Psychiatrist vs. Psych NP?

[BS81]

there is no reason it cant be both. Psychiatry is much easier to practice than surgery. Surgeons do feel that being a surgeon is much harder than being a psychiatrist.

As for cutting schizophrenics, Im not sure what you mean by "come crying"? They may do a capacity consult if warranted. Or they may ask for med recs if she is going to be in the hospital awhile and is unstable from a mh perspective. But I hardly see how thart equates to come crying....

I'm pretty sure surgeons think everything is easier than surgery.

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[snarfer]

I don't really care how they feel. They'll come crying to us just like everyone else when they need to cut a schizophrenic.

i've seen the most militant ED guys and orthopedists imploring psychiatry for help when any of their pts develop AMS or agitation. And yes, pre op and post op on pts with schizophrenia are quite difficult for them as well.

I try not to overgeneralize as I haven't met ALL surgeons or other MDs but I would think the first thing that comes to their minds at the mention of the word psychiatry would be "crazy" and not 'it's easy." But again, I can't say this is absolutely the case as I haven't met ALL/90%/97% of non psychiatrists or know how other psychiatry programs train their residents. I only trained at one residency and fellowship program.

 

[vistaril]

i've seen the most militant ED guys and orthopedists imploring psychiatry for help when any of their pts develop AMS or agitation. And yes, pre op and post op on pts with schizophrenia are quite difficult for them as well.

I try not to overgeneralize as I haven't met ALL surgeons or other MDs but I would think the first thing that comes to their minds at the mention of the word psychiatry would be "crazy" and not 'it's easy." But again, I can't say this is absolutely the case as I haven't met ALL/90%/97% of non psychiatrists or know how other psychiatry programs train their residents. I only trained at one residency and fellowship program.

where the heck are you guys training that other services freak out when their pts are "agitated"? Post that in other forums and you get laughed at.......agitation recs are not very difficult. When another service wants agitation recs, it's not a "oh my gosh how in the world do I handle this" consult, but more a snarky consult because they don't want to deal with it. Somehow I think other services would do about the same with agitated pts if they didn't have us coming.

and at some hospitals, psych is consulted for delirium/agitation very infrequently.....my fiance is a GI fellow and she has never consulted psychiatry for delirium/agitation.....no need as we arent going to tell her anything she doesnt already know. the only time she ever consults psych when she was on medicine is when a pt had attempted suicide and she needed a dispo. And in those cases she only consulted psych because she couldnt do a direct service to service transfer without an official consult. Regardless of what psych said, she wasn't going to let those couple pts go. If our psych said outpt, she told me she was just going to transfer them to another psych hospital. So even in some cases where good internists or whatever do consult us, it's not "for our recs" but more as just a formality that has to be done to get a pt moved.....

 

[nitemagi]

where the heck are you guys training that other services freak out when their pts are "agitated"? Post that in other forums and you get laughed at.......agitation recs are not very difficult. When another service wants agitation recs, it's not a "oh my gosh how in the world do I handle this" consult, but more a snarky consult because they don't want to deal with it. Somehow I think other services would do about the same with agitated pts if they didn't have us coming.

and at some hospitals, psych is consulted for delirium/agitation very infrequently.....my fiance is a GI fellow and she has never consulted psychiatry for delirium/agitation.....no need as we arent going to tell her anything she doesnt already know. the only time she ever consults psych when she was on medicine is when a pt had attempted suicide and she needed a dispo. And in those cases she only consulted psych because she couldnt do a direct service to service transfer without an official consult. Regardless of what psych said, she wasn't going to let those couple pts go. If our psych said outpt, she told me she was just going to transfer them to another psych hospital. So even in some cases where good internists or whatever do consult us, it's not "for our recs" but more as just a formality that has to be done to get a pt moved.....

Congratulations on your n=2 (you and your fiancee) experience. I'm sure that since you have your experience, and everyone else here has theirs that contradicts yours, You must be right.

Agitation recs are requested because other services often don't know WHY the pt. is agitated (such as delirium, psychosis), or because their primary management doesn't work. A GI fellow I'm sure can read epocrates as well as anyone and guess how to dose a little risperdal. IN MY EXPERIENCE (a key caveat that can be inserted to soften generalizations Vist), many academic centers (the 4 hospitals in which I've worked) as well as multiple clinics where referrals come in from other providers still refer to psychiatry because they know they don't have the experience to manage a mental health issue WELL.

Again, raise your own bar. If you believe psych is too easy, then you're staying at a pretty superficial level of examining the problems at hand.

 

[vistaril]

Congratulations on your n=2 (you and your fiancee) experience. I'm sure that since you have your experience, and everyone else here has theirs that contradicts yours, You must be right.

