Switching careers and interested in psychiatric NP

[Mkim680]

Hello everyone,

This is actually my first post on allnurses.com. Currently, I am a licensed psychotherapist working for the U.S. Army's addiction clinic. At my current work site, a recent legislation was passed that anyone possessing a LPC or LMHC license would have difficulty moving into management positions. I have encountered this at several places I've worked in for the federal government.

Actually, this worked out because I was thinking about going back to school anyway. I've grown a great interest in the psychiatric nurse practitioner route and wanted to ask a few questions. What does the current market look like for employment, salary available, and job flexibility?

I don't want to make the mistake of getting the wrong degree or license and hear that I will never be able to move up in any company I work for. Also, can psychiatric nurse practitioners be employed overseas by different organizations other than military branches?

I looked at the U.S. embassy positions but they only hire family nurse practitioners and MD Psychiatrists. Any advice would be appreciated.

Mark

[FuturePsychNP]

I see a metric boatload of psych NP positions advertised. I have thought about switching and getting PMC in psych. I do have a calming effect on those with mental illness. Strangely, I have the opposite effect on the well balanced. Good luck to those moving in this direction.

Me too, tim. I find that I form the best relationship with the patients that most people find beligerent and antagonistic. The ones most of the girls on shift call "sweet" usually try patience to no end, lol. So I'm in a psych NP program, lol.

[FuturePsychNP]

Do not give up your dream. The average pay for PhD is $85..Neuropsych get pay very well and in great demand.. PMHNP career is very limited to work in certain setting. Demand is still unknown. PhD gives a wide range of opportunities and prestige. It really depends on what you want in life. You may hate it later if you become one.. It can be very taxing.. You are given a case load of patient to be seen limited time 15-30 min.. barely have time to do anything other than assessment and med management.. and limited psychotherapy.. You can get burnt out really fast esp. when you know that you get 50% of MD pay with same headache and liability.

All of the organizations coming to campus recruiting the PMHNP soon to be grads WANT them for assessment and med management. All of the online jobs I've seen advertised for PMHNPs only discuss diagnosis and med managment. Pay, nothing. I made around a 30-35k for many years (and loved my job) before switching to nursing, and I had a B.S. degree. I won't gripe over making 90k or more as a NP with only a master's. I think that's a pretty darn good leap for any line of work. The docs put in the time . They deserve the increased salaries. They have unrestricted practice, generally, and NPs don't have that. I've never been on board with demanding equal pay and privileges. I knew what would be expected of me as a NP when I decided to go back to school to get the RN/BSN, while working as a RN, and now on into the MSN/PMHNP program. Pay is relative.

[TheOldGuy]

FuturePsych, you should get on board with equal pay. If you are not championing your intended future profession, you are hurting it - and nursing has a long history of shooting itself in the foot - please help be a force for positive change.

If we are doing the same work then we should be paid the same. When you say that docs put in the time and deserve increased salaries, you need to consider a few key points:

1. There is a range of Physician education - many in the US do not have an undergrad degree, while others have extremely strong academic backgrounds. Medical school is 2 years of didactics and 2 years of clinicals. Residencies and fellowships vary, and is often where the "real" learning takes place.

2. There is a range of Nurse Practitioner education - personally I have a BS in engineering and a BS in nursing. My BSN was an accelerated 2nd bachelors program where the average undergrad GPA was 3.75. My NP program included 1 year of advanced pathophysiology, 1 1/2 years of advanced pharmacology and a variety of other courses which built on my nursing education such as advanced assessment, epidemiology, etc. Following didactics, I had approx 18 months of clinicals. Prior to starting the NP program I was a trauma ER nurse, and worked in cardiac, respiratory and surgical intensive care. More than once, I had docs say to me - "thank God you were there - I (the doc) killed the patient and you (me) saved him". Nurses admin the meds that docs order and see the effects (benefits and nightmares) of that administration.

3. The concept of NP education is to build on years of clinical experience and bachelors level undergraduate nursing education. Undergrad nursing education includes coursework in anatomy, physiology, pharmacology, assessment, etc along with clinical rotations which typically include med/surg, mental health, telemetry, OB, etc.

4. The concept of MD education is to create a new practitioner whose undergrad prep may be anything from nonexistent (as it is sometimes from foreign trained docs) to those with history degrees (a good friend of mine) or those with biochemistry backgrounds (and other science based BS degrees).

5. In 17 jurisdictions, NPs do have unrestricted practice. Nursing is a different and effective approach to the delivery of health care than Medicine. NP's safety and efficacy has been studied for over 50 years. There has not been a single study that shows worse outcomes when NPs are the providers. NPs have proven to be safe and effective providers with consistently lower malpractice claims ratios than MDs in every setting - including those with independent practice.

