at the research and see if their programs need overhauling, at least for some courses. Might decrease your student loans. I did a traditional masters; now doing post-masters distance ed. I do psych and had to go in to do the hand's on patient interviewing and physical exams. Like I mentioned before some of my course references were online H & P's from medical school sites.

I would really like to do more clinical hours and I would like to do 40 hours a week. However, it's not our fault. The government does not pay hospitals to train us, nor give us a small salary. Therefore, we have to, in most cases seek out our own preceptors, and continue our work in order to survive. That's one reason we can only do so many hours a week...not overload our volunteer preceptors. I had to contract to do 12 hours a week and see 7 patients. Not my damn fault. But there is an advantage as I get to follow the patients longer versus rotating off in one month. Part-time for me means I can go home and really read up and research my patient's conditions and "lock it in" my brain versus scrambling so fast I can only retain half of what I did. And you wouldn't believe all the other stuff we have to do on top of that...all kinds of "learning experiences." Frankly, it would be easier for me to just knock out 40 hours a week at the hospital. I tried but didn't get anywhere with that one.

 

[smarttee88]

Can't imagine not having my great mid-levels in my practice. We have a strong team that has meshed together well.



Totally agree with this. I screened very carefully; found good people and pay them well. I also do not use NPs but only use PAs who are simply wonderful.

With all due respect, I am wondering why you prefer PAs over NPs, if for any reason at all.

 

[prairiedog]

With all due respect, I am wondering why you prefer PAs over NPs, if for any reason at all.

maybe ignorance ?

 

[Dwindlin]

maybe ignorance ?

Or maybe its because in general PA course work is actually medicine based instead of admin/nursing theories.

Their organizations are much less militant.

And they are regulated under the BOM instead of the BON.

 

[smarttee88]

Or maybe its because in general PA course work is actually medicine based instead of admin/nursing theories.

Their organizations are much less militant.

And they are regulated under the BOM instead of the BON.

Ahh, good point.

 

[Instatewaiter]

I would really like to do more clinical hours and I would like to do 40 hours a week. However, it's not our fault. The government does not pay hospitals to train us, nor give us a small salary. Therefore, we have to, in most cases seek out our own preceptors, and continue our work in order to survive. That's one reason we can only do so many hours a week...not overload our volunteer preceptors. I had to contract to do 12 hours a week and see 7 patients. Not my damn fault. But there is an advantage as I get to follow the patients longer versus rotating off in one month. Part-time for me means I can go home and really read up and research my patient's conditions and "lock it in" my brain versus scrambling so fast I can only retain half of what I did. And you wouldn't believe all the other stuff we have to do on top of that...all kinds of "learning experiences." Frankly, it would be easier for me to just knock out 40 hours a week at the hospital. I tried but didn't get anywhere with that one.

Ummm... med schools don't get money from the gov't to pay for our medical school rotations. The fact that your nursing schools can't get standardized education or legitimate clinicals just shows how substandard NP education is. That they make their students scrounge for clinical rotations on their own and then have no way to know if they were quality is an abomination.

 

[chimichanga]

...That they make their students scrounge for clinical rotations on their own and then have no way to know if they were quality is an abomination.

an angry murse practioner looking for a preceptor...

 

[Instatewaiter]

I'd precept. No doubt my patients would be more compliant if they knew that thing would come after them if they forgot their BP meds.

 

[zenman]

Ummm... med schools don't get money from the gov't to pay for our medical school rotations. The fact that your nursing schools can't get standardized education or legitimate clinicals just shows how substandard NP education is. That they make their students scrounge for clinical rotations on their own and then have no way to know if they were quality is an abomination.

I didn't say med schools got paid anything. Last I checked hospitals were getting money to train you.

Yes, while we might have to find our own preceptors the university may help us as they are doing down in my case. They carefully check out the preceptor and site and provide ongoing supervision of our progress and of each patient we see. So I not only have to please my preceptor, I also have to please my professor GODS who are also watching my every move. Are you happy now?

 

[jbar]

The hospital gets money from our tuition to support our rotations, not the government. I would be asking your school "if my tuition isn't going to pay people to precept me, what is my money going to during my clinical time." Also faculty at a med school have their career based in part on teaching medical students and residents. I'm sure they're here in part because they like to teach, but it's part of their job. They tend to get some financial support beyond what they bring in from patients because they are spending time teaching. If you want people to precept they should be getting paid.

