I feel like such a Karen when I ask to be seen by the physican but you have to stick up for yourself. Esp when they’re billing the same price, cause they don’t care. I went to a dermo appointment and they insisted I only be seen by the NP. I just walked out and went to a different office lol.
I never understood this line of logic.
If your only access to a specialist is through an NP, then you don’t have access to specialist care. Just treat it like the NP never existed.
Derm here. Book the appointment 6 months away, if it’s truly Urgent check in with your MD PCP while you wait for the upcoming derm appointment. Also if you think it’s unacceptable to wait 6 months for the issue, going to an NP absolutely doesn’t resolve the problem. Give me an example of something that can’t wait 6 months in derm and I’ll tell you why it’s inappropriate for an NP to assess that issue.
They won't be mad because your preference doesn't affect their job or salary. You may just have to wait longer to see an MD/DO because other patients also have your same preference.
I’ve also found that if I simply say to the secretary “I am a physician and I understand there might be a longer wait just like at my clinic but I prefer to see another MD” they usually understand immediately and don’t push any further.
They certainly never have differentiated from physicians when I've seen them. They've never explained for instance that their scope is more limited. I think they'd rather the patients view them as a doctor. I had a disastrous psych NP with a DNP back in 2016 ans he even used Dr. In my title. I knew he wasn't a MD though, and thought it was inappropriate, and I always just called him John, his first name.
I'm in psychiatry, and so much of my time is spent cleaning up disastrous results of midlevels misdiagnosing and overprescribing.
PLEASE make sure you see an actual psychiatrist.
A young woman DNP got me addicted to adderall back around the same time period. There was no good reason for her to prescribe it, and I've been dealing with the addiction up until this present day, in which I've finally taken steps to get treatment and get off of it.
There are times I’m fine being seen by a PA. Like after I got my gallbladder out, the post op visit was with a PA. Totally appropriate. No way in the seven hells would i get psychiatric care from anyone other than a physician
For me, it’s important I see a specialist and expert with more psychiatric knowledge than me. I would feel insulted to have midlevel direct my care knowing their training. Will they be mad? Who cares. It’s your mental health. I’m not going to entertain polypharmacy and misdiagnosis that’s going to be on my medical records.
Remember that. They can put shit like “bipolar disorder or shizo affective disorder” or whatnot and it WILL impact your insurance coverage and opportunities as a physician.
You get to see who you want to see. When I established with my current PCP they were going to assign me to an NP. I said no and that was that. I see the physician.
I’ve been a PA for 34 years.
It might be different in specialty care OR you may get some passive push back via long wait for an appointment but…. You get to choose your provider.
The office coordinator may protest because it’s their job to make as much money for the practice as possible, which means getting everyone to see NP/PAs. But it’s your job to take care of yourself and get the care you need, which means advocating for a MD/DO. Especially for initial visits/undifferentiated and/or complex patients . Once you’re on a stable management regimen and you just need to check in and get refills, sure, see the PA/NP.
If the office coordinator does get mad, go somewhere else. These practices need to know patients prefer to see someone with the most experience possible.
Gently but firmly state you are a physician and request to see another physician. If there's any resistance, request it as a professional courtesy. I've been doing this and it's been helpful. I'm also in psychiatry, and almost everyone I know in my program would bend over backwards to help out another resident.
Well I've gotta be honest I'm not a physician; but I am a licensed clinical mental health counselor, so I do know more about psych health care than perhaps your average patient. I just know I've been a patient of psych NPs, and one got me addicted to adderall, and I mean severe amphetamine use disorder that I've still been dealing with up until the present day when I finally decided to seek my own treatment, and the one after that was simply unknowledgeable and incompetent. I think maybe they flock to psychiatry because oftentimes the harm done isn't immediately evident like in other disciplines, sometimes is more subtle, and when recognized, the point where the provider would be able to be held accountable has already passed.
I am an NP myself (working within a hospital as an MLP under a supervising physician, the way the role was intended to always be IMO) and I only allow my children to be seen my MDs following an eye opening urgent care visit with an NP when my daughter was a baby. Have also had terrible experience with the PA at my PCP and therefore will only be seen myself by my MD. You are your own advocate for yourself and those under your care. Don’t ever worry about what others think about you.