Agitation recs are requested because other services often don't know WHY the pt. is agitated (such as delirium, psychosis), or because their primary management doesn't work. A GI fellow I'm sure can read epocrates as well as anyone and guess how to dose a little risperdal. IN MY EXPERIENCE (a key caveat that can be inserted to soften generalizations Vist), many academic centers (the 4 hospitals in which I've worked) as well as multiple clinics where referrals come in from other providers still refer to psychiatry because they know they don't have the experience to manage a mental health issue WELL.

Again, raise your own bar. If you believe psych is too easy, then you're staying at a pretty superficial level of examining the problems at hand.

as for the n= 2 comment, go over to the other forums(medicine, surgery, whatever) and see what they say about delirium/agitation.......you're very naive if you think the average GI person(just to pick one) is really freaking out when they have an agitated pt.....a lot of the times with a consult they just want us to do some of the busywork homework(like get old records to see if they have any previous psych hosp which may help management)

the medicine people who do say things to us like "you guys are so valuable" and "I don't know what I'd do without you" say those things to our face because it is the professional thing to do. If you really think they are saying those same things when they are in their cath and GI suites working together(without psych around), you're delusional......

As for raising my own bar, why? Just because psych isn't as hard as GI, surgery, etc doesn't mean I don't like it. I don't need to be stimulated all the time to enjoy my job.....I'm not the type of person who needs to feel like my job is as important or as hard as what most other physicians do, so it doesn't bother me that it's not.

On a similar note, reading some russian literary classic is "harder" than reading the latest carl hiassen book, but I prefer the latter......

 

[nitemagi]

you're very naive if you think the average GI person(just to pick one) is really freaking out when they have an agitated pt.....

Never said freaking out. You're just being dramatic to provoke.

a lot of the times with a consult they just want us to do some of the busywork homework(like get old records to see if they have any previous psych hosp which may help management)

the medicine people who do say things to us like "you guys are so valuable" and "I don't know what I'd do without you" say those things to our face because it is the professional thing to do. If you really think they are saying those same things when they are in their cath and GI suites working together(without psych around), you're delusional......

Or it's possible that the people in Your hospital don't respect You. And the rest of us do quite well with our colleagues.

Maybe it's your warm demeanor and sincere empathic style that has you getting along so well with your medical colleagues.

As for raising my own bar, why? Just because psych isn't as hard as GI, surgery, etc doesn't mean I don't like it. I don't need to be stimulated all the time to enjoy my job.....I'm not the type of person who needs to feel like my job is as important or as hard as what most other physicians do, so it doesn't bother me that it's not.

You raise the bar so you can see past the "even a monkey can do it" perspective. So you obviously endorse not really caring about doing a quality job, and that's fine. You shouldn't be crapping on people who want to take the work seriously and dig deeper that the superficial layer you inspect.

 

[BS81]

Never said freaking out. You're just being dramatic to provoke.


Or it's possible that the people in Your hospital don't respect You. And the rest of us do quite well with our colleagues.

Maybe it's your warm demeanor and sincere empathic style that has you getting along so well with your medical colleagues.


You raise the bar so you can see past the "even a monkey can do it" perspective. So you obviously endorse not really caring about doing a quality job, and that's fine. You shouldn't be crapping on people who want to take the work seriously and dig deeper that the superficial layer you inspect.

 

[vistaril]

Never said freaking out. You're just being dramatic to provoke.


Or it's possible that the people in Your hospital don't respect You. And the rest of us do quite well with our colleagues.

Maybe it's your warm demeanor and sincere empathic style that has you getting along so well with your medical colleagues.


You raise the bar so you can see past the "even a monkey can do it" perspective. So you obviously endorse not really caring about doing a quality job, and that's fine. You shouldn't be crapping on people who want to take the work seriously and dig deeper that the superficial layer you inspect.

I do just fine with my colleagues...in fact on several occasions I've had residents(and on two occasions attendings) page me wanting me to do a consult when I was off service. I told them I couldn't because it was against the rules, and they ended up not putting in the consult...

as for your last part, have no idea how you jumped to that conclusion. Certainly nothing in my posts indicates anything of the sort. I like my job and take it very seriously.

 

[nitemagi]

as for your last part, have no idea how you jumped to that conclusion. Certainly nothing in my posts indicates anything of the sort. I like my job and take it very seriously.

Really?

Here you simplify that basis of agitation as if all agitated pt's are psychotic or that all antipsychotics are created equal:

But even if a psychiatrist has no clue really what is going on, usually their med regimens might still overlap mostly with what a good psychiatrist would pick. It doesn't take a brain surgeon to figure out that most agitated agressive pts being admitted are on depakote and an antipsychotic....just pick one and you're not really going to stand out that much.

Here you specify on the simplicity of psychiatry compared to neurosurgery. As usual an oversimplication (different skillsets). And you call those that disagree "delusional":

the point being it is a *lot* harder and more difficult to practice neurosurgery than psychiatry. Any psychiatrist who doesn't feel that way is delusional frankly.

