psych np's taking over

[vistaril]

Somebody earlier--maybe Billy--pointed out that V extrapolates the lowest common denominator of our field and holds it up as the best it has to offer someone. I agree with that. But I also recognize that it's quite possible for someone to come away from a clerkship with that impression. My psych department has some good doc's but also has inspired a similar experience from my colleagues.

It's dismaying. And concerning.

But I still think an individual can create the space for themselves to engage more rigorously, to look for opportunities to elevate their service, and in short to be the person they want to be.

Not only does it reflect on the program's culture but also the individual to prostrate themselves in failure and worse to propagate that choice as some kind unalterable fate of making the choice to be a psychiatrist.

oh no the 'lowest common denominator' i see plenty of in the community at my other jobs.....unfortunately, this isn't that uncommon. It represents the psychiatrists who quickly dx everyone with bipolar d/o and have them on 2-3 mood stabilizers, an atypical, a z-drug, a benzo, 1-2 antidepressants, and +/- on a stimulant. that is the lowest common denominator out there in the community and it is not that uncommon.

I do agree that an individual can always engage more rigorously and do better work. That's true in anything of course. the downside, though, is that in psychiatry we are hindered from doing this in a lot of ways by issues larger than ourselves. But yeah, there are still ways you can work towards that if you are creative.

The field of psychiatry(or any field really) is ultimately judged on what happens day to day in the community. What the typical practioner out there is doing. What the evidence base for what the typical practioner out there is doing. It's not judged by what some academic psych researcher is doing with setting up another ketamine or tms study.

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[hamstergang]

In fact, many med students tell me that before the rotation they actually felt there was more of an overlap with medicine and viewed psychiatrists more as 'real doctors' than they do afterwards.

Meh, my students have told me the opposite. Maybe the field itself isn't to blame, then? Or my students were just trying to make me feel good...

 

[534455]

lol...I haven't seen you try to defend one of your 'points' yet. otoh, I'm always happy to answer questions directly....for example earlier you or something else asks me who I was(with an expletive thrown in). I've been very clear who I am....I am a pgy-4 psychiatry resident in the northeast. Who are you?

Touche Vistaril. Given the high number of posts in a 24- hour period to multiple threads by Journey Agent, it's pretty clear the following:

he can't possibly be a medical student. Do you have that much time to post 10-15 posts a dy on one to two threads?
His tact is just to flame, shout, get attention. Since you are doing a PGY 4 Psychiatrist Residency, would it be fair game to call the Journey Agent an Axis II disorder?
More importantly, I find the "ignore" button a lifesaver. It separate that chaff from the wheat. You are wheat, especially as a learned PGY4 Psych Resident. The Journey Agent poster is probably an adolescent who bounces around causing flame and wars.

I clicked on his profile name and will no longer see his ranting posts.

More importantly, tell me about your. How do enjoy your PGY 4 Residency?

I am looking forward to my Intern Year and then Residency.

check my blog: http://roadlesstraveledmd.wordpress.com/

I'd like your input as a more mature, experienced PGY 4 Resident.

Thanks

 

[PikminOC]

Have you seen the number of posts by Vistaril? With his 'grinding' and moonlighting and what not, how does he have time to post about his BM's on SDN?

 

[SpecterGT260]

Have you seen the number of posts by Vistaril? With his 'grinding' and moonlighting and what not, how does he have time to post about his BM's on SDN?

Probably while doing them. SDN mobile



Sent from my DROID using SDN Mobile

 

[madglee]

Well guys, here it is 2+ years later from my original response. I understand the frustration of psychiatrists and other MD's (or even DO's, which didn't you guys just recently accept as 'physicians?') regarding our practice. I read over most of the comments over the last two years. Sure, physician has been the "gold standard" for many years, but that is changing as the public becomes more aware. No nurse is trying to practice medicine. I suppose the bottom line is, I could have been a physician and had the MCAT and grades to get in - in fact, I was admitted to Stanford. I chose NP. There is no argument that one is better than the other. The only argument is that NP's aren't fit to act as primary care and must be supervised by an entirely different field. Obviously, I disagree, or would not have gone into the program I did.

