PAs vs NPs in psychiatry

[PApsychiatry]

Why are NPs so heavily preferred over PAs in psychiatry? I've been looking at companies such as minded and cerebral, but they only hire NPs. Can anyone shed some light on that?

[HmTwoPA]

NP's can practice independently in many states, but I think the biggest factor is the Mental health Nurse practitioners are exclusively trained in psych.

[iconic]

2 hours ago, PApsychiatry said:

Why are NPs so heavily preferred over PAs in psychiatry? I've been looking at companies such as minded and cerebral, but they only hire NPs. Can anyone shed some light on that?

They don't have psychiatrists to supervise PAs

[iconic]

1 hour ago, HmTwoPA said:

NP's can practice independently in many states, but I think the biggest factor is the Mental health Nurse practitioners are exclusively trained in psych.

NPs being trained in anything with their 500 hours is a misnomer. They have better legislative rights straight and simple 

[Cideous]

NP's can practice completely solo in many states.  No doc needed.  Period, end of story.

[HmTwoPA]

1 hour ago, iconic said:

NPs being trained in anything with their 500 hours is a misnomer. They have better legislative rights straight and simple 

Imagine PA school, but instead of covering a variety of topics relating to all disease fields, you were solely focused on psychiatry. The difference is not only their hours being concentrated, but all their clinical education. 

[PApsychiatry]

So then, is this the trend in many other areas of medicine? For those of you in other specialty fields, are you finding it more difficult to find jobs because of this?

[HmTwoPA]

Just now, PApsychiatry said:

So then, is this the trend in many other areas of medicine? For those of you in other specialty fields, are you finding it more difficult to find jobs because of this?

I think it's different because of the Mental health nurse practitioner specialty. One of the other members on here might know more than me, but is there a CAQ available for Psych? If so, getting that may make you more competitive. 

[rev ronin]

1 hour ago, HmTwoPA said:

One of the other members on here might know more than me, but is there a CAQ available for Psych? If so, getting that may make you more competitive. 

There is. You need to get Cat 1 CME, have 2k hours in the field, pass the test, and get a "mother may I?" endorsement from a Psych PA or MD.

[ventana]

14 hours ago, HmTwoPA said:

Imagine PA school, but instead of covering a variety of topics relating to all disease fields, you were solely focused on psychiatry. The difference is not only their hours being concentrated, but all their clinical education. 

So very wrong. 
imagine one semester of PA school with a bunch of fluff medicine theory courses.  That is NP school.    Oh yeah and about 400 hours of observational care.
yes there are programs that do a lot more but this is the minimum and a lot of programs only do min.  
funny new NP are far weeker then new PA even in their specialty.  Then outside their speciality they are frightening.  (Not all new np, but looking at averages here) 

[iconic]

1 hour ago, ventana said:

So very wrong. 
imagine one semester of PA school with a bunch of fluff medicine theory courses.  That is NP school.    Oh yeah and about 400 hours of observational care.
yes there are programs that do a lot more but this is the minimum and a lot of programs only do min.  
funny new NP are far weeker then new PA even in their specialty.  Then outside their speciality they are frightening.  (Not all new np, but looking at averages here) 

The most clinical hours I’ve seen in an NP program is 1000

[HmTwoPA]

3 hours ago, ventana said:

So very wrong. 
imagine one semester of PA school with a bunch of fluff medicine theory courses.  That is NP school.    Oh yeah and about 400 hours of observational care.
yes there are programs that do a lot more but this is the minimum and a lot of programs only do min.  
funny new NP are far weeker then new PA even in their specialty.  Then outside their speciality they are frightening.  (Not all new np, but looking at averages here) 

A lot of PA's here that know so much about what is included in NP programs. My wife is a Psych NP. I have to ask Ventana, where did you get your information on what is included in these "fluff" medicine theory courses? I helped her study alot through the program and it mirrored alot of our program, but was alot more in depth in the pharmacology of psychiatric medications and illnesses. This is one thing that always bothers me about this forum. The same 10 people reply over and over again circle jerking themselves on NP vs PA. While Doctors are bashing PA's the same way. 

[HmTwoPA]

2 hours ago, iconic said:

The most clinical hours I’ve seen in an NP program is 1000

My program had me do one psych rotation at the VA. So my psych hours were one month of working hours or about 160 hours. So if a psych program has 450 hours or 1000 hours of psychiatric care they are getting significantly more exposure than us. 

[Hope2PA]

18 hours ago, HmTwoPA said:

I think it's different because of the Mental health nurse practitioner specialty. One of the other members on here might know more than me, but is there a CAQ available for Psych? If so, getting that may make you more competitive. 

Yes they are exclusively trained mental health. Friend of family is Psych NP, went to brick and mortar program, only required 500 hours clinical.  After two  years practice still often feels inadequate because got very little to no other medical education that would have been helpful. Patients do not typically have only mental health issues, although not treated as primary care, he feels lacking in what physicians and PAs learn for the whole patient. I’d guess very few if any psych NP programs require or get 1000 hours. PA s usually get at least 2 months in primary care, which has a lot of mental health patients, let alone those seen in ER rotations, etc. though PA doesn’t have as much didactic dedicated as NP, I’d venture to say they are exposed to a lot more than the 160 indicated when you add in all other rotations that treat mental health. Especially PA who chose to do electives in psych. Still legislation and NP independence will hold back an exceptional  psych PA in many locations. 

[FiremedicMike]

On 4/28/2022 at 10:44 AM, HmTwoPA said:

My program had me do one psych rotation at the VA. So my psych hours were one month of working hours or about 160 hours. So if a psych program has 450 hours or 1000 hours of psychiatric care they are getting significantly more exposure than us. 

