Switching careers and interested in psychiatric NP

Nursing Students NP Students

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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

Unlike Texas, AZ, NM and some states, GA is backward in allowing NP to practice outside of their specialty. There is no point in going back for Psych NP cert in GA at all unless she/he wants to move out of the state. You will face competition with the generalist (FNPs & generalist PAs) in GA. The best NP degree to get in GA is FNP because you can work in all settings with that degree. In my opinion, they need to eliminate all psych NP program there. There is no demand for psych NP there since FNP can fill the slot.

It blows my mind that FNPs are allowed to practice full spectrum psych in Georgia. How are they trained for that?

Specializes in Psychiatric Nursing.

I find the variation of practice from state to state confusing. I do locums. Some want your certification and education to line up, some leave it up to you to decide. I have heard that most malpractice claims against APRN's are those who practice outside their scope of practice.

I guess one question is how can one acquire additional training to expand one's scope of practice. Is getting another certification the only way?? When is on the job training legitimate?

I am surprised many FNP's would want to do psych-it is very different.

I have no direct knowledge of FNPs working in a psyc NP role. For you psyc NPs out there, did any of you NOT have to take a pharmacology course that focused specifically on psyc drugs?

In my PMHNP program we were required to take the same pharmacology course that all NP concentrations took (FNP, WHNP, ACNP, etc.) and then also took a specific psychopharmacology course. Both were required to graduate.

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.

I too am in the same boat with the person you quoted. I did my undergrad in sociology and psychology and have a master's in cognitive neuroscience, publishing and gaining clinical experience in clinical neuropsychology only to find an extreme saturation of practitioners, an overall lack in public demand for what psychologists SPECIFICALLY offer (e.g. psychometric testing). Many insurance companies will not cover the costs for these assessments, some companies are now pushing to only allow medical doctors or some mid level people to be the only ones who will be reimbursed for testing (despite the fact they dont hold any formal experience in psychometrics, statistics, research ,etc.). NPs have a market demand over something >30% and psychologists have about a 12% market demand. Ph.D. programs in clinical psychology on average receive over 150 applicants a year and accept 3.78 and GREs >65% are considered and will almost always have a publication as a 2nd author or lower with a couple of conference presentations or some clinical exposure during undergrad (e.g. suicide hotlines, women's shelters, etc.).

I currently work in a private neurology practice as a neuropsychometrist, and make decent money off of it, but the demand is extremely small. If for some reason I were to ever get fired, left, moved, etc., the ability for me to reasonably find a similar job is

The NP route is something I have been scouting out for years, especially when I started my previous master's degree. Everything I listed about NP market viability and stability is much better than the current goal of becoming a psychologist. At the end of the day, my intent is to treat people's psychiatric illness, and recently it has been working with patients with CNS damage, degeneration, etc. I could go the MSW route, but the pay would be terrible, the market viability is 10% better than psychologists but nowhere near NP standards. From the research I have conducted, I know there are good opportunities for me to take on further education during the MSN program or afterwards to gain more therapy skills often seen and learned within MSW or LMHC programs.

Specializes in Mental Health.
I too am in the same boat with the person you quoted. I did my undergrad in sociology and psychology and have a master's in cognitive neuroscience, publishing and gaining clinical experience in clinical neuropsychology only to find an extreme saturation of practitioners, an overall lack in public demand for what psychologists SPECIFICALLY offer (e.g. psychometric testing). Many insurance companies will not cover the costs for these assessments, some companies are now pushing to only allow medical doctors or some mid level people to be the only ones who will be reimbursed for testing (despite the fact they dont hold any formal experience in psychometrics, statistics, research ,etc.). NPs have a market demand over something >30% and psychologists have about a 12% market demand. Ph.D. programs in clinical psychology on average receive over 150 applicants a year and accept 3.78 and GREs >65% are considered and will almost always have a publication as a 2nd author or lower with a couple of conference presentations or some clinical exposure during undergrad (e.g. suicide hotlines, women's shelters, etc.).

I currently work in a private neurology practice as a neuropsychometrist, and make decent money off of it, but the demand is extremely small. If for some reason I were to ever get fired, left, moved, etc., the ability for me to reasonably find a similar job is

The NP route is something I have been scouting out for years, especially when I started my previous master's degree. Everything I listed about NP market viability and stability is much better than the current goal of becoming a psychologist. At the end of the day, my intent is to treat people's psychiatric illness, and recently it has been working with patients with CNS damage, degeneration, etc. I could go the MSW route, but the pay would be terrible, the market viability is 10% better than psychologists but nowhere near NP standards. From the research I have conducted, I know there are good opportunities for me to take on further education during the MSN program or afterwards to gain more therapy skills often seen and learned within MSW or LMHC programs.

