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.
Crazynut, that isn't the problem. There is a shortage of psychiatrists who will go into the HOSPITAL to see patients. they don't earn enough to do that, typically: private practice pays more.
Newsboy, doesn't sound like any PMHNPs would want to work there. Similar situation in a local beh. health inpatient unit here. A colleague went in...........lasted less than a month. Treated like dirt - not just by the psychiatrists, but by the RNs as well. Paid not much more than an RN. Horrid.
The other hospitals - maybe YOU should check those out!
PS - If I'd known what I know now, I would never have gone to grad school for PMHNP. Never. Should have gone for psy-d or psychology PhD. This realllllly stinks as a career, we are disrespected, we have to be prescribing machines for the profit of docs, and with our relatively low pay and all, plus having to pay our own malpractice, DEA license, all those CEUs, licenses (expensive!), and more requirements that are added to every year, you end up with less earnings than a full time RN. It's not worth it. I regret having done this, every day. THAT said, however, we are looking at moving to a state where NPs ARE valued. Things can't be this bad as in the state where I live.
What state are you in? It sounds horrible. What you describe is the total opposite to my experience in all but one horrid OP practice. No way would I ever want to be a psy-d. They only make just over $100,000 and are mostly used for testing. In fact the ones I have encountered have a lack of clinical skills and their egos inflated so I would not consider that a better alternative. I feel very valued by my colleagues and have no desire to do anything more than prescribe. I make almost exactly twice as a NP as I made as a RN so definitely no complaints there and I love hanging with the super smart docs. Although being independently wealthy would be preferable I'm very happy with life as a Psych-NP right now. Note that is likely to change as more inexperienced nurses are deciding they "can do psych" and the schools continue cranking anyone out who is willing to pony up their tuition. I love the comparison to puppy mills that one poster made, pathetic but true.
That's my point. All of this is based on economics. Its all about that $$$$$! Maybe if hospital admins didn't get paid millions they could afford to offer competitive pay for psych docs. But then again its cheaper to pay an NP to it. And we must think about why is there a shortage of doctors. I tried to get a neurologist appt. one year wait. Efff that!
So what I really want to know is for all the NP's on here. Why did you pick NP over MD? If you go the MD route totally free. No loans. Would you do it? Because this is a real problem. And it effects everyone as anyone can get sick at anytime and need healthcare. I just think its scary that theres a huge push for mid levels. And we have med school graduates that cant get a residency. Mid levels are here to stay. We can debate the effectiveness of each. Which is actually very entertaining. But how is our healthcare system going to sustain itself if the number of midlevels exceeds the number of MD's? When we let economics rule our delivery of healthcare its surely not going to end well. I must say I just love the NP v MD debate. Never gets old!
Then your hospital knows nothing about business!!! NP's are practical and the pay is much cheaper than hiring the MD. I'm glad your hospital has money to give away!!! Good for them.
Well...... They can either consider hiring NPs knowing it will staff their psych unit at an affordable rate for them, or the can consider shutting the unit down due to not enough providers. That's the way I see it. If they're not willing to pay a competitive salary for MDs, it's crazy to me they won't consider NPs.
Newsboy, doesn't sound like any PMHNPs would want to work there. Similar situation in a local beh. health inpatient unit here. A colleague went in...........lasted less than a month. Treated like dirt - not just by the psychiatrists, but by the RNs as well. Paid not much more than an RN. Horrid.
The other hospitals - maybe YOU should check those out!
PS - If I'd known what I know now, I would never have gone to grad school for PMHNP. Never. Should have gone for psy-d or psychology PhD. This realllllly stinks as a career, we are disrespected, we have to be prescribing machines for the profit of docs, and with our relatively low pay and all, plus having to pay our own malpractice, DEA license, all those CEUs, licenses (expensive!), and more requirements that are added to every year, you end up with less earnings than a full time RN. It's not worth it. I regret having done this, every day. THAT said, however, we are looking at moving to a state where NPs ARE valued. Things can't be this bad as in the state where I live.
