Master's-Level Psychotherapist wants to be a DNP and needs help figuring it out...

PG2018 · Sep 14, 2015

Are you interested in the military? You might consider HPSP for clinical psychology or pursue the LCSW which the military also utilizes. Both of these may be reimbursed by Medicare, FYI. Psych NPs can do this as well and generally make far more than the others listed.

Ok, so for the DNP, your options are somewhat limited. I assume you're wanting to become a psychiatric nurse practitioner. If that's the case then great. The money is large and the opportunity is everywhere. You don't really need a DNP unless you're in a backwards state that requires it. The direct entry MSN/NP would be your most efficient (thus shortest and cheapest) pathway. If you're wanting some other specialty, say family practice, then you can do this as well. As a nurse practitioner, let alone a registered nurse, neither you nor your organization will be reimbursed more by insurers because you have a doctorate. If you find a NP that obtains a doctorate and starts making more money then you'll find yourself talking to a foolish clinician who was being short changed by their employer.

There is no DNP role for which DNPs are credentialed. You have to be something else such as a RN or APRN. If you're merely wanting to obtain a doctorate in nursing practice and remain a therapist well then I've got an ink jet printer and will be more than happy to make you a diploma for a nominal fee.

Thank you for not giving out medical advice to your clients. Too many therapists try to do this, and they come back to the prescriber (ultimately the head of the clinical treatment) questioning motives and competency. I have not been in this role long but have already had to admonish therapists for this act. Consequently, the nurse practitioners and physicians can change or render null and void the therapist's treatment plan in this state and likely many others.

But to distill this down for you as I choke down a Marie Callender meal, look for short and cheap. A DNP ain't it. If you want a DNP later then you can get one with about 30 semester hours of paper writing and some cash. If you're already reasonably competent at communicating with the mentally ill (and fakers) you don't need any nursing experience so shoot for the direct entry master's programs. If you don't have those in your region, I guess aim for an accelerated BSN program because you could do it in a year, finish, and enter a MSN program. You may have to work as a RN for some period of time going this route, or you may not. This requirement is typically at the leisure of the university. The idea is to cut out as many courses and semesters in school as possible. You will be hired for your license and prescriptive ability. You'll likely never do therapy again. This is an investment, and I guarantee you will see dividends. You may have to front some major cash, but you'll get it back if you work diligently and read Dave Ramsey. In this particular line of work, the more time you spend not in practice the more money you are losing. It's really quite better to drop some large, get the schooling done with, and get into practice.

You can also look at other funding programs through NHSC, VA, et al. The military has them too, but requirements vary among the services. For the next several birthdays and Christmases you can ask for college gift cards.

J C F · Sep 14, 2015

Thank you! I am already at the same level and do similar work as an LCSW, absolutely no interest in going that route, ROI there is also abominable. Haha I always joke that I would never make it through basic (I'm a tiny 5'3" and 110llbs) I think I would be eaten alive in the military!

I am well aware that

I do not possess the scope or education to make medical recommendations, any therapist who does this is acting illegally and should absolutely be called on it! At the same rate, I've found that many clients will misunderstand empathy for a agreement and state that a therapist told them something that they absolutely did NOT say. Client tend to hear what they want to hear regardless of the truth that was said, always best to check with the therapist before jumping to conclusions. I was just accused of commenting on suboxone last week, which I would NEVER do in a billion trillion years, as I always defer to the MD. Best not to jump to conclusions on account of what a client *thinks* they heard...

My my understanding was that all MSN programs were being phased into DSN programs by 2016? Is this true? If that's the case, it seems I'll end up in DSN anyway (or not?) can anyone speak to this?

From the inpatient setting I have worked at, it seems like the title "doctor" regardless of whether it's an md, phd, or DSN carries with it more opportunities and more ability to be in a leadership role. Does anyone agree or disagree?

I'm a natural leader so this is a consideration for me.

Does anybody know of any direct entry MSN or DSN programs in California? I'm currently in Los Angeles, looking to stay in Southern California if possible but open to ideas/suggestions.

PG2018 · Sep 14, 2015

My my understanding was that all MSN programs were being phased into DSN programs by 2016? Is this true? If that's the case, it seems I'll end up in DSN anyway (or not?) can anyone speak to this?
From the inpatient setting I have worked at, it seems like the title "doctor" regardless of whether it's an md, phd, or DSN carries with it more opportunities and more ability to be in a leadership role. Does anyone agree or disagree?

Actually this is the year that all NP were supposed to become DNPs, LOL. That's been a rumor for a long time. I can't speak specifically for CA, but there is no national consensus (or intent) to move all NP training to a doctoral level. The DNP is actually nothing but a smattering of courses in informatics, finance, leadership (which doesn't translate to being an administrator) and something they call a capstone project I believe. Most of them research something and draft a policy change. We did the same in MSN in our research utilization course.

Regarding "doctor," most folks seem to get really bent out of shape when nurses of any level of training or licensure start going by the title of doctor. I've even had someone on this board go far as to suggest that if there was an emergency and someone yelled "doctor" that a nurse might show up instead of a physician. Of course, the same could be said for psychologist, lol. This is absurd really as most clinicians, outside of those accustomed to operating in an emergent role, are grossly incapable of doing anything skillful. I say this having worked in ER and EMS as well as law enforcement.

And regarding the talk of jumping to conclusions, I wasn't. My previous non-health career taught me not to do that.

