Anyone know about PMHNP to Psy.d/Ph.d?

Coffeegirly · Jun 17, 2006

I just talked to several psychologists and they are quite envious about my ability to prescribe due to the fact that I am a PMHNP/NP. I have some other biases with regard to PsyD so I am more inclined at this point in time to get my doctorate in clinical nursing. A few years a go I wouldn't have said that- but time and experience has changed my views.

spaniel · Jun 22, 2006

Yes- I think it can cause some blur. And I'd welcome anyone else to look at this topic too. The Psy.D. takes ages to complete at a decent school-and you surely want to go to an APA approved school, or there are consequences to getting all sorts of things,like internships. Typically they might take about 9 credits from the masters nursing program.

Frankly you are far more marketable as a NP (NPP). However, the psychologist does NOT need physician approal or oversight in any way (at least from a regulatory standpoint.) that is a bonus.

91W · Jun 23, 2006

I appreciate all of the input on these questions. Here are a few more if you have any further insight on these matters.

1) Can a PMHNP be an autonomous practitioner, or must they be under MD supervision ? (specifically California), furthermore, if one were a PMHNP & Psy.d , would they then be able to prescribe on their own, without being under a MD?

2) I have seen DNP with a specialty in Psych. is this any different than practicing as a NP?

There are so many directions a nurse can go. My own goal is to pursue Psychiatric nursing as far as I can go, throughout my life. Thank you for your replys.

1911guy · Jun 25, 2006

Hello 91W (are you an Army Health Care Specialist, MOS 91W?).

Anyway, since I am a future psychologist (hopefully- I haven't gotten into graduate school yet) who looked into becoming a psychiatric nurse practitioner as a possible alternative I hope I can help.

Are you already an RN? If you are you may as well go the NP route. With an MSN a psych nurse can make close to what a doctorate level psychologist can make. In most states he/she will be able to prescribe meds (something a psychologist can do only in one state and some in the military, and then only with an additional post-doctorate masters in psychopharmacology, though prescription privileges for psychologists seem to be coming in the future). In many states a psych NP will be able to do a private practice on their own as a therapist (some may be able to prescribe meds in private practice, usually with a collaborating MD for the meds). A psych NP can also do research. About the only disadvantage is if you like testing- only psychologists and counselors can do psych testing in most states.

If you have a degree but aren't an RN then the Psy.D. or Ph.D. may be a better route. While a psych NP may have a private practice the public is more accepting of a psychologist in private practice (i.e. it will be easier to develop a clientele). The psychologist has a doctorate while a NP has a masters which will effect what you can charge per hour in private practice or effect your pay by most organizations (the one place a psych NP may make as much or more is in a hospital, but many clinical and counseling psychologists work in other settings other than hospitals). Also, psychology may be quicker. It takes 5 years minimum including the internship (actual time averages about 5.5 years for practice based Psy.D. programs and 6-7 for research based Ph.D. programs) while nursing school is 2-4 years for your BSN/RN depending on past coursework plus a year or two experience before you start your 2 year MSN program.

2) If you decide to pursue a Doctorate in Psychology as a Pmhnp, are you allowed to enter with a master level or much you start from the begining?

My first question would be "why". Both a pysch NP and a doctorate level psychologist are mental health professionals. In most states they can do independent practice of therapy. The difference is most states allow the NP to prescribe meds and right now only one state allows it of psychologists and then only after additional education. Other than meds both professions can do about 80% of what the other can do.

Anyway, most Ph.D. programs in clinical psychology require a BA in psychology. They require significant research in psychology. They require GPAs that rival medical school requirements. They don't particularly care for a MA before starting- most clinical psych Ph.D. programs make you start from scratch if you have a MA in psychology or not, they certainly won't give advanced standing for non-psych masters no matter how closely related.

Psy.D. programs in clinical psych and Ph.D.s in counseling psych are a little more MA friendly and a little more friendly towards people with non-psych BA/BS degrees. However, with few exceptions they will be looking for the MA in psychology or maybe counseling, not nursing or other psych related areas. It is unlikely that a Psy.D. in clinical or Ph.D. in counseling psych will give you any advanced standing for an MSN in psych nursing.

3) Besides advancing your knowledge and being able to teach, does having a Doctorate improve your marketablility or does it create a fuzzy role in the clinical setting and does it help you if you are self employed

The main advantage (other than psych testing) the doctorate in psychology will have for someone who wants to be a psych nurse is money. IF you do private practice or work in other non-hospital settings the psychologist will be paid more because they carry the title "doctor" which the psych nurse does not. However, if you work in a hospital the psych nurse probably won't be paid less, and may even be paid more.