[FuturePsychNP]

FuturePsych, you should get on board with equal pay. If you are not championing your intended future profession, you are hurting it - and nursing has a long history of shooting itself in the foot - please help be a force for positive change.

If we are doing the same work then we should be paid the same. When you say that docs put in the time and deserve increased salaries, you need to consider a few key points:

1. There is a range of Physician education - many in the US do not have an undergrad degree, while others have extremely strong academic backgrounds. Medical school is 2 years of didactics and 2 years of clinicals. Residencies and fellowships vary, and is often where the "real" learning takes place.

2. There is a range of Nurse Practitioner education - personally I have a BS in engineering and a BS in nursing. My BSN was an accelerated 2nd bachelors program where the average undergrad GPA was 3.75. My NP program included 1 year of advanced pathophysiology, 1 1/2 years of advanced pharmacology and a variety of other courses which built on my nursing education such as advanced assessment, epidemiology, etc. Following didactics, I had approx 18 months of clinicals. Prior to starting the NP program I was a trauma ER nurse, and worked in cardiac, respiratory and surgical intensive care. More than once, I had docs say to me - "thank God you were there - I (the doc) killed the patient and you (me) saved him". Nurses admin the meds that docs order and see the effects (benefits and nightmares) of that administration.

3. The concept of NP education is to build on years of clinical experience and bachelors level undergraduate nursing education. Undergrad nursing education includes coursework in anatomy, physiology, pharmacology, assessment, etc along with clinical rotations which typically include med/surg, mental health, telemetry, OB, etc.

4. The concept of MD education is to create a new practitioner whose undergrad prep may be anything from nonexistent (as it is sometimes from foreign trained docs) to those with history degrees (a good friend of mine) or those with biochemistry backgrounds (and other science based BS degrees).

5. In 17 jurisdictions, NPs do have unrestricted practice. Nursing is a different and effective approach to the delivery of health care than Medicine. NP's safety and efficacy has been studied for over 50 years. There has not been a single study that shows worse outcomes when NPs are the providers. NPs have proven to be safe and effective providers with consistently lower malpractice claims ratios than MDs in every setting - including those with independent practice.

Sir, I don't believe equal pay is warranted. I'm not shooting anything in the foot either.

For one, NPs are less educated. A physician with any sort of board certification has an undergrad degree, a medical degree, and three or more years of residency. A nurse typically has undegrad and a master's with less than a calendar year's worth of required clinical training hours. I'm sorry, but the freshman or sophomore level anatomy/physiology and microbiology (I used to teach A&P) that nursing school requires a prereq is not equivalent to the basic science courses required in the first couple of years of medical school. It's not the same, and I'm not sure why people are offended in recognizing that.

Additionally, NPs are not doing the same jobs as physicians. I don't mean to trample on anyone's feelings, but NPs have a restricted practice. Physicians don't. NPs, in most states still, cannot work without some nexus of physician involvement. The license of a NP, let alone the training, does not run the full gamut of a physician's.

There are completely ignorant physicians out there who are anything but an icon for medicine. Many of them can't make a decision with any kind of positive outcome. Conversely, there are nurses out there, perhaps as well prepared as you, OldGuy, who can toot their horn and reason through a myriad of problems, diagnose it, and know how it should be treated before any doctor may. Both are exceptions to the rule.

I'm not downing anything about nursing or nurse practitioner'ing. They're two separate jobs. I don't care if anyone is on board with that or not. Evidence suggests that NPs are great in their primary care roles, and that's wonderful. I'm not saying don't receive equal pay. I'm saying, I couldn't care less if the pay isn't equal.

[TheOldGuy]

Oh well....all I can do is try.....you'll see.....

[FuturePsychNP]

Oh well....all I can do is try.....you'll see.....

What shall I see?

Perhaps I see that before nursing needs to concern itself with salary that the many "professional" organizations that "represent" nursing need to get on board with what nursing is and isn't. Perhaps I see that an educational standard for RNs needs to manifest before concerning itself with the salary of NPs who also happen to be RNs. Perhaps I see that the DNP as hogwash in both intent and design. Perhaps I see that nursing needs to stop concerning itself with with how other professions perceive it and listen to the practicing nurses who find fault with the professions inner workings. Perhaps I see that nursing, particularly advanced practice, is more burdened with being equal to everyone else with a stethoscope and not concerned with efficacy.

But then I guess I will only see. I guess I'm as unhappy as you but for other reasons.

I got into this because it was a job I wanted to do - a role I wanted to fill. It's a profession alright, but until nursing is something that I can define professionally well then I'm just a healthcare provider - not a nurse. I just happen to have a nursing license as a necessity to practice. I do my job and know my role without it hurting my self-esteem.

[blondielocks]

Don't MDs have 4 yrs of undergrad + 4 yrs of med school?

To be an NP, especially if you are doctorally-prepared, you have 4 yrs undergrad (more, if your degree is ABSN) and 4 years of graduate preparation?

