Non-psych NPs working in psych

harmonizer · May 15, 2015

It really depends on the state you live in! There is really nothing wrong with FNP working in psych in many states unless BON clearly define the line. In my states, they hire FNP in psych all the time. Only a handful of states that specifically dictate that you have to practice within specialty. And also, Psych NP are not short supply at all. They can just pick a generalist PA to do the work. I saw this happens in many mental heatlh clinic and at the VA facility. Psych NPs only have more opportunity in the independent practice states that clearly define limit NP to practice within specialty. Regardless of market value, all NP should not work peanuts. :)

Jules A, MSN · May 16, 2015

It really depends on the state you live in! There is really nothing wrong with FNP working in psych in many states unless BON clearly define the line. In my states, they hire FNP in psych all the time. Only a handful of states that specifically dictate that you have to practice within specialty. And also, Psych NP are not short supply at all. They can just pick a generalist PA to do the work. I saw this happens in many mental heatlh clinic and at the VA facility. Psych NPs only have more opportunity in the independent practice states that clearly define limit NP to practice within specialty. Regardless of market value, all NP should not work peanuts. :)

The state of Maryland requires NPs working in psych to be board certified and here they are in very short supply.

PG2018 · May 16, 2015

I think reimbursement is an issue. Many non psych NPs cannot be paneled to see SMI, etc. The practice will learn they can't see what won't pay. I have no problems with any NP seeing uncomplicated MDD and GAD. Most folks will go to their PCP about that anyway.

As another hinted at, a PA can do just about anything his or her doc will allow. A PA could go from derm one day to psych the next.

I think this is a subconscious turf war. The mentally I'll aren't getting a cure and the incidence and prevalence aren't diminishing either. Our only real competition can be a market flooded with psychiatrists, psych NPs, or psych residency trained PAs. If/when the market crumbles I'll either set out to teach grad students or buy liquor stores. Either way, I won't run out of work.

BlackBettyRN,OCN · May 16, 2015

See, the FNP programs in my state don't have psychiatric practicum rotations at all, nor do the offer a psychopharmacology class. The advanced pharmacology and path courses hardly touch on psychiatric medications and illnesses. We only have one psychiatric np program in my state, and you must take a regular advanced pharm class and health assessment class in addition to a separate psychopharmacology course and psychiatric assessment course.

It doesn't seem safe to me for a practitioner to be treating mental illness and prescribing psychiatric meds with no prior coursework or practicums focused in psych.

Jules A, MSN · May 16, 2015

I think reimbursement is an issue. Many non psych NPs cannot be paneled to see SMI, etc. The practice will learn they can't see what won't pay. I have no problems with any NP seeing uncomplicated MDD and GAD. Most folks will go to their PCP about that anyway.
As another hinted at, a PA can do just about anything his or her doc will allow. A PA could go from derm one day to psych the next.
I think this is a subconscious turf war. The mentally I'll aren't getting a cure and the incidence and prevalence aren't diminishing either. Our only real competition can be a market flooded with psychiatrists, psych NPs, or psych residency trained PAs. If/when the market crumbles I'll either set out to teach grad students or buy liquor stores. Either way, I won't run out of work.

You make a good point about billing but I would guess the practices bill for their NP without the insurance companies having any idea what specialty the person has or doesn't have. With regard to PAs I'm not sure about your area but in this region there is no psych specialty that I am a aware of and I have not ever seen them working in psych except in the somatic capacity.

How long do you plan to work? I'm thinking things will likely get clogged up in 5-10 years but in that time with the money we are making now, if we are smart, we should be able to sock away enough to have some leeway. If you don't have your DNP don't count on being able to get a teaching job either because thats another touchy topic. Liquor store is sounding better all the time, lol.

PG2018 · May 16, 2015

There are no PA specialties for psych here, and I know of only two psych residencies in the country for them. Increasingly, the VA is incorporating them even into outpatient mental health.

I'm not afraid of the DNP. I think the curricula for them looks like utter crap, but a lady told me recently her friend procured a DNP and used even her normal work time as clinical time. If I could find one with reasonable tuition and was clinically oriented (which we'll never see) I'd likely enroll in it just for the academic insurance. I guess the FNP discussion we had addressing whether to become FNP certified is really nothing more than insurance.

I actually considered a PhD in experimental psychology. You're right the liquor stores do seem like a better idea, and presently it's easy for us to raise the capital on such a venture. If I were to work seven days a week. I could probably rake in around 390 a year. I don't want to work that much, but those are the numbers at the moment.