Many of my very good friends are psychiatrists and I respect them as they respect me. It's really all about the patient and making sure their quality of life is as good as it can be. For those who messaged me, trying to decide on a career path, the best advice I can give is that if you choose NP, you will be in a transitioning environment where NPs are treated much like DOs in the early days of their existence. It is far more difficult to work without interference in the US, and impossible except in a small number of exceptions worldwide (same is still true for DOs, I think).

You can't make as much money or get as much respect, if that matters, but it's close enough that it shouldn't (and is changing daily with public perception increasingly shifting towards outcome rather than licensure), as long as your focus is on making your patients' lives better.

Oh, and by the way, we now have our own nomenclature. NPs in Psychiatry are now known as neuriatrists, which is nice.

 

[digitlnoize]

Oh, and by the way, we now have our own nomenclature. NPs in Psychiatry are now known as neuriatrists, which is nice.

I have no words. Wow.

 

[vistaril]

I have no words. Wow.

yeah, that last part is absolute lunacy/nonsense......but most of the rest of the post was spot on.

 

[notdeadyet]

Oh, and by the way, we now have our own nomenclature. NPs in Psychiatry are now known as neuriatrists, which is nice.

That term is probably a long way from anything resembling "nomenclature."

Google "neuriatrist" and you get 5 hits. The first two are from an 1895 text. I'll grant you that the third is from JAMA, but it's from 1914. In fact googling "neuriatrist" only shows one reference in which it's used to refer to a Psych NP.

So congrats. With your post on this page, you've literally doubled the presence of the term on the Internet....

 

[xlithiumx]

Oh, and by the way, we now have our own nomenclature. NPs in Psychiatry are now known as neuriatrists, which is nice.

This is pretend.

 

[SteinUmStein]

Wait don't make fun of the neuriatrist thing. It would be fun if NPs started introducing themselves as neuriatrists. PM&R docs still can't get people to figure out the physiatrist thing...

 

[madglee]

Yeah, I saw the same JAMA article. Thank god it's been recycled. Ask the ANA, or the AANP, this is not a troll thread. I was trying to be respectful and explain that every advanced degree who is trying to help people deserves respect. I have the utmost respect for physicians and I hope that I will be treated the same.

 

[madglee]

yeah, that last part is absolute lunacy/nonsense......but most of the rest of the post was spot on.

You're right, that was some nonsense, but I do hold that nomenclature would help advance the profession. No one is trying to replace what a physician brings to the table. Everyone knows it is substantial and well-respected and relevant and integral. I just think that other practitioners trying to also be effective clinicians should be a laudable effort, not a source of competition. As I age chronologically, I feel less of the sort-of defensive, antagonistic defensive positions and more of the 'how can we seriously help by preventative measures' philosophy. That sounds more "CAM" than I mean it to be, but still.

 

[madglee]

That term is probably a long way from anything resembling "nomenclature."

Google "neuriatrist" and you get 5 hits. The first two are from an 1895 text. I'll grant you that the third is from JAMA, but it's from 1914. In fact googling "neuriatrist" only shows one reference in which it's used to refer to a Psych NP.

So congrats. With your post on this page, you've literally doubled the presence of the term on the Internet....

Nice. Did you used to lose to the "1 million dollars or I will double a penny on the chessboard, your choice" type scams in the 80's?

 

[Tyrone Slothrop]

As I age chronologically, I feel less of the sort-of defensive, antagonistic defensive positions and more of the 'how can we seriously help by preventative measures' philosophy. That sounds more "CAM" than I mean it to be, but still.

Were you aging haphazardly before? Putting that aside, it's wonderful that you don't see a need to feel defensive.

You do have to consider the dynamics of these types of situations, though. The man in the castle has to concern himself with defense. The peasantry at the gate tend to be in a more acquisitive state of mind.

 

[madglee]

Were you aging haphazardly before? Putting that aside, it's wonderful that you don't see a need to feel defensive.
You do have to consider the dynamics of these types of situations, though. The man in the castle has to concern himself with defense. The peasantry at the gate tend to be in a more acquisitive state of mind.

