I am considering applying to an MSN program in order to become a Psychiatric Nurse Practitioner. I have done some research on this particular specialty and have had trouble finding much information regarding job outlook and demand for my area. I live in the midwest. I have, however, done a job search and found only two ads for a PMHNP in my area, and they were both requiring atleast five years of experience! Can anyone offer any information regarding where I may find these statistics or more information?
Dual licensure as a psych NP and as a clinical psychologist is a very good avenue. In the larger sense, I have no problem with psychologists prescribing so long as they go back and take the same basic science classes that they were not required to take as psychology majors. Completion of basic sciences such as chemistry and biology is a necessary minimum standard to which all other prescribers are help prior to starting their training. Otherwise, the professional portion of the training will largely be comprised of information that the students would have already known had they bothered to take biology 101 at a junior college level. Neuroanatomy, neurophysiology, pharmacology and psychopharmacology are useful but they do not take the place of the basic sciences. I see no reason for psychologists to circumvent or skip these classes to take other classes in their own programs. At this point, most patients can take for granted that the person prescribing for them has taken at least two years of basic sciences prior to beginning their professional training. But, if the RxP legislation passes that does not require psychologists to take science classes prior to entering their RxP programs, patients will not be able to take for granted that the person prescribing for them has taken a single chemistry class even at the junior college level. Patients deserve more than that. Every other prescriber takes the time to become knowledgeable about science prior to their training. Those looking to skip over the basics are not doing their patients any favors.
If prerequisites and training in nursing were uniform, your arguments would hold more weight. However, one can become a nurse via multiple routes and the required training to get there varies tremendously. There are many Accelerated BSN programs out there for people with non-nursing baccalaureates. The modal "science" undergraduate pre-reqs for these programs that a psychologist would typically not have include: anatomy & physio I and II with labs, microbiology, and nutrition. Chemistry, biochem, and other bio courses are the exception, not the norm as far as prerequisites go.
I am familiar with several nursing programs' curriculum across the country and have also served on admissions committees back in my academia days. I know from discussions there that nursing prerequisites varied across institutions and in different parts of the country. I remember one applicant to the accelerated BSN program who had a bachelor's in Spanish. She had no science background and took the four above courses in addition to the required statistics and human development course. She went on to be an excellent student and, eventually, a NP.
Then, if you figure in all the online programs offering RN-BSN or LPN-BSN programs, there is typically no requirement for undergraduate chemistry, biology, or other undergraduate courses; the content is the BSN-specific courses that were not provided in ADN or LPN training. Again, you have widely varying requirements. And, even if you consider the most stringent BSN programs' prerequisites, the coursework usually involves a general, inorganic chemistry sequence (2 courses) although only one lab is usually required, in addition to the above courses. You speak of psychologists who prescribe needing the "same basic science classes" that other prescribers have. Nursing science prereqs are significantly less than pre-med prereqs that require all of the same stuff except nutrition, human development, and statistics and adds 6-12 more biology credits, the full-year organic chemistry sequence of courses with labs after the full year of inorganic with labs, and a year of physics just for the basics; in many med schools, you need more just to be competitive.
Organized medicine has argued for years (and continues to do so) that nurses are "woefully" unprepared to function in advanced practice roles. The data over the years as well as tens of thousands of hours of clinical practice has demonstrated that their criticisms are unfounded. Yet, the ideology continues to persist in medicine that anything less than medical school is inadequate. So, the arguments you are making against psychologists prescribing are essentially the same as those that medicine has made, and continues to make, against NPs - without merit.
Moreover, I think you are confusing the requirements for a doctorate in clinical psychology with those for the bachelor's in psychology. The two are night and day different. APA-accredited, doctoral programs in clinical psychology are required to provide foundational coursework in the biological basis of human behavior. My pathophysiology of behavior and psychopathology and diagnostic systems courses in clinical psych were more in-depth and comprehensive than the same courses I took for the psych NP. My clinical psych psychopharmacology course was taught concurrently with psychiatry residents and was significantly more difficult than the psychopharm course I had as a psych NP student. In addition, at least one course in neuropsychology is required and there was nothing that was similar in my psych NP program.
