Mental Health: NP vs PA vs MD

elkpark · Oct 3, 2010

Actually, within the three disciplines you mention there's v. little psychotherapy going on because it's not cost effective for those individuals to do so -- anyone who can write Rxs is pretty much limited to writing Rxs in mental health, and lower-paid disciplines (social workers, LPCs, some psychologists) do the bulk of the therapy that gets done. If you have licensure that permits Rx authority, you'll have a v. hard time finding someone to hire you to do therapy (or even spend a significant amount of time within a full-time job doing therapy).

Going to med school won't help in that regard -- it's been literally years since I've encountered a psychiatrist who does therapy. Psychiatric residencies don't even train physicians in psychotherapy any more (except what they may accidentally pick up along the way) -- the emphasis is on medication.

Of course, if you are able to have your own practice, you can use your time however you like. But, again, the reimbursement for therapy is much lower than the reimbursement for prescribing meds for people. That's just how the mental health world works these days.

buddhasmash · Oct 4, 2010

Thanks so much for the reply. It was very thorough. :-) Just to clarify: A PMHNP has the training necessary to perform psychotherapy and cognitive-behavioral therapy, though they rarely perform the service due to financial and time constraints. In a pinch, however, they are capable of it.

Correct?

elkpark · Oct 4, 2010

Thanks so much for the reply. It was very thorough. :-) Just to clarify: A PMHNP has the training necessary to perform psychotherapy and cognitive-behavioral therapy, though they rarely perform the service due to financial and time constraints. In a pinch, however, they are capable of it.
Correct?

I guess that depends on how you define "capable." I am a (child) psych CNS (which was the original advanced practice nursing role and, until recently, the only psych advanced practice role) and went to school back in the good ol' days before the psych NP role was developed. My graduate program consisted of two full-time years of training as a psychotherapist. If you look at psych NP curricula (and most psych CNS curricula these days), you'll see that the bulk of the program is physical assessment and pharmacology (because the prescribing part is the part that can kill people if you don't do it right :)), with a class or two on therapy tacked on almost as an afterthought. From my perspective, NP programs certainly do not include the "necessary" training to practice psychotherapy. But I'm sure others feel differently.