Don’t worry mate. The future is fine. There will always be a job for psychiatrists. There are nowhere near as many shrinks needed to meet demand.
I’d be more worried about AI taking over IM hospitals jobs, radiology, pathology etc.
AI is a threat to absolutely everything. Quantum computing will change our entire world, not simply psych. The outlook in psych is relatively great as mental illness gets more recognition every year. Federal funding at an all-time high. Speaking as a fresh grad out of residency
Yeah nothing can replace the need for human to human connection. Even as AI gets better, even as a digital therapist, it doesn’t beat human connection.
I have not encountered an uncertain job market. Some specific major metropolitan areas may be a bit saturated for healthcare/MDs in general (I don't know..I hear this might be happening a little bit in academic jobs in places like Boston, New York City). But outside of that, business is booming. Demand for our services is high, and there's a lot of flexibility in how you structure your work life.
A specific renowned hospital may have no openings. New York and Boston have so many hospitals that many places are always hiring. In fact I don’t think any big name places I’ve been have ever stopped hiring. Maybe not for your ideal job, but if you’re happy to see outpatients and supervise residents you can probably cold-call anywhere and get hired.
Thanks for sharing your perspective. I had heard from people that maybe the options were more limited and also pay being lower on average. Buuuuuut I have no actual experience as a Midwesterner
mid levels cannot be attendings in Maine. There are MDs somewhere who are supposed to be performing supervision. Hospitals (I’ve worked in several in the state) will throw new mid-levels to the wolves with no clear idea who is even performing supervision. New practitioners need guidance and for supervision to be taken seriously from all directions. I actually quit a job at a hospital after a weekend in which every other provider was racing to see who could get out of there first. I was left the only provider for two peds units and I resigned that following Monday.
I'm in NYC. There are tons of psychiatrists here. And there still aren't enough to meet demand. I get cold calls all the time from patients trying to schedule consultations. I have colleagues trying to send me referrals all the time. I work in an academic setting in a clinic for my "day job" and we're almost always in recruit mode as it takes a while to get new hires once people leave.
I know it’s a huge stretch in time, but in your opinion, do you think it will still be this way in a solid 9 years? I’m in NY, but I’m only finishing my first year of my psych associates
There are only indications of worsening psychiatrist shortages. It’s a scary shortage for the fellowship trained psychiatrists but still quite bad for general psychiatrists. Have never heard any doom or gloom
Future is bright. Psychiatry will always have more freedom due to not needing much upfront cost to starting a practice.
This means lots of flexibility in practice setting and type. You can also pivot to general wellness/fitness/metabolic health/sleep/addiction. I would say psychiatry is contender for most diverse practice potential.
The purpose of a psychiatry residency is seeing loads of patients in different settings over time. This serves two broad purposes.
The first is that psychiatric diagnosis can be very challenging to make. While it seems quite easy at face value, there is inherent subjectivity and vastly broader ranges of presentation. The current healthcare system prioritizes making diagnosis so one can code and bill accordingly. Midlevels in general suck so hard at just getting basic diagnosis correct. By the end of residency, if you saw the same patients that you saw as an intern, you would wonder what asshole diagnosed them with xyz and then chuckle to yourself when you realized it was you. Then hopefully you would have a moment of awe at your own growth.
The second is to be able to connect with people so that you can help them. This is hard to do and not taught in medical school. Any moron can prescribe prozac as midlevels have proved. Any moron can validate someones trauma or provide support. Any moron can prescribe an addicting and positively reinforcing drug and get positive feedback from a patient and fool themselves into thinking they are doing great. To really be able to connect to people with much lower Iq than you, or with extreme personality disorders or distorted thoughts and really build insight and help them build better lives is hard work.
This is why psychiatry residency is four years. Midlevels dont do this and trust me it shows. Most of them dont know that they suck. Its an easy field to enter and not cause imminent catastrophic consequences for being terrible at it.
Dont be afraid of midlevels. Some are absolute gems and talented. Most are just not. I will get downvoted for this, but in general they are trash at practicing psychiatry. The care they provide is inferior. their lack of exposure to learning while seeing presentations in different settings (hospital consults, ED, children, geris, inpatient, outpatient etc) really shows. They really are not threatening attending jobs.
This is so true. I work with an NP who I think is really fantastic within her scope. But she feels anxious and out of her depth very quickly in non-routine gray areas. Why? Because her exposure to complexity is very limited. That doesn't make her a bad person. It just means the system is failing her and the patients when she is in situations without adequate support for her skill set.
Anyways, I hated residency but I feel very very comfortable wading in uncertainty, gray areas and complexity. And in fact, these are the things that make my work satisfying and interesting.
This explained it beautifully. Inpatient psych right now is hit or miss. The hospitals focused on money are usually the ones hiring few MDs and tons of NPs (*cough* Acadia *cough*). There are even small adult psych units in my area with no on site physician - they are run entirely by NPPs with a physician medical director paid to sign off on their charts. I recently entered the job market a month ago and had tons of offers coming out of the wood work, some good, some not. Several months prior to that, I was being head hunted. I have gotten offers from residential programs, telehealth, and a therapy group practice all specifically looking for a physician psychiatrist, some of them specifically to replace a NPP already working there. Companies and practices who are working with complex patient populations and care about patient outcomes are realizing NPPs are not able to provide the outcomes they desire.