Here you write that psych residency is easier than most others, missing the difference between hour intensity and other intensity:

perhaps just look for the easy answer- a psychiatry residency is not as difficult as most others.

There's your evidence as to my comment. This in general shows a higher respect for other specialties and frankly not much respect for your own (assuming you are as you say a psych resident at all). Any idiot can do a symptom checklist, sure. Your simplification of "if they're agitated give them an antipsychotic" takes a superficial approach to mental health in general and is more akin to a medical students understanding of the field, neglecting the actual etiology of behavior. Unless you're a behaviorist in which case your approach would still be wrong. Your endorsement of these simplified interventions and minimal understanding of the complexity of an individual with mental illness essentially equates with You meeting your own definition of "subpar," here:

it seems to me that a large % of psychiatrists are, quite frankly, subpar.....at least compared to other fields in medicine. I think the reasons for this are as follows:

1) since the amount of hard ebm in psychiatry is far less than in anything else, people who are not practicing ebm in any way stand out less.

2) entrance standards in psychiatry are generally a good bit lower than other specialties. any american grad, no matter how they did in med school, will be able to find a residency somewhere in psychiatry. the bottom 5-10% of their med school class is likely to struggle to find a spot in moderately competitive fields like gen surgery, em, anesthesia, etc.....

3) let's be honest, if you're lazy(and some people are), psychiatry is a good fit. You can probably "get by" doing less in psychiatry than any other field.

4) If you're grossly incompetent, it's probably easier to "hide it" in psychiatry than any other field. A grossly incompetent surgeon's skills would be apparent to all in the OR. A grossly incompetent hospitalist would have pts decompensating much more frequently than other docs and be sending an abnormal number of pts to the micu. But even if a psychiatrist has no clue really what is going on, usually their med regimens might still overlap mostly with what a good psychiatrist would pick. It doesn't take a brain surgeon to figure out that most agitated agressive pts being admitted are on depakote and an antipsychotic....just pick one and you're not really going to stand out that much.

that sounds a little cruel, but thats how most people in medicine view it.

 

[vistaril]

Really?

Here you simplify that basis of agitation as if all agitated pt's are psychotic or that all antipsychotics are created equal:


Here you specify on the simplicity of psychiatry compared to neurosurgery. As usual an oversimplication (different skillsets). And you call those that disagree "delusional":


Here you write that psych residency is easier than most others, missing the difference between hour intensity and other intensity:


There's your evidence as to my comment. This in general shows a higher respect for other specialties and frankly not much respect for your own (assuming you are as you say a psych resident at all). Any idiot can do a symptom checklist, sure. Your simplification of "if they're agitated give them an antipsychotic" takes a superficial approach to mental health in general and is more akin to a medical students understanding of the field, neglecting the actual etiology of behavior. Unless you're a behaviorist in which case your approach would still be wrong. Your endorsement of these simplified interventions and minimal understanding of the complexity of an individual with mental illness essentially equates with You meeting your own definition of "subpar," here:

but where you fail is in equating respect with quality of care. Do I respect the average GI more than the average psych? gosh yes. That has absolutely nothing to do with the quality of the care I provide.

 

[priorities2]

Hi... so only about 20% of this thread has been used discussing the differences between psychiatrists and psych NPs. I hate to be greedy for information, but can anyone go into more detail about the differences in hospital duties in either an inpatient or outpatient setting between a psychiatrist and a psych NP?

 

[AnnoyedByFreud]

Hi... so only about 20% of this thread has been used discussing the differences between psychiatrists and psych NPs. I hate to be greedy for information, but can anyone go into more detail about the differences in hospital duties in either an inpatient or outpatient setting between a psychiatrist and a psych NP?

It's going to really depend on the state and the individual hospital's policy. I knew psych NPs who had full privileges at hospitals (and their own private practices) up in WA... but that state allows for independent practice. I'm not trying to open up a can of worms and launch this into a debate about NP independent practice, just trying to clarify that the amount of authority a NP has is highly variable.

 

[ghost dog]

Really?

Here you simplify that basis of agitation as if all agitated pt's are psychotic or that all antipsychotics are created equal:


Here you specify on the simplicity of psychiatry compared to neurosurgery. As usual an oversimplication (different skillsets). And you call those that disagree "delusional":


Here you write that psych residency is easier than most others, missing the difference between hour intensity and other intensity:


There's your evidence as to my comment. This in general shows a higher respect for other specialties and frankly not much respect for your own (assuming you are as you say a psych resident at all). Any idiot can do a symptom checklist, sure. Your simplification of "if they're agitated give them an antipsychotic" takes a superficial approach to mental health in general and is more akin to a medical students understanding of the field, neglecting the actual etiology of behavior. Unless you're a behaviorist in which case your approach would still be wrong. Your endorsement of these simplified interventions and minimal understanding of the complexity of an individual with mental illness essentially equates with You meeting your own definition of "subpar," here:

