Psychiatric NP Questions

luckylady5 · Sep 12, 2013

Nobody?

PsychiatricNP · Sep 19, 2013

Hi everyone - I haven't posted on here in quite a while, but thought I would today. I had been very interested in pursuing a direct entry PMHNP, but in recent months kind of have up on that plan in favor of becoming a LICSW, but I find that I'm just not as excited about the prospects likely available to me if I got an MSW, and still really interested in the nurse practitioner role.
I have tried to research, but there just doesn't seem to be that much info available, so I'm hoping I can get some here. Any information would be helpful, and I'm specifically curious about good job prospects in Boston area suburbs, starting pay in this area, are these jobs plentiful (I look on Indeed etc. and don't see much), and anything else you care to share! FYI I am non-traditional age (42) and part of what is holding me back is that I'm worried about being too old and all the debt involved. At this point in my life I basically need a sure thing, or as close to one as I can get. I'm certain I would love the work, I just want to make sure I'll be able to get a good job!
Thank you for any responses :)

Hi luckylady5 - I can't speak to the market in the Boston area...but I am both a PMHNP and an LCSW. I never had an issue with employment as an LCSW - there was always work, of course, I have found that this is the same with the PMHNP. I was first a clinical social worker and then went back to nursing school to become a PMHNP - I certainly don't regret the decision to pursue this educational path. My MSW provided me with a solid foundation in psychotherapy as well as an understanding of the more psychosocial aspects of patient care. My PMHNP program obviously prepared me to add in the psychopharmacology in my practice. I feel that this was the perfect marriage of careers and educational preparation, though not the most expeditious!

The best advise that I can offer is to consider the type of work that you hope to be doing - psychotherapy or medication management. As a PMHNP I do minimal psychotherapy and only within the context of medication management (supportive and solutions focused work), so if you are looking to do therapy, I would suggest that you look at an MSW program, because very few employers are going to hire you at an NP pay rate to do psychotherapy only (this isn't cost effective). If you lean toward more medication/physical/psychopharmacological management of patient problems, then the PMHNP route is probably for you. Of course, there isn't anything saying that you can't do both :) Best of luck to you!

priorities2 · Sep 21, 2013

Hi PsychiatricNP, do you find that an employer would hire you to do a certain % therapy or have some patients as your own caseload? I think the perfect balance would be primarily med management but a mix of intake and therapy also... is this feasible as a PMHNP?

PsychiatricNP · Sep 21, 2013

Hi PsychiatricNP, do you find that an employer would hire you to do a certain % therapy or have some patients as your own caseload? I think the perfect balance would be primarily med management but a mix of intake and therapy also... is this feasible as a PMHNP?

Hi priorities2 - I have some friends who I graduated with who were interested in doing some psychotherapy and they were able to negotiate the opportunity to have a few patients that they saw for both therapy and medications. One classmate had a specific interest and training in equine therapy. She negotiated with her employer to do equine therapy for 2-3 hours per week, but she was still expected to meet her productivity goals for the practice.

My personal interest is in evaluation, psychopharmcology and the use of brief/supportive psychotherapeutic interventions in conjunction with medication management, so I haven't ever asked any of my employers for time in my schedule to carry a therapy caseload. My guess is that I would be told no because it isn't a cost effective use of my time and because all of the settings that I work in already employ clinical social workers / counselors who provide therapy and need to do so to meet their productivity goals. If you consider that the average insurance company might reimburse an agency $50-$75 per hour of therapy versus ~$50 per E/M encounter (depending on coding) at 3-4 E/M encounters per hour ($200 an hour), you can imagine that your employer is likely going to expect you to spend most (all) of your time doing E/M encounters.

While I agree that the ideal practice would be for the PMHNP to provide both therapy and medications (and the evidence supports that this produces the best patient outcomes), we have followed the path of psychiatry and have been forced to spend most of our time in medication management because of the demand for psychopharmacologists and the economics of healthcare/managed care. This has just been my experience and you may find an organization that is willing to allow more psychotherapy time, but this may be at the expense of your take home pay (may or may not be important to you).

priorities2 · Sep 21, 2013

Hi priorities2 - I have some friends who I graduated with who were interested in doing some psychotherapy and they were able to negotiate the opportunity to have a few patients that they saw for both therapy and medications. One classmate had a specific interest and training in equine therapy. She negotiated with her employer to do equine therapy for 2-3 hours per week, but she was still expected to meet her productivity goals for the practice.
My personal interest is in evaluation, psychopharmcology and the use of brief/supportive psychotherapeutic interventions in conjunction with medication management, so I haven't ever asked any of my employers for time in my schedule to carry a therapy caseload. My guess is that I would be told no because it isn't a cost effective use of my time and because all of the settings that I work in already employ clinical social workers / counselors who provide therapy and need to do so to meet their productivity goals. If you consider that the average insurance company might reimburse an agency $50-$75 per hour of therapy versus ~$50 per E/M encounter (depending on coding) at 3-4 E/M encounters per hour ($200 an hour), you can imagine that your employer is likely going to expect you to spend most (all) of your time doing E/M encounters.
While I agree that the ideal practice would be for the PMHNP to provide both therapy and medications (and the evidence supports that this produces the best patient outcomes), we have followed the path of psychiatry and have been forced to spend most of our time in medication management because of the demand for psychopharmacologists and the economics of healthcare/managed care. This has just been my experience and you may find an organization that is willing to allow more psychotherapy time, but this may be at the expense of your take home pay (may or may not be important to you).

Thanks so much =) Your response aligns with something I noticed. A very experienced psych NP I spoke to - who happens to have his salary published online because he works for the state - only makes 75k a year. I know he works full time, so I thought this was low. In retrospect, it may be because he told me he does a lot of psychotherapy. That's definitely helping me connect the dots.

TheDude77 · Sep 23, 2013

Thanks so much =) Your response aligns with something I noticed. A very experienced psych NP I spoke to - who happens to have his salary published online because he works for the state - only makes 75k a year. I know he works full time so I thought this was low. In retrospect, it may be because he told me he does a lot of psychotherapy. That's definitely helping me connect the dots.[/quote']
I think salaries for PMHNPs can vary greatly. Like others said, it all depends on what you do. I know a PMHNP at my work who basically makes/works as much as she wants. She basically covers and does med management for psychiatrists at a practice. Word got out to other psychiatrists and she pretty much covers for lots of them at different practices now.