What states are midlevels replacing psychiatrists?

[PikminOC]

Is it? What's the evidence behind this? I haven't met any graduating psychiatrists with no red flags who had trouble find a job wherever they wanted. PP should be an even easier market for psychiatrists.

I get that some are dissatisfied with their careers, but projecting their dissatisfaction onto unfounded projections or baseless claims isn't helpful for prospective psychiatrists.

You're using a different metric than I'm discussing.

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[Mad Jack]

Are the states with restricted practice relatively immune to this?

If I had a dollar for every NP I had seen quit or fired because they found half the workload of an attending psychiatrist I would have quite a few dollars more than you would expect. There are very few places around that have had any success replacing paychiatrists with psych NPs, and the ones that have done so have generally done it because they literally cannot afford a psychiatrist (community mental health centers and the like) and just settle for what they can afford. I was scared of midlevels until I saw the reality on the ground, they just don't have the productivity levels or ability to handle extremely complex cases that allow them to successfully replace psychiatrists in most environments. They also can't sign commitment papers, provide second opinions, or many other legally necessary procedures in the three states that I have practiced in.

 

[deleted456421]

If I had a dollar for every NP I had seen quit or fired because they found half the workload of an attending psychiatrist I would have quite a few dollars more than you would expect. There are very few places around that have had any success replacing paychiatrists with psych NPs, and the ones that have done so have generally done it because they literally cannot afford a psychiatrist (community mental health centers and the like) and just settle for what they can afford. I was scared of midlevels until I saw the reality on the ground, they just don't have the productivity levels or ability to handle extremely complex cases that allow them to successfully replace psychiatrists in most environments. They also can't sign commitment papers, provide second opinions, or many other legally necessary procedures in the three states that I have practiced in.

Depends on the state. I have NPs signing commitment papers, second opinions, and other legally necessary paperwork without MD oversight. They're actually quite proud of their new powers, whereas myself and other psychiatrists are loathe to sign over human rights to others.

Please stop acting like the nursing lobby won't overrun MD rights. As I've mentioned previously, my MD medical director believes "Many NPs are equal to or better than medical doctors." My previous medical director told me her DNP daughter "Is at the forefront of primary care."

I've also seen MD only inpatient units switch to 1:4 MD:NP units. My own outpatient position has transitioned from 3 MDs to 1 MD and 4 NPs.

These fools will destroy us, especially since they seem immune from Stark Law provisions.

 

[deleted456421]

I can't even comprehend the people on this forum undermining the midlevel threat. Sure, many of my patients have suffered from NPs, but they only seem to stumble upon my MD services by accident. They show up to my clinic like, "Hey, I was started on lamotrigine and cariprazine because my husband was cheating on me, my third child was diagnosed with Down's Syndrome, and I didn't sleep well for a few nights."

 

[Mad Jack]

Depends on the state. I have NPs signing commitment papers, second opinions, and other legally necessary paperwork without MD oversight. They're actually quite proud of their new powers, whereas myself and other psychiatrists are loathe to sign over human rights to others.

Please stop acting like the nursing lobby won't overrun MD rights. As I've mentioned previously, my MD medical director believes "Many NPs are equal to or better than medical doctors." My previous medical director told me her DNP daughter "Is at the forefront of primary care."

I've also seen MD only inpatient units switch to 1:4 MD:NP units. My own outpatient position has transitioned from 3 MDs to 1 MD and 4 NPs.

These fools will destroy us, especially since they seem immune from Stark Law provisions.

If it is inevitable then I just need to hope I can save my **** you money before I'm out of a job. If society wants to make psychiatrists redundant and replace us with NPs then they will very quickly get what they have asked for, and it will not be pretty. I find it doubtful it will happen in my area for at least two decades though. It's just too hard to change the laws and mental health, in particular, has a set of laws that have gotten only more restrictive over the past 20 years.

 

[deleted456421]

If it is inevitable then I just need to hope I can save my **** you money before I'm out of a job. If society wants to make psychiatrists redundant and replace us with NPs then they will very quickly get what they have asked for, and it will not be pretty. I find it doubtful it will happen in my area for at least two decades though. It's just too hard to change the laws and mental health, in particular, has a set of laws that have gotten only more restrictive over the past 20 years.

I'm not saying it's inevitable or that psychiatrists will be unemployable. I'm just saying we need to advocate for ourselves and stop pretending that NPs (and some PAs) aren't trying to prove parity. I work in an organization where I'm a "provider" and the NPs clearly think they're equal or superior in quality of care. In fact, they seem to disdain any advice from myself or even the social workers whom see patients weekly. My entire point is that numerous actors within our own organization and outside it are trying to push midlevels as equivalent. Cash practice won't provide much solace in places with dozens of NPs providing insurance-based alternatives (see Sushirolls as key evidence).

 

[PikminOC]

If it is inevitable then I just need to hope I can save my **** you money before I'm out of a job. If society wants to make psychiatrists redundant and replace us with NPs then they will very quickly get what they have asked for, and it will not be pretty. I find it doubtful it will happen in my area for at least two decades though. It's just too hard to change the laws and mental health, in particular, has a set of laws that have gotten only more restrictive over the past 20 years.

This has already happened in gas and is happening in other fields. Race to the bottom.

 

[Mad Jack]

This has already happened in gas and is happening in other fields. Race to the bottom.