I don't advocate for equal pay for NPs and psychiatrists, because NPs are designed to be midlevel providers, but I do think that in terms of length of education, it works out to be within 1 year of each other.

[myelin]

Seems to me like it's an issue of equal pay for equal work. If a NP is practicing in the same capacity as a family practice doc, then I see no reason why the doc should make more money. The fact that the doc went to school for longer, went through a residency, etc., are all beside the point. At the end of the day, if the NP and the MD are doing identical jobs, I don't see how one can defend reimbursing the NP less.

[TheOldGuy]

OMG!

I apologize guys - I did not intend to initiate a big brouhaha!

Blondie, NPs were never designed to be "midlevels". You will find that the AANP specifically opposes that term. NPs are highly educated, highly trained providers who have a record of performance that is second to none. If NPs are doing the same work that MDs or DOs are performing then they should be compensated at the same rate.

FuturePsych -I really don't understand your hostility....You seem to feel that getting compensated appropriately is not important. Have you ever spent much time talking with your MD colleagues? Money is pretty much all they talk about. The AMA works very hard to ensure that MDs are well paid. I'm not understanding why you feel that it is inappropriate to want to be fairly compensated. Equal pay for equal work is a fundamental concept. You will see when you get into practice that you will often be doing exactly the same work as an MD. So why should the MD make $100+ per hour and you $45? I am not your enemy....I am someone who wants you and your family to enjoy the best possible lifestyle and financial security for doing work that can make a real difference in the lives of others.

[FuturePsychNP]

Seems to me like it's an issue of equal pay for equal work. If a NP is practicing in the same capacity as a family practice doc, then I see no reason why the doc should make more money. The fact that the doc went to school for longer, went through a residency, etc., are all beside the point. At the end of the day, if the NP and the MD are doing identical jobs, I don't see how one can defend reimbursing the NP less.

I'm not defending it, lol. I'm just saying it's not a big deal. Nursing is unique. Often nurses aren't reimbursed more for advanced degrees. I had another career before I became a RN, and we did get paid more based on our degrees. Be proud of what you got and show that off instead of comparing it to something else. I just don't get that.

If you want to advocate for something then get everyone on the same page regarding what terminal degree will result in qualifying to take the NCLEX-RN and standardize what classes are required and, more precisely, what is taught in nursing school. Finally, tout that nursing should align itself more with the sciences and less with areas like sociology as psychosocial theories seem to abound much more in nursing than does the cellular (biological)basis of disease. Ok, so RNs take A&P. Well, that book is in no comparison to volumes like Netter's, etc. There is a gap, but often people aren't aware of what they don't know. It's not a big deal really because nursing wasn't established to address that particular gap. Sure, I'd like to have learned more, but I can do that on my own (and do!). My undergrad A&P classes, which were allowed as prereqs for nursing school, left me with questions. The book would explain things, and I'd think "hmm, this doesn't explain what I'm wondering about." I got into NP school and used Pathophysiology: The Biologic Basis of Disease..., and wow what a difference! There's A LOT more detail in that, and yet still there are questions however less so than before.

I haven't been to medical school, but I don't think a MD program and a DNP program are equivalent. I base this on the curricula I've seen, and the course descriptions of each. Additionally, from my experience (first BS in sciences) the department of science and engineering was a lot more rigorous than the department of nursing although nursing school did require more time consuming albeit less than educational projects. I suspect that'll hit a sore spot for some people, and I don't mean to make enemies. However, I'm in a NP program, hence the name, and at least a third of what the instructional staff touts every semester is "we're good enough too" or "we're equal to doctors." I've heard this melodrama and foot stomping to the point that I'm sick of it. If you want to be a physician then go be one. A FNP and a FP (MD/DO) doesn't yield the same professional particularly with the residency requirements, and neither does a psychNP or a psychiatrist. There are A LOT of commonalities, but in most states some disease processes (and certainly medications) are deferred to what society, via legislation, has deemed a higher trained or higher qualified provider.

In summary, I'm sorry I offend everyone, but maybe sometimes it takes a fresh set of eyes to see that what you've got isn't so bad. Yes, I realize I haven't become a cynical psychNP, but I am a generally cynical and jaded person, lol. A decade of working for the government gave me that, haha. But no there are some peculiarities to nursing, but every profession has its own. Finally, I just don't see the big deal. Equal work, equal pay. When I'm able to do the exact same things that physicians, who by the way aren't technically (notice use of the term "technically") limited to practicing in their specialty as NPs are, then maybe I'll take a stand for reimbursement reform. Until then, just relax. If you want to change nursing then change from the bottom up. Fix one thing, as a profession, and work on something else. I've worked with the legislature. Things actually can happen for the better...(especially when Republicans are in office!) LOL. Just had to throw that in.