I'm the person that harmonizer was responding to. I thankfully did not take his advice. He means well but since then I've spoken to many psych NPs who share a much different opinion. Yes this is a great career with lots of demand. The pay is excellent. It's well worth the time and debt to do this if you're looking for a stable career. Of course it's impossible to predict the future. There could be some medical discovery that will make psychopharmacology obselete. I would be happy if that were the case, although a little freaked out due to my encroaching loan debt. But I highly doubt that'll happen. I really do not think that the demand for psych NPs is going to decrease anytime soon.

Re-reading harmonizer's post now.. there's a lot I disagree with. He's wrong about a lot. Psych NPs do make more than 50% of MD pay. It depends on where you live but you can make around 80% of psychiatrist pay. In Oregon you can make as much as a psychiatrist due to their parity law if you're in private practice. As for demand, unknown? It's known. Every psych NP i've spoken to gets hounded by job recruiters weekly. Every psych student in my school gets a job months before graduating. In most areas there is a several month wait to see a psychiatrist/psych NP due to the shortage of providers. There's plenty of demand, especially if you're willing to move. Not all geographical areas are ideal due to factors such as state restrictions on autonomy. The southeast is particularly terrible, which I think is where harmonizer is from, which might may be influencing his perception. As far as NP specialties go, psych is by far the most in demand after graduating. I've heard this directly from several faculty at my school. Lastly, in regards to the time management aspect. We have the freedom to open up a private practice. Then you can do whatever you want. 30 minute med checks, psychotherapy, you name it. We have the freedom to do all that and do not need to work for somebody else. And when you're looking for your first job, you can ask them about these factors going in, and if their practice environment doesn't suit your needs, you can walk away knowing there's plenty of other places where you can easily find work.

I'm currently in a PMHNP program, halfway done. I just did my RN year and just started the MSN year, so in a year i'll be working. If you have any questions just PM me and we can talk.

OMG!

I apologize guys - I did not intend to initiate a big brouhaha!

Blondie, NPs were never designed to be "midlevels". You will find that the AANP specifically opposes that term. NPs are highly educated, highly trained providers who have a record of performance that is second to none. If NPs are doing the same work that MDs or DOs are performing then they should be compensated at the same rate.

FuturePsych -I really don't understand your hostility....You seem to feel that getting compensated appropriately is not important. Have you ever spent much time talking with your MD colleagues? Money is pretty much all they talk about. The AMA works very hard to ensure that MDs are well paid. I'm not understanding why you feel that it is inappropriate to want to be fairly compensated. Equal pay for equal work is a fundamental concept. You will see when you get into practice that you will often be doing exactly the same work as an MD. So why should the MD make $100+ per hour and you $45? I am not your enemy....I am someone who wants you and your family to enjoy the best possible lifestyle and financial security for doing work that can make a real difference in the lives of others.

Hi there TheOldGuy, I definitely empathize with your point of view and I wanted to shed some light on a comparison that is similar to what psychologists do vs. midlevel social workers, mental health therapists are doing. At the moment, for one to provide mental health care to someone that is non nursing or medically related training, the standard is either the master's degree (social work, rehabilitation, school, community, mental health counseling) or the doctorate (Psy.D., Ph.D. in clinical, school or counseling psychology). Between these degrees, these practitioners learn approaches in talk therapy, psychologists are highly trained in psychometrics and advanced clinical training in talk therapies. Right now, many midlevel clinicians are able to provide the same counseling services as psychologists do, and for many insurance companies, the reimbursement rates are not all that different. However, now you are having some master's level clinicians providing psychological assessments, and frankly have nowhere near the training if at all compared to psychologists.

To put this in perspective, the average LMHC/LPC or LCSW will have a 4 year undergrad, a 2 year master's (some take longer due to personal needs, but not due to curriculum differences) and a 1 year post-master's practicum to accumulate the 3000 hours they need to apply for license to practice independently. The average psychologist will have a 4 year undergrad, a 5 year doctorate (Psy.D./Ph.D.) and a 1-2 year post-doctorate fellowship/residency. At face value, the sheer length of training is already greater for psychologists, let alone the amount of coursework and dissertation work they complete vs. midlevels. The average physician will have a 4 year undergrad, a 4 year DO/MD and for psychiatry, 4 years of residency training. The schools some people have referred to that don't require a bachelor's degree are

So, since we deal in evidence (e.g. significance), these are very rare exceptions to the overall labor force of practicing physicians. NPs on the other hand, have a BSN (4 years) and a MSN (2 years), again, if someone is taking longer than 2 years, that is due to personal needs and not due to difference in curriculum. According to the state of Florida, that is all that is required to apply for the ARNP license. By these calculations, NPs mathematically have less education than a physician, let alone the rigor of the coursework completed in medical school, for which I have personally experienced as I took several courses in neuroanatomy, etc. during my master's jointly with the neighboring medical school.

