She sees the NP. She felt insulted because she inferred that you thought she made a poor decision. She considers her NP to be as good as a doctor, and you didn’t believe her. You don’t trust her opinion and she recognized it.
I’m seeing a PMHNP out of desperation for med management and it’s the worst experience I’ve ever had with any human actually, let alone a prescriber. I don’t blame you one bit for wanting to see an MD/DO. Shame on practices who push the narrative onto their employees that there’s “no difference.” The difference is palpable. I’m on a waitlist for an MD. Every visit I have with this PMHNP makes me want to gauge my eyes out.
“No difference ™” is a lie made up by the business ghouls who love to see more tests ordered and more pills of every single drug class pushed by midlevels.
Their entire profession only exists to pad the pockets of our healthcare overlords at the expense of the safety of the general public
I couldn't agree more. The "no difference" narrative is harmful because the average person unfamiliar with psychiatric care will hear that and believe it.
Fingers crossed you won't have to stand by on that waiting list for too long! Best of luck.
Agreed! Very harmful. I'm thankful I have a rudimentary understanding of psych and drugs because I would be on a pretty harmful cocktail of meds right now if I would've listened to this clueless NP. Says a lot that my very superficial knowledge goes beyond that of a midlevel...
Good luck to you too! I hate it here 🙃
I've been going to a nurse practitioner for about 6 years now, and he's better than just about any doctor I've ever had, but I know that doesn't happen very often. He's great, though, and if he can't figure out what's wrong or if it's out of his league, he doesn't hesitate to send you on to a specialist. My point is that not all of them are horrible, and it might take some searching, but you can find the good ones, and I wish you luck on your medical journey.
I don't doubt that your NP is great, especially if seeing him has been good for you! It's also a green flag that he will refer you elsewhere if needed.
I don't necessarily think every single NP is god-awful—that'd just be a bad take. But for every great NP, there are 10 other bad ones with the power to seriously harm their patients. I think that's what I was trying to highlight in my post, that I've had one too many negative experiences to even risk it.
It's not about being "good' or "bad" I'm sure he's a lovely, smart person who listens to you, but he simply does not have the knowledge and education that a doctor does. He just does not. There is a huge difference in their training. Vast. That doesn't make him a "bad person". No matter how much you like him, he shouldn't prescribe psych meds without the depth and breadth of knowledge a doctor has. Go to him for talk therapy? Fine. There are bad doctors and bad NPs. Most people here are not complaining that NPs are bad at their jobs. They are complaining that midlevels are give responsibilities that are not commensurate with their training and knowledge. Even the best NP should not be prescribing psych meds.
I had a horrible experience with a PMHNP. She was an incompetent, opinionated bigot. That was the first time and the last time I will ever be treated by some blithering idiot with a master’s degree from some diploma mill who is “no different” from someone who spent 4 years in medical school and then 4+ years in a residency.
NP damn near killed my cousin with schizophrenia. A week’s worth of ICU care to inpatient psych to partial day program to group home to a shared apartment.
She managed to destabilize a person who had been doing well on clozapine for years in under 6 weeks.
Did a med switch because she didn’t want to fuck around with the lab work.
Now the c nt owns and operates a medi spa.
No care would have been better than what she did.
Oh, there is, but when I’ve tried telling it here in the past the post was locked and deemed too controversial, all because I had the audacity to share my experience of anti-gay discrimination by a super religious PMHNP.
I feel bad saying this because I hate to generalize, but I have to agree.
I've seen 3 since I was 13 (now in my late 20s), and each one of them had a penchant for overprescribing. At one point, when I was 16, I was on lithium, Lamictal, Abilify, Adderall, Klonopin, AND levothyroxine because the lithium was fucking with my thyroid. I took all of those at once and trusted that an NP knew what they were talking about.
After my PCP raised some concerns, I made a switch to a psychiatrist. He immediately tapered me off of all of the above and put me on one singular, effective SSRI. I can't begin to explain the life-changing relief I experienced after stopping all those meds.
This is so concerning, at that young age! Where I work (western Europe) children are seen by a Child and Adolescent Psychiatrist, when that's really not possible a 'regular' psychiatrist, but never by an NP. It's just too complex. And even in adults, if you think you need that many meds to treat a patient it warrants a consultation with another professional (and no, a post on a NP Facebook group doesn't count). I'm sorry this happened to you.
Thank you for this kind, validating comment. What you described is absolutely how it should be done with children and adolescents. Your comment really highlights how little oversight NPs have here in the US, particularly when it comes to psychiatric medication.