 

[prairiedog]

The hospital gets money from our tuition to support our rotations, not the government. I would be asking your school "if my tuition isn't going to pay people to precept me, what is my money going to during my clinical time." Also faculty at a med school have their career based in part on teaching medical students and residents. I'm sure they're here in part because they like to teach, but it's part of their job. They tend to get some financial support beyond what they bring in from patients because they are spending time teaching. If you want people to precept they should be getting paid.

Financing residency programs
The Department of Health and Human Services, primarily Medicare, funds the vast majority of residency training in the US. This tax-based financing covers resident salaries and benefits through payments called Direct Medical Education or DME payments. Medicare also uses taxes for Indirect Medical Education or IME payments, a subsidy paid to teaching hospitals that is tied to admissions of Medicare patients in exchange for training resident physicians. Some argue that Medicare subsidies for training residents simply provide surplus revenue for hospitals which recoup their training costs by paying residents salaries (roughly $35,000 per year) that are far below the residents' market value. http://en.wikipedia.org/wiki/Residency_(medicine)

 

[Dwindlin]

Financing residency programs
The Department of Health and Human Services, primarily Medicare, funds the vast majority of residency training in the US. This tax-based financing covers resident salaries and benefits through payments called Direct Medical Education or DME payments. Medicare also uses taxes for Indirect Medical Education or IME payments, a subsidy paid to teaching hospitals that is tied to admissions of Medicare patients in exchange for training resident physicians. Some argue that Medicare subsidies for training residents simply provide surplus revenue for hospitals which recoup their training costs by paying residents salaries (roughly $35,000 per year) that are far below the residents' market value. http://en.wikipedia.org/wiki/Residency_(medicine)

While you're right that the government does pay for residents, jbar wasn't talking about residents. He/she was talking about 3rd/4th year medical students, which aren't paid for by the government. Read a little more closely before quoting wiki.

 

[prairiedog]

While you're right that the government does pay for residents, jbar wasn't talking about residents. He/she was talking about 3rd/4th year medical students, which aren't paid for by the government. Read a little more closely before quoting wiki.

Thanks for helping me understand how to use wiki! My point was about residents. I suspect if you were to investigate who pays for medical students you will also find a strong government influence as institutions do receive federal funds for training 3&4 the year medical students. The reimbursement does not cover the cost, but there are a number of reasons teaching hospitals have their staff documenting the number of hours medical students are spending with their medical staff

 

[Denatured]

This isn't rocket science.

Residents aren't reimbursed, so gov't pays for the hospital for their training. Med students aren't reimbursed so the school tuition pays the hospital for their training. NPs and PAs in a postgraduate program ARE reimbursed and get paid like a resident so the hospital makes their money that way. Soooo, no reason for the gov't to give the hospital money when they are already making it.

 

[FireCloud9]

Well: with your numbers

80 x 52 x 1 = 4160
70 x 52 x 1 = 3640
60 x 52 x 1= 3120

= 10, 920 hrs

P.S. Even if you low balled 3rd year at 50 hrs a week (which I dont see many doing):
50 x 52 x 1 = 2600 (instead of 3120)

Total hrs = 10,400

This does not count 3rd or 4th year of medical school.

Interesting... I didn't know residents worked all 52 weeks of the year. Makes me wonder how my wife's cousin, an MD, managed to spend the holidays at home during those years of residency....

 

[adayatatime]

I'm reading this whole thing with a grain of salt. The OP was banned. Perhaps his attitude is part of the issue here? If even 20% of all mid-levels in the U.S. are raving incompetents, one would think that the governing authorities would put a stop to licensing and see what could be done to bring everyone up to par.

 

[Charles_Carmichael]

Interesting... I didn't know residents worked all 52 weeks of the year. Makes me wonder how my wife's cousin, an MD, managed to spend the holidays at home during those years of residency....

Even if you cut down the residents' work year to 48 weeks/year, it's still far, far, far, far more clinical hours of training than NPs/DNPs receive. What do they receive again? Oh yea, between 500 to 1000 hours of clinical training total. No matter how you look at it, NPs/DNPs get less than 10% of the medical training that physicians get (now, we'll see how quickly someone says "but we're not practicing medicine, it's advanced nursing").

