PMHNP Outlook

[oldsockventriloquist]

So, I've been doing some research on becoming a PMHNP. I think the work seems pretty cool, but wanted to hear how great the demand is for nurse practitioners in mental health. Upon researching on several nationally known job websites, the amount of positions seems fairly small compared to family nurse practitioner openings. Some of those positions are even open to PAs or other nurse specialists. This makes it seem like mental health nurse practitioners are not in-demand relative to other nursing specialties. So my first question is, am I looking in the right places? If so and my assumption is correct, is that because places would prefer hiring a psychiatrist over an NP? Also, how often do FNPs switch to becoming PMHNPs and vice versa?

[Goldenfox]

Many psych NPs aren't going to tell you all their secrets because they have it good and they don't want a flood of people storming on their scene as has happened with the FNPs.

It makes sense that there would be fewer psych positions because there are relatively fewer mental health facilities that utilize psych NPs compared to the other types of health care facilities that use FNPs. But, psych NPs are still in demand. There are far fewer of them than there are FNPs and they usually earn much more money than the average FNP. I don't know what job listings you've been looking at but psych positions are generally not open to FNPs or other types of NPs unless they have the psych certification. You can't just switch to psych, if you are an FNP you have to go back to school to take the psych courses and then pass the psych boards.

Perhaps mental health facilities would prefer to fill all their staffing needs with psychiatrists---especially the ones that are run by physicians. However, that's not happening because there simply aren't enough psychiatrists and most of the ones out there don't work for cheap. It costs them a lot less money to hire an NP than it does to hire a physician.

[PG2018]

Often, you'll find an organization willing to hire a FNP or PA because they merely need someone with a prescription pad that they can pay less than a physician. Also, a lot of inpatient units like PAs because their generalist training, greater than that of a NP, allows them to better manage medical comorbidities. For example, when I interned at the VA hospital the inpatient psych unit was largely run by PAs with the psychiatrists having involvement only so far as to determine admissions, discharges, and psychiatric evaluations. Most of the meds the PAs even initiated. I say "most." The docs could actually do whatever they wanted.

The PMHNPs for the most part have crummy training with regards to psychotherapy although we're credentialed to do it and may be reimbursed to do it. Our niche lies actually in psych diagnoses and psychopharmacology as most PCPs will fling a mental illness to us rather than try to manage it themselves after some failed trials of initial pharmacotherapy-lite.

Generally, we're paid well, but -as with all careers- that is variable and somewhat unique to the individual and setting. As a new guy I went in making more than a lot of primary care physicians, but it's largely based on simple economics. There is a large demand for psychiatric specialists, but there is a small supply. Until market saturation is reached -and it's coming- PMHNP will continue to be the "best" career for NPs as so far as lifestyle, income, etc. goes.

[oldsockventriloquist]

So, if there are not enough psychiatrists or if they cost too much, how are the mental health facilities usually staffed? Are there usually a number of PMHNPs under one or two psychiatrists? If so, for those that are PMHNPs, do you have to present your rationales for medical decisions (like prescribing certain medications) in staff meetings? Also, if there seems to be a great demand for PAs in psych, would you say it is better (as far as finding a facility where you manage the care of mental health patients) to go the PA route than the PMHNP route?