Texas Nurse practitioners-expert advice needed please

apocatastasis · Jan 11, 2012

You will not have trouble finding a job as a psychiatric provider in Texas, which is in dire straits as far as mental health goes. We lack providers and they continue to cut away the pennies that had been provided to the counties/MHMR system. They ran an article on Texas and mental health funding in the Texas Tribune in the past month: Interactive: Texas' Critical Shortage of Psychiatrists, Mental Health Professionals .

I feel like even the maps in the article paint a rosier picture than actually exists: I work at an ER in Austin and do clinicals at a MHMR in the area and at a drug rehab center... I see on a daily basis how bad it is and how fragmented mental health in Texas is. People regularly are held in the ER for days for a psych bed, while my patients in clinical complain how difficult it is to get timely appointments with a prescribing psych provider even in urban areas in Texas. They're frustrated by how they can't move from Williamson to Travis county because it's a different MHMR and it'll take 3 months before they get an appointment and they can't be scheduled for an appointment in Travis County until they are officially discharged from Williamson County.

As far as FNPs, generally speaking, they may not work in the same capacity as psych NPs as the scopes are different. The Texas board has really cracked down on non-psychiatric APNs working in psychiatric settings and the kinds of psychiatric illnesses that they can manage. If you want to do psych in Texas, you might as well not waste your time becoming an FNP, because, sooner or later, you WILL hear from the Board. Three of the seven people in my psych program are already APNs (two DNP/FNPs and an adult health CNS). At least one of them was formally ordered by the Board to cease and desist working in an advanced practice psychiatric role unless she obtained a post-Master's PMHNP certification. See APN Scope of Practice

It is true that Texas, legislatively speaking, is not currently an NP-friendly state, evidenced by the way we were thrown to the ground AGAIN in the last legislative session. APNs (and us APN students) lobbied like there was no tomorrow to gain ground in the battle against MDs, who have much more money, prestige, and lobbying power (they have a couple dozen lobbyists... the Texas Coalition for Advanced Practice Nurses has: ONE.). Although we have some sympathetic ears who sponsor our bills, the bills were not brought to a vote (cough for entirely bogus reasons cough) and so died in committee. There is a lot of disgust and anger, at least in the Austin psych NP community, over this. Eventually, Texas will have to follow the nationwide trends and grant increasing liberties to NPs, but will it be in 2 years or 20? I am beginning to hear rumblings over the pros and cons of a lawsuit arguing that physicians and the medical board are restricting NP trade.

However, all that said, there is wide variation in support for psych NPs at the institutional and local level. One of my classmates, who works at austin state hospital, has said that the chief medical officer has expressed great interest to her in hiring psych NPs and in significantly increasing their pay, which currently stands at 60k-70k a year. She has also been approached (i.e. begged) by another psych hospital in town who is willing to bend over backwards in desperation. They've offered her a VERY nice compensation package. And we are still 4 months from graduation!

At least in the Austin and San Antonio areas, where I know psych NPs, the money can be very good if you can find an institution and/or fair collaborating physician to support you. Our professor even said, "If you work for the State in psych, don't take less than 100k a year." I personally know of at least two psych NPs here in private practice who pull in over 200k a year working 40-50 hours a week. I know I've told you that I'm planning on going to Oregon or Washington; inability to find a job is NOT AT ALL a factor in that decision.

I'll shut up now. :)

Bodhi123 · Jan 11, 2012

Apocatastasis,

Wow! Thank you so very much for this information! You have no idea how much I appreciate you taking the time to answer. This decision has been so difficult to make. I realize that there is no way to know for sure what the market will be like in 2 years, but the added information you just provided REALLY helps. Thanks a million!

Bodhi:D