PMHNP Vs. Psychiatry MD

ICantthinkofagooddisplayname · Feb 20, 2020

Thanks all for the replies. I really appreciate all your input.

I understand psych is not over-saturated. However, with other NP roles becoming over-saturated, I can only assume that that will make PMHNP more appealing to aspiring NPs. Maybe at this point there isn't a concern, but I think there could be some issues down the road if NPs programs don't reconsider their admission criteria. Anyway, it's just speculation at this point but I think worth considering.

For those working in the field (as a PMHNP) what do you notice the biggest difference is between you and an MD (I know this varies depending on the state that you practice), as far as responsibilities? How is your job satisfaction?

DrCOVID, DNP · Feb 20, 2020

The other thing that people tend to gloss over is QOL. I am so much happier that I am almost done with this and will be a provider. I don't know how people can stay floor RNs. The quality of life is so much better. No wiping ***, lifting obese diabetics, I maybe do 2 handshakes per day. It is all talk. How can you complain? Being a floor nurse actually left me at least dysthymic and possibly depressed because of how stressful and catty other RNs were. I will never miss that time of my life.

The primary difference (I have studied with MDs and been under Psychiatrists) is their depth of knowledge is just more detailed. For ex, they learn where all the crainial nerves are located in the brain. APRNs know what crainial nerves are, but not like that. I think the longer you practice, the more this gap closes. Experience (Practice) is king when it comes to practice. A lot comes down to the setting and the staff you have like any job. You will find those awesome people that will support you and like you and want you to learn (as well as the opposite). I have been blessed that my current APRN preceptor reached out to me and we have grown close as we have great rapport. She has an encyclopedic memory of medications and the DSM-V simply bc she uses it 5 days a week for 9 hours over 10 years. And the same with the previous PsychMD I was under. He was very supportive of the students and of course we were there to make his life easier.

Depth of knowledge, pay and time spent in school are really the only differences. As far as autonomy, my current APRN calls their MD maybe once every few days and that's it. Responsibility is essentially the same, it is really just a structure or formality, that we are "under" the psychMD here in TX. I was fine making the psychMD happy. The APRNs cover patients during the weekend and consult the psychMD when needed. During the week, the senior APRN see's patients and the PsychMD would review the cases as needed.

ICantthinkofagooddisplayname · Feb 22, 2020

I agree 100% on QOL, that's why I want to get out of bedside. There's nothing wrong with enjoying it, but for me, it's just not the right career. I'm not so enamored by nursing that I couldn't possibly see myself doing something other than nursing. I do think the medical profession but there's not a whole lot I like about nursing itself. I think shaking some hands and having discussions sounds really great. I'm sure there's stressful things about the career, so I'm not trying to gloss over that.

AdammRN, how do you feel about the amount of opportunities you have vs an MD? I know this is state dependent, but do you feel satisfied with the opportunities you have or limited? What do you think about compensation (do you think it's fair or, again, limited in how much you can make)? I know money isn't important to everyone, but it is for me (obviously it's not the only motivating factor).

murseman24, MSN, CRNA · Feb 24, 2020

I think if you can do med school then do it. More money, no restrictions, can pick any specialty you want. For me the worst part of APRN is the politics with the MDs. You will not be questioned after med school. The system hierarchy is set up so that you are on top and the layperson is convinced the docs are so much better. If I wasn't married with kids and not willing to make my family suffer with me through med school when I decided to do advanced practice, I would have 100% done med school.

DrCOVID, DNP · Feb 24, 2020

On 2/22/2020 at 12:26 PM, ICantthinkofagooddisplayname said:
AdammRN, how do you feel about the amount of opportunities you have vs an MD? I know this is state dependent, but do you feel satisfied with the opportunities you have or limited? What do you think about compensation (do you think it's fair or, again, limited in how much you can make)? I know money isn't important to everyone, but it is for me (obviously it's not the only motivating factor).

It is state dependent yes, but even here in TX, which is notoriously large profit bent AMA bending the NP workforce over, I'm with an APRN that has her own office and just calls her doc like once every now and then. She is completely independent and has no immediate oversight. We can work things in such a way that you are truly independent. I am sure there are some that independently contract to hospitals as well. I think you can mainly take home more in an independent state. The MD/APRN thing is mostly one of rapport and relationships. You are more likely to get a "good deal" if you know someone. The APRN I am with has a great network and has known her MD for many years.

My plan is to work under a psychMD or really exp pmhnp for a few years, and eventually set up my own thing, or join someone as an independent partner. It seems APRNs have just as much autonomy as an MD. I really can't see being "questioned" if you are an DNP/APRN with 3+ years working. You are essentially a psychiatrist. I mean hell, if a Psych MD can tell me where all the crainial nerves are 4 years out of medical school, great for him. All I know that when it comes to psych practice, that is 99% useless information. You need to know the DSMV and have the latest med references for practice. We focus on like 3 diagnoses for literally everyone for billing reasons... regardless of where you work, FQHC, private hospital, small private practice. It is all MDD/Schizo/Bipolar.