Let's not forget his altruistic " benzos for all " outpatient program:

http://forums.studentdoctor.net/showthread.php?t=923463

 

[snarfer]

where the heck are you guys training that other services freak out when their pts are "agitated"? Post that in other forums and you get laughed at.......agitation recs are not very difficult. When another service wants agitation recs, it's not a "oh my gosh how in the world do I handle this" consult, but more a snarky consult because they don't want to deal with it. Somehow I think other services would do about the same with agitated pts if they didn't have us coming.

and at some hospitals, psych is consulted for delirium/agitation very infrequently.....my fiance is a GI fellow and she has never consulted psychiatry for delirium/agitation.....no need as we arent going to tell her anything she doesnt already know. the only time she ever consults psych when she was on medicine is when a pt had attempted suicide and she needed a dispo. And in those cases she only consulted psych because she couldnt do a direct service to service transfer without an official consult. Regardless of what psych said, she wasn't going to let those couple pts go. If our psych said outpt, she told me she was just going to transfer them to another psych hospital. So even in some cases where good internists or whatever do consult us, it's not "for our recs" but more as just a formality that has to be done to get a pt moved.....

A better question would be where are you receiving your training? Your program sounds awful. Seems like your department PD and chairman do not teach the trainees to respect the field, themselves and their patients.

 

[priorities2]

It's going to really depend on the state and the individual hospital's policy. I knew psych NPs who had full privileges at hospitals (and their own private practices) up in WA... but that state allows for independent practice. I'm not trying to open up a can of worms and launch this into a debate about NP independent practice, just trying to clarify that the amount of authority a NP has is highly variable.

Okay, cool! What about the difference in duties though..? Do they generally have more or less the same job description regardless of independence?

 

[digitlnoize]

If you really think they are saying those same things when they are in their cath and GI suites working together(without psych around), you're delusional......

As someone who has spent a good bit of time in cath labs, I disagree. Never heard any doctor, except you and a few quacks out for publicity, disparage our field. Certainly not in a procedure suite.

I am beginning to think our friend vistaril isn't an actual physician, but a troll. I will be activating my ignore button when I get home and suggest everyone else do the same.

 

[vistaril]

As someone who has spent a good bit of time in cath labs, I disagree. Never heard any doctor, except you and a few quacks out for publicity, disparage our field. Certainly not in a procedure suite.

I am beginning to think our friend vistaril isn't an actual physician, but a troll. I will be activating my ignore button when I get home and suggest everyone else do the same.

eh...whatever, feel free to.

 

[vistaril]

A better question would be where are you receiving your training? Your program sounds awful. Seems like your department PD and chairman do not teach the trainees to respect the field, themselves and their patients.

I go to a perfectly fine university program........the field is what it is.

 

[surftheiop]

Amusing story my friend was just telling me about his medicine rotation, apparently they had this elderly schizophrenic guy with tons of medical problems transferred to their floor from inpatient psych because his BP had gotten super low or something like that. Once they stabilized him overnight he got super agitated when they tried to get ready to take him back to psych, apparently the IM-team thought he was dangerous and ends up with like 5 cops in his room which decompensates him even more. About that time the psych consult rolls in, gets all the cops out, talks to patient for a minute and has the patient in a wheelchair rolling back to psych in like 5 minutes.

 

[vistaril]

Amusing story my friend was just telling me about his medicine rotation, apparently they had this elderly schizophrenic guy with tons of medical problems transferred to their floor from inpatient psych because his BP had gotten super low or something like that. Once they stabilized him overnight he got super agitated when they tried to get ready to take him back to psych, apparently the IM-team thought he was dangerous and ends up with like 5 cops in his room which decompensates him even more. About that time the psych consult rolls in, gets all the cops out, talks to patient for a minute and has the patient in a wheelchair rolling back to psych in like 5 minutes.

what was he doing to make the medicine team feel he was dangerous? Maybe he was at that time. Regardless, many of the social workers and even some of the techs(who make 12 dollars an hour) are actually better at talking to very agitated patients 1 on 1 for various reasons than senior psych attendings, so I'm not sure what point you are trying to make.....

in my experience many medicine residents and surgery residents are better than psych at talking to pts simply because at some psych programs so many of the residents are fmgs with not so great english.....

 

[OldPsychDoc]

...

in my experience many medicine residents and surgery residents are better than psych at talking to pts simply because at some psych programs so many of the residents are fmgs with not so great english.....

You need to broaden your experience, methinks.

 

[vistaril]

You need to broaden your experience, methinks.

well, I know that my program has a lower% of fmg residents than is the national average, so "broadening my experience" would likely only make the language/culture issues more prominent.....

 

[nitemagi]

well, I know that my program has a lower% of fmg residents than is the national average, so "broadening my experience" would likely only make the language/culture issues more prominent.....