I'm reading this whole thing with a grain of salt. The OP was banned. Perhaps his attitude is part of the issue here? If even 20% of all mid-levels in the U.S. are raving incompetents, one would think that the governing authorities would put a stop to licensing and see what could be done to bring everyone up to par.

The problem is, there is not a single well-done study that compares NP/DNP and attending outcomes. There are a lot of bad studies that the nursing organization quotes often (which is concerning, since the NP/DNP curricula seems to contain several stats courses at many of the schools I glanced at). In addition to that, there would be no way to get approval for a good, long-term prospective study comparing NP/DNP and physician outcomes...it would be unethical to knowingly randomize patients into the NP/DNP arm of the study (I doubt any patient would even be willing to participate in such a study in the first place).

 

[FutureDoc4]

Interesting... I didn't know residents worked all 52 weeks of the year. Makes me wonder how my wife's cousin, an MD, managed to spend the holidays at home during those years of residency....

Geeez, one of the dumbest things I have ever read (this is tough to accomplish). My original response was "in response" to someone pointing out that "some" (though I know few) residents that work 50 hrs a week in third year.

This is still assuming only a 3 year residency (many are longer). The point is approaching the 10K hr mark is the goal through this process. Please, think before posting.

If it makes you feel any better:

48 weeks a year:

48 x 80 =3840
48 x 70 = 3360
48 x 60 = 2880

= 10080 hrs

If you substitute third year with 50 hrs a week, total is 9600 (VERY close to that bench mark)

This is assuming one of the shortest residencies (Rad Onc--5 years, neurosurgery 6 years (I think)). And very decent residency working hrs by third year, with one month off a year.

And again, NOT including any time in medical school, including 3rd and 4th year.

 

[bradt9881]

Even if you cut down the residents' work year to 48 weeks/year, it's still far, far, far, far more clinical hours of training than NPs/DNPs receive. What do they receive again? Oh yea, between 500 to 1000 hours of clinical training total.

If you are going to criticize the clinical training of a PA, at least get it right. 1000 hours? you have lowballed it by at least half, and show your inexperience doing so. I know for sure I did more than 25 weeks training. It was 61 weeks in length, and we did better than 40 hours a week (it was the same hours as the family medicine residents at Womack Army Medical Center) . Its nowhere close to the training of a physician, but at least be accurate....

 

[Therapist4Chnge]

There are a lot of bad studies that the nursing organization quotes often (which is concerning, since the NP/DNP curricula seems to contain several stats courses at many of the schools I glanced at).

Fancy course titles do not make a proper researcher. I would rather rely on traditional training and mentorship, particularly for sponsored work that can impact clinical practice and day to day patient care.

 

[Charles_Carmichael]

If you are going to criticize the clinical training of a PA, at least get it right. 1000 hours? you have lowballed it by at least half, and show your inexperience doing so. I know for sure I did more than 25 weeks training. It was 61 weeks in length, and we did better than 40 hours a week (it was the same hours as the family medicine residents at Womack Army Medical Center) . Its nowhere close to the training of a physician, but at least be accurate....

If you're going to criticize something I wrote, at least read what I wrote before jumping to conclusions and responding. I said absolutely nothing about PAs. Even the sentence of mine that you quoted has "NPs/DNPs" written in it. I don't know how you could've missed it. My entire post was regarding the NP/DNP training...not PA training. Seriously. Go back and reread it. I'm completely fine with PA training. It would be wise in the future to read someone's post and understand what they're talking about before wrongly chastising them.

Fancy course titles do not make a proper researcher. I would rather rely on traditional training and mentorship, particularly for sponsored work that can impact clinical practice and day to day patient care.

Oh, I completely agree. I was trying to say that NPs/DNPs continue to cite these flawed studies in their arguments and that this continual citation suggests they didn't even learn basic stats to analyze literature (even though several programs seem to have multiple stats courses as part of their curricula). I didn't mean to refer to the researchers themselves...I'm talking about those in the nursing community who continue to ignore/possibly not understand the flaws of those studies and hold them as total evidence to the equivalence/superiority of NPs/DNPs to physicians. Hope that clarifies what I was getting at.