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So I’m a psych resident - we get specific requests on a daily basis. Accommodating to help the patient feel safe and appropriately treated seems very reasonable.
Given your position, the most important thing is finding someone you trust, who won’t write stupid things that might bite you in the future. A physician who understands your position will likely know the best ways to document to prevent you from future problems.
For instance, saying you sometimes see your mom for a second in your old house, two weeks after her passing should never be speculated to be schizophrenia, etc.
———-
With all that said, I personally follow with an NP but she was specifically recommended by my own supervisor because the PD trusts her discretion. I’m also only being treated for one condition and her whole private practice is centered around it.
Even then, she tends to ask if I think I need changes and if so, what do I want to do. I tell her and she usually accommodates (I don’t want to say always, because I’ve never asked for anything unreasonable and I hope she’d say no if I did).
Wish this was higher up. As a physician yourself OP, going to a midlevel could literally risk your career. They give misdiagnoses constantly and in psychiatry this could follow you around for the rest of your life.
I went to an md and then the follow up was with the np and I was upset. But then I ended up liking her more and requested her for my next follow up.
I think it depends on the person
The worst that will happen will be that you’ll have to wait longer (which can be a problem no doubt). Your co-pay won’t be less to see an NP/PA so I wouldn’t care about specifying
Ask to see the doctor. At the end of the day, you’re the customer and you want the person with the most expertise. Who cares about the office coordinator’s thoughts on the subject.
Some NP’s are restricted in what they can treat - like ADHD. Can’t rx 1st line medication therapies. I saw mine for 12 months before I realized she couldn’t rx 1st line drugs and instead wanted me on so many off label medications. Ridiculous. So don’t worry what anybody else thinks. It’s not the same whether they try to gaslight you or not. We get to decide who provides our medical care and you have every right to see a psychiatrist and not an NP or MA etc.
Is that state-based? Here they can definitely prescribe adderall- back in 2016, before I knew much about this stuff at all, an NP prescribed me it on what I know is a really flimsy basis now. And of course, it made me feel amazing; it took away my depression and social anxiety, helped me focus, took away my fatigue. It was a very short path to full-blown addiction. Of course its not just NPs who misprescribe, but I believe a physician's advanced education and training probably prevents such innocents moreso than with NPs. That's crazy that they didn't even inform you that they couldn't prescribe whaf would have been a useful medication for you though, and instead just prescribed you random off-label stuff. Sounds like incompetence of the opposite kind of my NP, but stemming from the same incompetence.
Well I had 5 hours of testing at a forensic testing center to confirm the actual diagnosis. I wasn’t about to start taking stimulants without undeniable proof they are needed. Most people don’t go through all of that to get a diagnosis. I am not aware of a legitimate adhd patient becoming addicted to the meds at the prescribed dose, so I’m not worried about addiction. I’m more worried about my decline in executive functioning and my need to keep a job despite that. The restriction on NPs could even just be at this one hospital but I have a restricted insurance plan and have to use this facility. Until open enrollment.
People with adhd can definitely become addicted. I became addicted to adderall, but I can use ritalin just fine, without any desire to misuse or abuse it. There are a lot of myths surrounding adhd. Fwiw, I too had about 5 or 6 hours of extensive neuropsychological testing.
I know it’s possible, I just don’t know anybody personally (under appropriate medical supervision) who has that issue with the medication, in my little cohort of 20 people. I’m also over 60 years old, and menopause has amplified all of the symptoms. The lack of estrogen makes it much worse now. For some of us there is no other good option, and as someone who continues to use DBT, sees a therapist bi-weekly and a psychiatrist monthly, and has tried all non-stimulant medications, the combination of low-dose stimulant and non-stimulant medication is life changing. The only time I’ve ever been able to get more than 4 hours of sleep is with this medication. So I’m willing to risk it.
Not likely. They may tell you the truth that the physician isn't seeing new patients or there's an extremely long wait time.
Would you be comfortable telling your GME that you're looking for a physician for MHC (you don't have to tell them why) so they can help with the search?
It took me multiple rounds of searching and trial and error before I found one that was a fit. It's easily said, hard to find. Having a couple extra people searching with you, especially with how busy you are in residency, is an advantage you have over others if you're comfortable asking for their help.
