Everyone is in NP school !

shibaowner, MSN, RN, NP · Aug 11, 2017

I can see why you might think that on the first point but it really is only maybe one person repeatedly referring to Hopkins, Yale, Columbia, U Penn, UCLA, UCSF, U of Maryland, etc. What I read from the majority is there should be consistent and high admission standards which I feel is very reasonable and a far cry from elitism.
As for your last point I'd urge you to consider that my just shy of $200,000 base salary doesn't require I "bust ass" any harder than the person who accepted a position making 1/2 that and yet it does require that I know my worth, negotiate and most importantly am keeping wages at a decent rate which only aids my peers in this specialty.

I gave the names of the top-ranked schools to demonstrate there are excellent schools with strict admission standards. I can't be expected to name every single good school in every single post. I'm not an elitist. Like most people here, an NP who only went to for-profit schools of dubious quality would not be a desireable hire for me. I freely confess I have a bias against for-profit schools.

Just to be clear, for me personally, here are the schools that I consider to be good, solid, and reputable (not in any particular order):

1. Top ranked "name brand" schools.

2. Public community colleges, 4 year colleges, and universities (local to me are numerous excellent CCs, SDSU, San Marcos State, UC Irvine).

3. Solid private colleges (local to me is University of San Diego, Point Loma Nazarene).

As to your salary, congratulations on earning a handsome living. I gather you have some years of PMHNP work experience as well. At the facility where I work, an individual like you would make $190K per year and have a MUCH lower cost of living (assuming you live in DC Metro area). So in the DC Metro area that would be like making $210 to $220K per year, in Baltimore it would equivalent to $200K per year. Therefore, I don't see how this is lowering PMHNP pay, especially since the average salary for psychiatrists in Calif is $230 - $240K per year. I am quite happy to make $90K while in training that is comparable to an NP residency program (which typically pay about $50K).

JustKeepDriving · Aug 11, 2017

The State of California does NOT require PMHNP cert. We also have not any issues around legal liability.

I'm quite aware of the standardized procedures and patient specific protocols for California and how loosely the Nurse practice act defines scope in terms of certification. I'm also aware of the problems that have come from this. Just a word of advice - the best people to contact isn't a nursing school in Baltimore - but your malpractice attorney, the state BRN and a local nursing school offering a PMHNP specialty in the area.

Even if everything with the licencing board is "okie-doikie" you still run the risk of something going wrong and you're sued for malpractice (which is different than a board investigation). The patient or family's attorney will attack your credentials and will point out stuff like the National Organization of Nurse Practitioner Faculties which states stuff like: "Educational programs do not prepare NPs to provide the full range of primary and acute care services. Instead, programs are limited to either primary or acute care and certification eligibility is based on the area of preparation. Although many NPs obtain informal, post-graduate education for specialization, scope of practice is determined by formal educational preparation and certification [...]".

There are NPs and PAs that work in pain management. I did a pain mgt clinical rotation under 2 fantastic doctors. Pain mgt NPs and PAs do a lot more than just prescribe opioids. The trend now is to minimize use of pain meds and focus on other treatments such as TENs, injections, procedures, lifestyle, and nonopioid meds.

You missed my point here as it wasn't a comment about the state of pain management but a discussion point about how practicing the whole gauntlet of pain management procedures and medication management would place a PMHNP at a lot of professional risk (despite practicing some pain management that does fall within our scope).

I don't begrudge RNs making good $. But being an RN and being an NP are 2 very different jobs and I want to be an NP.

As an RN I worked in an area of psych where getting hit/bit/kicked, having HIV+ blood spit on you, getting shanked by a patient is a real risk (I've seen bright young people get brain damaged in front of me) and where we literally need hostage negotiation training in the event a staff is taken hostage in a patient's room.

I've had staff get stalked by patients, find out where they live by looking up license plates, sent threatening mail to their house, showed up on their doorstep and found their kids at school.

As an NP I have all those same risks only now additional ones as well - like for example determining whether a patient is fit enough to reenter the community. Now these patients are smarter than me, know the system better than me and many know the right information to say - and providers who are a heck of a lot more educated/experiened than me have made the mistake of letting someone reenter too soon. The risk of that isn't just to the patient but to the population in general - no exaggeration here we've had patient's get out and go on to kill their entire family. That? Would devastate me so much on a personal level that I'd be profoundly negatively affected an the legal repercussions could be huge.