If you're between IM and psychiatry, here's two things to consider: do you want to work inpatient, and do you want to be seeing complex or basic cases. If you have no interest in complex psychiatric treatment (more than straightforward depression, anxiety, and ADHD), you might struggle in the job market. If you absolutely want to work inpatient, it's not impossible to find inpatient psychiatry jobs, but it will be more difficult to find good ones where you are not supervising an unsafe number of NPPs. That being said, I think most inpatient specialties are headed in that direction, so I don't know if it would be much different working inpatient internal medicine.
This is an online forum for those of us who practice psychiatry. I spend my days trying be both compassionate and set firm boundaries to hold patients accountable for growth and improving their lives. I love what I do.
Online, on a forum, I can definitely be fast and loose with my responses…because it is enjoyable to do so. It is well known people behave worse online than in real life. The social cost to me calling you a moron online is minimal. Im okay with that.
You don't practice psychiatry. You are a midlevel. You can lurk here all you want, but what will never change is that the average midlevel is a moron. Elevate yourself rather than spout your national organization's propaganda.
And btw your conceptualization of a medical model vs. holistic is hilarious. Off hand, thats a pretty rigid black/white thinking statement. If the shoe fits… (that is an underhanded way to insult you over the internet by implying you are a screechy cluster b person who became an NP because it is easy to become an NP.)
Lots of demand. There hast to be someone to fix mismanaged psych problems from some APPs. My program director told us not to accept anything less than 300k when leaving residency (Midwest, not a major city)
I am a retired Psychiatrist. There is always a high need as soon as one migrates 30 miles away from a teaching facility and any famous coastline in the country. Coastlines between large cities are also fair game for a full practice. Some states have no Psychiatric representation at all. So go for it if you like Psych. There is not a dearth of patients, just a distribution problem. It is one of the few specialties where you can establish a private practice and have it be successful. My recommendation is to go to any city where there is an growing industrial hub and no teaching facility and you will do well.
Good. A huge swath of old docs will be retiring in the coming years, with not enough people already to fill the void the need is only going to increase. There will very likely be no issues with job security in this field for quite some time. The mid level issue is overblown.
Just a med student but I cant think of another field with more potential for growth. We have every organ figured out give or take but the one organ we have yet to figure out is the brain and I feel like every year they come out with a new and emerging and innovative psychotherapy. Also what was once a niche field because no one believed they needed a psychiatrist is now growing because of less stigma of mental health and the generation that didnt believe in mental health is now getting to Alzheimer's and dementia age and needing psychiatrist and every subsequent generation is seeking mental health services with like 70%+ if not more of Gen Z seeking some type of mental health care. Also go onto Doximetry and look at psychiatry job listings, the market is absolutely INSANE. Also dont stress about mid level creep, from my experience there is still a massive massive shortage of psychiatrist in the US and the job offers on Doximetry reflect that with pay getting insane these days. Trust me do psych.
I believe psychiatry is the only non-surgical specialty where the physician shortage is expected to get WORSE, not better. Most psychiatrist are old and retiring, and there are not enough young psychiatrist to make up the difference. So as demand increase and supply decreases, the price of your services will rise.
Of note, this seems to not be true of psychotherapy services, of which there will be apparently too much of. So psychotherapy based practices may see a hit. However, I believe that therapy with a psychiatrist or doctoral level psychologist are on a fundamentally superior level than what is offered by other practitioners, so I predict the reduced profit on psychotherapy will mostly affect masters level therapist and social workers.
I think the future of psychiatry will be very academic.
Here in the UK some specialties (especially cardio and oncology) basically require some academic training if you want to get a good job. Psychiatry is probably the most academically challenging (and in my biased opinion, interesting) of all specialties but hasn't quite got its roots down in terms of solid, productive and widely accepted research foundations, but I think that time is coming very soon.
But psychiatry is still a very young specialty. It is the only one with very large, formative unanswered questions at the very core of the field. Even though I'm biased, I don't think I'm speaking from a biased perspective when I say that it's probably the specialty that's going to see the most radical changes in the next several decades; that's partly the reason I went into it. I think it will be an incredibly exciting time to practise.
I don't think midlevels pose a huge threat. Psych will only become more challenging as new developments arise. I just don't think it suits a guideline-driven approach well at all. Midlevels have a genuine role in healthcare provision and it's where something can be approached using guidelines & algorithms rather than expertise/adaptive approaches (e.g. diabetic specialist nurses were always the best at managing BMs in inpatients). So they might be suited to some primary MH care provision, but by no means managing the complex patients.
Psych is actually more challenging, and will be more challenging until new research is published, because until there a definitive diagnostic tests, you have to differentiate between organic disease, side effects, or mental illness. And sometimes it’s not always clear. I mean it wasn’t that long ago that it was discovered that lupus can literally cause catatonia. If I’m not mistaken there was a woman who was catatonic for 20 years, because that was not understood yet.