Jules A, MSN · May 16, 2015

I'm not afraid of the DNP. I think the curricula for them looks like utter crap, but a lady told me recently her friend procured a DNP and used even her normal work time as clinical time. If I could find one with reasonable tuition and was clinically oriented (which we'll never see) I'd likely enroll in it just for the academic insurance. I guess the FNP discussion we had addressing whether to become FNP certified is really nothing more than insurance.

Yup. I would have been happy to get the DNP, although I'm not crazy about people without a MD/DO who call themselves Dr. but thats another topic, if the DNP had a fair amount of material that would be worthwhile for my clinical practice-which it really doesn't. I'm a clinician simple as that and the thought of spending $30,000 which was the lowest I could find for a designation that is of no use to my practice is insulting.

Like we have discussed I do feel the FNP was beneficial to my clinical practice because of the large prevalence of comorbidities we see. The ability to make very basic somatic med changes and the comfort level to know which s/s are likely ominous and which aren't has been helpful. When I did my ED rotation they teased me because I used to be one of those nurses who had a cow for a diastolic bp over 100. :) The FNP has been useful in those regards and hopefully will be somewhat of an insurance policy as more NPs become dual certified and attempt to work their way into psych. Other than that I have a fairly good foothold in the local market based on my years working here with so many different providers and administrators and maintaining a good reputation so that helps. Like you I have been considering if I should really bust butt and start hoarding more money than I currently do. I make close to $200,000 with holidays and side jobs. I'm too freaking old to do 7 days a week although I manage to maintain about 50 hours a week fairly consistently.

harmonizer · May 16, 2015

The state of Maryland requires NPs working in psych to be board certified and here they are in very short supply.

Good for you. You are lucky to live there. I can't stand cold weather and higher cost of living up north! There are only a few states that is good for psych NP.

synaptic · May 17, 2015

I want to work in pych so I am getting my post masters which should pretty much be required. Highly doubtful that the pych market will ever be flooded. too much of a negative stigma on pych. Especially in rural areas, def not flooded there. People don't realize that just like real floods ( the ones with that stuff called water) flooded careers are localized. Just because one area is flooded does not mean everywhere is.

if everybody wants to live in a location, there is a higher chance it will be flooded with said career.

Not so ideal areas will almost always have more jobs, maybe this is excluded in rapidly growing areas such as certain places in Texas.

Wherever the lower-middle class wants to live but the regular middle class and degree educated people don't, for us there will be jobs.

If you are top in whatever you do, no matter what you do you probably will not have a problem finding work.

Be decent with people.

if you work harder than everybody else you will be fine.

I am probably a little off topic but it was a question in regards to obtaining a career so it applies at least a little. :)

Jules A, MSN · May 17, 2015

I want to work in pych so I am getting my post masters which should pretty much be required. Highly doubtful that the pych market will ever be flooded. too much of a negative stigma on pych. Especially in rural areas, def not flooded there. People don't realize that just like real floods ( the ones with that stuff called water) flooded careers are localized. Just because one area is flooded does not mean everywhere is.
if everybody wants to live in a location, there is a higher chance it will be flooded with said career.
Not so ideal areas will almost always have more jobs, maybe this is excluded in rapidly growing areas such as certain places in Texas.
Wherever the lower-middle class wants to live but the regular middle class and degree educated people don't, for us there will be jobs.
If you are top in whatever you do, no matter what you do you probably will not have a problem finding work.
Be decent with people.
if you work harder than everybody else you will be fine.
I am probably a little off topic but it was a question in regards to obtaining a career so it applies at least a little. :)

I think you make good points and I would never begrudge more competent psych providers to care for our beloved patients however I do worry about the quality of the Johnny Come Latelys who have no psych experience and are largely driven by either the money or their nursing co-dependent tendencies.

One thing I am counting on is the fact that in general people seem to either love psych or hate it so hopefully this will dissuade those with simply the monetary goal and no experience or talent from staying in our sandbox if they do happen to get the quickie post-masters. Definitely note I am not against working with the financial gain as a primary motivator but in particular with nursing I think this job is way too hard not to have some love for it also.

FolksBtrippin, BSN, RN · May 18, 2015

I would say just let it go. It's really not your problem. It is up to the NP to decide whether it is within her scope of practice. If you show other NPs that kind of respect, you are showing that you deserve that respect too.