Switching careers and interested in psychiatric NP

[Mkim680]

Hello everyone,

This is actually my first post on allnurses.com. Currently, I am a licensed psychotherapist working for the U.S. Army's addiction clinic. At my current work site, a recent legislation was passed that anyone possessing a LPC or LMHC license would have difficulty moving into management positions. I have encountered this at several places I've worked in for the federal government.

Actually, this worked out because I was thinking about going back to school anyway. I've grown a great interest in the psychiatric nurse practitioner route and wanted to ask a few questions. What does the current market look like for employment, salary available, and job flexibility?

I don't want to make the mistake of getting the wrong degree or license and hear that I will never be able to move up in any company I work for. Also, can psychiatric nurse practitioners be employed overseas by different organizations other than military branches?

I looked at the U.S. embassy positions but they only hire family nurse practitioners and MD Psychiatrists. Any advice would be appreciated.

Mark

[ChristineN, BSN, RN]

TheOldGuy, where did you go to NP school? I went to Duke and we didn't get anywhere near what you got. 18 months of pharm and clinicals? 1yr of advanced patho? Sweet. I want that program. I'm serious, that sounds like a tough and excellent program. They do a post masters program as well, don't they? Did you also get surgical training as well? Could you build your own clinical experience in several different clinical areas? That would be cool. Thanks.

I think your numbers are a bit off on independant practice. From another thread "New Mexico, Arizona, Alaska, District of Columbia, Idaho, Montana, New Hampshire, Oregon, Rhode Island, Washington, Wyoming." and maybe Hawaii?

PA almost had independent practice when I left 3 years ago. If they don't have it they are very close and it is only a matter of time

[elkpark]

Blondie, NPs were never designed to be "midlevels". You will find that the AANP specifically opposes that term.

While "midlevel provider" was a term invented, IIRC, by the insurance companies to encompass all of the advanced practice nurses plus PAs (and maybe some other groups that the insurance companies pay), it is certainly true that NPs were "designed" originally to function under and extend the services a physician is able to provide ("physician extender" is another generic term invented, I believe, by the insurance companies to also generically refer to APRNs and PAs collectively and equally disliked by the group(s) to which it refers). Look at the history of NPs.

[TheOldGuy]

University of North Dakota - it is an excellent program.

NPs were not designed by insurance companies, nor by MDs although an MD was involved in the first NP program in Colorado in 1965. Interestingly, one of the early challenges was that the medical profession wanted to use NPs in the extender role and teach using a medical model - nursing refused - which later paved the way for PA programs.

Advanced Practice Nursing is a different model of care - one that has been proven to provide equivalent or better outcomes than the medical model. I don't like to lump NPs with PAs because PAs are taught a different approach and one that is designed to function under a physician - which is why PAs do not have independent practice in any jurisdiction. Below is a map from the 2012 Pearson Report showing various scope of practice for NPs in various states:

[elkpark]

NPs were not designed by insurance companies, nor by MDs although an MD was involved in the first NP program in Colorado in 1965. Interestingly, one of the early challenges was that the medical profession wanted to use NPs in the extender role and teach using a medical model - nursing refused - which later paved the way for PA programs.

Advanced Practice Nursing is a different model of care - one that has been proven to provide equivalent or better outcomes than the medical model. I don't like to lump NPs with PAs because PAs are taught a different approach and one that is designed to function under a physician - which is why PAs do not have independent practice in any jurisdiction. Below is a map from the 2012 Pearson Report showing various scope of practice for NPs in various states:

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I did not say (or suggest) that NPs were "designed by insurance companies" -- I said that the term "midlevel provider" was invented (I believe) by insurance companies. And the NP community has rewritten the history to suit itself somewhat, which I certainly don't blame it for doing (we all do, to some extent), but, waaaaay back (when this was much newer history and the principals were still around), the version I always heard was that Dr. Silver dreamed up (himself) the idea of providing pediatric nurses with advanced training to enable them to assist physicians in carrying and managing a larger caseload and then went looking for a nursing program willing to help operationalize his idea (and found Dr. Ford at University of Colorado). Of course the current version of the story is better PR for NPs. However, the simple fact that NPs started out being supervised by physicians in all states and have gained independence to one degree or another over time in many of the states is itself evidence that the original intent and design of NPs was to function under the supervision of a physician. Otherwise, they would be have been fully independent in all 50 states from the get-go, rather than fighting for increased independence and autonomy in each individual state over time, would they not?