 

[FireCloud9]

Geeez, one of the dumbest things I have ever read (this is tough to accomplish). My original response was "in response" to someone pointing out that "some" (though I know few) residents that work 50 hrs a week in third year.

This is still assuming only a 3 year residency (many are longer). The point is approaching the 10K hr mark is the goal through this process. Please, think before posting.

If it makes you feel any better:

48 weeks a year:

48 x 80 =3840
48 x 70 = 3360
48 x 60 = 2880

= 10080 hrs

If you substitute third year with 50 hrs a week, total is 9600 (VERY close to that bench mark)

This is assuming one of the shortest residencies (Rad Onc--5 years, neurosurgery 6 years (I think)). And very decent residency working hrs by third year, with one month off a year.

And again, NOT including any time in medical school, including 3rd and 4th year.

I was just calling out the hyperbole in that 52 week per year comment. One would hope that accuracy is part of all that medical training... specially for a doctor!

 

[bradt9881]

If you're going to criticize something I wrote, at least read what I wrote before jumping to conclusions and responding. I said absolutely nothing about PAs. Even the sentence of mine that you quoted has "NPs/DNPs" written in it. I don't know how you could've missed it. My entire post was regarding the NP/DNP training...not PA training. Seriously. Go back and reread it. I'm completely fine with PA training. It would be wise in the future to read someone's post and understand what they're talking about before wrongly chastising them.

fair enough. My apologies.

 

[Charles_Carmichael]

fair enough. My apologies.

No worries. I didn't mean to come off that harshly in my post. I apologize for that.

 

[Therapist4Chnge]

Hope that clarifies what I was getting at.

I was agreeing with you, though things can be lost in web posts. I get particularly frustrated about research competency because I've seen some piss poor studies get published with obvious design flaws. They get through because they are "sexy" findings, but people reading them don't know enough to read the findings under a very conservative lens.

 

[Manicsleep]

I have spoken to several members in our group and consensus (no studies here) is that PA training is superior to NP and they perform better.

That being said, I work with excellent NPs but we had them work on a contract basis for a couple of months before offering them a job.
We ended up hiring 2 out of 6 that actually worked here. 1 was horrible, 2 were mediocre and the 4th we offered but didn't take the job. In the mental health dept we have not been able to hire a PA.

PAs have much more consistency in other aspects of our group and we are looking to have the next person in mental health we hire be a PA. However, there seems to be more NPs available, at least locally.

What is the demand/supply for psych oriented PAs and what is a typical salary compared to an NP?

 

[core0]

I have spoken to several members in our group and consensus (no studies here) is that PA training is superior to NP and they perform better.

That being said, I work with excellent NPs but we had them work on a contract basis for a couple of months before offering them a job.
We ended up hiring 2 out of 6 that actually worked here. 1 was horrible, 2 were mediocre and the 4th we offered but didn't take the job. In the mental health dept we have not been able to hire a PA.

PAs have much more consistency in other aspects of our group and we are looking to have the next person in mental health we hire be a PA. However, there seems to be more NPs available, at least locally.

What is the demand/supply for psych oriented PAs and what is a typical salary compared to an NP?

There are relatively few PAs doing psych. Overall less than 1% of PAs work in Psych. There are a lot of reasons for this. Part of it is the generally poor reimbursement for mental health. Overall salaries are slightly below the average for PAs. Many PAs in psychiatry have a background in mental health as either social workers or psychologists. Also many of the PAs are hired to do medical management of patients on mental health units and may do relatively little primary psychiatry. More information can be found here:
http://www.aapa.org/images/stories/Specialty_Practice/Psychiatry08C.pdf

There are two PA post graduate programs in psychiatry which might be fertile ground for finding new hires. Also all PAs have to do a rotation in psychiatry. One way of finding hires is to contact the local PA program and offer to precept students. Make sure they understand that you are looking for students interested in mental health. This will allow you to test out a few and possible offer a job to one.

