Note: The Board of Directors Here at Spo-reflections were puzzled by this one, and almost didn’t let it through. I don’t blame them, I am not sure what I am saying here either. I thought writing my thoughts out would solidify things but it didn’t work. Spo

Earlier this week at work I met the newly hired RN (nurse practitioner). I am told via office-gossip there is another one making his debut next month. Last autumn there were vague ‘someday’ speeches from The Bosses one or more would arrive some day, and here they are. I don’t know yet what capacity they will be working. These things are not told to me. Over the 17 years at this job I have seen several nurse practitioners come and go and they never stay long; let’s see how long these two last.

I have mixed feelings about nurse practitioners. On the positive, having anyone with a working pager and access to a prescription pad allows me to go away to conferences or on holiday, covered person. Imagine a vacation without having daily to call into work! With a MD and a RN on-board, the patients have a choice of two types of providers. The nurses, usually female, are often preferred by female patients, especially ones with trauma or PTSD issues.* In my experience, nurses are better than doctors, and females are better than males, at providing support and nurturance in counsel, which are so important when dealing with folks with mental illness.

On the negative, the nurses (so far) have come with the attitude ‘I am just as good at this job, buddy”. In my experience this is not so. They boasted their abilities, but quickly bailed when encountering difficult cases. “Oh, I’m just the nurse” they tell these patients, and send them to me. If you are going to claim you are just as good as a doctor, don’t pull this ‘I’m only a nurse” on your patients. On the whole I do a good job, thank you very much, so I often look brilliant in comparison.

Another issue: they don’t stick around, they retire or find other jobs. When they go, which is often sudden, they leave patients in a lurch and I get them – many are not happy about the sudden departure of their provider, and several very unhappy and uncomfortable about seeing the big bad male doctor, member of the patriarchy, and all he represents.**

The pay for two nurses is probably less than the salary of one psychiatrist and the clinic gets more work out of them. If I were a paranoid, I would worry my post is now jeopardy and I will be sacked by The Overlords, as less lucrative.

I wish I was working with another physician. This is said out of professional loneliness. For awhile there was ‘The Other Doctor’ but he went away to do a small pay-out-of-pocket set up***. We didn’t have much in common and we didn’t interact much but it was nice to have a colleague next door to bounce ideas off of him and consult on psychiatry stuff. Finding a proper psychiatrist to work here is near impossible. I sense the clinic is hiring nurses as doctors are not to be found for love or money. The few shrinks looking for work are heavily sought after and they can choose from far more lucrative offers than our humble abode.

I learned the nurse I met will work with children and adolescents , which is more rare than unemployed psychiatrists, so she fills a much-needed demand. I hope she stays. The fellow showing up in February is a wait and see sort whether he will be full time or a part time person is he an RN, a MD, or some other alphabet combination, and is he well over four feet.

Do you see a RN or a MD for your health care? Are you satisfied?

In your experience, are RN practitioners as good/better/worse than the doctor?

*There is a paradox to this. In general, female patients do better with female practitioners, but you don’t say to a female patient “because you are female, you are being assigned to the female nurse, and not the doctor.” Not nice.

**On the other hand, some patients are glad to have a ‘proper doctor’ now, having seen the nurse when I wasn’t available.

***It turns out a lot of shrinks in PHX work only for cash. How they manage to pull this off I don’t know.