Finding 1st job in PMHNP

[PsychedOut]

I am a 20+ year ICU nurse as well as some ED, PACU, IV Therapy, Outpatient Clinics, and even a few PRN shifts on an in patient Psych unit.  Also, my 1st degree is in Psychology. I was extremely interested in human behavior and all of the many diagnoses that come along with it.  I even started diagnosing my friends and myself!  We all have one, maybe just not documented! 

Anyway, I am very interested in returning back to school for the PMHNP.  I know that eventually all students land a job after school but how?  Every posting says that experience is required. I do not want to struggle to find a job after graduation.

Are there any PMHNPs that can explain the route that they took to land their very 1st job?  Any information at all will be greatly appreciated.

[verene, MSN]

Networking is what worked for me!

I reached out to an alumna of my school (at my director's recommendation) regarding informational interview and possible DNP clinical placement. (She works for an organization I *really* wanted to work for, but didn't think I had experience to actually get a job there so was hoping I could get clinical placement and prove myself and/or interview her about how to make myself a competitive candidate down the road). 

Long-story short after talking to her, she sent my resume to the Chief of Psychiatry and I had a recruiter calling me for an interview less than an hour later.  It was a full day of panel interviews -  I think I met with something like 20 people including Chief.  Chief called me the next week with an offer for a job saying that while she had a LOT of reservations about a new grad NP, particularly one who hadn't previously worked for the organization - I'd really rocked the interview process and she wanted to take a chance on growing me into the role.

It's been a very steep learning curve, but I'm super glad she took a chance on me as this job is a GREAT fit for my personality and my interests. I'm a little over a year into it and plan to stay with the organization long-term at this point.

[umbdude, MSN, APRN]

I just applied online. A lot of jobs in my area require experience these days, but not all.

If the jobs in your area require experience, you might have to move. Or try to find a psych RN job in one of the organizations that hire PMHNPs. Also, when you go into your clinical rotation, try to find a place that will be open to hiring you after you graduate.

 

[myoglobin, ASN, BSN, MSN]

If possible be open to relocation. That will maximize your chances for the best opportunity possible. You may also consider one of the residency opportunities via Trive formerly Midlevel U these pay less, but help "build" your resume.  I graduated last Oct from the University of Southern Indiana with most of my experience in ICU (neuro trauma/Med Surgical). I did have several years where I floated to the involuntary hold unit about once weekly for two years (me and four patients with a tech) before our hospital had a psych unit). However, I had no other Psych experience. I had a mediocre resume, poor interview skills, and didn't even tell any of my references that I would be using them as references. Still, I had about 15 offers in various parts of the country (about 30 interviews, not counting phone screens), but I was working with about 10 recruiters and put my resume "out there" on about five national platforms (and applied to several hundred jobs on Indeed).  In the end I took a 1099 position and am earning 25K (should be at 30K) per month in a few months.  

[verene, MSN]

On 12/15/2020 at 7:36 AM, myoglobin said:

  In the end I took a 1099 position and am earning 25K (should be at 30K) per month in a few months.  

What on earth are you doing to bring that pay in?! That's about 300K per year prior to taxes! The highest paid psychiatrists I know are making 400K/year and that's with decade+ experience, supervisory/extra duties, and generous amounts of call time (I.e. at least one overnight call per week, if not more) and overtime.  Most of the psychiatrists (I.e. those who don't work insane amounts of overtime/call) I work with are making around 200-250K/year. 

[umbdude, MSN, APRN]

$300k is most likely the gross revenue before any split/fees to the practice and using fairly optimistic assumptions (low no show rates, consistent 90833 billing, few to no medicaid patients). PMHNPs should be able to generate that or more in a private practice with a full panel. But it'll probably take at least 6 months to a year to establish a full panel.

It's pretty impossible to make that as an employee even though I believe we do generate that dollar amount (we're only billing ~15% less than psychiatrists). I'm not surprised that PMHNPs in private practice in independent states bringing in those numbers or even making more than salaried psychiatrists. But not everyone wants to work in that setting.