David Carpenter, PA-C

 

[Manicsleep]

There are relatively few PAs doing psych. Overall less than 1% of PAs work in Psych. There are a lot of reasons for this. Part of it is the generally poor reimbursement for mental health. Overall salaries are slightly below the average for PAs. Many PAs in psychiatry have a background in mental health as either social workers or psychologists. Also many of the PAs are hired to do medical management of patients on mental health units and may do relatively little primary psychiatry. More information can be found here:
http://www.aapa.org/images/stories/Specialty_Practice/Psychiatry08C.pdf

There are two PA post graduate programs in psychiatry which might be fertile ground for finding new hires. Also all PAs have to do a rotation in psychiatry. One way of finding hires is to contact the local PA program and offer to precept students. Make sure they understand that you are looking for students interested in mental health. This will allow you to test out a few and possible offer a job to one.

David Carpenter, PA-C

Thanks for the info.
We can't really allow precepting in our group. We work at a fast pace and we teach at a local university hospital for down/fun/teaching time.
Also, the NPs would probably flip out even though the person who is suggesting hiring PAs is nurse with an MBA.

 

[zenman]

Also, the NPs would probably flip out even though the person who is suggesting hiring PAs is nurse with an MBA.

What school are your NP's coming from? Not tooting my own horn but my psychiatrist preceptor wants to go into practice with me and even said he would trust me to treat his own family. I also just interviewed a psych NP for my final preceptorship, and they had me interview the medical director also. So now, not only do I have a great VA preceptor, I have a job waiting for me. They didn't even ask about my MBA

 

[adayatatime]

What school are your NP's coming from? Not tooting my own horn but my psychiatrist preceptor wants to go into practice with me and even said he would trust me to treat his own family. I also just interviewed a psych NP for my final preceptorship, and they had me interview the medical director also. So now, not only do I have a great VA preceptor, I have a job waiting for me. They didn't even ask about my MBA

I just dunno. Maybe they should amp up the NP curriculum with some cadaver lab and replace some of that nursing philosophy with a couple hard-care science units.

 

[jwk]

Thanks for the info.
We can't really allow precepting in our group. We work at a fast pace and we teach at a local university hospital for down/fun/teaching time.
Also, the NPs would probably flip out even though the person who is suggesting hiring PAs is nurse with an MBA.

You shouldn't care if the NP's flip out. Really. Who gives a crap if they do?

 

[Manicsleep]

What school are your NP's coming from? Not tooting my own horn but my psychiatrist preceptor wants to go into practice with me and even said he would trust me to treat his own family. I also just interviewed a psych NP for my final preceptorship, and they had me interview the medical director also. So now, not only do I have a great VA preceptor, I have a job waiting for me. They didn't even ask about my MBA

The NPs we do have are excellent but they want the next hire to be an NP. The PA wouldnt be working with them right away so its not a big deal. We do want them to be happy because we like them and they are good workers. However, the last 2 times we hired an NP it was kind of hit and miss. We have a few PAs working with our other specialties and they have been, with a couple of exceptions, very good (this is hearsay from my colleagues). They have also had a little bit of trouble with NPs and suggested that the MH side try hiring PAs.

 

[Charles_Carmichael]

I was agreeing with you, though things can be lost in web posts. I get particularly frustrated about research competency because I've seen some piss poor studies get published with obvious design flaws. They get through because they are "sexy" findings, but people reading them don't know enough to read the findings under a very conservative lens.

Gotcha.

That's what I thought, but I figured I should err on the side of explaining what I meant.

 

[studentinmich]

The Columbia DNP program is ABSOLUTELY a "puppy mill." Their freaking clinical training is only part time, 2-3 days of clinic or inpatient per week. The didactic is 100% online. They OPENLY ADVERTISE that you can work a full time 40 hour per week job in addition to the DNP and still graduate in 36 months.

This is supposed to be the "best of the best" DNP programs. What does that tell you about all the other third tier trash programs?

DNP education is an absolute joke.

Oh... I feel like a broken record. Thes programs are designed for MSN graduates to get their DNPs...they ALREADY are NPs....the DNP programs that are BSN to DNP programs are 3 &1/2 to 4 years long... this is comparing apples to apples....so If a NP with a MSN went back to get their DNP, then the program in some cases are online, and part time...

 

[zenman]

BMJ 2010;341:c3693
doi:10.1136/bmj.c3693

Doctors’ online learning programme is halted as part of government cuts

Government cuts have halted a programme to develop online learning packages in collaboration with the medical royal colleges.

Damn shame progress has to take a back seat to money....