I enjoy the population I work with, my job is interesting, the cases are complex but I would not be willing to take on the additional liability without an increase in pay. An NP and an RN are different jobs sure, but if I'm dealing with the same risks as I did at the RN level and then some? Being compensated more than I did when I was an RN is important to me as there is a very real risk of something happening where I couldn't work in this career and to that end the extra income provides a safety net so that I am not financially destitute.

shibaowner, MSN, RN, NP · Aug 11, 2017

I'm quite aware of the standardized procedures and patient specific protocols for California and how loosely the Nurse practice act defines scope in terms of certification. I'm also aware of the problems that have come from this. Just a word of advice - the best people to contact isn't a nursing school in Baltimore - but your malpractice attorney, the state BRN and a local nursing school offering a PMHNP specialty in the area.
Even if everything with the licencing board is "okie-doikie" you still run the risk of something going wrong and you're sued for malpractice (which is different than a board investigation). The patient or family's attorney will attack your credentials and will point out stuff like the National Organization of Nurse Practitioner Faculties which states stuff like: "Educational programs do not prepare NPs to provide the full range of primary and acute care services. Instead, programs are limited to either primary or acute care and certification eligibility is based on the area of preparation. Although many NPs obtain informal, post-graduate education for specialization, scope of practice is determined by formal educational preparation and certification [...]".
You missed my point here as it wasn't a comment about the state of pain management but a discussion point about how practicing the whole gauntlet of pain management procedures and medication management would place a PMHNP at a lot of professional risk (despite practicing some pain management that does fall within our scope).
As an RN I worked in an area of psych where getting hit/bit/kicked, having HIV+ blood spit on you, getting shanked by a patient is a real risk (I've seen bright young people get brain damaged in front of me) and where we literally need hostage negotiation training in the event a staff is taken hostage in a patient's room.
I've had staff get stalked by patients, find out where they live by looking up license plates, sent threatening mail to their house, showed up on their doorstep and found their kids at school.
As an NP I have all those same risks only now additional ones as well - like for example determining whether a patient is fit enough to reenter the community. Now these patients are smarter than me, know the system better than me and many know the right information to say - and providers who are a heck of a lot more educated/experiened than me have made the mistake of letting someone reenter too soon. The risk of that isn't just to the patient but to the population in general - no exaggeration here we've had patient's get out and go on to kill their entire family. That? Would devastate me so much on a personal level that I'd be profoundly negatively affected an the legal repercussions could be huge.
I enjoy the population I work with, my job is interesting, the cases are complex but I would not be willing to take on the additional liability without an increase in pay. An NP and an RN are different jobs sure, but if I'm dealing with the same risks as I did at the RN level and then some? Being compensated more than I did when I was an RN is important to me as there is a very real risk of something happening where I couldn't work in this career and to that end the extra income provides a safety net so that I am not financially destitute.

There are always risks. I appreciate your concern, but I'm not going to be scared off by the constant negativity on this forum. Even an FNP working in family practice can get sued. MDs get sued all the time. Given that our clinic has 20 NP-PA-MDs and 20 psychologists on staff and has been around for over 10 years, I am confident they understand the legal and practice issues in this state.

Also, I fail to see how making six figures is going to leave me destitute. Even Jules said he/she is making just shy of $200K in a high cost of living. Jules would make $190K in this clinic in a very low cost of living area, lower than his/her current location. Given psychiatrists in Calif average $230-$240K salary, how on earth can you think that we NPs are underpaid in this facility?

I think a lot of people on this forum have very unrealistic expectations of NP pay. Also, one must consider cost of living. $100K per year isn't going to get you very far in San Francisco or NYC, but it is an extremely high salary in an area like Las Cruces, NM. In addition, one cannot put a price on job satisfaction. I know plenty of NPs who could make more $ if they took a new job, but they truly love what they do and love their patients. At Hopkins, before we graduated, we were told the going rate for a new grad NP is about $90K in Baltimore, and about $10K more for specialty fields. A new grad PMHNP could make $150K in a facility like Sheppard Pratt in Baltimore. In San Diego County, my expectation as a new grad AGNP primary care was $100K. Based on my interviews, my expectations were realistic. As for RN pay, please, please, share with us how a new grad RN can make $90 to $100K w/o OT or holidays and working normal business hours M-Thurs. There are many RN students and new grads that would greatly appreciate this information. And if an RN can do this, great! RNs deserve good pay.

Jules A, MSN · Aug 11, 2017

Given psychiatrists in Calif average $230-$240K salary, how on earth can you think that we NPs are underpaid in this facility? .

That can not be an accurate figure and if its from a google search they are historically low. California psychiatrists in general do quite well especially due to the Kaiser presence there. I only know two in the San Diego area but they were recently teasing a friend from DC working a jail job for $200 an hour.

shibaowner, MSN, RN, NP · Aug 11, 2017

That can not be an accurate figure and if its from a google search they are historically low. California psychiatrists in general do quite well especially due to the Kaiser presence there. I only know two in the San Diego area but they were recently teasing a friend from DC working a jail job for $200 an hour.

Salary is different from private practice. Psychiatrists here can make $300+ per hour in private practice but not all psychiatrists are in private practice. So there certainly are high-earning outliers.

Higher pay, but also high rates of suicide and burnout for doctors - The San Diego Union-Tribune

[h=2]Medscape Psychiatrist Compensation Report 2016[/h]Medscape: Medscape Access

Psychiatrist Salary Information | US News Best Jobs

Paying doctors more — now will they treat more poor Californians?