Let's not even start talking about aging, and time, and the difference between molecular degradation and actual aging. That may be more of a nursing, rather than medical understanding of existence.

I do find it hilarious, though. Generally fear is expressed with defensive, condescending words. Much like bullying. Tons of yipping and yapping with nothing behind it. One can only hide behind history's folly for so long before the questions start, even with nearly endless vaults.

I do imagine the NPs as peasantry. I like it. Now you're really coming from the old priesthood, don't need to wash one's hands, let's put the leeches on people, and don't forget the 50's, when "water therapy" and "frontal lobotomy" seemed reasonable. Always trust the "doctors."

Damn it, now I stooped to arguing on a forum with a faceless person who may or may not be a physician.

Yet there shouldn't a competition. There is no meal ticket being stolen. I don't think the established AMA actually believes there is. Some individuals might, but most of the block to change comes not from idealistic med students, but an established plutocracy bent not on patient well-being, but chronic illness.

 

[Shikima]

Let's not even start talking about aging, and time, and the difference between molecular degradation and actual aging. That may be more of a nursing, rather than medical understanding of existence.

I do find it hilarious, though. Generally fear is expressed with defensive, condescending words. Much like bullying. Tons of yipping and yapping with nothing behind it. One can only hide behind history's folly for so long before the questions start, even with nearly endless vaults.

I do imagine the NPs as peasantry. I like it. Now you're really coming from the old priesthood, don't need to wash one's hands, let's put the leeches on people, and don't forget the 50's, when "water therapy" and "frontal lobotomy" seemed reasonable. Always trust the "doctors."

Damn it, now I stooped to arguing on a forum with a faceless person who may or may not be a physician.

Yet there shouldn't a competition. There is no meal ticket being stolen. I don't think the established AMA actually believes there is. Some individuals might, but most of the block to change comes not from idealistic med students, but an established plutocracy bent not on patient well-being, but chronic illness.

You're right, there is no meal being stolen. The real fear is legislation and reduced reimbursements on physicians. NP/PAs are needed to work in collaboration and there are significant roles for all within a collaborative practice environment.

 

[MLT2MT2DO]

(or even DO's, which didn't you guys just recently accept as 'physicians?') .

Yeah I believe it was just last Saturday that this happened.

Sent from my KFTT using Tapatalk HD

 

[Armadillos]

Its all fine and well for non-physician mental health providers to bash physician's approach to mental health, thats your opinion.

But expect to start raising some eyebrows when one day your saying physicians are doing it wrong, then the next day saying "By the way, I need to be able to prescribe all those same medications the physicians use"

If you really believe physicians are doing it wrong (as several of your posts above seem to imply) then why in the world would you want to use all these physician developed treatments?

 

[hamstergang]

No nurse is trying to practice medicine.

Why did no one else yet point out that this is obviously incorrect?

 

[@JackShephard]

What states do NPs have equal practice rights to physicians? Is there a list anywhere?

I laughed at this:

7. What do physicians think of Advanced Practice Psychiatric Nurses? Most physicians who have worked with Advanced Practice Psychiatric Nurses like having APPNs on staff. Studies done by the Federal Government have shown that APPNs, working with physicians, provide care that is comparable to physician care. The Eighth Report to the President and Congress on the Status of Health Personnel in the United States (released in 1992) states, "Advanced Practice Psychiatric Nurses have demonstrated their clinical effectiveness both in terms of quality of care and patient acceptance."

http://www.apna.org/

Edit: Hmm, may have found the answer - so all 50 states allow NPs to Rx?

Can Advanced Practice Psychiatric Nurses prescribe medications?

All fifty states and the District of Columbia authorize Advanced Practice Psychiatric Nurses prescribing if they are certified as a Nurse Practitioner. If a Clinical Nurse Specialist, APPNs are authorized to prescribe in 36 states.

 

[Tyrone Slothrop]

What states do NPs have equal practice rights to physicians? Is there a list anywhere?