I am a very liberal guy, I am pro choice, a gay married male, Democrat, etc. But in this case, I fail to see a feasible excuse other than "we do the same job."

This sounds wonderful! I too was looking at geographical fluctuations in rates as well as the nice map that shows states where NPs can practice independently. I just moved to Miami from Dallas. In Dallas, NPs are paid very very well ($90K+ starting). In the south Florida area, I have noticed a huge lack in psychiatric NPs. Needless to say, I don't see us staying here past the time it takes for my husband to complete his Pharm.D. In the meantime, I have switched my DL to Florida and will wait until next August to take pre-nursing courses at the local college around us so I can apply for a second bachelor's in nursing. I know my goal, I love working with patients, I like the private practice I work in now and is something I would love to continue doing, but with better pay. :p

Specializes in psych.

I am a very liberal guy, I am pro choice, a gay married male, Democrat, etc. But in this case, I fail to see a feasible excuse other than "we do the same job."

Cogneuroguy, I don't get how being a liberal makes you more understanding or whatever point you are trying to make by saying that.

My intent for using that was the imply that I typically view progressive actions in society favorably (e.g. gay marriage, equal pay for women, pro choice, etc.)...that was the point.

You are kidding aren't you?

If an LCSW does the same work as a Psy D (eg therapy) then the compensation is the same. However, PsyDs can do things that an LCSW cannot do. When they do those things, they deserve to be compensated appropriately.

If an NP does the same work as an MD then the compensation should be the same. However there are things MDs can do that NPs can't - because NPs don't have the training or experience (eg surgeries). When MDs do those things, they deserve to be compensated appropriately.

The issue isn't "training" or "years of schooling" its what the market will compensate and perceived value of the work. You're attempting to make the same claim that the AMA and various state medical associations have been arguing - and it doesn't hold water.

The US healthcare "system" is hosed beyond all recognition....and docs have been "the captain of the ship"....perhaps we need some new skippers!

you like that term "midlevel".... the way you used it repeatedly is interesting...as though you are trying to make some sort of point....not sure what that point is....

I use the term midlevel provider because it is an accurate description of that provider status. It seems like you are getting pretty defensive about this. We simply are differing on a matter of opinion here, but I would say that your basis for NPs or other midlevels to be compensated at the same rate as doctors for providing equal services doesn't hold water. Whether you like it or not, those who went on to further education got one and is reflective in their pay, if that offends you, I'm not sure what to tell you other than, go and do it yourself. The training is more intense, more in depth and much longer. You may have great experience, which it sounds like, and like another poster said, you seem to be the exception to the rule, but since you are working within a science related field, we must rely on facts, and the facts are laid out very plainly.

I myself often toss back and fort deciding if I should go onto medical school or nursing school. I'm not going to sugar coat the differences between the two providers, I will rationalize why one path was better for me vs. the other. Unlike other employment markets like business where having a credential doesn't matter in terms of getting paid a good salary (which I worked in mortgage for a long time myself), medicine and academia does. As a research scientist, I too performed all of the testing, the literature reviewing, the actual writing of morificecripts, data analysis and reporting of my findings. These are all things a Ph.D. scientist can do, but if you look at any major medical university and look at the research scientist jobs, you will see they pay differently at the master's level vs. the Ph.D. despite the fact that you are doing more work than the Ph.D. scientist. In business, I was working with people, getting paid the same salary for doing the same job that people with MBAs had, and at the time I only had a bachelor's degree. Again, business is a fine example of how one could take on roles that higher ups do and lack the credential and get paid nearly the same, and in some cases more than those who took the time to invest in their education.

Medicine on the other hand operates like academia, your credential places you within a certain bracket of pay. There is a reason why you don't see a lot of medical schools accepting the bulk of their applicants, otherwise you would see a huge influx of medical doctors (this goes beyond the shortage of internship sites). Overall, the services and knowledge of a physician provides to their patients is going to be more in depth and representative of the longer education and often times experience they provide vs. a NP. You may have had some crap experiences in which you seemed like the more knowledgeable provider, but again we are talking about variance, and insignificant variance at that.

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