Is it more practical to become a PMHNP or a FNP with specialization/cert in Psych

Psychcns · Sep 3, 2012

More jobs for fnp.. Depends on how you want to spend your time. I only do psych and would not want fnp at all. Psych is about treating emotional pain, helping people find hope. You get to do counseling and prescribe meds. I'm sure fnp is interesting too. But I like psych..

zenman · Sep 3, 2012

Psych is the new frontier where you can use science and art. FNP is where you handle snotty-nosed kids all day and parents who go, "goo-goo" to their kids while they are in your office. With FNP you use lab tests and x-rays. With psych you use nothing but your own mind and develop the ability to change a person's life by carefully chosen words.

myelin · Sep 3, 2012

Psych will absolutely limit you. As a FNP you will be treating everything, you'll be a generalist, jack of all trades, etc. As a psych NP you will be a specialist, so it will be all psych all the time. I'd argue that when it comes to jobs, it really really depends on your location. In my area, the market for FNP is saturated, so the pay is low-balled. In other places, this probably isn't the case. I think the market for psych looks really great, and psych NPs tend to be paid more than FNPs on average, but this really depends on where you want to practice.

In the end, it depends on your focus. I'm passionate about mental health, and I feel that as a FNP I won't be able to treat much more than very basic depression or anxiety. At the same time, I do recognize that by specializing in psych, I won't be able to treat much else. It all depends on your personal goals. Good luck!

harmonizer · Sep 3, 2012

Psych will absolutely limit you. If you are concerned about getting a job, being in a good job market, having flexibility, and enjoying "varieties", I would strongly encourage you to do FNP over PMHNP. Many more jobs for FNP. You still use medical knowledge as psych NP esp. if you work in Consult-liason, or to rule out medical complications, or taking care of patient with co-morbid medical problem.. but you won't be able to use it at the full extent like in FNP world.

Unlike FNP, like myelin said, I found that job openings for PMHNP are less and "geographically limited." Where do you live? Moreover, in "some states", they can even legally hire FNP with psych experience to moonlight or work in psych jobs. I know it's not right but the employers see it as a way to depress the wage of PMHNP when there are loopholes in BON regulations in some states. In my state, PMHNP and FNP 's salary is about the same partially due to this reason... no difference.... FNPs in high-demand sub-specialities (ER, Derm, oncology) even earn more.. I have planned to relocate to other places.

Also in psych, you earning is limited.. You can't just see patient for 10 min, send out the door, and collect the pay. It takes time to collect thorough psychiatric history, to obtain collateral info, and to built rapport especially when they are poor historian.

If I were you and had interested in other specialties, I would do FNP. If you have time later, you can always pursue psych later when you do DNP or post-master (if it still exists 2-3 years from now). I wish I had both certifications. However, if you do FNP now, you will have lots of flexibility and opportunities upfront.

myelin · Sep 3, 2012

I think harmonizer makes a really good point about different states allowing FNPs to treat psych, and how that can hurt pay, etc. The states that I'm looking at are strict about who can treat psych, and I think that might be a reason why PMHNPs tend to be better compensated and more in demand in those locations, since no other NPs are allowed to do what they do.

hoosier guy · Sep 3, 2012

Maybe its just my area but for the most part it seems Psych NP's mostly do 10-15min appointments for meds adjustment. Most of the counseling and therapy is done by clinical social workers and psychologists.

BlueDevil,DNP, DNP, RN · Sep 3, 2012

I think you could go either way and do well. There are many opportunities for behavioral health, and not nearly enough providers to go around. I live in the largest, most heavily populated county in my state, and there is not one single BH provider accepting new patients. The only way to get seen in less than several weeks is via a "serious" (vs. self harm behaviors deemed attention seeking or a "cry for help) suicide attempt.

My advice is to follow your true interest. That said, I love family practice and do a lot more than see snotty kids, lol.

Psychcns · Sep 3, 2012

I have 30 min med appt and ninety minute diagosnotic assessment.Electronic record--psych pts on multiple meds..So it depends..

zenman · Sep 3, 2012

The reason I ask is because while Psychiatric-Mental Health is a strong passion of mine, I am also interested in other specialties, such as Internal Medicine, Emergency Medicine, Family, Derm, etc. In other words, an FNP.
What's the big difference?

If PMHNP is your passion, then you already know the correct path. And I won't mention the fees some PMHNPs have:

FEES: Our standard cash fees are:

Initial psychiatric evaluation / diagnostic interview consultation - $225 / session.
Medical psychotherapy (psychotherapy with medication management) $150 / 45-50 min.
Psychotherapy without medication management $130 / 45-50 min
Medication management with counseling $125 / 20-30 min.
Medication management only $100 / 10-20 min typically though this is not a time based service

harmonizer · Sep 3, 2012

wow.. zenman.. But i think this is for the private pay patient... I don't think medicaid or even some health insurance pay that much.... Unfortunately, unlike medical patients, most mental health patients are either uninsured, homeless, or cannot afford the insurance and heavily rely on Medicaid/Medicare/other insurances contracted with the said.. I don't think they can go by this rate all the time.

harmonizer · Sep 3, 2012

I There are many opportunities for behavioral health, and not nearly enough providers to go around.

Where is this? There's either no need in my area or employers just simply don't want to pay well. If this is the case, I feel that the pay doesn't not reflect the demand at all at where I live. Due to low autonomy in my state, they can just easily grab the willing FNP providers or PA with no psych background for training. Can't blame on not having enough provider when the pay is below market rate. In the states where NPs are more independent, employers will prefer NP over PA due to less work for the collaborating physician.