I'm a behavioral health office coordinator, and I do not get upset if someone would rather see an MD/DO over a PA/NP at all. I do have to be upfront with those patients sometimes and let them know that they may need to wait for an intake, or ask them to reconsider because the doctor caseloads are completely full and not available to new patients at all. But there's no harm in asking on your part, and there should be no offense taken by the office coordinator.
Very good to know, thanks. I'd probably just get on the wait list, or perhaps search elsewhere in the community. If I was desperate, I'd look into the qualifications (I'd always see a PA over a NP any day) and also ensure they frequently consult with their supervising physician, too. It's the NPs that scare me more, they're just not trained in the same medical education model, the coursework is much more nursing focused. And I just don't think nursing experience does much to prepare one to be a provider, the roles are so different.
A RN can't just take a few chemistry, biology, anatomy classes and nursing theory classes for a year or two and suddenly have the medical knowledge of a doctor. Frankly, I'm not even a physician, but I'm a Psychotherapist who diagnoses and treats MH disorders, and I think if I were to get a NP degree, I'd be much more qualified than someone who was a RN for 20 years in a dermatology office. Not that I have any plans to do that, but they so often tout their nursing experience as what makes them competent to be providers, and I just don't buy it.
Sheesh, every week you're here on some flimsy pretext rage-farming the interns with a snarky new comment about mid-levels.
You are correct. You do need to see a psychiatrist. This is not healthy behavior.
The OP is a self-confessed drug abuser who trolls different forums trying to start fights between people regarding various credentials or beliefs. He/she is unwell. Falling for "hey guys, don't _______ suck?" posts is just feeding their pathology.
Indeed. I have mental health and substance abuse issues. Do you know how devastating those are? And how devastating it is not to even be able to practice in my own profession right now, because my very profession is literally psychotherapy for people with the same types of issues I'm having? It's not fun. I am unwell. I don't know why you're using my psychiatric issues and addiction as sort of a way to insult and denigrate me, though.
In your previous comment, you said "you do need a psychiatrist' but did I not admit that in the very title of my post? For you to emphasize it again for the purpose of a zinger at me makes me wonder about your subconscious attitudes towards those types of patients. I hope you have more empathy toward them when you encounter them in your own practice.
The way you wrote this also indicates to me that unfortunately you have a stigma against people with addiction. You basically are implying that a drug abuser is inherently less credible about everything with the tone of your comment. But you could find yourself struggling with addiction one day, or a close colleague of yours, addiction doesn't discriminate between professions, class, race, or anything else. I'm glad you're not in psychiatry or behavioral health.
My understanding is that complex schizophrenic patients and acute psychosis patients need an MD/DO.
Is that correct in your area? If so lie on intake.
/s.
This will be like the grad students that needed their principal investigator to get them out of in patient.
But google md your insurance covers and call their office and make appointment.
Why does it matter when all the literature supports that care delivered by APP are equivalent to MD counterparts? It seems you are focused on archaic arbitrary labels?
This particular situation may be different and makes it matter.
1. If it's related to residency, PAs and NP's don't go through residency training as intense as physicians. A physician is more likely to understand what's going on and offer better therapy and rapport.
2. I had multiple PAs and NPs who didn't listen to me or placed ordered outside recommended procedure which almost gave me a huge bill (insurance wouldn't cover because it's not recommended) or put me on meds that would make me worse.
That's not to say there aren't NP's or PAs who do a great job (thus the stats) but to someone who has had that experience, if someone wants a doctor to take care of them, don't take so much offense. You don't know the reason for the request.
Will they be mad? Who cares
This. Who gives a shit?! Nothing will get better unless we demand better care. Why would I want care from someone w less training than myself?!
I feel like such a Karen when I ask to be seen by the physican but you have to stick up for yourself. Esp when they’re billing the same price, cause they don’t care. I went to a dermo appointment and they insisted I only be seen by the NP. I just walked out and went to a different office lol.
Great if you’re in a place with more than one derm office, not to mention if they’re accepting new patients without a 6 month wait.
I never understood this line of logic. If your only access to a specialist is through an NP, then you don’t have access to specialist care. Just treat it like the NP never existed.