Psychcns · Sep 15, 2015

About furthering your education, agree with psych guy.

Your therapy skills will help you form alliances with patients and with conceptualizing cases. As a psych np you are qualified to do therapy but the main work is meds and diagnoses.

J C F · Sep 15, 2015

I can see people getting bent out of shape over the title "doctor" as I see Psychologists getting this sort of thing all the time. Unfortunately that title seems to still be of high value in my field and sub field (I specialize in addiction) so I'm erring towards the DSN.

As someone who is having their degree (MFT) phased out in a similar fashion and was promised grandfathering into LPC while I was still in grad school (not happening) I see the effects of this sort of thing first hand. New jobs are only being offered to MSW and LPC's, not MFT's. Medicare dropped MFT's and many insurance companies are following suite. I'm wary of the possibility of getting into this situation again. I don't trust anything professional organizations or governing bodies say at this point. They don't control the insurance companies and the employeers who are forced into not hiring certain degree levels due to the insurance companies decisions. It's a scary thing.

That being said, I am absolutely going the DSN route, not taking that risk this time. What would make the most sense as far as time? Would an accelerated BSN then getting a DSN make more sense? Or a direct-entry MSN then DSN (would the latter be more expensive?)

Are their other options?

Thank you :-)

PG2018 · Sep 15, 2015

I can see people getting bent out of shape over the title "doctor" as I see Psychologists getting this sort of thing all the time. Unfortunately that title seems to still be of high value in my field and sub field (I specialize in addiction) so I'm erring towards the DSN.
As someone who is having their degree (MFT) phased out in a similar fashion and was promised grandfathering into LPC while I was still in grad school (not happening) I see the effects of this sort of thing first hand. New jobs are only being offered to MSW and LPC's, not MFT's. Medicare dropped MFT's and many insurance companies are following suite. I'm wary of the possibility of getting into this situation again. I don't trust anything professional organizations or governing bodies say at this point. They don't control the insurance companies and the employeers who are forced into not hiring certain degree levels due to the insurance companies decisions. It's a scary thing.
That being said, I am absolutely going the DSN route, not taking that risk this time. What would make the most sense as far as time? Would an accelerated BSN then getting a DSN make more sense? Or a direct-entry MSN then DSN (would the latter be more expensive?)
Are their other options?
Thank you :-)

I think you need to look at opportunity cost. If you happen to find yourself enrolled in a direct entry MSN/PMHNP program (or whatever specialty you choose) then you're locked in. You still have to pick up the RN along the way, but you're making actual progress towards your goals. If you go the BSN route, regardless of whether it is accelerated, I perceive that as more expense, lost opportunity, and yet another hurdle to jump. I think the most sensible thing to do, if available, is going the direct entry route followed by the optional DNP. However, if that entails a move across the country when a something practical is available down the road from you then I'd pick the regional program.

As an aside, a local program is graduating dual MFT/LAC people. I knew they were lumped together politically, but I've never heard tale of the MFT being phased out.

J C F · Sep 16, 2015

When given the option to apply for intern status and start accruing hours, the options are now between MFT and LPC. Naturally, everyone chooses LPC because you can take the license to any state in the U.S. whereas MFTs can only practice in CA. LPC was not an option when I was applying for my intern registration, but I was told I'd be grandfathered in as it was just coming to Caifornia. Of course, that didn't happen.

It's a bit of an indirect phasing out, generated by the insurance companies, employers, and the industry as a whole. LPC's can provide therapeutic services across state lines...helpful when you're doing family or marital therapy over the phone with someone from another state. Anywho, Medicare and insurance don't want us even though our training exceeds many other masters level therapists with the family and child requirement and the sheer number of hours needed to complete.

I'd keep an eye on the nursing industry as a whole and what employers start doing. I hope the MSN is thoroughly protected. Your professional organization seems to be invested in protecting its people a lot more than ours is.

How long do direct-entry programs typically take? Are they difficult to get into? Does anyone know of any in CA?

Thank you everyone! The information is very valuable

HikingNinja, BSN, MSN, DNP, RN, APRN, NP · Sep 30, 2015

You are me about 10 years ago! My story board in a nutshell:

LPC - BA and MS in Psychology - lots of loan debt

Moved to another state

Wanted to pursue PMHNP

But I was more broke than Nicholas Cage or Fifty Cent combined

So.....

Got my accelerated BSN from a local state college (1 year and cheap!)

Started working as an RN making $$$ in the ED (crazy people AND sick people..awesome)

Paid down student debt

Achieved my MSN ED this year (cheap, decent program, got all those pesky ethics, etc classes out of the way)

Now attending a sorta pricey well respected post masters PMHNP program for my clinicals

Yep, its a round about way to do it. But at the time there were no entry level PMHNP programs I could reasonably attend. And honestly, being an RN has afforded me the ability to drastically pay down my debt, earn a decent living, travel (I'm a travel nurse at present), and really learn all about the comorbidities often present in the psych population. As for the DNP I will complete that someday for my own personal goals, not necessarily career goals. Whichever path you take, I would recommend starting your science prereqs now. Most are sequential and a I know for me it took nearly two years just to complete the prereqs as I literally had none of the sciences needed in my original BA (even if I did, they would have been out of date). Enjoy that in state CA tuition while you can because if you do decide on direct entry PMHNP you may have to pick a program out of state and pay those ridiculous out of state fees.