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Comment by phren0logy | Hacker News Reader

Disclosure: I'm an MD who specializes in psychiatry.

The idea that Nurse Practitioners and Social Workers "do almost everything that psychiatrists do but (for historical reasons) charge lower rates" doesn't feel like a fair characterization. I have worked with many excellent NPs and Social Workers, and have a tremendous regard for their work, but the level of training is - objectively - much different.

Here's an infographic comparing training, which is more or less accurate, but there's some variation between programs: https://i.redd.it/ixgg0l7v6lv51.jpg

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This is a very good point, and thank you for sending this information. However, the infographic is quite misleading because it doesn't stack up nursing school vs. medical school (i.e. it doesn't show the type of courses and training taught in a 4-year nursing program at all). A undergraduate bachelor's degree even in biology is not comparable to the clinical training in nursing school.

That being said, I see your point. There some types of complex care that only MDs/PhDs should be providing, and we will have psychiatrists and doctorate-level psychologists for that care. However, many of the services that our customers provide can be done by other clinicians in our network under the supervision of an excellent MD or PhD.

Part of our goal is to really figure out the "matching" problem so that we can triage care to the clinician type with the right amount of training for the patient situation. By doing that, we feel like we can really increase access the way that we hope.

The matching thing is a solved problem in hospitals. The patient meets a doctor level provider for the first visit then is assigned proper care based on the diagnosis with a lower level provider. The problem you will have is that you have a lot of low level provider with varying skills and a high level provider will have a hard time matching patient to the correct provider capable of administering the correct treatment protocols.

I think this is a very valid point and something that we will need to consider. Thank you for bringing it up. The variation in quality is certainly not easy to solve, especially when pairing it with a clinical decision-making hierarchy.

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