Just hopeful I can get out of the country before I'm old and sick enough to actually *need* care here lol

 

[Evidence Based]

I just graduated residency, and I could have walked into a job at any hospital or health system in my (highly saturated, highly desirable) city with my eyes closed so long as I had a pulse and an active medical license. Really hard to square the alarmism I sometimes see on SDN with my real life, in which this topic has never come up. Lots of anecdotes on this thread that don't square with salary #s, job #s, or the retirement crisis as all the boomer psychiatrists cut back hours or take a long deserved retirement. All of my residency classmates had their pick of jobs if they wanted to work in a system, and folks who went into cash only practice are already getting a ton of referrals (in a town with no shortage of cash only MD practices).

There are a few NPs I work with in my majority MD department who also don't match the picture being painted here. I generally enjoy working with them, have a collegial relationship with them, and witness them seeking and giving consultation on challenging cases. If anything they're being exploited by admin just and much if not more than I am, and I have more in common with an NP being hired by my system than with the CEO or CMO.

So I know it's boring to say there's not much to worry about, but some of the alarming posts in this thread feel like they're from another universe. And I'm in one of the most saturated markets for psychiatrists in the country!

 

[PikminOC]

I just graduated residency, and I could have walked into a job at any hospital or health system in my (highly saturated, highly desirable) city with my eyes closed so long as I had a pulse and an active medical license. Really hard to square the alarmism I sometimes see on SDN with my real life, in which this topic has never come up. Lots of anecdotes on this thread that don't square with salary #s, job #s, or the retirement crisis as all the boomer psychiatrists cut back hours or take a long deserved retirement. All of my residency classmates had their pick of jobs if they wanted to work in a system, and folks who went into cash only practice are already getting a ton of referrals (in a town with no shortage of cash only MD practices).

There are a few NPs I work with in my majority MD department who also don't match the picture being painted here. I generally enjoy working with them, have a collegial relationship with them, and witness them seeking and giving consultation on challenging cases. If anything they're being exploited by admin just and much if not more than I am, and I have more in common with an NP being hired by my system than with the CEO or CMO.

So I know it's boring to say there's not much to worry about, but some of the alarming posts in this thread feel like they're from another universe. And I'm in one of the most saturated markets for psychiatrists in the country!

Like I said many times, private practice is very different

 

[clausewitz2]

Like I said many times, private practice is very different

My town has a couple of big group private psychiatry practices that are an MD or two and a large stable of NPs. Nobody around here that I know of who accepts any insurance seems to have problems filling in private practice. What exactly is the difference you are talking about?

 

[PikminOC]

My town has a couple of big group private psychiatry practices that are an MD or two and a large stable of NPs. Nobody around here that I know of who accepts any insurance seems to have problems filling in private practice. What exactly is the difference you are talking about?

Cash practice

 

[deleted456421]

I just graduated residency, and I could have walked into a job at any hospital or health system in my (highly saturated, highly desirable) city with my eyes closed so long as I had a pulse and an active medical license. Really hard to square the alarmism I sometimes see on SDN with my real life, in which this topic has never come up. Lots of anecdotes on this thread that don't square with salary #s, job #s, or the retirement crisis as all the boomer psychiatrists cut back hours or take a long deserved retirement. All of my residency classmates had their pick of jobs if they wanted to work in a system, and folks who went into cash only practice are already getting a ton of referrals (in a town with no shortage of cash only MD practices).

There are a few NPs I work with in my majority MD department who also don't match the picture being painted here. I generally enjoy working with them, have a collegial relationship with them, and witness them seeking and giving consultation on challenging cases. If anything they're being exploited by admin just and much if not more than I am, and I have more in common with an NP being hired by my system than with the CEO or CMO.

So I know it's boring to say there's not much to worry about, but some of the alarming posts in this thread feel like they're from another universe. And I'm in one of the most saturated markets for psychiatrists in the country!

I'm also a recent graduate. I've seen hospital systems change dramatically in the few years I've been moonlighting and working as an attending. Sure, I can get a job anywhere. Unfortunately, expectations seem to involve developing "system-based programs" and overseeing midlevels while also seeing 16 patients daily.

Except I'm no longer allowed to say "patient" and any protest about prescribing copious benzos and/or stimulants is countered by reassignment to NPs or hints that I need to prescribe relevant medications.

I'm stuck in the crappy position of de-prescribing without any ability to fire "clients." I'm also seen as a problem if I don't supervise PA or NP students despite clearly indicating I only want to evaluate and treat patients.

 

[MedMan80]

I'm also a recent graduate. I've seen hospital systems change dramatically in the few years I've been moonlighting and working as an attending. Sure, I can get a job anywhere. Unfortunately, expectations seem to involve developing "system-based programs" and overseeing midlevels while also seeing 16 patients daily.

Except I'm no longer allowed to say "patient" and any protest about prescribing copious benzos and/or stimulants is countered by reassignment to NPs or hints that I need to prescribe relevant medications.

I'm stuck in the crappy position of de-prescribing without any ability to fire "clients." I'm also seen as a problem if I don't supervise PA or NP students despite clearly indicating I only want to evaluate and treat patients.

this has basically been my experience as well

 

[Trismegistus4]

Please stop acting like the nursing lobby won't overrun MD rights. As I've mentioned previously, my MD medical director believes "Many NPs are equal to or better than medical doctors." My previous medical director told me her DNP daughter "Is at the forefront of primary care."

Plus, as someone pointed out, several state medical boards have an NP as a board member. Try finding a state nursing board that has an MD on the board.

 

[WisNeuro]

Plus, as someone pointed out, several state medical boards have an NP as a board member. Try finding a state nursing board that has an MD on the board.

Mississippi.