Now, if you want to be a psychologist there are advantages to this route, but it is a different profession. You will be eligible to work in more settings, though certainly with some overlap (mental health clinics, schools, university counseling centers, hospitals, psych hospitals, community colleges or universities as a professor, research facilities, business consulting, etc). It is more flexible- it isn't uncommon for a psychologist to work more than one area (FT as a professor and PT in practice for instance). You can administer or even design psychological and educational tests. But, it isn't nursing.

91W · Jun 25, 2006

1911,

Thanks for the in depth reply, and yes I (was) a medical specialist. Just got out of the Army in Feb. I had taken a bit a college during my time in the Army and got out with about 80 credits ( I truly enjoy psychology), the bad thing is about nursing in my area is it is a 3 year program and would start next fall, bringing my total time invested to about 5 years to get a BSN when i already have 80 credits(school uses about 60). I know that if I were to go the Psychology route I could complete the education around the same time if not a year earlier than the PMHNP. I would have to do the MSN online unless I wanted to become a FNP which I truly do not.

Maybe I do not understand the flexibility of a Psy.d and am somewhat afraid of uncertainties with residency. Finacially the nurse to PMHNP seems more secure and with a life goal to include a Psy.d it just seemed to be long but benificial. This Dilemma is my own personal curse I think lol, this semester I am going to go to school and just feel it out. I am going to go with what seems to flow for me. Thanks or the info.

Coffeegirly · Jun 25, 2006

Hi again,

I have had plenty of PMHNP's who have said their experience and educational background have been of benefit to their admission to Psy.D. programs. In fact, on an application I have, it it listed as being preferable so I am a bit confused but perhaps I missed something.

I am curious to know what state it is legal for psychologists to prescribe. I am aware that this is a very hot issue which is one reason I went for the PMHNP post masters. The other reason being that I don't enjoy testing. I am not certain that prescriptive privelages will come to psychologists but we shall see. The AMA lobbies long and hard and are not too thrilled about PMHNP's prescribing. Everyone thinks it's not a big deal to prescribe mental health medications but it really is.

In addition, many NP's do not work under MD's. I don't and many NP's in neighboring states do not. That's what makes many NP's different from PA's. We are independent practitioners. If there are NP's out there who are not YET.... then the lobbying needs to continue because it will happen.

I know many psych NPs who are making as much if not more than MD's and psychologists merely because there are so many patients out there who need mental health services.

spaniel · Jun 26, 2006

Rx priviledges for psychologists: New Mexico

spaniel · Jun 26, 2006

I should have added that Louisiana also has Rx priviledges for psychologists, but a post -doc masters in pharmacology is required. Other states lookin "into" the matter include Hawaii, Tenn.,Conn.,Missouri,and Georgia. However, it surely is a very slow process .

jer_sd · Jun 26, 2006

I appreciate all of the input on these questions. Here are a few more if you have any further insight on these matters.
1) Can a PMHNP be an autonomous practitioner, or must they be under MD supervision ? (specifically California), furthermore, if one were a PMHNP & Psy.d , would they then be able to prescribe on their own, without being under a MD?
2) I have seen DNP with a specialty in Psych. is this any different than practicing as a NP?
There are so many directions a nurse can go. My own goal is to pursue Psychiatric nursing as far as I can go, throughout my life. Thank you for your replys.

In california NPs do not have a seperate scope of practice from a RN. Nursing functions can be preformed without physician collaberation. Making a medical diagniosis, and RX require MD/DO collaberation under standardized procedures. providing an RX is considered a deligated function.

Jeremy

1911guy · Jun 30, 2006

Thanks for the in depth reply, and yes I (was) a medical specialist. Just got out of the Army in Feb.

Thank you for your sevice. I joined out of high school but unfortunately I had a bad ankle that caused me to be unable to pass the run (short by 17 seconds) and I was discharged after basic training. Oh well. I have the greatest respect for military service.

How long were you in?

the bad thing is about nursing in my area is it is a 3 year program and would start next fall, bringing my total time invested to about 5 years to get a BSN when i already have 80 credits(school uses about 60). I know that if I were to go the Psychology route I could complete the education around the same time if not a year earlier than the PMHNP.

How old are you? If you are my age (30s) or older you may simply want to go the fastest route. If you are in your 20s I suggest going the way that would make you the happiest regardless of time.

Maybe I do not understand the flexibility of a Psy.d and am somewhat afraid of uncertainties with residency. Finacially the nurse to PMHNP seems more secure and with a life goal to include a Psy.d it just seemed to be long but benificial

If your life goal includes the Psy.D. you may want to pursue it, if that is really what you want would you be happy with something else? (That's one of the reasons I decided against the alternatives I've considered, including RN then PMHNP).