From https://www.ncsbn.org/APRNS_Scope_of_Practice_FAQs_for_Consumers.pdf

22 states and DC allow NPs to diagnose
and treat without physician involvement: (AK, AZ, CO, HI, ID, IA, KY, ME, MI, MT, NH, NJ, NM, ND,
OK, OR, TN, UT, WA, WV, and WY.

only 13 of the 23 jurisdictions that allow autonomous practice by
NPs allow them to prescribe medications for diagnosis and treatment without the involvement of a
physician: AK, AZ, DC, ID, IA, ME, MT, NH, NM, OR, RI, WA, and WY

Especially interesting is this..

The APRN profession encompasses a wide variety of advanced nursing specialties; hence a wide
variety of scope of practice issues is associated with this profession. However, the main scope of
practice issue across all APRN specialties is independent practice. This means enabling APRNs to
provide direct patient care services without supervision by or forced collaboration with physicians,
whether the services are provided in a hospital, a private office, a clinic, an outpatient center, or a
patient’s home

Why did no one else yet point out that this is obviously incorrect?

Because it immediately gets met with language saying that we're focused on financial issues rather than patient care. The counter-argument is that perhaps to provide quality care NPs who want to practice independently should meet the same educational requirements in terms of clinical hours and examinations that are already in place for physicians. That argument is met with silence.

They have better lobbies and better language.

I do imagine the NPs as peasantry. I like it. Now you're really coming from the old priesthood, don't need to wash one's hands, let's put the leeches on people, and don't forget the 50's, when "water therapy" and "frontal lobotomy" seemed reasonable. Always trust the "doctors."

All advances in medicine have come through increasing education and knowledge. Every generation of physicians has endeavored to know incrementally more medicine than the generation before them. The ideal is a state of lifelong education and self-improvement. Passing on what knowledge you have, as it was passed to you. To borrow from the Bible; as steel sharpens steel so one man sharpens another. Modern medicine is a cathedral built by countless generations of physicians.

The objection to independent practice for NPs is your acute rejection of this ideal. You don't even want to meet the current standards of education and training, let alone improve on them. You either don't respect the work enough to feel it warrants the effort to bring yourself to the established standard, or you believe you've somehow cut a shorter path up the mountain. Regardless, it is a conceit and a vulgar one at that.

 

[@JackShephard]

From https://www.ncsbn.org/APRNS_Scope_of_Practice_FAQs_for_Consumers.pdf





Especially interesting is this..




Because it immediately gets met with language saying that we're focused on financial issues rather than patient care. The counter-argument is that perhaps to provide quality care NPs who want to practice independently should meet the same educational requirements in terms of clinical hours and examinations that are already in place for physicians. That argument is met with silence.

They have better lobbies and better language.



All advances in medicine have come through increasing education and knowledge. Every generation of physicians has endeavored to know incrementally more medicine than the generation before them. The ideal is a state of lifelong education and self-improvement. Passing on what knowledge you have, as it was passed to you. To borrow from the Bible; as steel sharpens steel so one man sharpens another. Modern medicine is a cathedral built by countless generations of physicians.

The objection to independent practice for NPs is your acute rejection of this ideal. You don't even want to meet the current standards of education and training, let alone improve on them. You either don't respect the work enough to feel it warrants the effort to bring yourself to the established standard, or you believe you've somehow cut a shorter path up the mountain. Regardless, it is a conceit and a vulgar one at that.

Thanks for the state list. I couldn't find it via google.

Interesting which states do what, and when they do it. I would love to see a timeline and/or the burden of psychiatric needs in those states to determine if that's why legislation moved in that way or if the nurses in general have great lobbying in those states.

 

[heyjack70]

nurses have the lobby to get their scope of practice legislated into place, plain and simple.

I think two avenues in the scope of practice and licensing of midlevel NPs that haven't been pursued aggressively enough are:

1. If advanced nursing wants to be on par with physicians, they should meet the same standard of training. Quit with the claims that they are practicing "nursing not medicine"; they are practicing medicine (even floor RNs and ED techs are practicing medicine, within their scope of practice, healthcare=medicine). The advanced nursing schools should be 4 years plus residency training, held to the same standard as physicians and they should take the same licensing examinations. And they really don't need a nursing board anymore, the board of medicine should be able to license them.