It is also universally forgotten that NPs must be RNs first, which means even if they had 0 days of experience as an active RN, they still had clinical during RN school.  Obviously that clinical wasn't at the provider level, but it still built the basis for patient assessment, data interpretation, and managing care priorities, all of which are quite relevant at the the provider level.

RN school dresses things up as if we're only doing nursing diagnosis (i.e. impaired breathing and not COPD) but I can tell you from my experience in RN school that it was a lot more of "here's your presentation and lab/diagnostic findings, what's medically wrong with them and how will the provider probably treat them (and what are the upstream prevention measures and downstream management priorities).

 

 

[sas5814]

1 hour ago, FiremedicMike said:

It is also universally forgotten that NPs must be RNs first,

These days there is more nuance than that. Back in the day to become an NP one had to be an RN and have some experience, apply for school etc. These days you can be an LVN, become an RN online with virtually no clinical experience and then sign up for an online NP program doing whatever hours are required. So it is possible to become a NP with no real experience as an RN.

These conversations get polarized when it is so much more complicated than a linear black and white argument.

I graduated the Army PA program and had virtually no psych training. I spent a few weeks in the mental health clinic which was mostly depressed and/or anxious young healthy active duty soldiers or their family members. That isn't much compared to the NP specialty training regardless of the hours the program mandates.

I defer to the psych NP daily.

[FiremedicMike]

7 minutes ago, sas5814 said:

These days there is more nuance than that. Back in the day to become an NP one had to be an RN and have some experience, apply for school etc. These days you can be an LVN, become an RN online with virtually no clinical experience and then sign up for an online NP program doing whatever hours are required. So it is possible to become a NP with no real experience as an RN.

These conversations get polarized when it is so much more complicated than a linear black and white argument.

I graduated the Army PA program and had virtually no psych training. I spent a few weeks in the mental health clinic which was mostly depressed and/or anxious young healthy active duty soldiers or their family members. That isn't much compared to the NP specialty training regardless of the hours the program mandates.

I defer to the psych NP daily.

There were some concessions for clinical given during COVID, but only for COVID.  There are still a required number of clinical hours for RN school, whether it's an LPN to RN program, as a part of a direct entry NP program (where the first year is an accelerated BSN) or as a traditional delivery format.

Although I admittedly don't know everything, if there are programs out there that somehow skirt clinical hours, I'd be curious to know how they do it.

 

[sas5814]

6 minutes ago, FiremedicMike said:

There were some concessions for clinical given during COVID, but only for COVID.  There are still a required number of clinical hours for RN school, whether it's an LPN to RN program, as a part of a direct entry NP program (where the first year is an accelerated BSN) or as a traditional delivery format.

Although I admittedly don't know everything, if there are programs out there that somehow skirt clinical hours, I'd be curious to know how they do it.

 

I wasn't saying there are no clinical hours. I was pointing out the difference from back in the day when most NPs had been working RNs for a while some for many years. That was the basis for their model of training and practice.

[ventana]

On 4/28/2022 at 10:41 AM, HmTwoPA said:

A lot of PA's here that know so much about what is included in NP programs. My wife is a Psych NP. I have to ask Ventana, where did you get your information on what is included in these "fluff" medicine theory courses? I helped her study alot through the program and it mirrored alot of our program, but was alot more in depth in the pharmacology of psychiatric medications and illnesses. This is one thing that always bothers me about this forum. The same 10 people reply over and over again circle jerking themselves on NP vs PA. While Doctors are bashing PA's the same way. 

For two years recently I was responsible for hiring for my clinic.  Was part of my questions to ask how many patient contact hours. Then I would also review transcripts and have frank discussions with candidates.  Mostly it was the new np telling me they were scared to death.  Did not know enough to treat.   We would talk about what their education was.   Overwhelming number of NP applicants were saying same thing. 
10:1 ratio (or higher) of new grad NP to PA applicants.  
 

as well my local hospital system put about 10 RN through a distance learning NP.   Somewhat local program that is pretty respected. Upon graduation these new NP pretty much refused to work and demanded that the system close to all np and pa students for a year so the common preceptors for PA & NP students could switch and train the new NP.  
 

it is frightening how little they know.  
 

at the same time I have recently had a NP student who was excellent.  But they are a 10+ yr ER RN and attending a very prestigious program.  
 

there are still great NP programs out there but the  average new grad NP I see are not what they used to be and honestly are not educated enough to be a provider.  PA’s barely have enough education with 2000-3000 clinical hours and 2000+ academic hours.  
 

 

[Hope2PA]

A recent Reddit post was about a hospital wanting PA, NP and some physicians apparently do some of the nurse work while nurses are in strike. Couple hundred comments, most from nurses stating education and training is completely different.  PAs and physicians do not have same work, completely different field. Yet it is ok for a new grad nurse direct entry NP or even couple years in unrelated experience to practice as a physician. Can’t have it both way, but money talks, neither politicians nor nursing cares any beyond own self advancement. 

[m20hpa]

I think it depends on your area. I'm in TX and had a few psych offers in practices who employ equal number of PA/NP. Interestingly all of the NPs in the practice I work for went the family medicine route instead of psych NP.

[iconic]

17 minutes ago, m20hpa said:

I think it depends on your area. I'm in TX and had a few psych offers in practices who employ equal number of PA/NP. Interestingly all of the NPs in the practice I work for went the family medicine route instead of psych NP.

This is because TX does not have independent rights for NPs. However, those dominos will eventually fall in every state 

[Cideous]

2 hours ago, iconic said:

This is because TX does not have independent rights for NPs. However, those dominos will eventually fall in every state 

Exactly.  Try to get a job is a place like AZ in Psych where NP's own, run and have nothing to do with docs in Psych.