As for the PMHNP being more secure, that isn't necessarily so. There is a nursing shortage so most MSNs will never have a problem with jobs. Depending upon your psychological specialty that may or may not be the case with psychologists. While I've never heard of any having to spend time in the unemployment line, the job search for many clinical or counseling psychologists may be longer and more frustrating, especially since some jobs will also consider LCSWs or LCPCs often for lower pay (I'm using MD terminology for licensed social workers and counselors). However, some areas of psychology are every bit as secure as nursing. If you take coursework in the right areas and an internship in the schools and get certified as a school psychologist you will never be unemployed unless you want to spend time without a job. School psychologists are part of the special education team and with special ed services being federally mandated these programs tend not to get cut, and often have increased budgets, even during the leanest times. Also, there is a current school psych shortage in addition to an increasing need for their services. The employment picture is quite rosy for psychologists who are qualified (either primarily or secondarily) as school psychologists. Depending upon the school district, some are paid on the teacher scale (OK, but not great) but some are paid on their own scale or the administators scale (it isn't unheard of for even MA level school psychologists to be looking at starting salaries over $50K). You can also tailor your clinical specialty (either your specialty such as geriatrics or child psych, or your primary mode of therapy like family therapy or cognitive therapy types) to take into account current trends and needs in the field.

Flexibility of a Psy.D. is every bit as good as with a Ph.D. in practice areas. With a doctorate (whether Ed.D., Ph.D. or Psy.D.) in clinical, counseling, or school psychology you will be what the profession considers a "professional psychologist" (meaning you will be prepared for all practice areas) and along with your state license you will be educationally, ethically, and legally qualified to work in any practice based psychology setting. With school psych you may have some trouble landing a job in a hospital since they are run by medical staff and medical administrators who may not understand the different psychology designations, but you would be fine in other areas. With a clinical or counseling psych Psy.D. you shouldn't have trouble landing a job in a psychiatric hospital, med hospital, mental health clinic, university counseling center, group mental health practice (be it psychology only or multi-disciplinary), group health practice that includes mental health services, state agency, school, or any other mental health setting. You can also set up a private practice after you receive your license and many psychologists do organizational or business consulting work. You might have trouble landing a job as a professor due to the limited research in a Psy.D. program but you could quite possibly get a position at a community college and a part-time college teaching position on the side shouldn't be much trouble to land. In addition to therapy and possibly teaching, many psychologists take on administrative or management roles in the same settings mentioned above.

In research areas a Psy.D. is more limiting than a Ph.D. since the program involves far less independent research. However, if you go to a program with more stringent research requirements, take advantage of voluntary research opportunities, or take a post-doc research fellowship you can counter much of that disadvantage and be competitive with Ph.D.s for research and achedemic positions as well.

this semester I am going to go to school and just feel it out. I am going to go with what seems to flow for me.

Sounds to me like this is the best possible advice anyone could give you. Go back to school, take some psych and nursing related coursework, and decide what best "speaks" to you. If you decide on nursing, even if you don't go the PMHNP route, a psych background would be helpful. If you go the psych route, the science courses in the pre-nursing curriculum will be very useful, and psych programs do usually look favorably on science and nursing coursework.

1911guy · Jun 30, 2006

I have had plenty of PMHNP's who have said their experience and educational background have been of benefit to their admission to Psy.D. programs. In fact, on an application I have, it it listed as being preferable so I am a bit confused but perhaps I missed something.

My post addressed both Ph.D. and Psy.D. programs so that may not have helped. Let me try to clarify and expand on psychology doctorate programs MA preferences.

Ph.D. programs in clinical psych are extremely competitive. Many (about 20%) will even count an MA in psychology as a negative (as strange as that sounds) and strongly prefer BA/BS psychology students as the entry level. Almost all of the other programs will look at an MA or consider it neutral, but usually require a BA/BS in psychology as a minimum (with some taking an MA in psychology along with a bachelors in another area as a substitute). Almost all Ph.D. programs in clinical psych will make a person with an MA in psychology start from scratch so certainly a non-psych but related masters (education, nursing, social work, etc) will gain a person no advanced standing whether it is considered for admissions or not.

Ph.D. programs in other psych areas (including counseling psych and school psych which are very closely related to clinical psych) and Psy. D. programs in clinical psychology are a lot more MA friendly (some Ph.D. programs in counseling psych require an MA first) and also will often look more favorably on an MA in a related area. Some of these programs look very favorably for admissions towards an MA in any related area (including nursing, and not always psych nursing). However, usually for advanced standing (if offered at all, which often isn't the case) an MA in psychology or counseling is required. Also, even these programs will always prefer a BA or MA in psychology or counseling (counseling sometimes limited as a preference to counseling psych programs) over a BA and MA in a related field (the exception being school psychology programs which will look almost as favorably on a degree in education as they will a degree in psychology).