2. The original intent of NPs and PAs was to expand access to healthcare/medical care to rural areas and low income populations. We do not have a shortage of providers in affluent metropolitan areas, yet that is where the majority of healthcare providers (Physicians, NPs, PAs, etc) work. The midlevel degrees should be limited to practice in healthcare shortage areas.

Of course the objections would come rolling in from the nursing lobby. And the objections would do nothing but expose their goals of getting equal pay and equal status as physicians (despite less rigorous training, shorter duration of training, and less experience).

 

[IamPsychiatrist]

What is the lowest a psychiatrist salary could be driven down by these nurses?

Let's say there are tons of nurses out there...

150k? 125k?

I would imagine if psychiatrist salaries dropped to 125k and all other physicians continued to earn 200k+ then that prohibit the training of most future psychiatrists... like a exodus from training new MD psychiatrists. That would implode the specialty and then there would be even less people going into psych and an even larger shortage than there is today.

I can't imagine them dropping the psych salaries that low, so I guess they would increase the NP salaries higher?

We all have loans. When people have 250k in loans they need to earn some money.

For some reason I blame Obama!

 

[IamPsychiatrist]

nurses have the lobby to get their scope of practice legislated into place, plain and simple.

I think two avenues in the scope of practice and licensing of midlevel NPs that haven't been pursued aggressively enough are:

1. If advanced nursing wants to be on par with physicians, they should meet the same standard of training. Quit with the claims that they are practicing "nursing not medicine"; they are practicing medicine (even floor RNs and ED techs are practicing medicine, within their scope of practice, healthcare=medicine). The advanced nursing schools should be 4 years plus residency training, held to the same standard as physicians and they should take the same licensing examinations. And they really don't need a nursing board anymore, the board of medicine should be able to license them.

2. The original intent of NPs and PAs was to expand access to healthcare/medical care to rural areas and low income populations. We do not have a shortage of providers in affluent metropolitan areas, yet that is where the majority of healthcare providers (Physicians, NPs, PAs, etc) work. The midlevel degrees should be limited to practice in healthcare shortage areas.

Of course the objections would come rolling in from the nursing lobby. And the objections would do nothing but expose their goals of getting equal pay and equal status as physicians (despite less rigorous training, shorter duration of training, and less experience).

Physicians needs to start making the difference between MD and NP more clear. I'm all for having more patients served, but if they are making a crappy product and just putting anything out there while trying to gain equal rights, that's pretty much BS.

 

[SteinUmStein]

This precedes the Obama administration by many years. And psych is not the only field affected - far from it. Right now I don't think NPs are the largest factor driving down physician salaries, and it's too early to tell where the new normal will be when the dust settles. I do think future potential med students should weigh the pros and cons of their potential debt levels against the earning potential of the fields they are interested in, in the same way that I feel that college students need to weigh their undergrad debt with their career choices. Secondary ed majors should not be signing up for 80k in debt for example, and perhaps in the future students interested in primary care or other lower earning fields will need to look at whether those are viable options for their potential debt load. We have no magical guarantee that our future earnings will justify the debt we've taken on. Look at law school grads these days...

 

[TexasPhysician]

I thought it was interesting that a psych np started a patient on "prestique"....... Wonder what the pharmacist was thinking when he/she saw that?

 

[vistaril]

I thought it was interesting that a psych np started a patient on "prestique"....... Wonder what the pharmacist was thinking when he/she saw that?

honestly they probably thought to themselves what a stupid/unneeded medication that is in the first place and that contributed to their negative opinion of ps and psychopharm

 

[heyjack70]

How about a psych np who had a patient on 40 mg of Zydis. When I asked why he was on the dissolvable the np said, "I was worried he wasn't taking it." This was an outpatient who lived alone. He was the only one responsible for taking the meds, dissolvable or not. The np clearly understood that the dissolvable was useful for poor compliance, but it was completely lost on her that if the patient wasn't observed taking the pill, the fact of it being Zydis was completely irrelevant.

