Why Psychiatry Needs Psychiatrists (and not just psych NPs)
Vložit
- čas přidán 26. 05. 2024
- Psychiatrists are increasingly being replaced by non-physician practitioners - psychiatric mental health nurse practitioners (PMHNPs) and physician assistants (PAs). This webinar explains the difference between a psychiatrist and a PMHNP and reviews the evidence regarding unsupervised care of patients with mental illness by non-physicians.
Learn more: PhysiciansForPatientProtection.org
Contact me: PatientsAtRisk.com
Get the books!
www.amazon.com/Patients-Risk-...
www.amazon.com/Imposter-Docto... - Věda a technologie
I'm a nursing professor, RN for 40 years, teach full-time, and still work in the ED. I applaud this video. I thought you would be nurse-bashing, but you did not. You presented tons of research, insight, and data that encapsulated the issue well. I AGREE WITH YOU COMPLETELY. Many schools see the financial gains of pumping students out at record speed, regardless of the quality. Even basic RNs come out knowing little and can put patients at risk. Where I work, new grad RNs graduate after a 2-year Associate's degree and get hired into my ED, caring for patients independently after just a few months. These NPs practicing solo with no MD supervision is beyond concerning for new NPs. You can see that they see that the wise ones realize they're sometimes way over their head (A friend of mine quit his FNP program 2 months before graduation, saying he was scared to death. He ended up going to medical school). There's been a trend for a post-NP residency (tons of hours working with another NP and/or physicians) for a year full-time. (It doesn't come close to medical residency, but a step in the right direction). We can do better! We can invest in more doctors and NPs, but ensure they're all properly trained and supported.
Dr. Bernard doing the lords work. Don’t ever stop. We need someone to speak up about this!!!
9:47 New York needs to be added to the list on the right, they get to practice independently after 3600 hours. Also, just to add, the AANP'S position statement opposing mandatory "residency" for graduating NPs, citing they are ready to practice independently on day 1. Truly sickening!
Pre-med and is sad to see the reduce in quality care. The people don't know what kind of care they will be receiving.
This is what I’m interested in because I want to go to school to become a psychiatrist at my big age of 30
Do it, I'm 37 and going for it haha. you only live once
Great presentation, Dr. Bernard. Psych NP is now all the rage! . So many who came to the realization that primary care is hard, are pursuing it, It only takes about 15 months to get a second online certificate in psych for so much more money, not to mention doing it from home. I am a non-practicing FNP, who left medicine altogether for another career. I will go one step further and state that the nurse practitioner movement is the one of the worst thing that ever happened to nursing. There is enormous presure on new nurses to go to graduate training within the first few years to prove their worth, only to go from being a well-trained competent nurse to a poorly-trained pretend provider. I can't think of a less exclusive club. This puts the beside into such a crisis. Also, grade inflation in the NP programs has NPs thinking that their universal easily-obtained 4.0 indicates mastery. I spoke to a retired nurse about this topic, and she felt that the NP movement limits nurses. In her day, about 40 years ago, nurses who wished to spread their wings, went to law school, got their MPH, MBA, etc. I know of hardly any nurse that looks to the future in this way - its just the nurse pracitioner hamster wheel. Also, look to CRNA to be flooded in a couple of years, dampening the quality, and squeezing out the physician trained. Yes, it i much harder to become one, but there are many more schools that are now offering the program.
NP concept isn’t a bad thing at all. The issue I have is the regularisation of the programme. Here are my suggestions:
-Online programme should be scrapped
-Training should be increased to 4 years to help NP students cover more in depth knowledge
-Clinical hours should be increased to at least half of what physicians have(5000-7000) hours.
@@adegbolaoluwawamiri3027 I agree with you. But it is unlikely that the academic world will give up their present gravy train. Your wise suggestions sounds quite expensive to implement. What I think should happen immediately is that programs that do not have a clinical coordinator to match, evaluate and have oversight of the clinical settings should be shut down. The NP should have their own version of STEP testing for licensure. And NPs should go back to the original concept of being physician extenders with the physician at the head of the team.
I've been waiting for a video about this topic. People undervalue specialty like psychiatry and as a result, NPS, Psychologists, and other mental health professionals think that they could learn psychopharmacology and give pills.
The psychologists that can prescribe are very very rare and mostly work for the military. And an NP as part of a physician lead team is probably fine. It's unfortunate underserved communities only have NPs without md support due to the government made shortage of physicians. One almost killed me with bipolar meds but that's the reality in rural communities.
Why should self-care needs refusal to indulge any use of psychiatiric diagnostic terminology?