Apparently in your opinion vist, psychiatrists are the worst at talking to patients, do simplistic jobs that any other physician can do just as easily, and aren't respected by anyone. So why don't you save all of us the eyesore of reading more of your posts and go switch specialties, or at least switch forums.

Your posts do nothing but purposely oppose every other opinion, and are simultaneously degrading to the field you claim to represent, and condescening to those in this field that dedicate their careers to doing quality work.

time for the ignore button.

 

[AnnoyedByFreud]

Okay, cool! What about the difference in duties though..? Do they generally have more or less the same job description regardless of independence?

As far as I could tell, it was the same job. The only thing is an NP couldn't administer ECT. However, it really varies. I know that when I graduate I'm going to be looking for a position where I have a lot of support and am working under the mentorship/management of an experienced clinician. I'm also interested in applying to a psych PA residency that takes NPs, I believe there are a few programs out there.

 

[surftheiop]

Vistaril- Could you type out in a paragraph or two what you most enjoy about psych? If you don't enjoy it, you wouldn't be the only one to be unsatisfied with a field, but you always talk about loving the field so I'm just trying to understand where your coming from.

Obviously no field is perfect and there are poor practitioners in many fields, but from reading your posts you make it seem like psychiatrists as a whole offer little to society, Im sure you don't believe that or else you wouldn't be in the field.

 

[zenman]

As far as I could tell, it was the same job. The only thing is an NP couldn't administer ECT. However, it really varies. I know that when I graduate I'm going to be looking for a position where I have a lot of support and am working under the mentorship/management of an experienced clinician. I'm also interested in applying to a psych PA residency that takes NPs, I believe there are a few programs out there.

If you're working and have a supervisor, then what is the real need for a residency program? Just structure your job so you get the additional learning you need. So far I've worked in a detention center, Community Mental Health Center, and now in a hospital setting doing inpatients, outpatients, consults on every unit, and bariatric consults. I've told all my supervisors to present me with "educational moments" every chance they can. Plus I ask what they would have done in some cases.

 

[vistaril]

Vistaril- Could you type out in a paragraph or two what you most enjoy about psych? If you don't enjoy it, you wouldn't be the only one to be unsatisfied with a field, but you always talk about loving the field so I'm just trying to understand where your coming from.
.

sure....I find psychotic and manic people very interesting. Even when there isn't a lot of educational value in seeing the 300th person roll through bat**** insane and/or manic, it's still fun and interesting. I also find addicts fascinating, even if there isn't a lot medicine can do for them. And I like the hours. It's also important to talk about what I don't like- I don't like procedures, blood, etc......

so there is absolutely not a general dissatisfaction with psych. Would I prefer the field were more evidence based? Sure, but I don't know that that is possible in it's current state. Do I think the medical model approach to the field is too slanted in thar direction? Sure. Do I think psychiatrists as a whole(along with mainly family, but I think they get more out of training) are the least able bunch in medicine? Sure. But even given all that, it's still what I would prefer doing.....

 

[vistaril]

As far as I could tell, it was the same job. The only thing is an NP couldn't administer ECT. However, it really varies. I know that when I graduate I'm going to be looking for a position where I have a lot of support and am working under the mentorship/management of an experienced clinician. I'm also interested in applying to a psych PA residency that takes NPs, I believe there are a few programs out there.

thinking about what most of my attendings do on a day to day basis, there is really very little that a good NP or PA wouldnt be able to do if adequately trained.....of course the same could be said in some other fields I suppose to.

 

[vistaril]

Apparently in your opinion vist, psychiatrists are the worst at talking to patients, do simplistic jobs that any other physician can do just as easily, and aren't respected by anyone. So why don't you save all of us the eyesore of reading more of your posts and go switch specialties, or at least switch forums.

Your posts do nothing but purposely oppose every other opinion, and are simultaneously degrading to the field you claim to represent, and condescening to those in this field that dedicate their careers to doing quality work.

time for the ignore button.

well that's certainly your choice.....I don't think my posts are 'degrading' to psychiatry. Even with it's problems, it's still fun to practice. you just have to let the negative parts not get to you. It doesn't mean they aren't there though.

 

[splik]

so there is absolutely not a general dissatisfaction with psych. Would I prefer the field were more evidence based? Sure, but I don't know that that is possible in it's current state.

I am a big proponent of evidence-based medicine but it is laughable that you compare psych to GI when GI is fairly unevidence based - where is the evidence for omeprazole infusions for massive UGI bleeds? how ridiculous is that in this day and age the best they have to offer for hepatic encephalopathy is lactulose! speaking of which, how good is the evidence base for that! Sure, the evidence base for most of psychiatry is a joke, but pretty much outside of diabetes and cardiology, the evidence base for most of medicine is wanting....