[myoglobin, ASN, BSN, MSN]

47 minutes ago, umbdude said:

$300k is most likely the gross revenue before any split/fees to the practice and using fairly optimistic assumptions (low no show rates, consistent 90833 billing, few to no medicaid patients). PMHNPs should be able to generate that or more in a private practice with a full panel. But it'll probably take at least 6 months to a year to establish a full panel.

It's pretty impossible to make that as an employee even though I believe we do generate that dollar amount (we're only billing ~15% less than psychiatrists). I'm not surprised that PMHNPs in private practice in independent states bringing in those numbers or even making more than salaried psychiatrists. But not everyone wants to work in that setting.

My income now is around 25K per month plus after my split and fees, but before taxes. Most NP's that have been there over a year are above 30K per month. However, I do many things that decrease my income. No collections, I do not charge cancelation fees, I do 90min intakes, and 30min followups. Thus, I might not be able to obtain the higher numbers. Also, I see patients four days per week for 8.5 hours where as many only see patient three days per week.    

[myoglobin, ASN, BSN, MSN]

On 12/20/2020 at 5:09 PM, verene said:

What on earth are you doing to bring that pay in?! That's about 300K per year prior to taxes! The highest paid psychiatrists I know are making 400K/year and that's with decade+ experience, supervisory/extra duties, and generous amounts of call time (I.e. at least one overnight call per week, if not more) and overtime.  Most of the psychiatrists (I.e. those who don't work insane amounts of overtime/call) I work with are making around 200-250K/year. 

Also, I believe that NP's in most places  could be earning this 1099 in practices (NP owned even in non IP states where MD had to be paid to collaborate). Let's look at some basic math: 99214 plus 90833 (supportive therapy for 16-30 min therapy which can overlap) pays about $180 per 30min or $360 per hour give or take depending upon the insurance. If a practice "pays" the 1099 employee 70% that equates to around $250 per hour. If the employee "bills" about 7 hours per day that equates to around $1,750 per per "seven" hour day or to around $5,250 per three day week or to around 252,000 per 48 week year.  This requires using "complexity based" coding since if "time based coding" is used you are not allowed to add, add on supportive therapy codes. However, even FNP's doing "time based coding" should be able to approach or exceed these numbers (or PMHNP's using time based coding) if they were to do 20min appointments and thus see three, rather than two patients per hours (this is less ideal from a patient care perspective for obvious reasons).    Hence, my "business model" of empowering NP's to earn about 70% of gross revenues should I ever be in a position to implement and expand it.  Note in addition to my 30% I also pay an additional $600.00 per month for support services and office space but that is factored in to my 25K per month net earnings (before taxes).  

[umbdude, MSN, APRN]

4 hours ago, myoglobin said:

Also, I believe that NP's in most places  could be earning this 1099 in practices (NP owned even in non IP states where MD had to be paid to collaborate). Let's look at some basic math: 99214 plus 90833 (supportive therapy for 16-30 min therapy which can overlap) pays about $180 per 30min or $360 per hour give or take depending upon the insurance. If a practice "pays" the 1099 employee 70% that equates to around $250 per hour. If the employee "bills" about 7 hours per day that equates to around $1,750 per per "seven" hour day or to around $5,250 per three day week or to around 252,000 per 48 week year.  This requires using "complexity based" coding since if "time based coding" is used you are not allowed to add, add on supportive therapy codes. However, even FNP's doing "time based coding" should be able to approach or exceed these numbers (or PMHNP's using time based coding) if they were to do 20min appointments and thus see three, rather than two patients per hours (this is less ideal from a patient care perspective for obvious reasons).    Hence, my "business model" of empowering NP's to earn about 70% of gross revenues should I ever be in a position to implement and expand it.  Note in addition to my 30% I also pay an additional $600.00 per month for support services and office space but that is factored in to my 25K per month net earnings (before taxes).  

Those numbers sound right. But most 1099 jobs I see online pay by the hour much lower than the revenue you can derive and not by percentage of what you bill; larger practices typically hire w2 employees.