You’re still not seeing a dermatologist?
Derm here. Book the appointment 6 months away, if it’s truly Urgent check in with your MD PCP while you wait for the upcoming derm appointment. Also if you think it’s unacceptable to wait 6 months for the issue, going to an NP absolutely doesn’t resolve the problem. Give me an example of something that can’t wait 6 months in derm and I’ll tell you why it’s inappropriate for an NP to assess that issue.
It’s getting more and more like this! F’in NP’s will rule the world someday!
They won't be mad because your preference doesn't affect their job or salary. You may just have to wait longer to see an MD/DO because other patients also have your same preference.
I’ve also found that if I simply say to the secretary “I am a physician and I understand there might be a longer wait just like at my clinic but I prefer to see another MD” they usually understand immediately and don’t push any further.
Only MD/DO can be psychiatrist, so if you need to see a psychiatrist you should only be seeing an MD or DO.
Np/pa frequently call themselves psychiatrists to their patients to confuse them. I’ve seen it >10 times as an attending
They certainly never have differentiated from physicians when I've seen them. They've never explained for instance that their scope is more limited. I think they'd rather the patients view them as a doctor. I had a disastrous psych NP with a DNP back in 2016 ans he even used Dr. In my title. I knew he wasn't a MD though, and thought it was inappropriate, and I always just called him John, his first name.
I'm in psychiatry, and so much of my time is spent cleaning up disastrous results of midlevels misdiagnosing and overprescribing. PLEASE make sure you see an actual psychiatrist.
A young woman DNP got me addicted to adderall back around the same time period. There was no good reason for her to prescribe it, and I've been dealing with the addiction up until this present day, in which I've finally taken steps to get treatment and get off of it.
MBBS can be psychiatrists (:
Of course! You guys went to some form of British run medical school.
There are times I’m fine being seen by a PA. Like after I got my gallbladder out, the post op visit was with a PA. Totally appropriate. No way in the seven hells would i get psychiatric care from anyone other than a physician
For me, it’s important I see a specialist and expert with more psychiatric knowledge than me. I would feel insulted to have midlevel direct my care knowing their training. Will they be mad? Who cares. It’s your mental health. I’m not going to entertain polypharmacy and misdiagnosis that’s going to be on my medical records. Remember that. They can put shit like “bipolar disorder or shizo affective disorder” or whatnot and it WILL impact your insurance coverage and opportunities as a physician.
Does it matter if they’re mad? I highly doubt the psychiatrist would be mad.
You get to see who you want to see. When I established with my current PCP they were going to assign me to an NP. I said no and that was that. I see the physician. I’ve been a PA for 34 years. It might be different in specialty care OR you may get some passive push back via long wait for an appointment but…. You get to choose your provider.
if they get mad, call a different place, but most likely all that will happen is it will take longer to get the appointment
The office coordinator may protest because it’s their job to make as much money for the practice as possible, which means getting everyone to see NP/PAs. But it’s your job to take care of yourself and get the care you need, which means advocating for a MD/DO. Especially for initial visits/undifferentiated and/or complex patients . Once you’re on a stable management regimen and you just need to check in and get refills, sure, see the PA/NP.
If the office coordinator does get mad, go somewhere else. These practices need to know patients prefer to see someone with the most experience possible.
Gently but firmly state you are a physician and request to see another physician. If there's any resistance, request it as a professional courtesy. I've been doing this and it's been helpful. I'm also in psychiatry, and almost everyone I know in my program would bend over backwards to help out another resident.
Well I've gotta be honest I'm not a physician; but I am a licensed clinical mental health counselor, so I do know more about psych health care than perhaps your average patient. I just know I've been a patient of psych NPs, and one got me addicted to adderall, and I mean severe amphetamine use disorder that I've still been dealing with up until the present day when I finally decided to seek my own treatment, and the one after that was simply unknowledgeable and incompetent. I think maybe they flock to psychiatry because oftentimes the harm done isn't immediately evident like in other disciplines, sometimes is more subtle, and when recognized, the point where the provider would be able to be held accountable has already passed.
