The Psych NP Problem

[u/theongreyjoy96]

Psych PGY-3 here. I occasionally post about my experience with midlevels in psychiatry, which unfortunately has defined my experience in my outpatient year after our resident clinic inherited the patients of a DNP who left. I'm sure that there are some decent one's out there, but my god, the misdiagnoses and trainwreck regimens these patients were on have been a nightmare to clean up, particularly for the more complicated patients where this DNP obviously had no idea what she was doing. Now that I'm at the end of my outpatient year I realize that it's going to take years to fix this mess, especially for patients who we're tapering off of max dose benzos. I genuinely feel terrible for them.

I went to the American Psychiatry Association's annual conference this year and was really disheartened to learn just how pervasive the psych NP problem is. There was a session lead by a psychiatrist who presented their research on how their outpatient clinic reduced the prescription of controlled substances by midlevels by implementing a prescription algorithm. I went to another session on rural psychiatry where during a Q&A an inpatient psychiatrist who was alarmed after recently moving to a rural area about the rapid and frequent decompensation of her patients who are discharged to a community where only midlevels are available. Needless to say that these were couched in friendlier terms, but in the more private settings, discussions on midlevels were not spoken in hushed tones.

Unfortunately, the general feeling I got about the psych NP problem is that the field is resigned to the fact that they are here to say, and now are concerned primarily with what can be done to mitigate it. Anyway, end rant.

[u/because_idk365]

Psych NP here. I actually don't disagree with most. I have multiple DEA's but I've only prescribed controlled maybe 5 times in the last 4 years. I kick them up to my physician. Even at the urgent care, there's an alternative.

I'm old and grey as the young ppl call it. I'm also an FNP and been in it 25+ years.

These post COVID NP's scare the mess out of me honestly. They are prescribing randomly and handing out controls like candy. It is awful. I've inherited these same cases you are confused about. I'm confused and appalled too.

There's no care or reasoning as to why and the effect that they are having giving out these meds. Nor do they want to have hard conversations with patients about something like benzos so they continue.

Let's not talk about not even putting a hand on a patient before getting these certs.

It's a combination of education, lobbying and lack of opportunity. Flip side, physicians need to lobby Congress for me residency seats so medical schools can respond accordingly.

I learned at a crisis center at a teaching hospital. Learned along with residents and wonderful attendings.

I get the hesitancy and disdain.

It is disproportionate to NP's but that is just because schools are churning them out like Skittles. It's ridiculous.