FNP to PMHNP--Is it Better?

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Hello, 

Has anyone made the switch from FNP (primary care) to PMHNP (psychiatry)? If so, what were your reasons, and was it worth it? 

I graduated as an FNP in 2020, completed a yearlong residency, and though I'm doing fine at work, I'm struggling to find work-life balance and am really disillusioned with how little time I have with patients and how rushed our visits are.

I am considering the post-master's PMHNP certificate because I want to have the luxury of time to spend with patients--at both of my jobs, psychiatry gets 30-60 minute appointments with patients versus 15 minutes for primary care. I also like the idea of flexibility. It seems psychiatry has more options for remote work. Becoming an expert in one area, rather than a jack of all trades, also appeals to me. 

I'd love to hear the perspective of people working in the field. Perhaps the grass is not greener--I want to know before I drop another $40k on school 🙂 Thank you for insight!

Specializes in FNP-C, PMHNP-BC. Has 10 years experience.

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

81 Posts

Specializes in psych. Has 7 years experience.

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. 

Specializes in Psychiatry. Has 10 years experience.

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.

 

Specializes in Occupational Health. Has 19 years experience.

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, RN

631 Posts

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

umbdude, MSN, APRN

1,224 Posts

Specializes in Psych/Mental Health. Has 6 years experience.

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.

Specializes in Tele, Cardiac Post Op, ER. Has 13 years experience.
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? 

Specializes in Psychiatry. Has 10 years experience.
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!

Tommy5677

111 Posts

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.