Feel free to make that demand. You might just have to wait a bit longer for an appointment
I am an NP myself (working within a hospital as an MLP under a supervising physician, the way the role was intended to always be IMO) and I only allow my children to be seen my MDs following an eye opening urgent care visit with an NP when my daughter was a baby. Have also had terrible experience with the PA at my PCP and therefore will only be seen myself by my MD. You are your own advocate for yourself and those under your care. Don’t ever worry about what others think about you.
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You have every right to choose your type of health practioner
So I’m a psych resident - we get specific requests on a daily basis. Accommodating to help the patient feel safe and appropriately treated seems very reasonable. Given your position, the most important thing is finding someone you trust, who won’t write stupid things that might bite you in the future. A physician who understands your position will likely know the best ways to document to prevent you from future problems. For instance, saying you sometimes see your mom for a second in your old house, two weeks after her passing should never be speculated to be schizophrenia, etc. ———- With all that said, I personally follow with an NP but she was specifically recommended by my own supervisor because the PD trusts her discretion. I’m also only being treated for one condition and her whole private practice is centered around it. Even then, she tends to ask if I think I need changes and if so, what do I want to do. I tell her and she usually accommodates (I don’t want to say always, because I’ve never asked for anything unreasonable and I hope she’d say no if I did).
Wish this was higher up. As a physician yourself OP, going to a midlevel could literally risk your career. They give misdiagnoses constantly and in psychiatry this could follow you around for the rest of your life.
I went to an md and then the follow up was with the np and I was upset. But then I ended up liking her more and requested her for my next follow up. I think it depends on the person
The worst that will happen will be that you’ll have to wait longer (which can be a problem no doubt). Your co-pay won’t be less to see an NP/PA so I wouldn’t care about specifying
No they will never be upset. Just plan to maybe see a physician later since the APP have more open schedules typically
Ask to see the doctor. At the end of the day, you’re the customer and you want the person with the most expertise. Who cares about the office coordinator’s thoughts on the subject.
Some NP’s are restricted in what they can treat - like ADHD. Can’t rx 1st line medication therapies. I saw mine for 12 months before I realized she couldn’t rx 1st line drugs and instead wanted me on so many off label medications. Ridiculous. So don’t worry what anybody else thinks. It’s not the same whether they try to gaslight you or not. We get to decide who provides our medical care and you have every right to see a psychiatrist and not an NP or MA etc.
Is that state-based? Here they can definitely prescribe adderall- back in 2016, before I knew much about this stuff at all, an NP prescribed me it on what I know is a really flimsy basis now. And of course, it made me feel amazing; it took away my depression and social anxiety, helped me focus, took away my fatigue. It was a very short path to full-blown addiction. Of course its not just NPs who misprescribe, but I believe a physician's advanced education and training probably prevents such innocents moreso than with NPs. That's crazy that they didn't even inform you that they couldn't prescribe whaf would have been a useful medication for you though, and instead just prescribed you random off-label stuff. Sounds like incompetence of the opposite kind of my NP, but stemming from the same incompetence.
Well I had 5 hours of testing at a forensic testing center to confirm the actual diagnosis. I wasn’t about to start taking stimulants without undeniable proof they are needed. Most people don’t go through all of that to get a diagnosis. I am not aware of a legitimate adhd patient becoming addicted to the meds at the prescribed dose, so I’m not worried about addiction. I’m more worried about my decline in executive functioning and my need to keep a job despite that. The restriction on NPs could even just be at this one hospital but I have a restricted insurance plan and have to use this facility. Until open enrollment.
People with adhd can definitely become addicted. I became addicted to adderall, but I can use ritalin just fine, without any desire to misuse or abuse it. There are a lot of myths surrounding adhd. Fwiw, I too had about 5 or 6 hours of extensive neuropsychological testing.
I know it’s possible, I just don’t know anybody personally (under appropriate medical supervision) who has that issue with the medication, in my little cohort of 20 people. I’m also over 60 years old, and menopause has amplified all of the symptoms. The lack of estrogen makes it much worse now. For some of us there is no other good option, and as someone who continues to use DBT, sees a therapist bi-weekly and a psychiatrist monthly, and has tried all non-stimulant medications, the combination of low-dose stimulant and non-stimulant medication is life changing. The only time I’ve ever been able to get more than 4 hours of sleep is with this medication. So I’m willing to risk it.
