FNP to PMHNP--Is it Better?

StellaAnn, BSN, MSN, APRN · Jan 22, 2023

I have spent the last year in a post-graduate PMHNP program at George Washington University, and just graduated. Personally, I think the work of a PMHNP is more rewarding compared to FNP. I feel like I am really helping my clients achieve their goals. There are more people than ever seeking mental health care, which is great for job stability...and being dual certified will help make you more marketable. More perks: the pay is higher, and yes - remote work is more accessible for PMHNPs. I have to say, with regard to remote work, it's only worth it if you're licensed in a lot of states or have a large local client base who prefer telehealth. I have been working the last year remotely for three national telehealth companies as an FNP, and the licensing is VERY expensive and tedious to keep up with. I was lucky enough that one of the companies licensed me in about 20 states and has paid for my licensing renewals. Most of these telehealth companies are start ups and have more negatives than positives IMO. The pay can be inconsistent, pill mill vibes (Cerebral is a good example), scheduling is inconsistent, always restructuring something, internal communication is weird, lots of lay offs, and typically there are no benefits as they're 1099 positions. Also...most telehealth companies specializing in mental health do not follow the standard of care, only allow 30 minute intakes and 15 minute follow-ups. With that said - I'm heading back into the office for a new behavioral health clinic job because consistency in pay, 1 hr intakes and 30 min follow ups, and benefits are very important to me...and I want to work closely with a team especially as a new PMHNP.

deza, MSN, NP · Jan 23, 2023

Most places I think do 60min evals(30min for ADHD companies). And most do 15-20min follow ups. My current job is at a community mental health clinic doing 60min evals and 20mins follow ups. I can request 30min follow ups for some patients. I get 40mins if they haven't been seen in 6 months or if recently out of a psych hospital. I feel rushed some days when I have a long eval then need to catch up by having a couple of quick follow up appts. I'm an PMHNP. Never been an FNP.

MentalKlarity, BSN, NP · Jan 24, 2023

It's a grass is greener on the other side situation:

Everyone and their mother is going to PMHNP programs or getting a post-master cert. The percentage increase for PMHNP graduates is the highest of any speciality. The "great hours" and high pay WILL go away as the field saturates.
You need to love psych. 30-60 appts sound great until you realize you have to FILL UP 30-60 minutes of talking - mostly with people who want to tell you their life story and need help/advice/discussion on coping skills. It can be very, very draining.
The 60 min appts length is not common - SOME places have that for initial appts but many have moved to 45 or even 30. Just like primary care, the focus has become on treating as many as possible for revenue - I worked at a private clinic early in my career that did 15 min med followups, 4 per hour - adjusting psych meds and talking about depression/anxiety/trauma back to back in 4 patients per hour for 7-8 hours a day can be a quick road to burnout.
Telehealth is possible but becoming more limited due to start-ups getting in trouble and Congress cracking down on it. You have to be licensed in the state where the patient is, and the waiver to allow controlled substances to be prescribed online (Ryan Haight Act) that was put in place during the pandemic is set to expire so in-person appts will become required again for benzos and stimulants.

sleepwalker, MSN, NP · Jan 24, 2023

Interesting question so I made a "pro" vs "con" list for myself in case I ever consider obtaining the PMHNP cert.

PRO= more money

CON= just about everything else I can think of

Personally I'm leaning towards "not at this time"

Mergirlc, MSN, APRN, NP · Jan 27, 2023

Definitely following. @raycna please update this thread if you decide to go through with this.

umbdude, MSN, APRN · Jan 29, 2023

FNPs can specialize too (e.g. neuro, derm, onco, cards). When I had my shoulder surgery, my follow up appointments with my ortho NP were at least 20-30+ minutes.

Also, many PMHNP jobs don't offer 30 min follow ups. Plenty of PMHNPs are required to see 20-30 patients per day. And as another poster pointed out, even 30-min follow ups with psych patients back to back can be draining. Ability to work remotely is not a guaranteed and most employers now require at least hybrid. Furthermore, although there are a lot of PMHNP jobs out there, most of them these days are junk and/or 1099 basis (I.e. zero benefits, income not guaranteed). I would seriously research your area first.

hunnybaby24, BSN, APRN, NP · Jan 30, 2023

MentalKlarity said:

It's a grass is greener on the other side situation:

Everyone and their mother is going to PMHNP programs or getting a post-master cert. The percentage increase for PMHNP graduates is the highest of any speciality. The "great hours" and high pay WILL go away as the field saturates.