I heard CMS is making many of the covid waivers permanent. I wonder if that includes the Ryan Haight Act restrictions and whether private insurance will follow suit? (Thinking about branching out, perhaps weekends , to a telepsych PP in an IP state as a side gig.) Is there a market for that?

[myoglobin, ASN, BSN, MSN]

I would say there is demand for part time and weekend. I doubt that Ryan H suspension will be permanent. I am planning on spending one week per month in Washington state once it is put back in place in order to meet the in person requirement for new schedule II medication clients.  My point is that there is no reason that NP's could not band together and pay "more along the lines" that I've outlined. At the place in Florida where I did clinical NP's were paid 120K and Psychiatrists about 160K and they were expected to see between 25 and 30 clients per day. If someone wanted  to see that many patients with the reimbursements that company generated the clinicians (both MD's and NP's) would have earned more than double the salary actually paid. It would of course mean a "leaner" support staff and the owner would not make as much (but probably still do OK especially if they continued to see some patients).  There is no legal reason this cannot occur, it's just that it seldom "does".   Indeed, I find it ironic that the therapist owned practices in Washington state and elsewhere tend to pay so much better than the MD owned practices elsewhere (granted they also pay 1099).

[mangopeach]

I used a recruiter. As others have mentioned, if you are flexible and open to relocation, there are lots of jobs out there. If you use a recruiter, just make sure to use a reputable one.  Use one that will listen to you and cares about what you are looking for. It can be daunting dealing with recruiters as a new grad. They get paid by the employer, not by you. It's a lucrative business. Some will try to get you to go wherever, so they can get paid. No attention paid to whether this is a good fit for you or not.  It can be  like dealing with used car salesmen that want to sell you junk.  

Once I decided I would relocate for work, I settled with the one I felt most comfortable with. There were the ones that wanted to place me in the most remote rural places.  Not a bad thing to work in a rural clinic. I'm a city girl and just did not want that. I did not want to be in the boondocks and far away from the closest city. I was making this move on my own and already knew it was going to be a difficult transition as a new provider and living in a new environment by myself.   In the end, the recruiter I worked with helped me to secure a job in a location that I absolutely loved. It was an 8.5 hr drive from my home state. Not too bad of a drive. I knew I could make that drive a few times through out the year,  and by air, the flight was less than 2 hrs. That way, the home sickness wasn't too much of a factor, I could get back home for a few days without too much difficulty. 

I am now back in my home state. Sadly the job did not work out as I would have liked. I loved the city I was placed in though. Small enough, not a big city, but still had somewhat of a city vibe and I was within 3 hrs or less drive to the major big cities in the state. I could drive to Miami in a little over 2 hrs for a day of fun, shopping, restaurant hopping, sight seeing. 

I decided to leave the job, after a bit over a year. I was surprised how much easier it was to get interviews with  just a bit over a year's experience. I got a job within 3 weeks after I started sending out my resume. I only sent it to 3 places, got 2 interviews and was offered the job at both. Point is, I don't regret relocating to get that year's experience. 

I would absolutely work with a recruiter again, if I wanted to relocate or had trouble finding work locally.  

 

You can Google NP recruiters, to see what's out there. 

[PsychedOut]

I have read everyone of your replies at least 3 times and I am grateful for your responses! This is very detailed and extremely helpful information. I’m no longer concerned about finding a job nor how to go about it. I’ve even wrapped my mind around relocating, albeit only a year for I have a 12 year old and a husband that I would need to get back to. My mother lives with us also so I have the support. However my hope is that I will be able to find a job here in the DMV ( DC, Maryland, Virginia) or surrounding states like Delaware, PA, NJ, or NY (mid Atlantic). All of these states are still close to home here in Baltimore, no more than a 3 1/2 hour drive but I would certainly be willing to go to a rural area in the mid Atlantic also. We’ll see. I have plenty  of time to think about as I’m just filling out my application now. 

Again, thank you all for your responses as they have eased any concern I had about employment.?