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 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.

Specializes in Psych NP.

I do it, no problem.  

Specifics:  Solo practice, self-pay only  It is a sideline for my day job, but pushing FT.  I have about 80 clients, ranging from those who come every 3 mo for med checks to those who see me for weekly therapy.  I have about five of those, and some who are coming biweekly.  There's a fair number in the middle who are officially just seeing me for meds, but always opt for a longer appointment to have more time to discuss issues.  (I gave up on calling them "therapy" or "med" visits, as some seemed to think taking with me for 45 min about meds counted as the cheaper med visit -- now it's just "long" or "short.")  My rates are $300/intake (which lasts ~90 min), $185/45 min Long Appt, and $85 for 15 min Short.  Scheduled to allow 1 hr, and 30 min, since everything tends to run long.  If I worked in an insurance-driven group practice where I was expected to crank through four med visits every hour...  ugh.

But whoever said you could do 32 billable hours a week....  Remember, for every client there is an abundance of unpaid other time needed -- phone calls/emails, prior auths, writing notes, etc.  It can come close to 1:1.  But if I was seeing patients 20hr/wk, about $170/hour, that's around $175k/yr, so not too bad.  

Specializes in Psychiatry, Oncology.
db2xs said:

I am not a psych NP but I have a colleague who has been one for I think at least seven, eight years (probably longer). She told me that she got to a point in her career where she got tired of being just a pill pusher and so reassessed what was meaningful to her. She has a private practice now, where she incorporates integrative mental health services, such as somatic/emotional release modalities for trauma and craniosacral therapy. I imagine with time and the right leg work, you can eventually create something that will be more meaningful for you. I believe it is possible. 

This is great to know. I am half way through my PMHNP program now and that is my goal as well: to work 5-10 years in the traditional medical/nursing model and then have an integrative private practice and incorporate yoga, meditation with mental health services (therapy focused at that point).

Specializes in CST, APCC, RN student.

I also had this same question.  I just completed my masters in professional clinical counseling and have obtained my liscense to practice which is the same as lmft...I want to obtain my RN and shoot back up to doctorate...I've been looking at schools and I just withdrew from phD prog as clinical psychologist as the requirements were not feasible for my family at this time.  I have prior medical background as a Licensed scrub tech but was injured which caused the career change can someone who is experienced help me navigate as I was thinking I could bypass the NP portion and go enter DNP

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