What's the difference between a clinical thinking disorder and one that is best tolerated with softeness and steadfast calm?
Unbelievable that people without physician training are allowed to prescribe opioids and benzos. America is crazy!
Canada follows America.
Nurse practitioners specializing in psychiatric care often refrain from prescribing necessary medications, like low-dose Klonopin for anxiety, due to their qualifications. Instead, they opt for medications like gabapentin, which may not be as effective. While some patients benefit from certain medications, nurse practitioners sometimes overlook this, prescribing what seems like a plethora of unnecessary drugs. This approach can be harmful and wastes both the patient's time and resources.
there are dozens of countries that employ nurse practitioners and advanced practice providers.
@@ayuhlex yep that is true
Also, you do know in certain states psychologist can prescribe medication
That I do not have a problem with. They are doctors that diagnose. The ones I knew that were trained to do so, were way more qualified to care, than any psychiatrist I ever encountered, and there were many.
@@edie4321 You don’t know what you don’t know.
@@WillieFordham< I'm sure you are right. I knew them both. One was a neuropsychologist, that saw me and saved my life. My psychiatrist, on the other hand, was trying to give me diet pills for my post natal care. I was breastfeeding. Leaves me wondering, is there a way to do it from experience, and care. We really have to get the care back into this inverted system.
@@edie4321 I understand what you’re saying, but that’s based off of experience and not actually being both a nurse practitioner and a psychiatrist. I’m sorry that you went through that but you still do not know what you don’t know you know your experience.
@@WillieFordhambut it’s fair to say that the people who devote their whole doctoral career to understanding the theory and science of mind and neuropsychology, with all its complexity and abstractness, aka, psychologists, are often more knowledgeable of diagnostics and the need for medicine, etc. psychiatrists don’t necessarily have as much of an in-depth understanding of these things, unless their residency emphasizes all sorts of diverse psychology trainings, or they go at it themselves. Being doctors, they do tend to prescribe more medications, but as we are learning with mental illness, many many psychiatric disorders can be corrected without medications, given that patients perform the proper therapies consistently. And the research on nonpharmacologic treatments is growing. Although, to the contrary, the days of highly intelligent, groundbreaking, deep-thinking and philosophical psychologists is over, and we have a lot more ideology-addled brains entering the field. In that note, it’s probably better to have mental health treatment coming from rigorously educated and intelligent folks, even if they are overprescribing medications for, say, anxiety and depression. I mean, we’re in a tough place…
I agree and disagree with your title. I am about to graduate as a psychiatric nurse practitioner. My program (at a Division 1 university) was insufficient, even though they thought otherwise. I learned on my own. I studied like it was a full-time job and feel very confident in treating. I am also an older student with other degrees and ran my own business for ten years. I say this because I am mature and independent enough to question others, including professors who infantilized graduate students. I could (and might) write a book about my entire experience.
The part where the disagreement is titled "Why Psychiatry Needs Psychiatrists." I have yet to meet a good psychiatrist. All my internships were with psychiatrists, and I learned little from them. In fact, I challenged them with their methods and taught them (I am serious). Granted, all of them were over the age of 70. This has nothing to do with ageism. I am merely pointing out that they were treated with outdated, unscientific ways from years ago. Examples include prescribing IM haloperidol and fluphenazine because "that is what the previous practitioner did."
Meanwhile, that particular psychiatrist had a high number of patients with tardive dyskinesia. Instead of lowering and switching the first-generation antipsychotic, he continued the benztropine (an anticholinergic not recommended) and added Ingrezza without changing the medication. This is one example of my numerous situations and experiences with all of them. None of them understand the CYP450 enzyme system, including 2D6 inhibitors and interactions.
My point is that it isn't just nurse practitioner schools. I see it with therapists who are more concerned with the patient being their friend and calling it a therapeutic relationship whereby the patient doesn't learn coping mechanisms and derails sessions by treating the therapist like a friend to psychiatrists. Then, I could go on about NP schools. One example I will give is this:
I was in the second to last clinical semester of an online meeting with other students and a professor presenting cases from the week. A psych NP student was discussing a case of bipolar mania when she remarked the patient was jumping from topic to topic and might have ADHD as well. My jaw dropped as the professor never said a word to her. She mistook flights of ideas for ADHD. Unbelievable! I hold all students in all programs and universities accountable. If I could recognize that being good would be up to me, then there is no excuse. One of the major problems in my program was that everybody was working full-time jobs and barely had time to study. The university accommodated it in many ways.
Physician?