Doctor's negative view of NP / Psych NP

[Granted Fal]

As an NP that currently specializing in psych, i sometimes attend medication marketing dinners and meet with the reps and found it's a great way to connect with others in the field and with networking. On occasion, you get a doctor who has a really negative and pompous view of the NP. The comment was something to the effect of, "I waited three months to see my doctor and it turned out that it was an NP and then I left to find another doctor." Implying the NP wasn't competent. I didn't know whether to really feel offended or not.

I've found I have my own biased thoughts to some extent, hypocritically, with reservations about general practice NPs, however, in the psychiatric arena I've seen concerns from both the NP and the doctors. It sometimes seems that doctors often don't seem to know what they are doing either. This is psych mind you which isn't never a "perfect science," and the negative comment above by the doctor was aimed more at general practice NPs.

I've found that there are good NPs and bad NPs as well as good and bad doctors. But I have to say in my field with psychiatry, sadly, I've seen more bad NPs. Is it maybe true at least in my field? Not that I'm the best of all or something but I feel like i've been witness to some pretty shoddy care and have to often left to the task of trying to iron it out. For example, multiple antidepressants, serotonin syndrome, multiple antipsychotics, benzo plus a stimulant, numerous med interactions, no labs or monitoring, no EKG in some cases that are critical, very poor history, questionable diagnoses, no patient teaching, etc. Curious to see if any others have the same experience. Please comment.

Study your asses off and know your stuff!!!!

[BostonFNP, APRN]

How long have you been working as an NP? I only ask because some of your comments are typical reactions in the first year or two of practice.

I think you really answered your own question: there are good/bad docs and good/bad NPs and good/bad PAs and good/bad patients. I actually have a term I use called the "trifecta" for the many patients that come to me on a benzo, stimulant, and a narcotic. Who knows that's treating what.

I've found that most docs that have negative comments about NPs are not the "good ones" they are the ones worried about the $ not patient care.

Do you think that psych NPs are better educated and prepared for practice in psych compared to NPs in primary care?

[Psychcns]

Within past few years have done inpatient and outpAtient psych in NH OR and MN. Have found most if not all practitioners (MDs and APRNs) to be competent and diligent.

[Jules A, MSN]

How long have you been working as an NP? I only ask because some of your comments are typical reactions in the first year or two of practice.

I think you really answered your own question: there are good/bad docs and good/bad NPs and good/bad PAs and good/bad patients. I actually have a term I use called the "trifecta" for the many patients that come to me on a benzo, stimulant, and a narcotic. Who knows that's treating what.

I've found that most docs that have negative comments about NPs are not the "good ones" they are the ones worried about the $ not patient care.

Do you think that psych NPs are better educated and prepared for practice in psych compared to NPs in primary care?

I'd agree 100% there are good and bad NPs and MDs I just take it more personally when it is a NP. But yes some of the psychiatrists I have seen are horrific. Anecdotally many of the new grad psych NPs I have seen in my area from the well respected and the not-so-well respected schools are woefully inexperienced especially in addictions as you mentioned. The trend I'm observing is probably in line with the increase in schools admitting students with absolutely no psych and often no nursing experience and naturally most of them they lack the ability to discern the subtleties.

I think this is a timely discussion and while I appreciate most of the OPs observations I haven't ever heard of a Doc just blindly going to see a provider NP or not. Around here we don't just go see someone we don't already know or who hasn't been recommended and arranged by a colleague nor do we wait months for an appointment. As for the poll I don't have children but if I did it would be unlikely I'd take them to a NP unless it was for something simple I had already diagnosed myself. I'm as particular with my physicians also.

[MikeFNPC, MSN]

Totally agree, the threat of losing their (MD's) cash cow incites defensiveness and/or Might-Makes-Right” arguments. The medical professionals that maintain altruism are typically more understanding and look at evidence.

I've yet to see any evidence that NP's provide substandard care. Articles that attempt to, do so with anecdotal, opinions; not evidence. It doesn't take much experience to find a doc with a false sense of entitlement. Likewise, as a profession, NP's need to be diligent to maintain professionalism and the highest level of care. We also need to stick together. I'm amazed at home many NP's are not involved with their local professional organizations or who are not involved with local and national legislation.

How long have you been working as an NP? I only ask because some of your comments are typical reactions in the first year or two of practice.

I think you really answered your own question: there are good/bad docs and good/bad NPs and good/bad PAs and good/bad patients. I actually have a term I use called the "trifecta" for the many patients that come to me on a benzo, stimulant, and a narcotic. Who knows that's treating what.

I've found that most docs that have negative comments about NPs are not the "good ones" they are the ones worried about the $ not patient care.

Do you think that psych NPs are better educated and prepared for practice in psych compared to NPs in primary care?

[FolksBtrippin, BSN, RN]

My psych NP took my family from a state of crisis due to one family member's psychosis to a state of peace, cooperation, love. No doctor even came close to helping us. We struggled for years before finding her. She is my rock.

I personally know another psych NP with zero integrity.

I worked with two psychiatrists; one of whom was a gem and one who was so-so.

So I guess it depends.

In primary care, I tend to prefer the MD when I am sick and the NP when I'm not. I prefer my WHNP to my gynecologist whom I despise for regular care because she makes a big deal out of everything. Period too heavy? Let's take out your uterus! Um, no.

For my kids, I knew one NP who was so incompetent I had to tell the office not to schedule us with her. The others were great and so was the PA. One doctor was smart and a great diagnostician but rude.

[smartassmommy]

I prefer to see a NP. I have found that they listen better and understand patients more. Perhaps because their practice is based in the nursing model rather than the medical.

[Jules A, MSN]

I prefer to see a NP. I have found that they listen better and understand patients more. Perhaps because their practice is based in the nursing model rather than the medical.

Love your user name. Its excellent that you like your NP but sometimes it seems the extra time spent and empathetic nature of NPs can act as smoke and mirrors for a clinician who is less than skilled. Not saying providers ideally shouldn't be both excellent clinicians as well as kind and empathetic but I know a couple who get rave reviews from patients and couldn't diagnose or prescribe their way out of a paper bag. Patients love them because they are sweet and spend a lot of time listening to their complaints and often prescribe whatever the patient is requesting such as an inappropriate benzodiazepine or antibiotic. As an attending on an inpatient acute unit I see a variety of local physicians and NPs diagnostics and prescribing styles which has been an excellent learning experience for me also.

[BostonFNP, APRN]

I know a couple who get rave reviews from patients and couldn't diagnose or prescribe their way out of a paper bag.

You are speaking about the exception not the rule. From someone that works full time in primary care, nearly always the best providers are the ones that take the time to talk to, listen to, and understand their patients.

[Psychcns]

I think empathic listening and engaging patients in their treatment is important. So is accurate diagnosing and prescribing. So is staying within time frames.

[Granted Fal]

I've been an NP for over 6 years, and an RN over 13

[Granted Fal]

Thanks for the feedback, I'm finding this to be the case as well.