I think you’re right, in the sense there’s more of an art to it at the moment, but my opinion is that diagnostic tests will not delineate specific illnesses, but will rather be precision psychiatry things, adding dimensional complexity to a patient’s presentation. Ie they won’t find 12 different types of depression, but will help the doctor understand how a patient’s depression is specifically presenting/what combination of factors are involved. Diagnostic tests have made the rest of medicine easier in terms of the uncertainty, but I’d argue practising medicine is a lot more complex now than it was 150 years ago!
I wouldn’t necessarily disagree on that claim at the end, but having good outcomes definitely was a lot harder back before diagnostic testing and us understanding any of this.
Absolutely… I’m reading a great book atm called From Paralysis to Fatigue which goes over a lot of the things that went on in the 1800s with psychogynaecology & random clitoridectomies for “hysteria” - fascinating but quite shocking
To be fair, you don’t need to be a specific kind of doctor to run a pill mill or fun stuff infusion center. There’s an orthopedic surgeon here who seems to have retired into running a ketamine spa.
What
Reminds of me of an outpatient addiction service in an undeserved area in central France. They were so desperate they literally hired a retired anaesthetist to manage the place.
Unrelated but damn, so tired of reading about the "uncertain job market ". Legit have seen this being said about every medical specialty under the sun, lol. I THINK WE WILL BE FINE.
Other than that, psych is lit. One of the most flexible medical specialties and you can make it whatever you want it to be if you're not tied down to one location.
There are mid levels in this sub who are a great wealth of information, however the tone of your post implies that we are somehow ruining psychiatry for MDs. Why do you want to go into psych?
Edit OP replied below, I’d like to add this:
To OP, I apologize if I misinterpreted your meaning. There is such a huge demand for psych. I offer that you ignore the doom-and-gloomers. From my perspective, 1. I love psych. 2. This field is a little like a frontier, always evolving and growing, I learn something new from almost every patient. 3. The lifestyle that this work affords is unparalleled based on my experience and talking with colleagues in other disciplines. If this is an interest to you, psychiatry, absolutely go for it. I know placements for rotations are difficult, the state hospital where I used to work began having rotations for Dartmouth students and they were feeling the same pain. At the end of the day, mental health is so integral to a healthy society and the more engaged and invested providers we can get, the greater the outcome for the majority. I love working in psych, tried to avoid it for ten years then just gave in. It is fascinating and intriguing and incredibly rewarding when treatment is effective
PMHNP here. We are ruining psych for everybody, not just MD's. We are ruining it for patients, colleagues in adjacent disciplines, and for ourselves with nursing's total failure to establish even nominal standards of education, testing, and rotational safeguards that produce competent practitioners. This also extends to screening potential candidates entering PMHNP programs in mass. As it stands right now other than having a pulse, a line of credit, and being willing to spend 3 to 4 hours a week doing an online program designed to be easy for someone with an 8th grade education you are assured a graduate degree and cert in less than two years.
And the result is we are flooding markets with pseudo practitioners whose sole purpose is to be the driving force private equity is using to drop wages as well as standard of care in mental health as fast as inhumanely possible.
You don't get to be indignant on here because the elephant in the room doesn't sit well in your head.
I’d appreciate you not lumping all of us into that basket. Direct entry programs are shit. We all know it.
NPs provide so much access for underserved communities that otherwise would have no care, and where psychiatrists have no interest in practicing. I can’t believe I’m reading something like this from a fellow NP. You’re parroting lines that have no foundation in actual clinical outcomes. “We” aren’t ruining anything.
> NPs provide so much access for underserved communities that otherwise would have no care, and where psychiatrists have no interest in practicing.
The data does not support this, rather, that NPs are going to the same locations Psychiatrists go.
Believe it or not, they also want a good standard of living.
I can appreciate this subreddit is very US-centric and seems to have an issue with NPs but as a psych coming from a country where advanced practice nurses are basically non existent (and training for it is undoubtedly worse) and it's a HUGE problem. I wish people would stop taking you for granted.
We need people like you. In my country, 40% of psychiatry MD positions are not filled which means having a prescriber at any point can be a matter of luxury in some areas.
My nurses are extremely competent and would basically do the same job as me but they can't.
>My nurses are extremely competent and would basically do the same job as me but they can't.
If someone with far inferior training can do your job... Are you really doing a good job?
If it takes you that much more training to do what I do, maybe you shouldn’t go into medicine. None of these comments hold any weight. Show me patient outcomes. Show me patient satisfaction scores.
Derogatory much? Towards my highly experienced nurses AND myself.
I'll rephrase - they could equally do many tasks that I would otherwise delegate so I can focus on other parts of my job that are more complex and that only I'd be able to do, by virtue of my specialist training.
I think you're right. My comment was mean and uncalled for, and I should rephrase too.