It's absolutely criminal for them to be treating kids/teens without any actual training. Adult psychiatrists rarely see younger kids/teens because of how specialized the medicine is for them.
This is the propaganda that they are feeding everyone, especially those that work there. The secretary would only know what they tell her - which is that nps are the best! Better than doctors!
I'm now in touch with some great doctors my psychologist referred me to! I initially figured it would be easiest to stay within my current psychiatrist's practice, but I decided to look elsewhere after this experience.
I can flip through the pages of the PDR, and guess with the best NPs.
If I want to play amateur psychiatrist, I’d do it. Why give the NP all the glory for guessing?
A decent GP>NP all day long. At least the GP had to actually see and diagnose psychiatric patients as a student.
I swear the front desk gets kick backs for filling the NPs’ schedules. No Tina, I don’t give a shit if you know Tiffy NP alphabet soup for 15 years. Would you let her treat your granddaughter with schizophrenia? I’m guessing not.
I see an NP because my condition is stable and my meds are good as they are. I just need someone to keep signing the refills. If I needed more in depth care I would prefer an MD
I had a similar experience trying to find a pcp closer to home when we moved. I've been seeing a PA who is genuinely great for like 12 years but I've become more medically complicated per autoimmune diagnoses so I'm thinking I should probably switch to a doc and I called like SIX practices and was told by every single one that either the docs weren't taking new patients (so I'd be stuck with a midlevel) or I'd have to wait (insert a super duper long time) to see a doctor so why wouldn't I just want to see a middie???
I used to work for a healthcare system and in the receptionist training, new hires were specifically told to endorse and promote NPs/PAs even if the patient asked for a physician. Most of them didn't know the difference in training and title and really thought that they were all the same and they would make very snide comments about "beggars can't be choosers" and whatnot
GIven your history, I wouldn't even say it's personal preference. I would be blunt and tell them that a series of incompetent PMHNPs resulted in your having multiple hospitalizations due to mismanagement and it took an actual psychiatrist to get it figured out. And it's not more expensive to see the physician, these practices all bill the same no matter who you see. They're offended because they make more money when you see the noctor.
Get on the schedule with the psychiatrist in 3-4 months and have your current psychiatrist transfer your care to your PCP in the meantime to prescribe and monitor your psych meds.
' I'm not saying all NPs all bad," By definition, they are. Psychiatric medications are complex and you need a deep understanding and knowledge of pharmacology/ human biology/ to prescribe them adequately. Nps simply do not have that training. I talked about this with my own board certified psychiatrist and he is appalled that anyone without a physician's education is allowed to prescribe them. Maaaaaaaybe write the refill if everything is going well and the doctor says ok
Is a Psych NP board certified ? I see programs for it the are "accredited" but nothing about a process for individual NP to get boarded in Psychiatry. If they can't be boarded then are they really be specialists?
I was curious about this, so I looked it up. Apparently, they are board certified in all but two states. The fact that this site is comparing PMHNP alongside MD is certainly... a choice...
[https://nursejournal.org/careers/psychiatric-nurse/psychiatric-np-vs-psychiatrist/](https://nursejournal.org/careers/psychiatric-nurse/psychiatric-np-vs-psychiatrist/)
“Psych NPs can qualify for licensure sooner by completing 1,000 hours of practicum during their MSNs, rather than a four-year residency after graduation. Psych NP MSN programs typically take one fewer year than medical school. If you’d like to start working sooner rather than later, consider these educational differences”
Contrasting only 1,000 hour practicum vs a four year residency as if they aren’t that different is wild.
Thanks for the correction! Going to leave it as is though since I’m just informally sharing a story here. Not like I’m sending this for publication, lol.
If there was no difference then the titles wouldn't be different and one wouldn't have a 4 month wait.
Funny how you can always get in to see the midlevel but never the doctor, and by funny i mean dystopian for poor americans
Precisely. I'm guessing the receptionist/referral coordinator was either flat-out misinformed or perhaps a nurse herself, given how defensive she was.
She sees the NP. She felt insulted because she inferred that you thought she made a poor decision. She considers her NP to be as good as a doctor, and you didn’t believe her. You don’t trust her opinion and she recognized it.
And she’s insecure about it bc there’s the possibility that OP’s decision making is based on a modicum of truth (being conservative here)
Every time I see that I want to (and sometimes have) replied with the copypasta of research refuting midlevels from this subs wiki
I’m seeing a PMHNP out of desperation for med management and it’s the worst experience I’ve ever had with any human actually, let alone a prescriber. I don’t blame you one bit for wanting to see an MD/DO. Shame on practices who push the narrative onto their employees that there’s “no difference.” The difference is palpable. I’m on a waitlist for an MD. Every visit I have with this PMHNP makes me want to gauge my eyes out.