Wow, I'm sorry about your situation. I decided not to push it; like many of you have said, it wouldn't make a difference. I think it's really crazy when ego drives a business rather than logic and vision. However, one of the on-call Psychiatrists also put some things into perspective for me so I understand there are valid reasons why some MDs feel the way they do. Similar to what another poster described, he said the main concern is patient care.
Similar to what another poster described, he said the main concern is patient care.
That's what they say because it sounds better. It isn't the truth, because if it were than the demonstrated comparable outcomes data for NPs and MD/DOs would be enough to end the argument.
The truth is, it's about money and control. NP/PAs are revenue generators for physicians, that's why physicians hire them. Physicians don't have concerns about patient care when they are making the money from arrangement. With many states moving toward independent practice, I think we can all understand why physicians would be nervous about their revenue stream.
Maybe if hospital admins didn't get paid millions they could afford to offer competitive pay for psych docs.
Absolutely, it is about economics. If you could get the same outcomes for 20-40% less cost what's the rationale for spending the additional money. For the hospital. For the people buying health insurance.
If the argument is that patients are receiving inferior care because of the use of NPs, then that should be an easy argument for the MDs: poorer outcomes increase cost to the hospital and decrease the cost benefit of NPs. But there isn't and data to support that.
So what I really want to know is for all the NP's on here. Why did you pick NP over MD? If you go the MD route totally free. No loans. Would you do it? Because this is a real problem. And it effects everyone as anyone can get sick at anytime and need healthcare. I just think its scary that theres a huge push for mid levels. And we have med school graduates that cant get a residency. Mid levels are here to stay. We can debate the effectiveness of each. Which is actually very entertaining. But how is our healthcare system going to sustain itself if the number of midlevels exceeds the number of MD's? When we let economics rule our delivery of healthcare its surely not going to end well. I must say I just love the NP v MD debate. Never gets old!
Maybe it's just me but I have a hard time following your posts.
I didn't become an NP as a second choice, and I would absolutely do it again. I work in primary care and my quality measures are higher than nearly every other provider in my practice association. If I wanted to do surgery, then I would go MD. If I wanted to do a speciality, then I would go MD.
There isn't much real debate about the effectiveness of each, as it is very well documented.
What is the problem with sustaining a healthcare system that has more NP/PA than MDs?
And why are there med grads that can get residency spots? Because those spots are purposely limited to create demand and maintain salary. Remember, as you said, this is about economics. Or perhaps the foreign-educated physicians taking spots as well....
A hunnert or so years ago I was ICU clin spec in a community hospital, one of two MNs in the building (for what that's worth)(the other was psych, but working as a house supervisor) and asked to be part of a group to help brainstorm/problem-solve a decrease in hospital admissions, particularly in OB.
Well, there was only one OB group in town, and they were not called "the three clowns" for nothing. The only good guy had recently moved to town and joined them, but they rapidly discovered that any patient (including all the nurses) that saw him requested to see him and only him, and hounded him out of the practice. (He has been doing GYN only ever since-- you can't do solo OB unless you want to be on call 24/7/52). So one of my suggestions was that they allow CNMs privileges, because more and more women were going that way, and volunteered that I had had excellent care from CNMs for both of my pregnancies, with hospital births. The other hospital in the area had them, and they were doing well.
Crickets.
OB use kept going down, a few year later my position evaporated and I left there. And guess what? Now they have midwives and tout it in their advertising.
OP, don't worry. Eventually management will note the increased utilization at the other facility, ask around, and discover that your psych attendings are holding things back. Meanwhile, the odd appearance of flyers mentioning their services in the CEO's interdepartmental mailbox might pique his curiosity.
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.
Are you really advising that Nurses base their professional career choices on what others think? Many NP's do quite well despite shallow judgment. MD's are more worried about losing patient income to NPs than whether the degree is "legit." Less competition is good for the MD, so they will continue to belittle the NP. NP's need to press forward, regardless.
PMHNP-1
46 Posts
Crazynut, that isn't the problem. There is a shortage of psychiatrists who will go into the HOSPITAL to see patients. they don't earn enough to do that, typically: private practice pays more.