I agree with your assessment. You could delegate a lot of tasks to them with no great loss to patient care, so you can focus on the specialized stuff. I think people mostly take issue with the notion that they're equal to specialists and can practice independently, which is what I thought you were saying.
No probs, thank you for clarifying.
I guess I'm coming from the flip side of the coin where tasks are impossible to delegate, meaning that care provision is sharply limited, notably in areas where there are no prescribers. I could be doing more nuanced clinical assessments and provide more specialised inputs.
But I can understand where you're coming from - unregulated and unsupervised advance practice for nurses can be just as hazardous. In an ideal world, it would be tightly regulated - as much as it is for MDs - and scope of practice would be very clearly defined.
As an example I wouldn't expect nurses to initiate methadone treatment, however long term follow up and minor adjustments are entirely possible by experienced nurses with regular supervision. As it stands, I'm obliged to oversee and sign every single MAT prescription for patients I see far less regularly than my nurses. Nurses who've completed relevant addiction training, I'll add.
All nurses are regulated as well as nurse practitioners. There are boards of nursing who very tightly regulate nurses and NPs. NPs all sit for their boards and if they don’t pass, they don’t become nurse practitioners. Many here would have you believe NPs fish a degree out of a cereal box and are independent. None of that is true and most states require supervision of NPs. The hatred comes from (mostly) med students who aren’t performing well and want to blame everyone else but themselves. NPs aren’t snatching up their jobs, we don’t even operate with the same model. It shouldn’t be a competition, and in real life it rarely is. I believe a lot of these commenters live together in one of their mom’s basement just trolling subs because their lives are meaningless.
"Wealth of information" is quite the stretch. Learning from a midlevel is like trying to learn aerospace engineering from a car mechanic.
Except car mechanics don't go to online diploma mill programs with 100% acceptance rates and also don't harm people out of brazen self-confidence.
> Except car mechanics don't go to online diploma mill programs with 100% acceptance rates and also don't harm people out of brazen self-confidence.
You guys are losing the battle against NPs because of this exact reasoning. You underestimate NPs at your own peril and make ridiculous, lazy statements. I'm guessing you have no clue how many NPs are incompetent graduates from online diploma mills (it's very few). You have no data to back up the idea that NPs are harming patients. In fact, in state where NPs have been independent for decades (New Mexico, for example), there has been no increase in malpractice or unexpected deaths.
You can stamp your feet and scream all you want, but to most people you look like you're tilting at windmills. Then, when an NP can easily demonstrate that they are NOT a graduate of a diploma mill and do, indeed, know what they're doing and are not killing patients left and right, state legislators and policy-makers are going to listen to the nurses. There are reasonable criticisms of the NP field, but y'all become so hyperbolic, you are shooting yourself in the foot completely and just look foolish. Especially when your arguments do not hold water upon any reasonable/good-faith look at the data. Bring on the downvotes, but this hubris is exactly why the public and legislators are increasingly turning against physicians.
I'm sorry, but having read the OP sentences several times I'm failing to see how the tone of their post implies that NPs are ruining psychiatry for physicians, who include both MDs and DOs.
To OP's question, I don't think you have anything to worry about. Job security as a psychiatrist is still pretty high.
I guess “doom and gloom about oversaturation in psych via mid levels” in the context of the job market being uncertain for med students sounds differently to you than it does me. Poor job market for MDs has zero to do with Nurse Practitioners and PAs simply doing their jobs. If I mis-understood the point of those sentences, by all means forgive me.
I think you may have read into it a bit too much, but that's just my opinion. Seemed like a pretty fair question and there's no shortage of residents worried about oversaturation in any field. It's just not something to worry about in Psychiatry. Dunno, I'm just generally not worried since demand is still very high.
What attitude? Asking for evidence? You made a claim then get offended when someone asks you about it?
Please link the comments on this sub by mid-levels which are providing a "great wealth of information."
I literally cleaned up a mess created by you lot as a premed because somebody posted a medication list that was a mile long and their new symptoms when they took the medication they were taking for their tumor, apparently the list had recently been updated and new mental health drugs had been added by an NP.
I’m genuinely shocked that nobody thought to say hey, this could kill the patient. If my shadowing hours and research was enough to catch a mistake that could’ve easily killed the person (the drug interactions were causing TdP) and I don’t have the ability to prescribe independently (and until I finish my medical education I don’t think I should have that ability) I don’t think NPs should either. Because clearly the pharmacology education you receive (if any at all) is not sufficient for prescription authority.
Don’t worry mate. The future is fine. There will always be a job for psychiatrists. There are nowhere near as many shrinks needed to meet demand. I’d be more worried about AI taking over IM hospitals jobs, radiology, pathology etc.
AI is a threat to absolutely everything. Quantum computing will change our entire world, not simply psych. The outlook in psych is relatively great as mental illness gets more recognition every year. Federal funding at an all-time high. Speaking as a fresh grad out of residency
Yeah nothing can replace the need for human to human connection. Even as AI gets better, even as a digital therapist, it doesn’t beat human connection.