Furthermore, the ANCC requirements for hours of supervised practice to sit for the PMHNP exams is 500. To be licensed as a psychologist requires at minimum, 4000 hours of supervised practice (1500 during graduate school practica, 1500 internship, 1500 postdoc) and most states require more (5500). I had 7000 hours of supervised clinicals before I was even licensed to practice independently as a psychologist.
This is not to say that I believe clinical psychology training is superior to that of psych NPs, because I don't. I wouldn't have gotten the NP if I didn't believe it had value; it has been a tremendous asset to my practice. My attempt is to convey that clinical psychologists are well-suited to be trained to prescribe. Nursing would do well to align with our natural allies to advance the practice of each profession to its fullest.
If doctorally trained physical therapists were to purpose similar legislation allowing them to function as sports medicine physicians, most lawmakers would recognize a serious incongruence in training and regard that proposal with great skepticism. But, since the word "psychologist" sounds so much like the word "psychiatrist", I think that there is a great deal of role confusion on the part of the public about just how different these 2 professions really are. And, that confusion is only enhanced by popular culture's portrayal of anyone who works in mental health being a "shrink". But if we look beyond the stereotype, we can see that a psychiatrist has gone to medical school and therefore has a doctorate in medicine while a psychologist has a doctorate in what is primarily a social science. They may have rather complex physiology classes in their psychology programs and even take those classes with medical students (though this is the first I've ever heard of these two groups sharing any classes). But, patient care is such a different thing in practice between these two professionals. The psychologist may have thousands of hours of therapy and testing experience but as you know, the NP has around 1200 total (rn + np) in whole patient assessment/ care and usually thousands of on the job hours, administering meds, monitoring for side effects and assessing for changes. As a nurse, I can sort out a medical mimic in psych because I've cared for patients with the real disease. A psychologist has never cared for a CHF patient in as much depth as most undergrad nursing students have.
And I don't think that nursing programs vary so widely in prereqs that taking basic sciences becomes a negligible issue. It's a very important issue. My NP program won't admit students if they don't have enough chem in undergrad. Doctorally trained Physical therapists do have training in basic sciences but they seem content to stick to physical therapy. So, I don't see why we would even consider having an individual with training in psychotherapy function like a physician or NP especially when half of their profession doesn't even want this legislation to pass anyway. BTW, if we are going to continue our debate, we should probably start a new threat and stop hijacking this one. It's my fault. I got us off track w/ this rxp stuff.
I'm wondering why clinical psychologists want to venture into the medication area anyway. They seem to have a better handle on talk therapy and this seems to appeal to those who would rather not take meds. Granted, there are those who don't want meds but could function better with them as well as those who would have greater benefits from talk therapy with a little med.
You make an excellent point. Yes, many patients that psychologists see are not interested in medication. However, as you know, there are many patients that need medication, at least initially, to manage their symptoms and make better use of psychotherapy. There are two main reasons why clinical psychologists want to prescribe:
1. It is becoming increasingly difficult to get patients into a psychiatrist or even an psych NP for that matter. This was clearly the case prior to my becoming a psych NP. In graduate school, I mistakenly thought that I would simply refer my patients that needed medication to a psychiatrist and work collaboratively with them. What I quickly realized was that the wait times to get a referral seen ranged anywhere from 1-3 months and sometimes longer (in my area). Even when I had a relationship with the psychiatrist, the best they could do was take the referral in a month. I also tried working with their PCPs and found that it was generally easier to get a referral seen, but that, more often than not, when I would speak with the PCP their response was some version of, "What do you think I should write for?"
2. There are many patients out there who are on too many meds, the wrong meds, or the wrong doses. They are also not typically followed closely enough to have their meds monitored correctly. The ability to prescribe is also the ability to un-prescribe or not to prescribe at all. I run in to this all the time and am constantly taking new referrals where I am titrating down meds and/or d/c a med(s), particularly with children. Patients often tell me that they seek me out specifically b/c I combine meds and therapy and am able to see them more frequently.