[FuturePsychNP]

OMG!

I apologize guys - I did not intend to initiate a big brouhaha!

Blondie, NPs were never designed to be "midlevels". You will find that the AANP specifically opposes that term. NPs are highly educated, highly trained providers who have a record of performance that is second to none. If NPs are doing the same work that MDs or DOs are performing then they should be compensated at the same rate.

FuturePsych -I really don't understand your hostility....You seem to feel that getting compensated appropriately is not important. Have you ever spent much time talking with your MD colleagues? Money is pretty much all they talk about. The AMA works very hard to ensure that MDs are well paid. I'm not understanding why you feel that it is inappropriate to want to be fairly compensated. Equal pay for equal work is a fundamental concept. You will see when you get into practice that you will often be doing exactly the same work as an MD. So why should the MD make $100+ per hour and you $45? I am not your enemy....I am someone who wants you and your family to enjoy the best possible lifestyle and financial security for doing work that can make a real difference in the lives of others.

What about anything I said was hostile? I'm not hostile. I find however, in 2013, when people are in opposition to another then the differing party interprets that as being hostile. I guess it has something to do with being politically correct and a society-wide over focus on self-esteem. Brother, we're on the same team. I'm never been your enemy. I'm just saying that 85% of reimbursement, for example, isn't so bad compared to 100%. Yeah, guy, I LOVE to make money although I have grown into a spendthrift. I've worked more than one job since I could work just to have extra money, lol. No, I grew up in the suburbs as an only child. I had what I needed and most of what I wanted, but I realized when I started working that tax, FICA, welfare, etc. was eating a lot of my pay so I wanted to get another job so I could save more, plus there isn't much good on tv anymore so working instead of sitting at home wasn't a big deal.

In my area, the psych NP, for example would demand a salary of approx. 95-115,000 annually with the average income in my state being in the mid-30s for all persons. Most positions include the standard workplace benefits, paid malpractice, CMEs, etc., and I've yet to see a position with less than four weeks of annual vacation. Sure, some places will get less and others will get more. That's normal. A psychiatrist in this area may make 120-140,000. That's not a huge difference to me. I made good grades in college, but I definitely did not spend the majority of my time studying even though I took the same stuff the premed guys did, and I worked through my 20s and into my 30s instead of being stuck in a book. Then I went back to school and continued to work, with very little alteration in what I did with my spare time, and did really well in nursing school. I spent about 20k on nursing tuition over two years of the "generic" BSN program. I had a academic scholarship my first time in college so my first BS didn't really cost anything appreciable. Med school is about 25k per semester here. I'm in the MSN program now, and it'll cost around 21k when it's all said and done (total). I'm relatively young, working, and paying out of pocket to go. It's not that big of a deal. I still live life. I'm in an online program through a state university. Other than the days that I sit down at the kitchen table and type up an assignment I can't tell I'm in a graduate program. If I were in med school I'd be stuck to the book or being abused during rounds or at M&M conferences, lol, plus I'd have a four year residence if I wanted to be a psychiatrist over five or six if I wanted to include a fellowship or combination in child and adolescent. I'm really learning a lot but not nearly putting in the time I'd have to otherwise I'm sure.

So yes, in the end we're still friends, but I guess we'll have to disagree. Being called a midlevel isn't a big deal either. Anyway, for once and for all I am not defending a less than equal reimbursement, lol! Instead, I'm saying relax. It'll be ok. If CMS, BCBS, UnitedHealthcare, and all the others want us to get paid the same then hey more bucks, and I'll retire even sooner. Until then I have no animosity about getting paid less because, as a NP, I'll still get paid more than most of America. Take solace in that if status is important to you.

And yes, I'm as much as a cynic as anyone else. Don't think for a minute I'm some kind of idealist, lol. I'm definitely a realist and spend quite a bit of time these days posting comments to online news articles and writing my congressional delegation. (I even have a YouTube channel I won't share here.) There is A LOT about modern society that I can't stand and am continuously puzzled by how America has drifted away from our American values to be over run with freeloaders, leeches, perceived entitlement, self-serving/liberal media, illegal aliens, and criminals, but the issues of nurse practitioner competitiveness and reimbursement is a non-issue for me.

[nursetim, NP]

TheOldGuy, where did you go to NP school? I went to Duke and we didn't get anywhere near what you got. 18 months of pharm and clinicals? 1yr of advanced patho? Sweet. I want that program. I'm serious, that sounds like a tough and excellent program. They do a post masters program as well, don't they? Did you also get surgical training as well? Could you build your own clinical experience in several different clinical areas? That would be cool. Thanks.

I think your numbers are a bit off on independant practice. From another thread "New Mexico, Arizona, Alaska, District of Columbia, Idaho, Montana, New Hampshire, Oregon, Rhode Island, Washington, Wyoming." and maybe Hawaii?