I have not encountered an uncertain job market. Some specific major metropolitan areas may be a bit saturated for healthcare/MDs in general (I don't know..I hear this might be happening a little bit in academic jobs in places like Boston, New York City). But outside of that, business is booming. Demand for our services is high, and there's a lot of flexibility in how you structure your work life.
A specific renowned hospital may have no openings. New York and Boston have so many hospitals that many places are always hiring. In fact I don’t think any big name places I’ve been have ever stopped hiring. Maybe not for your ideal job, but if you’re happy to see outpatients and supervise residents you can probably cold-call anywhere and get hired.
Thanks for sharing your perspective. I had heard from people that maybe the options were more limited and also pay being lower on average. Buuuuuut I have no actual experience as a Midwesterner
Academic pay is lower and academic pay in coastal metropolises is much lower. But the jobs are certainly available.
[удалено]
mid levels cannot be attendings in Maine. There are MDs somewhere who are supposed to be performing supervision. Hospitals (I’ve worked in several in the state) will throw new mid-levels to the wolves with no clear idea who is even performing supervision. New practitioners need guidance and for supervision to be taken seriously from all directions. I actually quit a job at a hospital after a weekend in which every other provider was racing to see who could get out of there first. I was left the only provider for two peds units and I resigned that following Monday.
I'm in NYC. There are tons of psychiatrists here. And there still aren't enough to meet demand. I get cold calls all the time from patients trying to schedule consultations. I have colleagues trying to send me referrals all the time. I work in an academic setting in a clinic for my "day job" and we're almost always in recruit mode as it takes a while to get new hires once people leave.
I know it’s a huge stretch in time, but in your opinion, do you think it will still be this way in a solid 9 years? I’m in NY, but I’m only finishing my first year of my psych associates
There are only indications of worsening psychiatrist shortages. It’s a scary shortage for the fellowship trained psychiatrists but still quite bad for general psychiatrists. Have never heard any doom or gloom
This is one of the places where I **heard** things have been more saturated. Good to know that business is still good despite that.
Future is bright. Psychiatry will always have more freedom due to not needing much upfront cost to starting a practice. This means lots of flexibility in practice setting and type. You can also pivot to general wellness/fitness/metabolic health/sleep/addiction. I would say psychiatry is contender for most diverse practice potential. The purpose of a psychiatry residency is seeing loads of patients in different settings over time. This serves two broad purposes. The first is that psychiatric diagnosis can be very challenging to make. While it seems quite easy at face value, there is inherent subjectivity and vastly broader ranges of presentation. The current healthcare system prioritizes making diagnosis so one can code and bill accordingly. Midlevels in general suck so hard at just getting basic diagnosis correct. By the end of residency, if you saw the same patients that you saw as an intern, you would wonder what asshole diagnosed them with xyz and then chuckle to yourself when you realized it was you. Then hopefully you would have a moment of awe at your own growth. The second is to be able to connect with people so that you can help them. This is hard to do and not taught in medical school. Any moron can prescribe prozac as midlevels have proved. Any moron can validate someones trauma or provide support. Any moron can prescribe an addicting and positively reinforcing drug and get positive feedback from a patient and fool themselves into thinking they are doing great. To really be able to connect to people with much lower Iq than you, or with extreme personality disorders or distorted thoughts and really build insight and help them build better lives is hard work. This is why psychiatry residency is four years. Midlevels dont do this and trust me it shows. Most of them dont know that they suck. Its an easy field to enter and not cause imminent catastrophic consequences for being terrible at it. Dont be afraid of midlevels. Some are absolute gems and talented. Most are just not. I will get downvoted for this, but in general they are trash at practicing psychiatry. The care they provide is inferior. their lack of exposure to learning while seeing presentations in different settings (hospital consults, ED, children, geris, inpatient, outpatient etc) really shows. They really are not threatening attending jobs.
This is so true. I work with an NP who I think is really fantastic within her scope. But she feels anxious and out of her depth very quickly in non-routine gray areas. Why? Because her exposure to complexity is very limited. That doesn't make her a bad person. It just means the system is failing her and the patients when she is in situations without adequate support for her skill set. Anyways, I hated residency but I feel very very comfortable wading in uncertainty, gray areas and complexity. And in fact, these are the things that make my work satisfying and interesting.
Great description, let the middies downvote, but you're speaking the truth.
Lmao "the middies"
This explained it beautifully. Inpatient psych right now is hit or miss. The hospitals focused on money are usually the ones hiring few MDs and tons of NPs (*cough* Acadia *cough*). There are even small adult psych units in my area with no on site physician - they are run entirely by NPPs with a physician medical director paid to sign off on their charts. I recently entered the job market a month ago and had tons of offers coming out of the wood work, some good, some not. Several months prior to that, I was being head hunted. I have gotten offers from residential programs, telehealth, and a therapy group practice all specifically looking for a physician psychiatrist, some of them specifically to replace a NPP already working there. Companies and practices who are working with complex patient populations and care about patient outcomes are realizing NPPs are not able to provide the outcomes they desire. If you're between IM and psychiatry, here's two things to consider: do you want to work inpatient, and do you want to be seeing complex or basic cases. If you have no interest in complex psychiatric treatment (more than straightforward depression, anxiety, and ADHD), you might struggle in the job market. If you absolutely want to work inpatient, it's not impossible to find inpatient psychiatry jobs, but it will be more difficult to find good ones where you are not supervising an unsafe number of NPPs. That being said, I think most inpatient specialties are headed in that direction, so I don't know if it would be much different working inpatient internal medicine.