I will leave the MD for people thinking they want to take an easy route to make good money, or think DNP is not valuable enough or won't give them enough autonomy. Or for those kids that don't know what they are getting into.

popopopo · Feb 25, 2020

On 2/24/2020 at 10:31 AM, adammRN said:
It is state dependent yes, but even here in TX, which is notoriously large profit bent AMA bending the NP workforce over, I'm with an APRN that has her own office and just calls her doc like once every now and then. She is completely independent and has no immediate oversight. We can work things in such a way that you are truly independent. I am sure there are some that independently contract to hospitals as well. I think you can mainly take home more in an independent state. The MD/APRN thing is mostly one of rapport and relationships. You are more likely to get a "good deal" if you know someone. The APRN I am with has a great network and has known her MD for many years.
My plan is to work under a psychMD or really exp pmhnp for a few years, and eventually set up my own thing, or join someone as an independent partner. It seems APRNs have just as much autonomy as an MD. I really can't see being "questioned" if you are an DNP/APRN with 3+ years working. You are essentially a psychiatrist. I mean hell, if a Psych MD can tell me where all the crainial nerves are 4 years out of medical school, great for him. All I know that when it comes to psych practice, that is 99% useless information. You need to know the DSMV and have the latest med references for practice. We focus on like 3 diagnoses for literally everyone for billing reasons... regardless of where you work, FQHC, private hospital, small private practice. It is all MDD/Schizo/Bipolar.
I will leave the MD for people thinking they want to take an easy route to make good money, or think DNP is not valuable enough or won't give them enough autonomy. Or for those kids that don't know what they are getting into.

^LOL at the bolded. Damn MD taking the easy route through a decade plus of training and wanting to pay back their loans and be an expert in their field!

DrCOVID, DNP · Feb 25, 2020

On 2/24/2020 at 11:42 PM, popopopo said:
^LOL at the bolded. Damn MD taking the easy route through a decade plus of training and wanting to pay back their loans and be an expert in their field!

It's not even that. Even after you train you work long and hard to make that $.

TuxnadoDO · Feb 25, 2020

On 2/24/2020 at 9:31 AM, adammRN said:
I will leave the MD for people thinking they want to take an easy route to make good money, or think DNP is not valuable enough or won't give them enough autonomy. Or for those kids that don't know what they are getting into.

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA

TuxnadoDO · Feb 25, 2020

If you want the most thorough education and the best possible preparation before independence for this very important job, go MD/DO.

If that route seems too lengthy, or too difficult (in terms of commitment and work/life balance), then go the NP route.

Both options are available to you, which is a good place to be in.

DrCOVID, DNP · Feb 25, 2020

I think you two are inferring a lot/misinterpreting what I wrote, please emphasize the word "thinking" in that sentence you chose to excerpt. Moving forward, what would bring a DO to a nursing forum? Any nurse worth their salt knows what the difference is between the two. I mean come on, we work alongside each other and I'm sure most people carefully consider more education at some point.

I would have done MD when I was early 20s, but once you spend so much time in nursing I just don't think it is worth the time. I can tell I am not as sharp as I was, probably because our brains lose plasticity and finish developing at 26. Unless for some reason you are dying for the MD title, I couldn't make sense of it... I was making about 90k working 36 hours a week and as a practitioner have close to 200k potential (money doesn't equate to more satisfaction after 75k). When you get to 30, why on earth would you spend another 9-10 years of my life to get the MD title when the difference is a drop in the bucket, and there is not real difference in autonomy. And just like all schoolwork, you will probably forget 90% of med school when you get to the actual job. Everywhere I have worked, we literally diagnose people with one of 3-4 things most of the time in psych.

I have met so many doctors who never took time to take care of themselves and don't have the energy for other things. A good friend of mine complained she doesn't even have sex with her husband anymore because he is so tired from working. Another good buddy in anesthesia seems like he has had the life and humor sucked out of him. The main thing I am frustrated with is the current curriculum & explaining what a DNP actually is. Obviously, both of these I am sure will get better with time.

FullGlass, BSN, MSN, NP · Feb 26, 2020

On 2/25/2020 at 6:09 PM, adammRN said:
I think you two are inferring a lot/misinterpreting what I wrote, please emphasize the word "thinking" in that sentence you chose to excerpt.

You are the one who wrote:

"I will leave the MD for people thinking they want to take an easy route to make good money"

I have never heard of anyone refer to becoming an MD as an "easy" route to make good money. That is really insulting to doctors.

While you may feel less sharp, that is not true for everyone. Plenty of people make their greatest contributions intellectually in middle and even old age.

Medical school is more expensive than NP school, yes, but MDs also make a lot more money than NPs. A shrink in Los Angeles with private practice can bill at $300 to $350 per hour. That's $600K to $700K per year if they work full time. That difference in earning over what a PMHNP makes is hardly a drop in the bucket. So that will justify higher student debt.

For an individual who already has a college degree, it takes about 8 years to become a psychiatrist - 4 years med school, then 4 years internship/residency. Residents do get paid.