Most metro areas don't have a shortage. And, in case of psychiatric emergencies, joint commission rules stipulate a requirement for psych consult services in every single emergency dept (even rural ones). RxP advocates claim that psychologists need to be able to prescribe to alleviate the shortage of psychiatrists in rural areas. As if there isn't a shortage of all healthcare services in rural areas (including psychologists). There is a shortage of jewelry stores and delis, hardware stores and ice cream shops and beauty parlors for that matter. The reason is that it is very hard for a small business to survive in an area with a limited population. That's always been true. Psychologists prescribing isn't going to change that. But I'll tell you what it will change ... the number of medical students opting for psychiatry residencies in states with rxp laws. It will go down. If medical students see that lawmakers have decided that the job of a psychiatrist can be learned in one weekend a month online, their reaction will be to pick another specialty or get matched with a residency in another state. Then we will see what a true shortage of physicians in mental health really looks like.
I am in a metro area and the wait times are ridiculous. Joint commission rules only pertain to inpatient settings; I am talking about outpatient. The number of medical students going into psychiatry has been decreasing for at least a decade and, currently, over 50% of the available slots are filled by FMGs and a number go unfilled each year. My sister is a physician. In her graduating medical school class of 130, 4 went into psychiatry!
Perhaps psychiatrists gravitate towards my area (the pacific nw) because they like to treat seasonal affective disorder. It seems like I can't walk 3 steps without tripping over a psychiatrist in Portland or Seattle. I work at a psych hospital and know quite a few psych MDs and residents. Only one out of perhaps 10 of the psychiatrists w/ whom I work is foreign trained but that is just my area and my hospital. Nationally, a lot of psych residencies go to FMGs. That's true. The same is true of general practitioner residency spots. On the other hand, two local universities have psych NP programs that are at capacity and I have heard professors discussing concerns of saturation. So the sky isn't falling up here in terms of numbers of clinicians. But, access remains a problem due to lack of insurance which is a whole other issue about which I have much stronger feelings than I do over rxp.
I agree. The issue of insurance reimbursement is of much greater importance; it would be nice to have a collective effort from all providers to lobby for improved coverage and reimbursement. Hopefully, the Mental Health Parity Act that recently passed will evolve into something meaningful.
You make an excellent point. Yes, many patients that psychologists see are not interested in medication. However, as you know, there are many patients that need medication, at least initially, to manage their symptoms and make better use of psychotherapy. There are two main reasons why clinical psychologists want to prescribe:
1. It is becoming increasingly difficult to get patients into a psychiatrist or even an psych NP for that matter. This was clearly the case prior to my becoming a psych NP. In graduate school, I mistakenly thought that I would simply refer my patients that needed medication to a psychiatrist and work collaboratively with them. What I quickly realized was that the wait times to get a referral seen ranged anywhere from 1-3 months and sometimes longer (in my area). Even when I had a relationship with the psychiatrist, the best they could do was take the referral in a month. I also tried working with their PCPs and found that it was generally easier to get a referral seen, but that, more often than not, when I would speak with the PCP their response was some version of, "What do you think I should write for?"
2. There are many patients out there who are on too many meds, the wrong meds, or the wrong doses. They are also not typically followed closely enough to have their meds monitored correctly. The ability to prescribe is also the ability to un-prescribe or not to prescribe at all. I run in to this all the time and am constantly taking new referrals where I am titrating down meds and/or d/c a med(s), particularly with children. Patients often tell me that they seek me out specifically b/c I combine meds and therapy and am able to see them more frequently.
I guess my job outlook is pretty good as a PMHNP student....
fidelio
25 Posts
Dual licensure as a psych NP and as a clinical psychologist is a very good avenue. In the larger sense, I have no problem with psychologists prescribing so long as they go back and take the same basic science classes that they were not required to take as psychology majors. Completion of basic sciences such as chemistry and biology is a necessary minimum standard to which all other prescribers are help prior to starting their training. Otherwise, the professional portion of the training will largely be comprised of information that the students would have already known had they bothered to take biology 101 at a junior college level. Neuroanatomy, neurophysiology, pharmacology and psychopharmacology are useful but they do not take the place of the basic sciences. I see no reason for psychologists to circumvent or skip these classes to take other classes in their own programs. At this point, most patients can take for granted that the person prescribing for them has taken at least two years of basic sciences prior to beginning their professional training. But, if the RxP legislation passes that does not require psychologists to take science classes prior to entering their RxP programs, patients will not be able to take for granted that the person prescribing for them has taken a single chemistry class even at the junior college level. Patients deserve more than that. Every other prescriber takes the time to become knowledgeable about science prior to their training. Those looking to skip over the basics are not doing their patients any favors.