Who cares?! Stick up for what you want!!!
Not likely. They may tell you the truth that the physician isn't seeing new patients or there's an extremely long wait time. Would you be comfortable telling your GME that you're looking for a physician for MHC (you don't have to tell them why) so they can help with the search? It took me multiple rounds of searching and trial and error before I found one that was a fit. It's easily said, hard to find. Having a couple extra people searching with you, especially with how busy you are in residency, is an advantage you have over others if you're comfortable asking for their help.
I'm a behavioral health office coordinator, and I do not get upset if someone would rather see an MD/DO over a PA/NP at all. I do have to be upfront with those patients sometimes and let them know that they may need to wait for an intake, or ask them to reconsider because the doctor caseloads are completely full and not available to new patients at all. But there's no harm in asking on your part, and there should be no offense taken by the office coordinator.
Very good to know, thanks. I'd probably just get on the wait list, or perhaps search elsewhere in the community. If I was desperate, I'd look into the qualifications (I'd always see a PA over a NP any day) and also ensure they frequently consult with their supervising physician, too. It's the NPs that scare me more, they're just not trained in the same medical education model, the coursework is much more nursing focused. And I just don't think nursing experience does much to prepare one to be a provider, the roles are so different. A RN can't just take a few chemistry, biology, anatomy classes and nursing theory classes for a year or two and suddenly have the medical knowledge of a doctor. Frankly, I'm not even a physician, but I'm a Psychotherapist who diagnoses and treats MH disorders, and I think if I were to get a NP degree, I'd be much more qualified than someone who was a RN for 20 years in a dermatology office. Not that I have any plans to do that, but they so often tout their nursing experience as what makes them competent to be providers, and I just don't buy it.
Sheesh, every week you're here on some flimsy pretext rage-farming the interns with a snarky new comment about mid-levels. You are correct. You do need to see a psychiatrist. This is not healthy behavior.
You’re wrong! The OP has a valid point!
The OP is a self-confessed drug abuser who trolls different forums trying to start fights between people regarding various credentials or beliefs. He/she is unwell. Falling for "hey guys, don't _______ suck?" posts is just feeding their pathology.
You’re reading it also. You must also have some pathology?
Indeed. I have mental health and substance abuse issues. Do you know how devastating those are? And how devastating it is not to even be able to practice in my own profession right now, because my very profession is literally psychotherapy for people with the same types of issues I'm having? It's not fun. I am unwell. I don't know why you're using my psychiatric issues and addiction as sort of a way to insult and denigrate me, though. In your previous comment, you said "you do need a psychiatrist' but did I not admit that in the very title of my post? For you to emphasize it again for the purpose of a zinger at me makes me wonder about your subconscious attitudes towards those types of patients. I hope you have more empathy toward them when you encounter them in your own practice.
The way you wrote this also indicates to me that unfortunately you have a stigma against people with addiction. You basically are implying that a drug abuser is inherently less credible about everything with the tone of your comment. But you could find yourself struggling with addiction one day, or a close colleague of yours, addiction doesn't discriminate between professions, class, race, or anything else. I'm glad you're not in psychiatry or behavioral health.
My understanding is that complex schizophrenic patients and acute psychosis patients need an MD/DO. Is that correct in your area? If so lie on intake. /s. This will be like the grad students that needed their principal investigator to get them out of in patient. But google md your insurance covers and call their office and make appointment.
Yeah. Although PA’s have the edge.
Why does it matter when all the literature supports that care delivered by APP are equivalent to MD counterparts? It seems you are focused on archaic arbitrary labels?
Which “literature”?
“ A professional resource and study guide for the CRNA “ by Scott Foster
LOL
This particular situation may be different and makes it matter. 1. If it's related to residency, PAs and NP's don't go through residency training as intense as physicians. A physician is more likely to understand what's going on and offer better therapy and rapport. 2. I had multiple PAs and NPs who didn't listen to me or placed ordered outside recommended procedure which almost gave me a huge bill (insurance wouldn't cover because it's not recommended) or put me on meds that would make me worse. That's not to say there aren't NP's or PAs who do a great job (thus the stats) but to someone who has had that experience, if someone wants a doctor to take care of them, don't take so much offense. You don't know the reason for the request.