 

[vistaril]

I am a big proponent of evidence-based medicine but it is laughable that you compare psych to GI when GI is fairly unevidence based - where is the evidence for omeprazole infusions for massive UGI bleeds? how ridiculous is that in this day and age the best they have to offer for hepatic encephalopathy is lactulose! speaking of which, how good is the evidence base for that! Sure, the evidence base for most of psychiatry is a joke, but pretty much outside of diabetes and cardiology, the evidence base for most of medicine is wanting....

wanting is much different than a joke......In GI today for example, my fiance did an an endoscopy, identified a lesion that was responsible for a recent major drop in H/H requiring the inpt endoscopy, and then she did something with the scope to basically stop the bleeding.

that seems like pretty definitive treatment to me with an obvious benefit.

even in areas where fields like GI don't have the evidence for some of their treatments yet, they are least no WHAT they are treating.

 

[AnnoyedByFreud]

If you're working and have a supervisor, then what is the real need for a residency program? Just structure your job so you get the additional learning you need. So far I've worked in a detention center, Community Mental Health Center, and now in a hospital setting doing inpatients, outpatients, consults on every unit, and bariatric consults. I've told all my supervisors to present me with "educational moments" every chance they can. Plus I ask what they would have done in some cases.

I didn't mean to imply that I preferred a residency program, only that I would consider one if I couldn't find a working situation with a great mentor. I don't want to be "cut loose" when I graduate, is all. I want some sort of mentorship. If I can find it in my first job, then fantastic. If not, I'd consider a midlevel residency.

 

[JESSFALLING]

I don't think my posts are 'degrading' to psychiatry

+

Do I think psychiatrists as a whole (along with mainly family, but I think they get more out of training) are the least able bunch in medicine? Sure.

=

As a premed interested in psychiatry, I appreciate the opportunity to lurk in this forum, which is all that I typically do......So, I hope that you don't mind if I interject a few comments.

This is just my interpretation of your postings vistaril, but you write on here as if you strongly dislike your field and have no respect for its practitioners. I would likely come off sounding similarly disgruntled if I had to discuss my previous career in engineering, which I slowly grew resentful and calloused to. Anyway, hopefully you are not really as miserable with your career as your postings suggest. I certainly hope that you find your working life as a psychiatrist meaningful. I don't wish unfulfillment on anyone!

 

[F0nzie]

wanting is much different than a joke......In GI today for example, my fiance did an an endoscopy, identified a lesion that was responsible for a recent major drop in H/H requiring the inpt endoscopy, and then she did something with the scope to basically stop the bleeding.

that seems like pretty definitive treatment to me with an obvious benefit.

even in areas where fields like GI don't have the evidence for some of their treatments yet, they are least no WHAT they are treating.

I wish we could simply remove a lesion in your brain or implant something to activate your dorsolateral prefrontal cortex to reduce some of your hostility because it seems that no amount of talk or feedback from the experts in the field has helped. But that solution may be far too simplistic for you. The fact several valuable attending psychiatrists and residents have already abandoned you by blocking you is a serious red flag. I wonder if your posts may be a form of emotional communication that you are seriously struggling with? Perhaps sitting at the dinner table where you and your GI fiancee bash psychiatry and pompously agree that your colleagues fail in your field of choice and how much more respected and successful she is at definitive treatments is something you want to talk about?

 

[vistaril]

I wish we could simply remove a lesion in your brain or implant something to activate your dorsolateral prefrontal cortex to reduce some of your hostility because it seems that no amount of talk or feedback from the experts in the field has helped. But that solution may be far too simplistic for you. The fact several valuable attending psychiatrists and residents have already abandoned you by blocking you is a serious red flag. I wonder if your posts may be a form of emotional communication that you are seriously struggling with? Perhaps sitting at the dinner table where you and your GI fiancee bash psychiatry and pompously agree that your colleagues fail in your field of choice and how much more respected and successful she is at definitive treatments is something you want to talk about?

1) removing/implanting something in my brain would involve a technical skill set that psychiatrists don't possess......

2) I'm hardly concerned by who does or doesn't block me. Some people are sensitive to any criticism. Oh well.

3) you still don't seem to understand that acknowledging that psychiatry isn't as important ordoesnt require as much skill/ability as many other fields in medicine isn't "bashing" it......the fact you view it as such is your issue, not mine.

Im happy to practice psychiatry and I'm pretty darn good at it. That position does not contradict anything I have said above either.

 

[F0nzie]

1) removing/implanting something in my brain would involve a technical skill set that psychiatrists don't possess......

2) I'm hardly concerned by who does or doesn't block me. Some people are sensitive to any criticism. Oh well.

3) you still don't seem to understand that acknowledging that psychiatry isn't as important ordoesnt require as much skill/ability as many other fields in medicine isn't "bashing" it......the fact you view it as such is your issue, not mine.

