myelin

I live in an area with an extremely high cost of living on the west coast. Psych NPs making 150-200k base salaries is not that uncommon here. As a new grad I made more like 130-140k. Also, frankly, I am not afraid to negotiate rather aggressively if need be. I also found both my positions through networking (aka jobs weren't advertised and I was recommended by a colleague).

Hmm. Your offer doesn't seem terrible, but that salary is a bit low, especially if you're unwilling to take a new grad. Experienced psych NPs can easily make 150k+ base. Perhaps try increasing the base salary and nixing the commission for the first year, then once the candidate has been working for a year and has a decent following you can add in commission? Also, frankly, psych NPs are just hard to find, especially experienced ones. We tend to get snapped up rather quickly and in my experience employers will do a lot to prevent us from leaving. There's a huge shortage in most areas in the country. Do you offer PTO? Sick leave? CME money and time off? Do you cover licensing fees, DEA, etc? Those are pretty much industry standards for most psych NP positions and if you're not offering it, it could be turning people away... Hope this helps.

1. Psychiatry 2. My main position is 38 hours per week, other job is 8-16 hours per month 3. Vacation + sick is like 5-6 weeks 4. A little over 3 years now 5. Main job pays me 175k/year. Plus benefits (401k match, health benefits, $1500 CME, etc.). The other job is 1099 and pays $150/hr. 6. I don't know, sorry. I see like 8-12 patients in an 8 hour day and 13-17 in a 12 hour day, usually a couple evals but mostly follow ups.

I'm not sure if the above person is replying to me (it seems unclear but I'm guessing no), but I have to say - PAs really vary IMO. NPs do too. But I have met enough scary PAs to think that maybe everyone should do a residency. Hah.

I wrote a large reply but honestly I think it boils down to this: nurses want crappy/easy schools. We do. We want convenience, cheap, online, etc. We as a field have a huge problem and until this mentality changes NP schools have 0 incentive to make this change. How many times do we see people seeking out programs with low barriers to entry because they're "too scared" to take the GRE or they "couldn't possibly go part-time" during NP training. I mean, I don't think anything will change unless we change the mentality that studying medicine (and lets be real, NP school is basically another approach for practicing medicine) is something that someone shoehorns in during their spare time while they work their "day job." Learning to be a provider should be your day job!! Also, I agree that comparing PAs to NPs is apples and oranges. Entirely different. PAs are meant to be able to jump into any area of medicine and be a provider. NPs are meant to be trained for a specific scope (I agree with limiting FNPs to only primary care BTW). And to be honest, I've had a few new hire PAs shadow me for a psychiatry job (psych NP here) and I was appalled by how terribly prepared they were. One asked me what schizoaffective was! Then I found out his "psych rotation" in PA school was not done with a psychiatrist, but rather that he was allowed to count any anxiety/depression visit during his family medicine rotation as "psychiatry hours." He had never even rotated in a psychiatric unit/clinic before. And don't get me started about his lack of didactic knowledge. I mean, my experience is that PAs are not uniformly better trained than NPs. It really depends on the clinician.

oh my god PREACH!

Maudsley prescribing guidelines - succint, evidence-based, no pharma interference. It's a UK guideline and it is wonderful. I also love the MGH psychiatry texts (hospital psychiatry, they also have a more general book, etc). There's neurology for psychiatrists that's really good as well but dense. Lastly, Kaplan and Saddock are a must have for a great general reference text (the condensed version is plenty thorough). Lastly, I highly recommend subscribing to the monthly Carlat Report. Really great resource for general updates in psychiatry, comes out monthly. Once again it's highly evidence based w/mechanisms in place for avoiding bias, pharma influence, etc.

Just an FYI but from what I understand no site with a HPSA score of

A HPSA score of 14 is very low. You are unlikely to get loan repayment with that low of a score, sorry to say (assuming you are applying for the loan forgiveness program). 50/hr is ridiculously bad pay for an NP in CA. I mean, you're making what an RN makes but with a lot more responsibility and risk. Is is just me or do new grad primary care NPs really get taken for a ride? I cannot believe the low wages people accept. And it just causes the wages to fall even further because employers know they can get someone for that cheap, plus it sets you up to accept paltry wages throughout your career since you started so low, blargh. I'll stop now.