 

[vistaril]

How about a psych np who had a patient on 40 mg of Zydis. When I asked why he was on the dissolvable the np said, "I was worried he wasn't taking it." This was an outpatient who lived alone. He was the only one responsible for taking the meds, dissolvable or not. The np clearly understood that the dissolvable was useful for poor compliance, but it was completely lost on her that if the patient wasn't observed taking the pill, the fact of it being Zydis was completely irrelevant.

Im sure we could also go on and on about psychiatrists who do dumb things too........not to mention I know of bunches of psychiatrists in Atlanta right now who speak terrible English.

 

[IamPsychiatrist]

Im sure we could also go on and on about psychiatrists who do dumb things too........not to mention I know of bunches of psychiatrists in Atlanta right now who speak terrible English.

You speak terrible Engrish.

 

[vistaril]

You speak terrible Engrish.

perhaps but pts can at least understand and communicate with me. These psychs Im thinking of paients can't understand.....

 

[Tyrone Slothrop]

What is the lowest a psychiatrist salary could be driven down by these nurses?

Let's say there are tons of nurses out there...

150k? 125k?

I would imagine if psychiatrist salaries dropped to 125k and all other physicians continued to earn 200k+ then that prohibit the training of most future psychiatrists... like a exodus from training new MD psychiatrists. That would implode the specialty and then there would be even less people going into psych and an even larger shortage than there is today.

I can't imagine them dropping the psych salaries that low, so I guess they would increase the NP salaries higher?

We all have loans. When people have 250k in loans they need to earn some money.

For some reason I blame Obama!

While our own individual financial situations are obviously important to us, they aren't the real issue here. Market forces don't care about our individual debt, and we're all mature enough to have no expectations of "fairness". Neither is the issue psychiatry, family medicine, or anesthesiology.

The real thing at stake here is the idea of medicine itself. We're all the beneficiaries of centuries of medical tradition. Every generation of physicians has stood atop the shoulders of those who came before them. The truth is we're all probably overqualified for the work we do, but we should be. A surgeon doesn't really need to know very much pharmacology to do his work, and perhaps a psychiatrist doesn't need a knowledge of anatomy to do his. They should though, or physician is reduced to technician.

NPs are a symptom of the commodification of medicine. The idea that there is no holistic value in a full medical education, that medicine is simply a set of cheaply reproducible processes. From a short-sighted financial perspective that may well be true. For society and medicine however, the outcome seems less favourable. Medicine progresses by the pursuit and acquisition of knowledge. NPs don't seek knowledge; they seek parity without investment, reward without effort, and ultimately mediocrity rather than achievement. They want a short-cut because they can't apprehend that the path itself is the destination. These won't be the people who'll tend our garden.

I doubt there is much to really be done about any of this. Market forces will move to the tune of short-term profits, and politicians are only worried as far as the next election. Perhaps instead we'll create a two-tiered system of medicine. People who can afford better will see physicians, those who can't will see NPs. To me it seems like a tremendous sad step backwards.

 

[Tyrone Slothrop]

perhaps but pts can at least understand and communicate with me.

But do they regret it afterwards?

 

[Zenman1]

Medicine progresses by the pursuit and acquisition of knowledge. NPs don't seek knowledge; they seek parity without investment, reward without effort, and ultimately mediocrity rather than achievement. They want a short-cut because they can't apprehend that the path itself is the destination. These won't be the people who'll tend our garden.

I'm calling BS or total ignorance on this. I'm a well-paid Psych NP and I'm always seeking knowledge....

 

[Tyrone Slothrop]

I'm calling BS or total ignorance on this. I'm a well-paid Psych NP and I'm always seeking knowledge....

Are you in favor of requiring NPs to pass the same examinations as physicians? Do you think you should be required to complete a residency comparable in hours to a typical medical residency?

How many hours of psychiatry specific training did you complete beyond NP school? Do you think this is commensurate to the training of a residency trained psychiatrist?

Does it seem strange to you that the standard for independent practice and prescriptive authority have long been these examinations and course of training, but now the nursing board has created out of whole cloth a new objectively lower standard?