Im happy to practice psychiatry and I'm pretty darn good at it. That position does not contradict anything I have said above either.

You're the one defining what does and does not require skill and posting in a very negative and belligerant tone. You want everyone to acknowledge that Psychiatry has a substandard skillset in a forum where people are passionate about their work at helping the mentally ill and people who actually find it more challenging than having a technical skillset. You're entitled to your opinion, but geez where is your sensibility.

 

[digitlnoize]

Ignore doesn't work that well. I can still see everyone else talking about vistaril's posts...sigh.

Vistaril: you are mistaking technical/manual skill for mental/communication skill.

Surgeons need to be very good with their hands. They do not, and for the most part, are TERRIBLE at communicating or empathizing with their patients.

Psychiatrists, on the other hand, need the opposite skill set. It doesn't matter a bit if we could remove an incidentaloma one-handed with a fogged up laparoscopic camera driven by a blind medical student. What matters is that we are skilled at communicating, empathizing, and thinking with and about our patients.

It's like saying Gary Kasparov sucks at chess because he can't build a model car.

 

[vistaril]

You're the one defining what does and does not require skill and posting in a very negative and belligerant tone. You want everyone to acknowledge that Psychiatry has a substandard skillset in a forum where people are passionate about their work at helping the mentally ill and people who actually find it more challenging than having a technical skillset. You're entitled to your opinion, but geez where is your sensibility.

I dont "want" everyone to acknowledge any such thing.....I'm simply stating what I believe. You can take anything you want from that. I will say, however, that it's obvious that in a psychiatry forum most of the psychiatrists will be biased......just like if you go over in another forum you will find much a much different tone.....to be expected.

 

[vistaril]

Ignore doesn't work that well. I can still see everyone else talking about vistaril's posts...sigh.

Vistaril: you are mistaking technical/manual skill for mental/communication skill.

Surgeons need to be very good with their hands. QUOTE]

you somehow got the idea(not from my posts certainly) that I believe surgeons only need to be technically skilled.....they need to be skilled in management principles of illness related to surgery as well.

my 3 year old nephew could follow around a psychiatrist for a day, and then follow around for a surgeon for a day, and determine which one is more challenging. That's not a knock on psychiatry. My 3 year old nephew could also follow around a psychiatrist for a day, then follow around an elevator operator and come to the conclusion that being a psychiatrist is of a higher skill level than being an elevator operator. That's not a knock on being an elevator operator.

 

[digitlnoize]

I'm sure a 3yo would agree with you.

Again, they are both challenging, but in different ways. Much of what surgery does is outwardly apparent. Because most of what we do is cerebral, it seems easier on the outside, but if you're doing it right, is much harder on the inside.

 

[vistaril]

I'm sure a 3yo would agree with you.

Again, they are both challenging, but in different ways. Much of what surgery does is outwardly apparent. Because most of what we do is cerebral, it seems easier on the outside, but if you're doing it right, is much harder on the inside.

still not nearly as hard, on the "inside of outside"(whatever that means), as surgery and most other fields of medicine......

again, that's not neccessarily a bad thing. not everyone has to maximally utilize their intellect for their profession

 

[surftheiop]

still not nearly as hard, on the "inside of outside"(whatever that means), as surgery and most other fields of medicine......

again, that's not neccessarily a bad thing. not everyone has to maximally utilize their intellect for their profession

what field did you really want to do? From the abrasive nature of your posts it seems likely your only in psych b.c you couldn't cut it for one of the higher paying fields that also has relaxed lifestyle. (That being said, you could be a perfectly pleasant person in real life, sometimes our internet personas are way different for whatever reason)

 

[splik]

have you ever been a surgical resident? i have, and i can tell you that whilst it is more taxing physically and in terms of hours, it is not that hard - cutting, sucking, stitching, burning... that is pretty much all there is to it. surgeons aren't brilliant at the diagnostic aspects, they suck at managing medical problems, and typically defer management of perioperative medical problems (CHF, AFib etc) to the medical team. I also know a few psychiatrists who used to be surgeons and guess what they find more challenging intellectually? it's not surgery.

no one is saying it isn't easy to get away with a lower standard of care in psychiatry without ramifications, or that it isn't harder to get into surgery or GI than psychiatry. But that does not mean that practicing psychiatry well is easier than practicing one of these fields you appear to be under the misapprehension are so advanced because you can see a lesion which frequently has nothing to do with the symptoms the patient has. GI docs are fast becoming scope-monkeys and they will pay the price for their greed when they get undercut but the growing cadre of nurse endoscopists.

 

[vistaril]

no one is saying it isn't easy to get away with a lower standard of care in psychiatry without ramifications, or that it isn't harder to get into surgery or GI than psychiatry. But that does not mean that practicing psychiatry well is easier than practicing one of these fields you appear to be under the misapprehension are so advanced because you can see a lesion which frequently has nothing to do with the symptoms the patient has. GI docs are fast becoming scope-monkeys and they will pay the price for their greed when they get undercut but the growing cadre of nurse endoscopists.

lol......Gi docs aren't going to pay the price for anything.