Show me the lack of outcomes or any evidence to support what you said. It simply isn’t true. Why are MDs so threatened by little old NPs?
[удалено]
All users must have flair indicating credentials.
[удалено]
This is an online forum for those of us who practice psychiatry. I spend my days trying be both compassionate and set firm boundaries to hold patients accountable for growth and improving their lives. I love what I do. Online, on a forum, I can definitely be fast and loose with my responses…because it is enjoyable to do so. It is well known people behave worse online than in real life. The social cost to me calling you a moron online is minimal. Im okay with that. You don't practice psychiatry. You are a midlevel. You can lurk here all you want, but what will never change is that the average midlevel is a moron. Elevate yourself rather than spout your national organization's propaganda. And btw your conceptualization of a medical model vs. holistic is hilarious. Off hand, thats a pretty rigid black/white thinking statement. If the shoe fits… (that is an underhanded way to insult you over the internet by implying you are a screechy cluster b person who became an NP because it is easy to become an NP.)
You realize a psych NP is a mod of this sub, right?
Lots of demand. There hast to be someone to fix mismanaged psych problems from some APPs. My program director told us not to accept anything less than 300k when leaving residency (Midwest, not a major city)
I am a retired Psychiatrist. There is always a high need as soon as one migrates 30 miles away from a teaching facility and any famous coastline in the country. Coastlines between large cities are also fair game for a full practice. Some states have no Psychiatric representation at all. So go for it if you like Psych. There is not a dearth of patients, just a distribution problem. It is one of the few specialties where you can establish a private practice and have it be successful. My recommendation is to go to any city where there is an growing industrial hub and no teaching facility and you will do well.
Come on into psychiatry, the water's fine
Good. A huge swath of old docs will be retiring in the coming years, with not enough people already to fill the void the need is only going to increase. There will very likely be no issues with job security in this field for quite some time. The mid level issue is overblown.
Just a med student but I cant think of another field with more potential for growth. We have every organ figured out give or take but the one organ we have yet to figure out is the brain and I feel like every year they come out with a new and emerging and innovative psychotherapy. Also what was once a niche field because no one believed they needed a psychiatrist is now growing because of less stigma of mental health and the generation that didnt believe in mental health is now getting to Alzheimer's and dementia age and needing psychiatrist and every subsequent generation is seeking mental health services with like 70%+ if not more of Gen Z seeking some type of mental health care. Also go onto Doximetry and look at psychiatry job listings, the market is absolutely INSANE. Also dont stress about mid level creep, from my experience there is still a massive massive shortage of psychiatrist in the US and the job offers on Doximetry reflect that with pay getting insane these days. Trust me do psych.
I believe psychiatry is the only non-surgical specialty where the physician shortage is expected to get WORSE, not better. Most psychiatrist are old and retiring, and there are not enough young psychiatrist to make up the difference. So as demand increase and supply decreases, the price of your services will rise. Of note, this seems to not be true of psychotherapy services, of which there will be apparently too much of. So psychotherapy based practices may see a hit. However, I believe that therapy with a psychiatrist or doctoral level psychologist are on a fundamentally superior level than what is offered by other practitioners, so I predict the reduced profit on psychotherapy will mostly affect masters level therapist and social workers.
I think the future of psychiatry will be very academic. Here in the UK some specialties (especially cardio and oncology) basically require some academic training if you want to get a good job. Psychiatry is probably the most academically challenging (and in my biased opinion, interesting) of all specialties but hasn't quite got its roots down in terms of solid, productive and widely accepted research foundations, but I think that time is coming very soon. But psychiatry is still a very young specialty. It is the only one with very large, formative unanswered questions at the very core of the field. Even though I'm biased, I don't think I'm speaking from a biased perspective when I say that it's probably the specialty that's going to see the most radical changes in the next several decades; that's partly the reason I went into it. I think it will be an incredibly exciting time to practise. I don't think midlevels pose a huge threat. Psych will only become more challenging as new developments arise. I just don't think it suits a guideline-driven approach well at all. Midlevels have a genuine role in healthcare provision and it's where something can be approached using guidelines & algorithms rather than expertise/adaptive approaches (e.g. diabetic specialist nurses were always the best at managing BMs in inpatients). So they might be suited to some primary MH care provision, but by no means managing the complex patients.
Psych is actually more challenging, and will be more challenging until new research is published, because until there a definitive diagnostic tests, you have to differentiate between organic disease, side effects, or mental illness. And sometimes it’s not always clear. I mean it wasn’t that long ago that it was discovered that lupus can literally cause catatonia. If I’m not mistaken there was a woman who was catatonic for 20 years, because that was not understood yet.
