So the director of psychiatry and some senior psychiatrists at my hospital are in a funk. It appears surrounding hospitals are offering incentives (increased salary and other benefits) to attract psychiatrists to their institutions - and its working. So far, we have lost four psychiatrists in the past five months to nearby hospitals that are offering those incentives. Those facilities also hire FNPs and PMHNPs whereas my hospital doesn't. Clearly there is no way for my hospital to match the benefits of the other competitive institutions and there is a huge shortage of psychiatrists in the area. So... I suggested that we start hiring NPs.
Bad move.
I never seen so much hatred from health professionals. One of the senior psychiatrists actually shouted at me for coming up with "a stupid idea." He then proceeded to tell me how many years of schooling and training he's had out of some need to compare himself to a PMHNP. What really bothered me is that the director said, "I HATE Nurse Practitioners" as if that was a good enough reason for not hiring them in our facility. What they think is what they think; I can't change that. But would I be overstepping boundaries if I drew up a presentation at our next meeting to outline the benefits of hiring NPs? The chief director of psychiatry will be present at the next meeting and I really think its worth a mention.
I would let it go. You won't be able to change their minds. This is why I would never do NP. Nurses so really think twice before going NP. Alot of MD's have that opinion. Right or wrong. It's hard to work with someone that doesn't even see your degree as legit.
Nurses should absolutely "think twice": think twice about why the "opinion" of a minority of "MDs" that is in direct opposition of a myriad of published studies and the IOM bares even the slightest bit of weight.
Nurses should absolutely "think twice" about the "advice" of other nurses that simply assume the "MDs" must be right because...well because they say so.
Nurses should absolutely "think twice": think twice about why the "opinion" of a minority of "MDs" that is in direct opposition of a myriad of published studies and the IOM bares even the slightest bit of weight.
Nurses should absolutely "think twice" about the "advice" of other nurses that simply assume the "MDs" must be right because...well because they say so.
Could not have said this better myself. Why should anyone let such pettiness get in the way of their goals and the patient care they want to be involved in? There are going to be naysayers no matter what profession you are in. Personally, I'd rather take into account those published studies than random opinions. This is a good time to brush up on that hierarchy of evidence we all learned about in research class. And yes, it's true... Not every single physician in America hates NPs. Despite what is going on in the political realm, many physicians value NP's as important healthcare professionals and respect what we do.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
While although I think adding Psych-NPs to an inpatient psychiatric team is a great idea what I'd really like to know is why the heck can't they offer a competitive salary? That is baloney.
No it makes sence. The OP already stated that the other facilities are both offering incentives AND they hire NPs. The use lower pain NPs (compaired the the MDs) to do some of the work, thus they are able to see far more patients (and bill them of course) than the faciliety that chooses not to use NPs.
No it makes sence. The OP already stated that the other facilities are both offering incentives AND they hire NPs. The use lower pain NPs (compaired the the MDs) to do some of the work, thus they are able to see far more patients (and bill them of course) than the faciliety that chooses not to use NPs.
That doesn't explain why the OPs hospital is saying they aren't able to offer a competitive wage for providers. I haven't ever heard of a facility using that cheesy excuse. They will have to offer a competitive wage and hopefully they won't wait until all their present staff has left.
If I were you, I would keep out of it. I worked with a NP who was not very friendly. It seemed as though she was in her own little world, not a doctor or a bedside nurse, so she wasn't easy to deal with. I don;t think they are all difficult, but if the doctors are resisting it, I wouldn't push it.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
That doesn't explain why the OPs hospital is saying they aren't able to offer a competitive wage for providers. I haven't ever heard of a facility using that cheesy excuse. They will have to offer a competitive wage and hopefully they won't wait until all their present staff has left.
My assumtion is that there are other problems. However it is logical to think that the hospitals that do use NPs would have more cash since they can bill for more patients while using loweer cost providers.
If I were you, I would go ahead and get a job at the hospital that's paying more for providers. I've noticed that when the PTB pay the providers more, they pay everybody more.
and what you've described about your organization's closed-minded and ignorant leadership is exactly why it fails and is in this predicament in the first place, and will continue to fail. Their mentality is archaic and not congruent with current research and healthcare trends on the inclusion of practitioner's.
Any member of any profession will start kicking and screaming when someone can do their job equally well for less cost. Imagine the factory workers whose jobs were supplanted by more efficient and cost effective machines. This is just the part of the evolution of mankind. If the studies show that NPs can provide healthcare with outcomes equivalent to primary care MDs but at a much lower cost, then the evolution from MD to NP will be inevitable, no matter how much education the MD's have.
As a specialist MD, I have observed one significant difference in the practice style between NPs vs. primary care MDs. It seems the NPs are much quicker to refer a patient to a specialist before acquiring enough diagnostic workup to justify the referral, compared to their MD counterparts. For example, if a patient has back pain, the NP would possibly order some x-rays of the spine, and then refer to a spine surgeon regardless of the results of the x-ray; whereas, the primary care MD would work it up further with additional MRIs, etc, before considering referring.
This difference may reflect the difference in education between the NP and the primary care MD, as the MD has many more years of education/residency, and thus feel more confident to work-up these situations before referral to a subspecialist. Again, I cannot prove this practice style to be true with any hard data as of yet, but it is what I have definitely observed amongst multiple referring NPs in the community.
If this proves to be true, then the lower cost of an NP may be offset by the increased cost of the referrals to subspecialists that they are ordering.
Other than that, I am all for NPs taking the role of primary medical decision makers for patients if they are willing to take the responsibility, even if it means the dwindling of my fellow MDs, for the sake of more economic health delivery.
If the studies show that NPs can provide healthcare with outcomes equivalent to primary care MDs but at a much lower cost, then the evolution from MD to NP will be inevitable, no matter how much education the MD's have.
Anecdotally I would agree with your observations. In my experience FNPs in particular seem fairly heavy handed with the diagnostics and specialist referrals as compared to physicians. As we are already seeing I imagine physicians will continue to move move out of general practice and instead specialize which is a better allocation of your superior education and will result in larger salaries.
I have been very fortunate to work with physicians who have been extremely gracious. In our field there is plenty of work to go around and it seems as long as the NP is competent they are not bothered by our presence. As for NPs being a much lower cost that isn't always true in the specialties. My gross last year was 80% of the psychiatrists I work with so not that much cheaper. This doesn't bother the physicians I work with but it sure irritates the hospital bean counters who think I should be willing to work for $60 an hour.
I would let it go. You won't be able to change their minds. This is why I would never do NP. Nurses so really think twice before going NP. Alot of MD's have that opinion. Right or wrong. It's hard to work with someone that doesn't even see your degree as legit.
That's an interesting reason to not become an NP. Hmm... A lot of MD's actually do not have that opinion and value Nurse Practitioners. But to each his own. :)
BostonFNP, APRN
2 Articles; 5,584 Posts
I don't think the incentives are the only reason providers are leaving en masse.
Any director who basis their practice on bitterness and jealously rather evidence isn't worth working for or with.
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