You need to love psych. 30-60 appts sound great until you realize you have to FILL UP 30-60 minutes of talking - mostly with people who want to tell you their life story and need help/advice/discussion on coping skills. It can be very, very draining.

The 60 min appts length is not common - SOME places have that for initial appts but many have moved to 45 or even 30. Just like primary care, the focus has become on treating as many as possible for revenue - I worked at a private clinic early in my career that did 15 min med followups, 4 per hour - adjusting psych meds and talking about depression/anxiety/trauma back to back in 4 patients per hour for 7-8 hours a day can be a quick road to burnout.

Telehealth is possible but becoming more limited due to start-ups getting in trouble and Congress cracking down on it. You have to be licensed in the state where the patient is, and the waiver to allow controlled substances to be prescribed online (Ryan Haight Act) that was put in place during the pandemic is set to expire so in-person appts will become required again for benzos and stimulants.

How do you combat burnout?

MentalKlarity, BSN, NP · Jan 30, 2023

hunnybaby24 said:

How do you combat burnout?

Lots of vacation and structuring my days with breaks constantly. I start at 9am, take a 30 min break at 10:30, lunch from 12:30-1:30 and another break at 2:30 before finishing around 4:45. I takes about 6-8 weeks of vacation annually.

Life is too short to be miserable!

hunnybaby24, BSN, APRN, NP · Jan 30, 2023

Absolutely!!

Tommy5677 · Jan 30, 2023

I actually work for a psyciatric NP and love it. I can't speak from the perspective of a NP but I can tell you how it works for her. Keep in mind that she is an independent, not part of a group.

I manage the holistic side of her practice, working with her patients providing neurofeedback, Alpha-Stim, and PEMF.

In order for her practice to be sustainable and support a staff, her new patient visits are 40 minutes and follow ups are 20 minutes. Her day starts at 10, stops at 5, with a one hour lunch. So, she sees approx. 18 per day, something that is manageable for her and it seems plenty of time for her patients to get what they want/need.

Miss.Jersey, MSN, APN · Mar 4, 2023

I think the first question to answer for yourself is, do you have a passion for mental health care?

Have you considered opening your own practice as an FNP? Then you can set your own schedule and visit length. Also, you might make more money with cutting out the middle man.

There's a group on facebook called the elite nurse practitioner group. They could give you some direction, and ideas of how to pick a niche and work for yourself. I think they even offer courses that people seem to like.

I work for myself as a pmhnp. I opened my practice using Headway. Check out my page, Arisew.org, if you want to see what it looks like to be a 1099 with Headway. In March of 2022, and gave notice in August of 2022 to my employer. As of November 2022, when I left my hospital job, I met my financial goals. And I'm getting ready to expand and hire more apns.

Financially, it's been extremely lucrative. I work from home, I have tax write-offs, I can change my work hours anytime I feel like it, I generally do 30 minute follow-ups, and 60 minutes intakes.

Seeing how great my work life/balances is, and how lucrative the practice is, I have APNs coming to me asking to work for me. It's been wonderful. So I'm beginning the process to expand into a group.

Someone had commented that as psych nurse practitioner graduates increase, that the market will be saturated, and pay will decrease. This may be true from a supply and demand perspective, when you work for someone else.

There are still plenty of areas in this country with very limited access to mental health care. Some of them even offer incentives to work there and allow for practice. Depends on what people want to do and are willing to do.

But if you work for yourself, and are taking insurance for example, they're not going to likely start reimbursing less than a currently do for mental health services. For those who are inclined, you can even set your own cash rate.

But in general, at least here in New jersey, you can expect to make at least $200 an hour working for yourself through Headway. They're also very upfront with the reimbursement rates, which seem to match or exceed private credentialed rates in New Jersey at least, and you don't have to pay a cut to a biller, as Headway takes care of it.