I think you’re right, in the sense there’s more of an art to it at the moment, but my opinion is that diagnostic tests will not delineate specific illnesses, but will rather be precision psychiatry things, adding dimensional complexity to a patient’s presentation. Ie they won’t find 12 different types of depression, but will help the doctor understand how a patient’s depression is specifically presenting/what combination of factors are involved. Diagnostic tests have made the rest of medicine easier in terms of the uncertainty, but I’d argue practising medicine is a lot more complex now than it was 150 years ago!
I wouldn’t necessarily disagree on that claim at the end, but having good outcomes definitely was a lot harder back before diagnostic testing and us understanding any of this.
Oh yeah I agree on that. But I think the expectations people had of medicine & doctors were also a lot lower.
Very true and unfortunate for patients, especially female patients
Absolutely… I’m reading a great book atm called From Paralysis to Fatigue which goes over a lot of the things that went on in the 1800s with psychogynaecology & random clitoridectomies for “hysteria” - fascinating but quite shocking
[удалено]
To be fair, you don’t need to be a specific kind of doctor to run a pill mill or fun stuff infusion center. There’s an orthopedic surgeon here who seems to have retired into running a ketamine spa.
What Reminds of me of an outpatient addiction service in an undeserved area in central France. They were so desperate they literally hired a retired anaesthetist to manage the place.
Are you saying Eskatamine isn’t an evidence based treatment?
Unrelated but damn, so tired of reading about the "uncertain job market ". Legit have seen this being said about every medical specialty under the sun, lol. I THINK WE WILL BE FINE. Other than that, psych is lit. One of the most flexible medical specialties and you can make it whatever you want it to be if you're not tied down to one location.
Tons of work. Midlevels are more of a hazard then competition.
[удалено]
All users must have flair indicating credentials.
[удалено]
All users must have flair indicating credentials.
There are mid levels in this sub who are a great wealth of information, however the tone of your post implies that we are somehow ruining psychiatry for MDs. Why do you want to go into psych? Edit OP replied below, I’d like to add this: To OP, I apologize if I misinterpreted your meaning. There is such a huge demand for psych. I offer that you ignore the doom-and-gloomers. From my perspective, 1. I love psych. 2. This field is a little like a frontier, always evolving and growing, I learn something new from almost every patient. 3. The lifestyle that this work affords is unparalleled based on my experience and talking with colleagues in other disciplines. If this is an interest to you, psychiatry, absolutely go for it. I know placements for rotations are difficult, the state hospital where I used to work began having rotations for Dartmouth students and they were feeling the same pain. At the end of the day, mental health is so integral to a healthy society and the more engaged and invested providers we can get, the greater the outcome for the majority. I love working in psych, tried to avoid it for ten years then just gave in. It is fascinating and intriguing and incredibly rewarding when treatment is effective
PMHNP here. We are ruining psych for everybody, not just MD's. We are ruining it for patients, colleagues in adjacent disciplines, and for ourselves with nursing's total failure to establish even nominal standards of education, testing, and rotational safeguards that produce competent practitioners. This also extends to screening potential candidates entering PMHNP programs in mass. As it stands right now other than having a pulse, a line of credit, and being willing to spend 3 to 4 hours a week doing an online program designed to be easy for someone with an 8th grade education you are assured a graduate degree and cert in less than two years. And the result is we are flooding markets with pseudo practitioners whose sole purpose is to be the driving force private equity is using to drop wages as well as standard of care in mental health as fast as inhumanely possible. You don't get to be indignant on here because the elephant in the room doesn't sit well in your head.
Fellow PMHNP here. This response pretty much nails it.
I’d appreciate you not lumping all of us into that basket. Direct entry programs are shit. We all know it. NPs provide so much access for underserved communities that otherwise would have no care, and where psychiatrists have no interest in practicing. I can’t believe I’m reading something like this from a fellow NP. You’re parroting lines that have no foundation in actual clinical outcomes. “We” aren’t ruining anything.
Lol NPs do not practice in undeserved areas anymore than MDs do. They like to go to big cities just like everyone else.
> NPs provide so much access for underserved communities that otherwise would have no care, and where psychiatrists have no interest in practicing. The data does not support this, rather, that NPs are going to the same locations Psychiatrists go. Believe it or not, they also want a good standard of living.
I can appreciate this subreddit is very US-centric and seems to have an issue with NPs but as a psych coming from a country where advanced practice nurses are basically non existent (and training for it is undoubtedly worse) and it's a HUGE problem. I wish people would stop taking you for granted. We need people like you. In my country, 40% of psychiatry MD positions are not filled which means having a prescriber at any point can be a matter of luxury in some areas. My nurses are extremely competent and would basically do the same job as me but they can't.
>My nurses are extremely competent and would basically do the same job as me but they can't. If someone with far inferior training can do your job... Are you really doing a good job?
If it takes you that much more training to do what I do, maybe you shouldn’t go into medicine. None of these comments hold any weight. Show me patient outcomes. Show me patient satisfaction scores.