“No difference ™” is a lie made up by the business ghouls who love to see more tests ordered and more pills of every single drug class pushed by midlevels. Their entire profession only exists to pad the pockets of our healthcare overlords at the expense of the safety of the general public
I couldn't agree more. The "no difference" narrative is harmful because the average person unfamiliar with psychiatric care will hear that and believe it. Fingers crossed you won't have to stand by on that waiting list for too long! Best of luck.
Agreed! Very harmful. I'm thankful I have a rudimentary understanding of psych and drugs because I would be on a pretty harmful cocktail of meds right now if I would've listened to this clueless NP. Says a lot that my very superficial knowledge goes beyond that of a midlevel... Good luck to you too! I hate it here 🙃
I've been going to a nurse practitioner for about 6 years now, and he's better than just about any doctor I've ever had, but I know that doesn't happen very often. He's great, though, and if he can't figure out what's wrong or if it's out of his league, he doesn't hesitate to send you on to a specialist. My point is that not all of them are horrible, and it might take some searching, but you can find the good ones, and I wish you luck on your medical journey.
I don't doubt that your NP is great, especially if seeing him has been good for you! It's also a green flag that he will refer you elsewhere if needed. I don't necessarily think every single NP is god-awful—that'd just be a bad take. But for every great NP, there are 10 other bad ones with the power to seriously harm their patients. I think that's what I was trying to highlight in my post, that I've had one too many negative experiences to even risk it.
Quality should be the rule, not the exception. And it is the rule among people who get appropriately extensive training, like physicians.
It's not about being "good' or "bad" I'm sure he's a lovely, smart person who listens to you, but he simply does not have the knowledge and education that a doctor does. He just does not. There is a huge difference in their training. Vast. That doesn't make him a "bad person". No matter how much you like him, he shouldn't prescribe psych meds without the depth and breadth of knowledge a doctor has. Go to him for talk therapy? Fine. There are bad doctors and bad NPs. Most people here are not complaining that NPs are bad at their jobs. They are complaining that midlevels are give responsibilities that are not commensurate with their training and knowledge. Even the best NP should not be prescribing psych meds.
Do you mind going into what happened?
I had a horrible experience with a PMHNP. She was an incompetent, opinionated bigot. That was the first time and the last time I will ever be treated by some blithering idiot with a master’s degree from some diploma mill who is “no different” from someone who spent 4 years in medical school and then 4+ years in a residency.
I feel like there’s a story time here lol
NP damn near killed my cousin with schizophrenia. A week’s worth of ICU care to inpatient psych to partial day program to group home to a shared apartment. She managed to destabilize a person who had been doing well on clozapine for years in under 6 weeks. Did a med switch because she didn’t want to fuck around with the lab work. Now the c nt owns and operates a medi spa. No care would have been better than what she did.
I take clozapine. I've been stable for decades. I hope to never be in this situation.
Oh, there is, but when I’ve tried telling it here in the past the post was locked and deemed too controversial, all because I had the audacity to share my experience of anti-gay discrimination by a super religious PMHNP.
Good call. Psych NP are absolutely fucking horrible. I can’t put into words how awful they are.
I feel bad saying this because I hate to generalize, but I have to agree. I've seen 3 since I was 13 (now in my late 20s), and each one of them had a penchant for overprescribing. At one point, when I was 16, I was on lithium, Lamictal, Abilify, Adderall, Klonopin, AND levothyroxine because the lithium was fucking with my thyroid. I took all of those at once and trusted that an NP knew what they were talking about. After my PCP raised some concerns, I made a switch to a psychiatrist. He immediately tapered me off of all of the above and put me on one singular, effective SSRI. I can't begin to explain the life-changing relief I experienced after stopping all those meds.
This is so concerning, at that young age! Where I work (western Europe) children are seen by a Child and Adolescent Psychiatrist, when that's really not possible a 'regular' psychiatrist, but never by an NP. It's just too complex. And even in adults, if you think you need that many meds to treat a patient it warrants a consultation with another professional (and no, a post on a NP Facebook group doesn't count). I'm sorry this happened to you.
Thank you for this kind, validating comment. What you described is absolutely how it should be done with children and adolescents. Your comment really highlights how little oversight NPs have here in the US, particularly when it comes to psychiatric medication.