As for "practicing psychiatry well"......that's an arbitrary and impossible to define standard. Obviously(as you say above) it is easier to get away with a lower standard of care in psychiatry than fields like GI, and since a lot of docs practice with such a standard....well...figure it out. There are a lot of "average" docs out there.

 

[priorities2]

Is the day to day job of a PMHNP easier than that of a psychiatrist in any way? Both work 40 hrs a week, right? Do PMHNPs need to do more menial jobs than psychiatrists, ie would they ever need to help clean patients who haven't showered or something like that?

 

[splik]

Is the day to day job of a PMHNP easier than that of a psychiatrist in any way? Both work 40 hrs a week, right? Do PMHNPs need to do more menial jobs than psychiatrists, ie would they ever need to help clean patients who haven't showered or something like that?

no nurse quacktitioners do not clean patients or do any nursing. the day-to-day job will depend on their setting which will be quite varied, the state and its laws, and the institution and their regulations, and whatever their job description is. Some NPs work completely independently, whilst others work under a psychiatrist who will carry the brunt of the responsibility. Where I am NPs basically work at the level of a psychiatry resident, except that because you can't bill as much for an NP assessment, all the patients then have to be seen (which could basically be an eye-balling) by the attending psychiatrist. If a pt is admitted by an NP here then I still have to write something, whereas if they were admitted by another resident I wouldn't. But there are other places where they would be a lot more independent. In that sort of setting I'd imagine they're job would be harder as its all on their ass if they mess it up.

I don't want to start an argument re midlevels vs psychiatrists as practitioners are either good or bad inspite of not because of their training background, but in general NPs seem alot better than physicians at ticking all the boxes, dotting Is and crossing Ts and following protocols. We are not good at doing that but use our extensive broad-based training to deal with difficult diagnostic challenges, medicolegal problems, ethical dilemmas, and come up with creative therapeutic solutions. This is a generalization of course, but theres a lot of truth in it. Nurses by training tend to be risk averse, whilst physicians seem to be better at taking risks. This is less true in the US than where I trained because there's more of a CYA mentality, but true enough.

 

[priorities2]

Okay. So I wasn't really asking who is better at what, but where the duties differ between these two professionals. It sounds like it varies a lot, but becoming a psychiatrist is a safer path to autonomy, though you can get there as a psych NP as well, perhaps with some luck or ability to switch from job to job if the market is there.

When you say that psych NPs don't do any kind of nursing, do you mean they also wouldn't do wound care or anything like that, should the need arise?

 

[splik]

When you say that psych NPs don't do any kind of nursing, do you mean they also wouldn't do wound care or anything like that, should the need arise?

im sure it varies, but no wound care etc would typically be done by a nurse, not an NP. There are many reasons for this including 1) if they wanted to do wound care they wouldnt have become a psych NP, 2) they are being paid more so its not really cost-effective for them to deal with general nursing issues when its cheaper for someone else to do that 3) there is a slipperly slope... if you do one thing outside of your job description then you could end up being snowed under with doing that stuff when you need to do your job. 4) *some* may think it is 'beneath' them now

As a psych resident who was formerly doing IM, I like doing the medical management of my patients. But quite apart from the liability issues, if I spent my time dealing with my patients' medical issues, it would snowball and suddenly I would find myself not having enough time to look after their mental health problems.

make sense?

 

[zenman]

Okay. So I wasn't really asking who is better at what, but where the duties differ between these two professionals. It sounds like it varies a lot, but becoming a psychiatrist is a safer path to autonomy, though you can get there as a psych NP as well, perhaps with some luck or ability to switch from job to job if the market is there.

When you say that psych NPs don't do any kind of nursing, do you mean they also wouldn't do wound care or anything like that, should the need arise?

We have a wound care nurse specialist so I just consult her. I have, however, just removed sutures on a patient that was being discharged and didn't want to waste anyone's time and keep the patient waiting in surgical clinic.

You're almost beating a dead horse here about duties. Where I'm at there is almost no difference except the shrinks make more and my boss has to attended those dreaded management meetings and get beaten up by admin. I just see patients...and patients...and patients.

 

[BS81]

We have a wound care nurse specialist so I just consult her. I have, however, just removed sutures on a patient that was being discharged and didn't want to waste anyone's time and keep the patient waiting in surgical clinic.

You're almost beating a dead horse here about duties. Where I'm at there is almost no difference except the shrinks make more and my boss has to attended those dreaded management meetings and get beaten up by admin. I just see patients...and patients...and patients.

If you do the same things that the psychiatrists do but for less money, why doesn't the hospital just hire a bunch of NPs to replace the MDs?