A salaried psychiatrist can easily make $300k or more. That's $100K more than a PMHNP. I don't call that a drop in the bucket.

Not all doctors finish medical school with a boatload of debt. There are scholarships available and there are also loan repayment programs.

Psych offers a good life style for MDs. Most psychiatrists don't have the grind of many other specialties.

Being a doctor or an NP is not just a job - it is a calling. There are plenty of other ways for a smart person to make more money and without all the hassle.

For a person under 40 or 45 years old, who wants to be a doctor, I say go for it. There are people who go to med school in their 50s and even 60s. If that is a person's passion, then good for them!

I also find your off-hand attitude towards practice a bit surprising. I have worked in psych and didn't find it easy or just had 3 or 4 diagnoses. There are a lot of different mental health issues and the diagnosis is not always obvious. Some patients have more than one condition. There were times when my consulting psychiatrists and I discussed challenging cases and even they admitted a case was not clear cut. Psychiatry is a very challenging field.

As for the DNP, it is in no way comparable to an MD or DO. The current DNP curricula are generally woefully deficient in additional relevant clinical knowledge.

Doctors are the unquestioned "top of the totem pole" in healthcare providers. I'm very proud of being an NP, but doctors get superior education and training.

Tegridy · Feb 26, 2020

On 2/25/2020 at 9:05 PM, FullGlass said:
You are the one who wrote:
"I will leave the MD for people thinking they want to take an easy route to make good money"
I have never heard of anyone refer to becoming an MD as an "easy" route to make good money. That is really insulting to doctors.
While you may feel less sharp, that is not true for everyone. Plenty of people make their greatest contributions intellectually in middle and even old age.
Medical school is more expensive than NP school, yes, but MDs also make a lot more money than NPs. A shrink in Los Angeles with private practice can bill at $300 to $350 per hour. That's $600K to $700K per year if they work full time. That difference in earning over what a PMHNP makes is hardly a drop in the bucket. So that will justify higher student debt.
For an individual who already has a college degree, it takes about 8 years to become a psychiatrist - 4 years med school, then 4 years internship/residency. Residents do get paid.
A salaried psychiatrist can easily make $300k or more. That's $100K more than a PMHNP. I don't call that a drop in the bucket.
Not all doctors finish medical school with a boatload of debt. There are Scholarships available and there are also loan repayment programs.
Psych offers a good life style for MDs. Most psychiatrists don't have the grind of many other specialties.
Being a doctor or an NP is not just a job - it is a calling. There are plenty of other ways for a smart person to make more money and without all the hassle.
For a person under 40 or 45 years old, who wants to be a doctor, I say go for it. There are people who go to med school in their 50s and even 60s. If that is a person's passion, then good for them!
I also find your off-hand attitude towards practice a bit surprising. I have worked in psych and didn't find it easy or just had 3 or 4 diagnoses. There are a lot of different mental health issues and the diagnosis is not always obvious. Some patients have more than one condition. There were times when my consulting psychiatrists and I discussed challenging cases and even they admitted a case was not clear cut. Psychiatry is a very challenging field.
As for the DNP, it is in no way comparable to an MD or DO. The current DNP curricula are generally woefully deficient in additional relevant clinical knowledge.
Doctors are the unquestioned "top of the totem pole" in healthcare providers. I'm very proud of being an NP, but doctors get superior education and training.

On 2/25/2020 at 6:09 PM, adammRN said:
I think you two are inferring a lot/misinterpreting what I wrote, please emphasize the word "thinking" in that sentence you chose to excerpt. Moving forward, what would bring a DO to a nursing forum? Any nurse worth their salt knows what the difference is between the two. I mean come on, we work alongside each other and I'm sure most people carefully consider more education at some point.
I would have done MD when I was early 20s, but once you spend so much time in nursing I just don't think it is worth the time. I can tell I am not as sharp as I was, probably because our brains lose plasticity and finish developing at 26. Unless for some reason you are dying for the MD title, I couldn't make sense of it... I was making about 90k working 36 hours a week and as a practitioner have close to 200k potential (money doesn't equate to more satisfaction after 75k). When you get to 30, why on earth would you spend another 9-10 years of my life to get the MD title when the difference is a drop in the bucket, and there is not real difference in autonomy. And just like all schoolwork, you will probably forget 90% of med school when you get to the actual job. Everywhere I have worked, we literally diagnose people with one of 3-4 things most of the time in psych.
I have met so many doctors who never took time to take care of themselves and don't have the energy for other things. A good friend of mine complained she doesn't even have sex with her husband anymore because he is so tired from working. Another good buddy in anesthesia seems like he has had the life and humor sucked out of him. The main thing I am frustrated with is the current curriculum & explaining what a DNP actually is. Obviously, both of these I am sure will get better with time.

Addamrn there’s plenty of doctor jobs out there where you don’t work yourself to death. you can make as little or as much as you want.

hospitalist in my neck of the woods start at 290k and go up from there for 7on 7off. One can do nocturnist for 5on 10 off same pay and bennies.

I think those people choose to work that much and one could say the same about any career