Many of the NPs seem to get fired or quit rather quickly from what I've seen though, and often refuse to take complex cases, so I don't know how big of a long-term impact they'll have. Some of the better ones from good programs are great but many come out of online programs where they arranged their own lackluster rotations and they really don't know much
I've seen this turn over in a lot of places with NPs, mainly because they see their work as shift work, clocking in, and gigs. I can't blame them, because these clinics hire them to replace physicians and very few want to work the physician lifestyle, despite expecting to be treated like one.
Thankfully there's many things they simply cannot legally do or be reimbursed for, such as ECT, TMS, commitment hearings, etc. And we can always peace out of the insurance market and work for ourselves with very little overhead. Many of the positions that had tried hiring NPs either had them quit or fired them where I was before and brought doctors back on because the NPs weren't working out for various reasons. It's very likely psych NPs will end up like many NPs in other fields- unable to find full-time practitioner work and forced to stay on doing part-time RN work due to saturation at the midlevel. Given all of that, I think we've still got at least 15 years before things really get concerning, if even then. And by concerning, I mean for people out of the gate looking for employed positions- experienced psychiatrists can easily start their own private practice and build it up before the system saturates.
I suspect this is very regional. I've seen clinics and inpatient units be completely replaced with NPs in my area. You get the turn over still, but these places rarely care about the quality of psychiatric treatment, so continuity is meaningless. I've even watched and seen them hire 2 NPs at a greater overall expense to do the work of one psychiatrist. I genuinely have no idea why that happens. In my region though, they also open up their own clinics, run ketamine infusion clinics and "integrative" clinics where they sell supplements. Quality of care between the CMHCs vary significantly based on management, where newer psych grads will actually care and employ midlevels with supervision, whereas the older psychiatrists or non-psychiatrists never seem to care about quality or supervision.
Barrier to becoming an NP is so ridiculously low with these online programs... They should have to go to school for it. Forgo their nursing salary for 1.5-2 years to get an advance degree like CRNA.
But ofc they lobby for "shortages" in middle-of-nowhere for new grads to open up med spa and psych PP in a nice city.
It's honestly very disturbing. Some NP programs boast 100% acceptance rates and I've seen multiple NPs that work fulltime as RNs while getting their PMHNPs online. They basically spend at most a couple hours a day on the curriculum, have someone they know let them shadow, then they get their hours signed off.
I agree with
@Mad Jack that I've worked with some good ones that know their limits, but sometimes even they surprise me every once and a while. Not to mention the sheer variability in quality is in insane, at best they're OK, but the majority I've seen I can't tell what they were thinking.
I'm currently getting a bunch of patients from one that was working for a couple years at this clinic. For some patients, they hadn't had metabolic labs checked the entire time despite on neuroleptics (some weren't actually taking them, despite carrying an array of diagnoses that contradicted each other - and clearly having SUD and personality disorders), others paradoxically were stuck on subtherapeutic SRI doses despite having genuine poorly controlled OCD and answering negative to being asked if they ever had tried or been offered higher doses (no evidence of it in documentation), and then others just seemed to have weird boundary expectations based on the way she did things. I genuinely think in some cases they just aren't taught how to manage psychiatric patients and make it up as they go along, rather than actually seek education/advice on it.