Is doing therapy as a psych NP realistic?

What Members Are Saying (AI-Generated Summary)

Members are discussing the time required for medication management appointments, with some stating that the standard 20 minutes may not be necessary for all cases. They also talk about the financial aspects of different appointment lengths and codes, as well as the potential for nurse practitioners to provide therapy along with medication management. Additionally, users are sharing their experiences and perspectives on balancing therapy and medication management in their practice.

Im considering pursuing my psych NP but I know most psych NPs are med management focused and I would really want to incorporate a lot of therapy into my practice, I was wondering if this is a realistic goal? 

Specializes in ICU, trauma, neuro.

Perhaps it is a matter of semantics, , but at least 16 minutes of every 30 min followup, and 45 min of every 90-120 intake. Given that I see about 15 patients four days per week that seems like a good deal of therapy.  In fact it is so much that my wife who will be starting at the same company often expresses that she “isn’t sure she can do what I do and in her words coddle her patients so much.” I’m not saying I am particularly good at the therapy that I do, but I do earn from $600 to 1k per day in add on therapy fees.

Specializes in Hospice, Geri, Psych and SA,.
On 11/25/2020 at 8:23 PM, myoglobin said:

Perhaps it is a matter of semantics, , but at least 16 minutes of every 30 min followup, and 45 min of every 90-120 intake. Given that I see about 15 patients four days per week that seems like a good deal of therapy.  In fact it is so much that my wife who will be starting at the same company often expresses that she “isn’t sure she can do what I do and in her words coddle her patients so much.” I’m not saying I am particularly good at the therapy that I do, but I do earn from $600 to 1k per day in add on therapy fees.

If you are admittedly not particularly good at a provided service, I think you should evaluate whether or not to continue to do it. Sure, it takes practice to become competent in any skill but that practice usually takes place under supervision. I just don't think it's ethical for PMHNP's to be providing in depth psychotherapy with the lack of education and practical experience in psychotherapy. Supportive therapy during an appointment, sure that's great, should be done, and is appropriate. Many mental health patients with severe mental illness need more than just basic talk therapy and that is more appropriately handled by an LPC, LCSW, PsyD, or PhD. 

Out of curiosity though, do you if PA's are allowed to add on therapy fees the way NP's can? You don't see very many PA's in psychiatry, at least in my area, and the ones I have seen were therapists prior to becoming a PA. Most PA programs from my understanding have just one course/rotation in psychiatry, is it in depth enough for them to provide psychotherapy?

Specializes in ICU, trauma, neuro.

All digressions aside this was the original post/ question"Im considering pursuing my psych NP but I know most psych NPs are med management focused and I would really want to incorporate a lot of therapy into my practice, I was wondering if this is a realistic goal? "

The answer is a definitive YES at least in the state where I practice ie Washington. Essentially, every NP in my practice (well over 40) bills add on therapy codes and earns an income well above 300K (of those that work full time) in part for doing so.  Many of done so for more than a decade.  Thus, I submit that it is beyond reasonable argument that therapy can be part of a successful practice. Also, in almost every case the clients see a dedicated therapist on a weekly basis on top of the PMHNP.   

Specializes in Psychiatric and Mental Health NP (PMHNP).
16 hours ago, MentalKlarity said:

It is not, however, the norm. Prospective PMHNPS should understand that the vast majority of employers will utilize the 15 min med management appt. That's a stressful way to practice and you basically have time to just go over meds and prescribe and nothing else. If they ask you to bill add on therapy in that time it's unethical and fraudulent.

It appears to be the norm to bill for supportive therapy - I do 20 minute follow up appts and that is enough time for basic supportive therapy.  

Specializes in Psychiatry.
2 hours ago, FullGlass said:

It appears to be the norm to bill for supportive therapy - I do 20 minute follow up appts and that is enough time for basic supportive therapy.  

That leaves 4 mins max for med management so it's easy to fall behind.

Specializes in Psychiatry.
40 minutes ago, FullGlass said:

We specify how much time on therapy - I can do about 11 to 15 minutes.  

Ah, okay. What add on code allows 11-15 mins or do you not do an add on code?

Specializes in Psychiatry.
myoglobin said:

I use 90833 which requires at least 16 minutes of therapy.  I do 30 minutes appointments. Most of the insurances that I take pay anywhere from $75.00 to $125.00 for this add on code on top of the 99214 or 99213.

Same. I enjoy it. I get to spend more time with patients, don't feel as rushed, have half as many notes to complete and make the same or more than if I was trying to do 15 min med management 4x an hour.

Specializes in Psychiatric and Mental Health NP (PMHNP).
On 5/19/2021 at 3:07 PM, myoglobin said:

I usually take my whole 30 minutes. I will usually do a PHQ, GAD-7 and an ADHD V1.1  or Yale Brown if relevant.  

Yes, my point is that just the med mgt doesn't usually take the whole 20 minutes.  I use the rest of the tiime to provide supportive therapy.  A lot of patients tell me they just want someone to talk to, and that alone provides them with a lot of benefit.

Specializes in ICU, trauma, neuro.
1 hour ago, FullGlass said:

Yes, my point is that just the med mgt doesn't usually take the whole 20 minutes.  I use the rest of the tiime to provide supportive therapy.  A lot of patients tell me they just want someone to talk to, and that alone provides them with a lot of benefit.

I agree, but just as importantly even the "assembly line" place where I trained in Florida where appointments were only 20 minutes included the therapy add on code with each visit (even as a student I was required to see about 25 to 30 patients per day and had I stayed on there I would have been offered a salary of around 120K).  Now I see about 14 patients per day.  If I worked on that basis (rather than 30 min followup and 90 minute intakes) and still received the 70% I currently earn then I would earn $828,000 per year (my workweek at that place would have been five days per week rather than the four that I currently work).  Again, the point is that MD's especially in the South are making "a killing" on their NP's.  

Specializes in Psychiatric and Mental Health NP (PMHNP).
14 hours ago, myoglobin said:

 Again, the point is that MD's especially in the South are making "a killing" on their NP's.  

The southeast does not seem to be a good work area for NPs.  I'm curious, how much does insurance pay for the standard 20 min follow up appts and the 40 to 50 min intake?

Specializes in Family Practice, Integrative/Holistic Health.

Good for you for wanting to make a positive difference.  I'm a board-certified FNP in holistic/integrative practice, and virtually 100% of my patients with chronic disease, which I aim to manage conservatively through healthy changes, have traumatic histories that create barriers to adherence.  I'm considering PMHNP certification to enhance my current practice, with plans to remain independent and free-standing as I am now.  You won't likely find a hospital or mental-health clinic job with a primary focus on therapy, but who's to say that you couldn't complete additional continuing ED to become an expert for the therapeutic modalities that would allow you to practice as you wish to?  I hope you find the clarity that you need in order to make the right decision!

What a great thread, thank you! I am graduating nursing school in May and this would be my dream career.

+ Join the Discussion