I am curious to know what state it is legal for psychologists to prescribe.

The only state I knew of was New Mexico. Someone here said Louisiana also allows it, but I wasn't aware of this.

Additionally, the military has successfully had psychologists with prescription privileges since 1994 (first as a trial program which I believe has been expanded), and South Africa has had it for some time with no problems.

Over the past few years several states have introduced bills to allow it including: AK, CA, IL, FL, NH, OR, WY, HI, TX, GA.

Indiana has passed a law allowing psychologists involved in a federal government sponsored training or treatment program to prescribe. I'm not sure if regulations have been written and the law implemented yet though.

I am aware that this is a very hot issue which is one reason I went for the PMHNP post masters... I am not certain that prescriptive privileges will come to psychologists but we shall see. The AMA lobbies long and hard and are not too thrilled about PMHNP's prescribing.

Yes, the AMA is strongly against it, as they were psychologists even being allowed to practice therapy. For decades the AMA fought long and hard to prevent the states from licensing psychologists for professional practice. Today, I think very few people would argue that psychologists as professional providers of mental health services has been anything but an asset to patients and clients. The AMA is opposed, but they don't always win (many other non-physician professionals can prescribe, and most came with the AMA's strong opposition and predictions of dire consequences) and the APA (the American Psychological Association) is fighting just as hard.

Everyone thinks it's not a big deal to prescribe mental health medications but it really is.

I don't hear anyone saying it is no big deal. Can I guess from this wording that your personal take is that psychologists aren't qualified to prescribe and that psychologists and psychology students pushing for it consider meds to be "not a big deal"?

First, this certainly wouldn't be the first time a non-physician profession was given prescription privileges. Podiatrists and optometrists not only can prescribe within their specialties but they can perform surgery. Some chiropractors can prescribe and perform medical procedures like x-rays and in some states can prescribe some medication. NPs and PAs can prescribe, and in some states they don't require supervision or even consultation with a physician.

Many psychologists already work in consultation with physicians and collaborate on medication issues. Nine states (CA, CT, DC, FL, IL, MA, OK, TX and UT) currently recognize such consultation to be within the official scope of practice for psychologists.

Psychologists certainly already possess a high level of education on mental illness, physiological aspects of mental illness, and psychopharmacology. At minimum it requires 4 years of graduate level coursework plus a one year internship to get the doctorate (many programs due to the amount of coursework and research requirements take an average of 6-7 years to complete). Included in this coursework are classes on psychopharmacology and the physiology of mental illness. While in school, often after, psychologists do research, including research on psychopharmocology. To be licensed a psychologist has to have an understanding of the symptoms of common physical as well as mental illnesses, they need an understanding of psychophysiology and psychopharmacology and they need to know the behavioral and cognitive effects of common drugs (not just psychotropic medications but most commonly prescribed meds)- think about it, someone licensed to diagnose and treat mental illness and psychological issues needs to be able to determine if the symptoms may be a psych problem or a side effect of a med or symptom of a physical illness. Many psychologists already take additional coursework in these areas, fellowships in these areas, or post-doc masters degrees in psychopharmacology or physiology. The fact that over 3000 psychologists are currently teaching in medical schools, including courses on psychopharmacology, shows that even physicians recognize that psychologists have some competence in the field.

Psychologists already prescribe in South Africa, the US territory of Guam, New Mexico and the US military (I'm not sure if the military program is still in the test phase or if all psychologists who meet certain criteria are qualified to do so) with no resulting problems.

Psychology as a profession is pushing for prescription privileges, but only for psychologists who meet certain criteria. Specifically, the APA is pushing for legislation that requires 5 years experience as a professional psychologist, a current license as a psychologist, and advanced training in psychopharmocology including training in:

Neuroscience, Clinical and Research Pharmacology and Psychopharmacology, Physiology and Pathophysiology, Physical and Laboratory Assessment, and Clinical Pharmacotherapeutics. Additionally, the legislation they are pushing would require a practicum for the psychologist seeking prescription privileges in which he/she would be required to see at least 100 patients before they could independently prescribe.

So, a 5-7 year Psy.D. or Ph.D. which includes coursework and competency in psychopharmocology and psychophysiology, 5 years of professional psychological experience, and then an additional 1-3 years of psychopharmocology education with a practicum shouldn't be enough to qualify a professional to prescribe? If so, prescription privileges for NPs, PAs, podiatrists, and optometrists should be reconsidered.