Please just answer honestly. Then tell me as a profession regardless of what you were seeking, what have you actually found? Is it knowledge and mastery or a short-cut to parity and renumeration?

 

[TexasPhysician]

I'm calling BS or total ignorance on this. I'm a well-paid Psych NP and I'm always seeking knowledge....

I believe the poster was more referring to the current NP educational system. The problem with the NP system is that there is a much wider degree of variation between different NP schools. Some provide minimal quality instruction and others are quite good. My thought is that nursing politics thrives on numbers and uses the numbers game to their advantage. This is smart politically, but my opinion is that it results in some much lesser quality results at institutions that provide education at the minimum level. The politics isn't pushing knowledge, just the bare minimum to increase their force. Thus many NP's require continued instruction through supervision. This was the original purpose, but now politics is trying to make NP practice independent after an education that was never originally meant to be independent. Unless the degree requirements drastically change to force much better education, I believe this independent practice results in a poor quality of care outside those NP's that have received continued supervision and education for many years post graduation.

I've attended a few nursing meetings, and I am always impressed by how political they are. They stress lobbying, donations, and public presence to force results. I wish physicians would do this, but we have no focus here.

In no way would I say that an individual poster on here (MD, PA, or NP) is not very intelligent or lacks the drive to seek knowledge. I don't personally know y'all. I've met NP's that are more intelligent than physicians, but I've also met too many that don't demonstrate quality care at a basic level.

If I were a quality NP, I'd be pushing to make the NP degree much more difficult to obtain through more rigorous and in-depth education. Just my thoughts.

 

[hamstergang]

If I were a quality NP, I'd be pushing to make the NP degree much more difficult to obtain through more rigorous and in-depth education. Just my thoughts.

So basically make NP school medical school?

 

[TexasPhysician]

So basically make NP school medical school?

If the goal is independent practice, yes.

If the goal is a well-trained practitioner with continued physician support, not medical school but still vast retooling to become more self-sufficient with life-long learning skills.

An NP with 5+ years experience I've worked with in residency needed to call the physician supervisor for the correct dose of Bactrim for UTI in an un-complicated patient at a FM clinic. My answer was not sufficient. This is why supervision exists, but basic things as this should be drilled into your brain during training.

 

[Tyrone Slothrop]

If the goal is independent practice, yes.

If the goal is a well-trained practitioner with continued physician support, not medical school but still vast retooling to become more self-sufficient with life-long learning skills.

I agree with you. The problem is though that it's a self-selecting group. People who purposefully seek out a path of less education, aren't the same people who'll support higher standards being placed upon themselves.

Like you said, nursing is a numbers game. Their organizations get support and donations by promising more authority and more compensation. If they start advocating for higher standards and longer training, that support will rapidly dry up. They also have to maintain the fiction of knowledge equivalence they've propagated. Their game only works while NP training is seen as a faster route to the same place. The closer it comes to actual medical training, the less attractive it seems.

I don't see a practical way for them to reverse their course. How do they mandate new standards without closing training programs? Can they de-accredit NPs who can't meet those standards? It sounds like organizational suicide.

 

[F0nzie]

I noticed that NPs aren't even touching independent practice in Neurology. We have oversimplified the practice of Psychiatry to 10 or so checklist symptom questions. Thanks DSM! Maybe release a cliff notes version so a high schooler can practice Psychiatry on the side. That way we can be sure we are ALL speaking the same language.

 

[Zenman1]

Are you in favor of requiring NPs to pass the same examinations as physicians? Do you think you should be required to complete a residency comparable in hours to a typical medical residency?

How many hours of psychiatry specific training did you complete beyond NP school? Do you think this is commensurate to the training of a residency trained psychiatrist?

Does it seem strange to you that the standard for independent practice and prescriptive authority have long been these examinations and course of training, but now the nursing board has created out of whole cloth a new objectively lower standard?

Please just answer honestly. Then tell me as a profession regardless of what you were seeking, what have you actually found? Is it knowledge and mastery or a short-cut to parity and renumeration?

