Medical student very interested in practicing Psychiatry but with some reservations

[dl2dp2]

Should've included "most employed jobs". Niche things like prison will probably get you higher than that

Maybe true, but keep in mind a plurality of psychiatrists in outpatient practice own their practice, and I would imagine that a plurality of inpatient/ER psychiatrists are perma-1099. If you limit yourself to employed jobs your salary will be by definition lower, but this field is unique in that it's easier to own practices or find a combination of higher-paying locum jobs.

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[Sushirolls]

Desirable area - is defined as potential area where cows may outnumber people within the county/parish, gun laws are true to the constitution, law enforcement is celebrated not berated, traffic is only experienced from tractors/road repairs/school busses, and hunting seasons have notable impact on local labor markets / service sectors. HOA is an unknown acronym. Light pollution is non-existent.

That's my abbreviated definition of desirable.

 

[Stagg737]

Should've included "most employed jobs". Niche things like prison will probably get you higher than that

This is still false. It is not difficult to find employed positions in "desirable" (however you define that) locations that make $300k. Even if it's not initially there, you can frequently negotiate to get there.

I believe it but what are the consequences? How often do NP actually get into any nursing board complaints or malpractice issues as result? My guess is very infrequently. Patientz continue to see them for care. Just go on zocdoc and you'll see thousands of psych NPs with rave reviews

This is a concern of mine as well.

NPs are not held to the standards of the medical boards, they're held to the standards of nursing boards. As I understand it, suing them is also less money payout (for lawyers + pts) vs. physicians, so less likely for lawsuits to go forward.

Until or unless the malpractice lawsuit laws change to catch up with independent practice, NPs will continue getting off almost scot-free regardless of how many patients they harm...

I'll give you that nursing board complaints are a joke and often should be much harsher on NPs, but malpractice is a concern for them and both the number of cases and amount they're having to pay out is steadily increasing along with their malpractice insurance rates (while rates of cases are declining for physicians):

https://www.nnpen.org/resources/Documents/MedPro_NP_Claim_Trend_Report_FNL.pdf

Most patients cannot tell the difference between an NP or MD/DO. In fact, most patients refer to their NP as their "psychiatrist."

Also, patients love to get benzos/stimulants from their NP. The same medications that their MD/DO may have denied.

True for the first line, and fortunately I can usually tell if the patient is seeing a mid-level when they say that "Nikki" or "Kevin" (or Dr. Nikki/Kevin) prescribes their Xanax. They can keep seeing their NP for their controlled substances, but when patients get sick of being sick (which is pretty frequently around here) and taking ridiculous med lists I'm happy to help them out.

 

[DOswag]

Desirable area - is defined as potential area where cows may outnumber people within the county/parish, gun laws are true to the constitution, law enforcement is celebrated not berated, traffic is only experienced from tractors/road repairs/school busses, and hunting seasons have notable impact on local labor markets / service sectors. HOA is an unknown acronym. Light pollution is non-existent.

That's my abbreviated definition of desirable.

Definitely not CA or NY then. But this does sound like where I grew up in Arkansas lol

 

[calvnandhobbs68]

I'll give you that nursing board complaints are a joke and often should be much harsher on NPs, but malpractice is a concern for them and both the number of cases and amount they're having to pay out is steadily increasing along with their malpractice insurance rates (while rates of cases are declining for physicians):

https://www.nnpen.org/resources/Documents/MedPro_NP_Claim_Trend_Report_FNL.pdf

This is why I say just let them do independent practice at this point. "Collaboration" is a joke in most states and is essentially just a liability sponge. Let em rip to play with the big boys and see what happens, look at the charts legal defense cost per claim has gone up 50% in the last 8 years for NPs. It's actually interesting that physician claim frequency has fallen 20% at the same time they're having to pay out more for claims or to defend NPs.

 

[Candidate2017]

This is why I say just let them do independent practice at this point. "Collaboration" is a joke in most states and is essentially just a liability sponge. Let em rip to play with the big boys and see what happens, look at the charts legal defense cost per claim has gone up 50% in the last 8 years for NPs. It's actually interesting that physician claim frequency has fallen 20% at the same time they're having to pay out more for claims or to defend NPs.

The problem is hospitals, insurance, EMRs, and lawmakers continue to lobby for increased administrative burdens on physicians, to the point where more doctors are employees rather than independent professionals. It is a lot quicker to earn a physician income from Day 1 by taking an employed job, than to build a practice. For most doctors, building a practice will leave them financially behind compared to employed peers. A minority of independent psychiatrists will out earn employed ones in the long run, but the main benefit of independent practice is career satisfaction.

Making NPs independent will likely discourage them from starting their own clinics, due to malpractice premiums/lawsuits. But the end result of making NPs independent is employers will still require employed doctors to soak up NP liability, like this:

An major ER in NY used to allow independent NPs as recently as last month, but after one sent a patient with DKA home without any labs or proper treatment and the patient died, now that ER no longer allows independent practice of an NP (even though the State does), and now each MD has to see the patient and sign off before discharge (so, even huge organizations are noticing the pain and liability of hiring NPs).

 

[Stagg737]

It is a lot quicker to earn a physician income from Day 1 by taking an employed job, than to build a practice. For most doctors, building a practice will leave them financially behind compared to employed peers. A minority of independent psychiatrists will out earn employed ones in the long run, but the main benefit of independent practice is career satisfaction.

This is why many people are starting employed while they build their practice on the side, which is very feasible in psych. I guess NPs could do the same, but their employed salary would likely start much lower than ours.

 

[G Sheb]

The problem is hospitals, insurance, EMRs, and lawmakers continue to lobby for increased administrative burdens on physicians, to the point where more doctors are employees rather than independent professionals. It is a lot quicker to earn a physician income from Day 1 by taking an employed job, than to build a practice. For most doctors, building a practice will leave them financially behind compared to employed peers. A minority of independent psychiatrists will out earn employed ones in the long run, but the main benefit of independent practice is career satisfaction.

Making NPs independent will likely discourage them from starting their own clinics, due to malpractice premiums/lawsuits. But the end result of making NPs independent is employers will still require employed doctors to soak up NP liability, like this:

Missing here are per diem jobs.
You get the best of both worlds.
You are 'employed' but you can walk out any time you want, you set your own schedule, can make a ton of money and you aren't beholden to the system. Which is the most important shield against burnout. You can do this while you build your practice.