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 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? 

Specializes in Psychiatric and Mental Health NP (PMHNP).
emgem9 said:

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? 

I do not understand the attitude that PMHNPs and psychiatrists are just "pushing pills" and that it is somehow boring.  I certainly don't push pills.  I am honest with my patients and I have no issue telling some of them that they do not need, or are not suited to, taking medication.  If a patient expresses an interest in nonpharmaceutical interventions, I am happy to work with them on that level, as I am pretty knowledgeable in alternatives to pharmaceuticals.  Even a good primary care practitioner must be knowledgeable about lifestyle changes for improved health.  

Being really good at med mgt is not easy, nor it is boring.  I suggest those who feel this way enroll in programs like the NEI Master Class in Psychopharmacology. It is impossible to know everything about psychopharmacology and there are new developments every day.  

In order for a PMHNP to be good at their job, they must develop a therapeutic alliance with their patient.  That relationship alone can be very healing for the patient.  In fact, the therapeutic alliance is the most important component of successful treatment.  Good med mgt requires the ability to listen to the patient, elicit additional information, and be someone the patient trusts.  

 

Specializes in PMHNP.

Yes. Check out Happier Living where all appts are 40 min and therapy is a focus. 

Specializes in Psychiatric and Mental Health NP (PMHNP).
Kyky said:

Honestly,  before I started this journey I spent hours researching a variety of things r/t therapy treatments.    I LOVE this stuff and I throw at my friends all the time.  I fully plan to add extra certificates so I have something to back the talk.   You have NO idea the capabilities of the person you are talking to.    

So you believe your hours of "researching" are the equivalent of an LMFT or psychologist with a master's or doctoral degree + 5,000 hours of supervised practice?  

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