Honestly, if I wanted to do what you had to do, I'd go to medical school and be a physician. Anytime you're making this type of argument you're just saying your route is the only path. I do think NPs need longer clinical hours. I seek knowledge and know from other training I'll never call myself a master although my staff used to call me that or "boss" when living in other countries, lol!

 

[Zenman1]

I believe the poster was more referring to the current NP educational system. The problem with the NP system is that there is a much wider degree of variation between different NP schools. Some provide minimal quality instruction and others are quite good. My thought is that nursing politics thrives on numbers and uses the numbers game to their advantage. This is smart politically, but my opinion is that it results in some much lesser quality results at institutions that provide education at the minimum level. The politics isn't pushing knowledge, just the bare minimum to increase their force. Thus many NP's require continued instruction through supervision. This was the original purpose, but now politics is trying to make NP practice independent after an education that was never originally meant to be independent. Unless the degree requirements drastically change to force much better education, I believe this independent practice results in a poor quality of care outside those NP's that have received continued supervision and education for many years post graduation.

I've attended a few nursing meetings, and I am always impressed by how political they are. They stress lobbying, donations, and public presence to force results. I wish physicians would do this, but we have no focus here.

In no way would I say that an individual poster on here (MD, PA, or NP) is not very intelligent or lacks the drive to seek knowledge. I don't personally know y'all. I've met NP's that are more intelligent than physicians, but I've also met too many that don't demonstrate quality care at a basic level.

If I were a quality NP, I'd be pushing to make the NP degree much more difficult to obtain through more rigorous and in-depth education. Just my thoughts.

NP schools have to met certain standards last time I checked. Improving those will always be a good thing. Personally, I've never been involved in any political activities except for pushing for the ability to carry my firearm/knife with me.

 

[Zenman1]

If the goal is independent practice, yes.

If the goal is a well-trained practitioner with continued physician support, not medical school but still vast retooling to become more self-sufficient with life-long learning skills.

An NP with 5+ years experience I've worked with in residency needed to call the physician supervisor for the correct dose of Bactrim for UTI in an un-complicated patient at a FM clinic. My answer was not sufficient. This is why supervision exists, but basic things as this should be drilled into your brain during training.

That NP was just dumb. I know that and I'm in psych.

 

[Tyrone Slothrop]

Honestly, if I wanted to do what you had to do, I'd go to medical school and be a physician.

Except you do want the position, you do want the authority and the financial reward. You just don't want the accountability and the rigor.

I understand. I've always wanted to be a pilot, I've just never wanted to go to flight school. You'd let me fly your plane, right? I've also always had an interest in being a vet, but again I just didn't want to spend all that time in training. You get it though, you'd let me treat your animals wouldn't you?

Luckily I don't have a lobby to engage in wish fulfillment on my behalf.

Anytime you're making this type of argument you're just saying your route is the only path.

No. I'm just saying that if you want to call something equivalent it should meet the same standards of performance.

 

[hamstergang]

I'm just saying that if you want to call something equivalent it should meet the same standards of performance.

So long as those are reasonable standards. To outsiders, doctors may seem over-trained for the sake of exclusivity. How can we convince them otherwise?

 

[johnhoedack]

I noticed that NPs aren't even touching independent practice in Neurology. We have oversimplified the practice of Psychiatry to 10 or so checklist symptom questions. Thanks DSM! Maybe release a cliff notes version so a high schooler can practice Psychiatry on the side. That way we can be sure we are ALL speaking the same language.

I've run into neurologists training their NPs how to do everything. It's coming, trust me. In that office they literally just randomly grabbed patients, there was no discrimination in who saw the doc and who saw the np.

 

[Armadillos]

At least around here NPs are pretty big in neurology, there is an entire epilepsy clinic where most of the work is done by NPs. Also the post-stroke clinic has a large NP presence as well.

 

[@JackShephard]

I noticed that NPs aren't even touching independent practice in Neurology. We have oversimplified the practice of Psychiatry to 10 or so checklist symptom questions. Thanks DSM! Maybe release a cliff notes version so a high schooler can practice Psychiatry on the side. That way we can be sure we are ALL speaking the same language.

It's the same with anesthesia. They oversimplified the simple cases and now anyone can do it.