Jules A, MSN · Aug 11, 2017

Salary is different from private practice. Psychiatrists here can make $300+ per hour in private practice but not all psychiatrists are in private practice. So there certainly are high-earning outliers.
Higher pay, but also high rates of suicide and burnout for doctors - The San Diego Union-Tribune
Medscape Psychiatrist Compensation Report 2016
Medscape: Medscape Access
Psychiatrist Salary Information | US News Best Jobs
Paying doctors more â€” now will they treat more poor Californians?

I'm well aware there is a difference and I know docs in private practice, inpatient, outpatient, boutique, VA and corrections.

What I am telling you is the numbers you will see published are historically low. In my area they list median for psychiatrists as $236,500 and I don't know any psychiatrist making less than $300,000. The average for inpatient docs is $325,000. Try doing an online search for salaries of psych NPs in DC if you want an example of how low the advertisements can be.

shibaowner, MSN, RN, NP · Aug 11, 2017

I'm well aware there is a difference and I know docs in private practice, inpatient, outpatient, boutique, VA and corrections.
What I am telling you is the numbers you will see published are historically low. In my area they list median for psychiatrists as $236,500 and I don't know any psychiatrist making less than $300,000. The average for inpatient docs is $325,000. Try doing an online search for salaries of psych NPs in DC if you want an example of how low the advertisements can be.

I'm sorry, but your anecdotes are not true evidence. I didn't just cite job ads - I provided numerous sources and I am about to publish more in a separate article. We're talking averages, so of course some psychiatrists will make more. We don't know how representative your sample of psych MDs is. Here in Calif there are plenty of job openings for new primary care MDs and they get about $225 to $250K to start. New grads are going to pull the average salary down.

shibaowner, MSN, RN, NP · Aug 11, 2017

I'm well aware there is a difference and I know docs in private practice, inpatient, outpatient, boutique, VA and corrections.
What I am telling you is the numbers you will see published are historically low. In my area they list median for psychiatrists as $236,500 and I don't know any psychiatrist making less than $300,000. The average for inpatient docs is $325,000. Try doing an online search for salaries of psych NPs in DC if you want an example of how low the advertisements can be.

The figures below are from the Merritt Hawkins 2016-2017 recruiting report for MDs, NPs, and PAs. If a company is willing to pay a headhunter (Merritt Hawkins) they are usually willing to pay very good salaries as well. Remember that pay will also vary widely by location.

Physician Salary Surveys and Articles: Average Salaries by Specialty, Physician Compensation and Physician Practice Data

Psychiatrist pay

Low$120K

Average$263K

High$450K

Psychiatrists average pay by setting

Academic$230K

Community Health Center$240K

Group$263K

Hospital$280K

Solo N/A

Jules A, MSN · Aug 11, 2017

I'm sorry, but your anecdotes are not true evidence. I didn't just cite job ads - I provided numerous sources and I am about to publish more in a separate article. We're talking averages, so of course some psychiatrists will make more. We don't know how representative your sample of psych MDs is. Here in Calif there are plenty of job openings for new primary care MDs and they get about $225 to $250K to start. New grads are going to pull the average salary down.

You truly don't know what you don't know. Its unfortunate and yet another example of why real world experience and book learning is often the best combination.

shibaowner, MSN, RN, NP · Aug 11, 2017

You truly don't know what you don't know. Its unfortunate and yet another example of why real world experience and book learning is often the best combination.

Please explain what you mean by this comment. I have provided numerous sources, including a national headhunter survey of what they had to pay to recruit psychiatrists. All you respond with is anecdote after anecdote. I dare say a national recruiting firm has better insight into MD compensation than you do. In addition, one of my instructors in healthcare management recruits MDs for a local hospital here and has shared info with me. And since you are so fond of anecdotes, here are mine, based on doctors I know:

1. Beverly Hills psychiatrist charges $350 / hr = $700K year private practice (at 2000 hours per year billable).

2. Brentwood (also very prestigious area) psychiatrist charges $135 / hr private practice at 20 hours per week = $135K year because he wants to help out people who aren't rich and he has already made all his money. He spends the rest of his time treating underprivileged children in a psych clinic he helped found in East LA.

3. Silicon Valley psychologist charges $185 hour = $370K year

3. Private specialty doc (not psych) in Baltimore makes $500K per year and he is quite happy with his income, but he also works like a dog - 12 to 13 hours a day, 6 days a week.

Those data points above prove nothing.

shibaowner, MSN, RN, NP · Aug 12, 2017

I'm well aware there is a difference and I know docs in private practice, inpatient, outpatient, boutique, VA and corrections.
What I am telling you is the numbers you will see published are historically low. In my area they list median for psychiatrists as $236,500 and I don't know any psychiatrist making less than $300,000. The average for inpatient docs is $325,000. Try doing an online search for salaries of psych NPs in DC if you want an example of how low the advertisements can be.

The Merritt Hawkins report is based on salaries paid in order to recruit psychiatrists. The BLS numbers are based on reports from employers of what they are actually paying. In addition, I am providing a link to the Veterans Affairs payscale, which is now quite good as they are working to match private sector pay.

Psychiatrists

Federal Register

::

Annual Pay Ranges for Physicians and Dentists of the Veterans Health Administration (VHA)

ivyleaf · Aug 12, 2017

that is scary...