I agree with the above, straight forward depression and anxiety can (and should) be managed by PCPs. These patients should also be referred to therapy right away. In fact, if the patient has mild/moderate depression they likely should be receiving therapy as a primary treatment anyway. SSRIs do not separate well from placebo for these patients, especially those on the milder end. If treatment resistant or if you suspect bipolar/something more complicated, please refer to psychiatry. Please do NOT start pt's on benzos and then turf them to psych. At my last FQHC I made a rule that whoever starts the benzo must manage the benzo. The only exception is if they start a short course (and make it clear to the pt that it is a short course) while titrating up an SSRI/referring to me. Also not everyone needs a short course of benzos (most don't). Try Vistaril or gabapentin instead. When a patient is started on a benzo by their PCP and turfed to psych it can cause a lot of problems, including damaging the relationship between the patient and psychiatrist/psych NP. I inherited a patient with very clear PTSD from his PCP who was a PA. She started him on Xanax. No matter what I did/said he was absolutely convinced that Xanax was the solution to his problems and would not hear anything else. It didn't matter how much data I showed him, how many convos we have about SSRIs/prazosin/exposure therapy/etc. He had been started on that magic pill by his PCP. I maintained boundaries and refused to continue it, but every appointment with him was like pulling teeth. BTW, daily/scheduled benzos are now considered contraindicated and have been shown to damage outcomes for patients with PTSD by the VA. PCPs starting and maintaining benzos is a huge problem. I always tell patients that daily/scheduled benzos will be continued at a maximum of 4 weeks. I initiate lots of tapers and I have the pt sign a contract. If the pt goes to another provider/is benzo shopping then there are repercussions and they no longer received any scheduled meds from our clinic. Benzo dependence is no joke, and lots of people die because of it. I think one reason why some providers have such cavalier attitudes towards benzo prescribing is they don't see the damage they are doing because it can take years to develop. I did geripsychiatry 2 days/week for 2 years and seeing the effect that chronic benzo use had on my 70+ year-old patients was tragic. This above rant is mainly focused on daily/scheduled benzo regimens. PRN benzos are another story and I am somewhat looser with those. Although I still expect these patients to be in therapy, attending appts, and on a regimen for managing their anxiety (SSRs, buspirsone, etc). Break through anxiety can happen with some severe cases and I understand that. For those patients I will relent and prescribe a small amount of PRN benzos (5-10 tabs per month max). But if a person is requiring sedation/tranquilization on a daily basis in order to live their life - they are clearly not having their problem managed correctly. Sorry to write a novel. This is an issue near and dear to my heart after seeing heartbreaking cases of benzo dependence during my geripsychiatry days. Rant over!

Depends on where you live. But generally psych NPs make more money and are in very high demand.

Wow, this thread really took a turn... before it gets locked, I'd just like to say that I am a direct entry psych NP and have been quite successful. Being direct entry has not been a problem at all. Before I became a psych NP I worked in clinical psychology and research, so I knew what I was getting into to some extent. I did begin working per diem as an RN in a psych ER during my last year of school. While I found the RN experience helpful, it wasn't necessary. The most important experience is NP experience - both in school and after graduation. I am hopeful that more and more NPs will complete residencies which will help w/competency. I do not think RN experience cuts it. Truly, my first few years of NP practice were like a 'mini' residency in that I provided care autonomously but was supervised weekly by a variety of wonderful psychiatrists, read journal articles with them, etc. The amount that I learned during that time was exponential and far more (unfortunately) than what I learned in NP school or working as an RN. I don't think the solution to NP education is more RN experience. I mean, whose to say that the RN experience is even relevant? Several of my PMHNP classmates were ICU nurses who had never stepped foot in a psych unit. I'm hoping residencies become increasingly commonplace.

I am a direct entry NP grad. I did get some RN experience before graduating, but it was per diem. I would describe myself as quite successful. I literally have only had good feedback from the physicians and other providers I work with. I was very careful and cautious (especially when I first started) and now 2+ years into practice am really settling into the groove of my field. I also do a lot of reading, which has helped. Was my RN experience helpful? Sure. But it has been completely eclipsed by my first few years of practice as an NP and the support I've had from my provider colleagues. The reality is that what matters (IMO) to be successful as an NP is having a supportive, high quality NP position as a new grad. You want to see a variety of pathology in a supportive environment with reading on the side - this is what makes a great provider. It sounds like OP did not have that in her job and was set up to fail. Also, I can't help but find it frustrating to hear non-NPs comment on NP practice. The fact that they are so highly focused on RN experience indicates to me that they don't really know a lot about what it's like to be an NP and develop your way of practicing. RN experience in minuscule in comparison to working as an NP - seeing patients, working through diagnoses and tests, coming up with treatment plans, and getting guidance from more experienced providers - this is what matters. Truly every single person from my program is a successful NP or RN. Some chose to not go on to become NPs but to stay RNs. Those of us (the majority) who opted to continue on to become NPs after the accelerated RN training are practicing in this role without any issues at all. My biggest concern is online NP programs with low barriers to entry. These are what will damage our field. I know two terrible psych nurses. Both are attending some BS part-time online PMHNP program. One is such a terrible psych nurse that he was recently remediated and is having to go through training again. He has no business whatsoever becoming an NP. Of course his online program is happy to take his money.

I guess myself and pretty much my entire direct entry NP class would be considered a 'success' story. We are pretty much all practicing with no issues whatsoever. Just go to a reputable program.

I'd say in my market (psych) there is still a huge shortage. That shortage is projected to get worse as psychiatrists retire in droves (majority of psychiatrists are over 55 years old) for the next few decades. However, it does seem like primary care NPs have caught wind of the high salaries in psych and I'm seeing more and more FNP/AGNPs going back to school for the PMHNP license. So that could potentially tighten things up. Only time will tell.