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.
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 ICU, trauma, neuro.
7 hours ago, FullGlass said:

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?

In Washington "my" average take for a 30min appointment (70%) averages around $150.00 for a 99214 plus 90833 NPT.  In Florida you could decrease that by about 10 to 20%.  For my 90 min intakes "my" portion is around $200-250 on average.  Thus, I do better on repeat clients.

Specializes in ER Nurse, Ped Med/Surg, Psych.
On 5/25/2021 at 6:33 PM, myoglobin said:

In Washington "my" average take for a 30min appointment (70%) averages around $150.00 for a 99214 plus 90833 NPT.  In Florida you could decrease that by about 10 to 20%.  For my 90 min intakes "my" portion is around $200-250 on average.  Thus, I do better on repeat clients.

Hi Myoglobin, thank you for sharing your wisdom on this thread.  It's such a relief to see that there are PMHNPs out there who are providing holistic care for their patients and they can still make a good living out of the work that they do. 

Like one of the people who posted on this thread, I was an in PMHNP program but dropped out because I could not ethically see myself seeing patients for 15 minutes or less for little more than a medication check-up.  I thought that PMHNPs had to do this work quickly, so I applied to school to become an MFT to spend more time with the patient.  But to become an MFT part-time with full time nursing work would be 4 years and an additional 3000 hours of pre-licensure counseling that pays very little in comparison to being a nurse in California. 

Even though there is 3000 hours of pre-licensure training to become an MFT, nearly every therapist I know does additional post-degree education to supplement their learning in different modalities.  I don't see why we cannot do the same as nurses/nurse practitioners.

I think that many nurses can be great therapists.  Why can't PMHNPs become better trained at doing therapy along with medication management?  I'm thinking about reapplying again to the PMHNP school.  Thanks for sharing your perspective.

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!

myoglobin said:

I am a new graduate and I integrate therapy with every client. I use codes that pay me more for doing so.  Most of my therapeutic interventions are evidence based lifestyle and I heavily rely upon information from podcasts like The Carlat Report and Dr. David Puder's excellent podcast. However, having said that I almost always encourage my clients to see a dedicated therapist trained in the modality most suited to their needs be it CBT, CBT-T, CBT-I  EMDR, ERP, DBT or another approach.  Part of what we are trained to do as NP's (hopefully) is to identify the best evidence based therapies and then to facilitate clients receiving those therapies.  There are times when I have clients who's insurance will not pay for therapy (Medicare typically) where I will will make the followup appointments an hour rather than 30 minutes so that I can at least give them some therapy. I also almost always cover the basics of CBT(I) with anyone suffering sleep issues since it is perhaps the most evidence based intervention for insomnia, more effective in the long term than any supplement or RX.  Having 90 minute intakes and 30minute standard followups helps to create a solid opportunity to provide at least some therapy on an ongoing basis. Insurance compensates me usually in the $300 to $500 range for codes on intakes like 99205 along with 90838 and 90785 on my 90 minute intakes.  On my 30 minute followups I will often use the combination of 99214, 90833, and 90785 (where appropriate) and this compensates around $150-200 for most of my insurances for a 30 min visit.  Thus, I am getting compensated for the therapy that I offer and the time that it takes.

My wife often talks to former classmates (PMHNP) who charge $400.00 for intakes and $150.00 per 30 minute visit cash only without regard to whether or not it is therapy, prescribing, or a combination of the two. I am not to that point yet (and may never get there), but it is something to keep in mind ($300 x 32 billable hours per week times 48 weeks per year would gross around $460,800 per year if my math is correct. Not too bad). I probably get 20-30 calls or emails per week from my poorly written Psychology Today ad and my troll like picture., and many more appointments provided by the company that I work with. If I had a nice website and worked to build some Google reviews I suspect that I could generate many more leads, but such organizational precision is beyond my severely ADHD impacted brain.

This is super helpful! I am soon starting an Accelerated BSN program and then would like to go on to become a PMHNP, and I'd like to use both medication in therapy in the treatment of my clients one day. I've been scouring the internet looking for descriptions of the role of therapy in the practice of a PMHNP, but it's been hard to find. That has made me think that providing therapy as a PMHNP is rare. But I also spoke with a few PMHNPs as well as a Psy D about the role of therapy as a PMHNP and it seems like I can boost my credentials as a therapist, outside of my MSN program, with additional trainings, certifications, residencies, etc. and carve out a niche for myself, probably in a private practice. 

In both of my conversations with a PMHNP and a Psy D, they both alluded to PMHNPs being more prescription heavy providers rather than therapists, and that being due to the money. I still have a handful of questions about how those things affect your pay and how insurance is billed, etc. Could I send you a message Myoglobin? I'm a new user to the site though, so I don't know if I have that ability yet.

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

myoglobin said:

I am a new graduate and I integrate therapy with every client. I use codes that pay me more for doing so.  Most of my therapeutic interventions are evidence based lifestyle and I heavily rely upon information from podcasts like The Carlat Report and Dr. David Puder's excellent podcast. However, having said that I almost always encourage my clients to see a dedicated therapist trained in the modality most suited to their needs be it CBT, CBT-T, CBT-I  EMDR, ERP, DBT or another approach.  Part of what we are trained to do as NP's (hopefully) is to identify the best evidence based therapies and then to facilitate clients receiving those therapies.  There are times when I have clients who's insurance will not pay for therapy (Medicare typically) where I will will make the followup appointments an hour rather than 30 minutes so that I can at least give them some therapy. I also almost always cover the basics of CBT(I) with anyone suffering sleep issues since it is perhaps the most evidence based intervention for insomnia, more effective in the long term than any supplement or RX.  Having 90 minute intakes and 30minute standard followups helps to create a solid opportunity to provide at least some therapy on an ongoing basis. Insurance compensates me usually in the $300 to $500 range for codes on intakes like 99205 along with 90838 and 90785 on my 90 minute intakes.  On my 30 minute followups I will often use the combination of 99214, 90833, and 90785 (where appropriate) and this compensates around $150-200 for most of my insurances for a 30 min visit.  Thus, I am getting compensated for the therapy that I offer and the time that it takes.

 

Are you on one of the popular platforms, or did yall get credentialed on your own and bill the insurance companies directly?

RockyMtnHi-ya said:

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!

I would love to take the holistic route. Originally I wanted to become a clinical psychologist, but have always had a passion for medical sciences and most recently naturopathic/functional medicine. I was thinking of intergrading the two. I would love to become a pmhnp, and be able to utilize medication therapy (if needed, not because I have to push it on someone) while incorporating and placing emphasis on nutritional/supplementary approaches. Psychotherapy is something I would love to incorporate and place more emphasis on while working with patients. I would not be able to do the whole "15 min" sessions. What type of additional eduction would you recommend to provide more therapeutic modalities? 

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