PsychMD

No doubt there are a lot of really incompetent and dangerous doctors out there. It's harder for the bad ones to sneak their way into prestigious teaching hospital gigs. Luckily, most of doctors I've worked with have been top notch, and some really great. But yeah, I've certainly seen a lot of bad doctors at smaller non-academic hospitals, private practices, jails, prisons, and community clinics. Really bad, really scary stuff. I recently took a non-academic job to make more money and be closer to family. The PA I work with, while lacking in experience and not getting good supervision, is really smart and already better than several of my MD coworkers, sadly.

You're missing the point. I'm not saying NPs don't practice independently in some states or that it's the norm for NPs to staff all their patients. What I'm saying is 1. academic hospitals seem to inherently have a framework in place for ongoing education and training. 2. Not all teaching hospital may use a dyad model where the physician and NP see patient's individually, run the list at noon, and then the physician sees some or most of the NP's patients, but it was this way at two hospitals I worked at, so I doubt it's that atypical. 3. I think this type of setup is an excellent way for a NP to improve, especially as a new grad.

Peds, internal medicine, and family medicine are 3 year residencies after medical school. Some would also include obgyn and psychiatry (both 4 years) in this list. I obviously don't know about everywhere and every different specialty, but at the two large academic teaching hospitals where I've been, NPs in my department had to staff 100% of their patients with their attending physician, and sometimes they would see the more difficult patients together. They had similar responsibilities as 2nd year residents. As you said, NPs often are assigned more straight forward cases, and there's no reason well-trained NPs can't provide excellent quality care for routine things independently. But part of it is a prestige thing. Some patients have expectations when they go to a big name hospital that they will be seen by a world renowned physician. There was some talk at my last place to allow a couple of experienced NPs to manage a small inpatient caseload on their own, but it was shot down, I think mostly because it didn't look good. As far as the cost goes, yeah, it would be cheaper if NPs all worked on their own without supervision, but not everywhere is always 100% profit driven, and NPs are still much cheaper than hiring additional physicians. A lot of doctors at academic centers are not seeing patients all day anyway. Many may only have a 50% clinical appointment. Many will have time allotted for supervising residents/NPs, teaching classes, doing research, and other admin tasks. I was never try to disparage anyone, so sorry if it came across that way. Just was pointing out the most competent mid levels I've worked with have been in these type of environments. Being surrounded by bright minds, getting quality supervision on a daily basis, sitting in classes/journal clubs with residents, going to grand rounds, etc seems like an easier path to greatness than just doing 500 clinical hours and going at it on your own.

I don't know what an "NP residency" is, but it looks like a few months of extra supervision. I would be careful who you are getting this supervision from. Regarding a new grad not needing a supervising MD, I guess that depends what state you live in and what your goals are. I would strive to be the best clinician I could. An employer giving you an easy few months to get accustomed to the job or working with a more experienced NP is not going to give you the same experience as staffing 100% of your cases and seeing patients together with a top physician in his field for a few years.

This is going to depend a lot on location. The local community mental health salaries here top out at about $130k for NPs, which is about what RNs make on average here, too. Crazy, right? I have one nurse acquaintance who works 1/2 time as a psych NP in a community clinic (because that’s what she was trained for) and 1/2 time at a hospital as a psych rn (because it pays better).

Same with lipids and blood pressure. Weight is typically monitored more frequently, and some recommend getting waist circumference annually, but I feel this recommendation probably isn't as often followed.

Large academic teaching hospitals likely will best fit what you're looking for. They usually have really good benefits, the prestige is there, and it's the safest bet for finding competent physicians to work with. Doctor quality varies greatly. It's usually a little harder for the bad ones to sneak their way into academics.

It's really insane when you think about it. I assume a lot of NPs take this 500 hours of experience, go to work, and try to learn as they go. This is not the best recipe for success. The most competent NPs I've worked with have been in academic settings where they were being supervised and 100% of their cases staffed with a solid academic attending physician. This is the best environment to learn and become an competent clinician. If you want to become a good healthcare provider, I would at least consider looking for a job like this for at least the first few years out of training.

Not happening. I know a few RNs in the Bay Area making over $200k and know that some are making over $300k, but they all do a lot of overtime.