[zenman]

]Seems to me like it's an issue of equal pay for equal work.[/b] If a NP is practicing in the same capacity as a family practice doc then I see no reason why the doc should make more money. The fact that the doc went to school for longer, went through a residency, etc., are all beside the point. At the end of the day, if the NP and the MD are doing identical jobs, I don't see how one can defend reimbursing the NP less.[/quote']

Many people miss this point. It's not equal pay for equal work; it's more pay for more knowledge. Now does that clear up this argument...forever I hope?

[mzaur]

Do not give up your dream. The average pay for PhD is $85..Neuropsych get pay very well and in great demand.. PMHNP career is very limited to work in certain setting. Demand is still unknown. PhD gives a wide range of opportunities and prestige. It really depends on what you want in life. You may hate it later if you become one.. It can be very taxing.. You are given a case load of patient to be seen limited time 15-30 min.. barely have time to do anything other than assessment and med management.. and limited psychotherapy.. You can get burnt out really fast esp. when you know that you get 50% of MD pay with same headache and liability.

The average pay for clinical psychologist may be 85k, but that will be going down as degree mills pump more and more useless psychologists into an already oversaturated field. There is also the internship crisis where many have to delay licensure because there are not enough internship slots. On top of that, psychologists cannot prescribe, so they are very limited in terms of direct care. Don't get me wrong, if one has a passion for research, the PhD is a great choice, but when I realized that's not what I wanted to do, the choice was easy to make. Psychologists only interested in clinician work have to compete with Masters level therapists, and I don't think prestige factors into it. PsychNPs can start at 85k and can practice independently in many states. Perhaps you do not realize this since you say that the career is limited. PMHNP can prescribe and do psychotherapy, while a psychologist can only do the latter. PMHNP isn't just med management.

And I'm not sure what you mean by "the demand is unknown" ? It is very known. There is a big demand for PsychNPs in many areas as less and less med students are going into psychiatry, and the direction this country is going in terms of healthcare will allow for more access to mental healthcare services.

[TheOldGuy]

LOL - Zen, I can't believe I keep responding!

Anyway, I don't agree that it is more pay for more knowledge. If knowledge was the determining factor then those in academic roles would be making the most. The practice of medicine (and advanced practice nursing) is a business. Docs have controlled compensation for some time, nurses have traditionally been labor. Now, as the APRN role is more developed and accepted and we are able to practice independently, I don't feel there is any reason that we should be compensated less. If we are not doing the same job, if we don't have the same responsibilities eg in California unfortunately, then we don't deserve the same compensation. I do agree with you that this horse really ought to be dead by now since it's been beaten in so many threads! I also agree that in most settings, NPs are functioning with support from docs. From your experience, do you think that newly minted docs have that much less need for support than newly minted NPs? Just out of curiosity, did you see much difference in pay between states where NPs had independent practice eg New Mexico and where there is a requirement for collaboration ?

Peace!

[FuturePsychNP]

History is always slanged towards one party. If NPs wrote the book then the book will make NPs out to be more of a heroin, i.e. rising from meager hospital wards to caped, provider. I stand by my remarks. Do your job, enjoy it, or leave and do something else. Nothing is to be gained by begrudging another occupation.

[Psychcns]

The equal pay for equal work argument-has anyone considered that APRN's doing the same job as MD's will bring down the rate of compensation for that job.

[FuturePsychNP]

LOL - Zen, I can't believe I keep responding!

Anyway, I don't agree that it is more pay for more knowledge. If knowledge was the determining factor then those in academic roles would be making the most. The practice of medicine (and advanced practice nursing) is a business. Docs have controlled compensation for some time, nurses have traditionally been labor. Now, as the APRN role is more developed and accepted and we are able to practice independently, I don't feel there is any reason that we should be compensated less. If we are not doing the same job, if we don't have the same responsibilities eg in California unfortunately, then we don't deserve the same compensation. I do agree with you that this horse really ought to be dead by now since it's been beaten in so many threads! I also agree that in most settings, NPs are functioning with support from docs. From your experience, do you think that newly minted docs have that much less need for support than newly minted NPs? Just out of curiosity, did you see much difference in pay between states where NPs had independent practice eg New Mexico and where there is a requirement for collaboration ?

Peace!

No, academic salaries are smaller because of funding. Public universities are funded largely through legislative appropriation as well as other government measures, and since funding has to be divided amongst such a large pool then salary is decreased. A NP at the VA would likely make less than most NPs in private/group practice.

[Mkim680]

Thanks everyone for all the responses. I had one question to ask everyone. Currently, I am torn on whether to get my BSN first then apply for a psychiatric nurse practitioner program or go straight into a MSN program that offers the psych nurse practitioner NP speciality. I just want to make sure and get the right license for employment after graduation. What would people suggest? Also, i already have a LMHC license and have been doing psychotherapy for 6 years.

[mzaur]

I had a similar question recently and was told that the BSN isn't necessary