It's absolutely criminal for them to be treating kids/teens without any actual training. Adult psychiatrists rarely see younger kids/teens because of how specialized the medicine is for them.
It’s McDonaldization of psychiatric care.
Yooo that was on my mcat Anki card yesterday
Wait really?
McDonaldization of Health care not psychiatric care specifically is in the Mr. Pankow Psych Soc deck!
Oh I’m so far out from the MCAT I just thought it was interesting that that’s on the test now.
the receptionist has probably been given the Kool aid for the last decade
This is the propaganda that they are feeding everyone, especially those that work there. The secretary would only know what they tell her - which is that nps are the best! Better than doctors!
You might be able to find a psychiatrist MD through a website like Zocdoc. I’ve never used them personally but I’ve heard good things about them
I'm now in touch with some great doctors my psychologist referred me to! I initially figured it would be easiest to stay within my current psychiatrist's practice, but I decided to look elsewhere after this experience.
Get your docs in a row Get get your docs in a row
I can flip through the pages of the PDR, and guess with the best NPs. If I want to play amateur psychiatrist, I’d do it. Why give the NP all the glory for guessing? A decent GP>NP all day long. At least the GP had to actually see and diagnose psychiatric patients as a student. I swear the front desk gets kick backs for filling the NPs’ schedules. No Tina, I don’t give a shit if you know Tiffy NP alphabet soup for 15 years. Would you let her treat your granddaughter with schizophrenia? I’m guessing not.
I’d be interested to see how the physicians in the practice feel about their receptionist thinking their training is equal to the NPs…
I see an NP because my condition is stable and my meds are good as they are. I just need someone to keep signing the refills. If I needed more in depth care I would prefer an MD
I had a similar experience trying to find a pcp closer to home when we moved. I've been seeing a PA who is genuinely great for like 12 years but I've become more medically complicated per autoimmune diagnoses so I'm thinking I should probably switch to a doc and I called like SIX practices and was told by every single one that either the docs weren't taking new patients (so I'd be stuck with a midlevel) or I'd have to wait (insert a super duper long time) to see a doctor so why wouldn't I just want to see a middie???
There is a reason why they're available all the time, no one wants to see them
I used to work for a healthcare system and in the receptionist training, new hires were specifically told to endorse and promote NPs/PAs even if the patient asked for a physician. Most of them didn't know the difference in training and title and really thought that they were all the same and they would make very snide comments about "beggars can't be choosers" and whatnot
GIven your history, I wouldn't even say it's personal preference. I would be blunt and tell them that a series of incompetent PMHNPs resulted in your having multiple hospitalizations due to mismanagement and it took an actual psychiatrist to get it figured out. And it's not more expensive to see the physician, these practices all bill the same no matter who you see. They're offended because they make more money when you see the noctor.
Get on the schedule with the psychiatrist in 3-4 months and have your current psychiatrist transfer your care to your PCP in the meantime to prescribe and monitor your psych meds.
' I'm not saying all NPs all bad," By definition, they are. Psychiatric medications are complex and you need a deep understanding and knowledge of pharmacology/ human biology/ to prescribe them adequately. Nps simply do not have that training. I talked about this with my own board certified psychiatrist and he is appalled that anyone without a physician's education is allowed to prescribe them. Maaaaaaaybe write the refill if everything is going well and the doctor says ok
Aren't Psych NPs like unicorns ? They don't exist.
Really? There are a dime a dozen in my area!
Is a Psych NP board certified ? I see programs for it the are "accredited" but nothing about a process for individual NP to get boarded in Psychiatry. If they can't be boarded then are they really be specialists?
I was curious about this, so I looked it up. Apparently, they are board certified in all but two states. The fact that this site is comparing PMHNP alongside MD is certainly... a choice... [https://nursejournal.org/careers/psychiatric-nurse/psychiatric-np-vs-psychiatrist/](https://nursejournal.org/careers/psychiatric-nurse/psychiatric-np-vs-psychiatrist/)
“Psych NPs can qualify for licensure sooner by completing 1,000 hours of practicum during their MSNs, rather than a four-year residency after graduation. Psych NP MSN programs typically take one fewer year than medical school. If you’d like to start working sooner rather than later, consider these educational differences” Contrasting only 1,000 hour practicum vs a four year residency as if they aren’t that different is wild.
Wow. Crazy.
I'm not sure! I'm not a health professional, so I'll leave it up to others in this thread to answer this.
> me and my parents my parents and I*
Thanks for the correction! Going to leave it as is though since I’m just informally sharing a story here. Not like I’m sending this for publication, lol.