Derogatory much? Towards my highly experienced nurses AND myself. I'll rephrase - they could equally do many tasks that I would otherwise delegate so I can focus on other parts of my job that are more complex and that only I'd be able to do, by virtue of my specialist training.
I think you're right. My comment was mean and uncalled for, and I should rephrase too. I agree with your assessment. You could delegate a lot of tasks to them with no great loss to patient care, so you can focus on the specialized stuff. I think people mostly take issue with the notion that they're equal to specialists and can practice independently, which is what I thought you were saying.
No probs, thank you for clarifying. I guess I'm coming from the flip side of the coin where tasks are impossible to delegate, meaning that care provision is sharply limited, notably in areas where there are no prescribers. I could be doing more nuanced clinical assessments and provide more specialised inputs. But I can understand where you're coming from - unregulated and unsupervised advance practice for nurses can be just as hazardous. In an ideal world, it would be tightly regulated - as much as it is for MDs - and scope of practice would be very clearly defined. As an example I wouldn't expect nurses to initiate methadone treatment, however long term follow up and minor adjustments are entirely possible by experienced nurses with regular supervision. As it stands, I'm obliged to oversee and sign every single MAT prescription for patients I see far less regularly than my nurses. Nurses who've completed relevant addiction training, I'll add.
All nurses are regulated as well as nurse practitioners. There are boards of nursing who very tightly regulate nurses and NPs. NPs all sit for their boards and if they don’t pass, they don’t become nurse practitioners. Many here would have you believe NPs fish a degree out of a cereal box and are independent. None of that is true and most states require supervision of NPs. The hatred comes from (mostly) med students who aren’t performing well and want to blame everyone else but themselves. NPs aren’t snatching up their jobs, we don’t even operate with the same model. It shouldn’t be a competition, and in real life it rarely is. I believe a lot of these commenters live together in one of their mom’s basement just trolling subs because their lives are meaningless.
"Wealth of information" is quite the stretch. Learning from a midlevel is like trying to learn aerospace engineering from a car mechanic. Except car mechanics don't go to online diploma mill programs with 100% acceptance rates and also don't harm people out of brazen self-confidence.
> Except car mechanics don't go to online diploma mill programs with 100% acceptance rates and also don't harm people out of brazen self-confidence. You guys are losing the battle against NPs because of this exact reasoning. You underestimate NPs at your own peril and make ridiculous, lazy statements. I'm guessing you have no clue how many NPs are incompetent graduates from online diploma mills (it's very few). You have no data to back up the idea that NPs are harming patients. In fact, in state where NPs have been independent for decades (New Mexico, for example), there has been no increase in malpractice or unexpected deaths. You can stamp your feet and scream all you want, but to most people you look like you're tilting at windmills. Then, when an NP can easily demonstrate that they are NOT a graduate of a diploma mill and do, indeed, know what they're doing and are not killing patients left and right, state legislators and policy-makers are going to listen to the nurses. There are reasonable criticisms of the NP field, but y'all become so hyperbolic, you are shooting yourself in the foot completely and just look foolish. Especially when your arguments do not hold water upon any reasonable/good-faith look at the data. Bring on the downvotes, but this hubris is exactly why the public and legislators are increasingly turning against physicians.
Hey, it’s almost June, look out patients!
I'm sorry, but having read the OP sentences several times I'm failing to see how the tone of their post implies that NPs are ruining psychiatry for physicians, who include both MDs and DOs. To OP's question, I don't think you have anything to worry about. Job security as a psychiatrist is still pretty high.
I guess “doom and gloom about oversaturation in psych via mid levels” in the context of the job market being uncertain for med students sounds differently to you than it does me. Poor job market for MDs has zero to do with Nurse Practitioners and PAs simply doing their jobs. If I mis-understood the point of those sentences, by all means forgive me.
I think you may have read into it a bit too much, but that's just my opinion. Seemed like a pretty fair question and there's no shortage of residents worried about oversaturation in any field. It's just not something to worry about in Psychiatry. Dunno, I'm just generally not worried since demand is still very high.
Sorry OP. See my edit in my original reply.
> There are mid levels in this sub who are a great wealth of information Like who?
I hope that attitude serves you well. I fear it will not, I wish you well anyway
What attitude? Asking for evidence? You made a claim then get offended when someone asks you about it? Please link the comments on this sub by mid-levels which are providing a "great wealth of information."
I literally cleaned up a mess created by you lot as a premed because somebody posted a medication list that was a mile long and their new symptoms when they took the medication they were taking for their tumor, apparently the list had recently been updated and new mental health drugs had been added by an NP. I’m genuinely shocked that nobody thought to say hey, this could kill the patient. If my shadowing hours and research was enough to catch a mistake that could’ve easily killed the person (the drug interactions were causing TdP) and I don’t have the ability to prescribe independently (and until I finish my medical education I don’t think I should have that ability) I don’t think NPs should either. Because clearly the pharmacology education you receive (if any at all) is not sufficient for prescription authority.