Why are FNP paid less than Psychiatric NP?

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Specializes in Psych.

This ksnisn't a knock against any specialists. I look up the salary to each and in most states I read that the PMHNP gets paid more than FNP. I would have assumed that the FNP would be able to work with any patient since they deal with all ages and the PMHNP deals with psych patients. Is there something I'm missing between the 2?

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Specializes in OB.

Supply and demand?

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My guess is that it's harder to fill the PMHNP positions. The general comments from my colleagues have been, "I do not like working with psych patients" or "It takes a special/unique person to work in psych" (i.e., not them). For example, my emergency medicine friends tell me the psych patients are the most challenging and trying, and that they would rather deal with cardiac arrests and bullet wounds than a psych patient freaking out.

There is a lot of mental health illness within our population yet if not a lot of providers want to work in psych medicine, then there has to be an incentive.

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Simple: PMHNP's are specialists and spend their entire clinical time working in one area. There are not many PMHNP programs and like you said, not many people want to work in psych.

I firmly believe that FNPs working in psych environments are absolutely outside of their scope of practice. If they are in a primary care environment and have a patient with generalized anxiety or depression? Absolutely..that is primary care. But anything past that? Nope...refer. Or else you'll be sitting in court trying to defend yourself if one of your patients commits suicide if they have advanced needs...and will come up short when they ask you to review your psych training in FNP school.

FNPs are not qualified to treat any condition in any aged patient. They are PRIMARY care providers and many states are cracking down on the misuse of FNPs working outside of their scope as it has been going on for years. Recognizing your limitations as an APRN is part of professional responsibility.

FNPs do generally three areas.....pediatrics, women's health/OB, and adult/gero. Last semester is generally dedicated toward a more intensive practicum of around 200+ hours. Psych is not part of the mix.

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In the 2 main jobs I have had, as a Psych NP, I have not been paid more than my FNP counterparts. Both are large companies.

And most psych pts do not have "good insurance" by definition.

So I am not sure where this comes from, but there is a rumor going around that some psych NPs make big money that others do not.

I can neither prove nor disprove it.

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Specializes in Behavioral Health.

I do think it is supply and demand at this time, HOWEVER, we are seeing a shift in this in my region. I go to a local brick and mortar, and my program alone has over 100 students enrolled in the PMHNP track--whether it be for a new MSN degree or a post-masters cert. I work for one of the largest healthcare systems in my state in an outpatient behavioral health clinic. I am graduating in 7 months and was just told by my employer that they presently have NO PMHNP positions open, so there may be a possibility that I will have to look elsewhere :(

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1 hour ago, USA987 said:

I do think it is supply and demand at this time, HOWEVER, we are seeing a shift in this in my region. I go to a local brick and mortar, and my program alone has over 100 students enrolled in the PMHNP track--whether it be for a new MSN degree or a post-masters cert. I work for one of the largest healthcare systems in my state in an outpatient behavioral health clinic. I am graduating in 7 months and was just told by my employer that they presently have NO PMHNP positions open, so there may be a possibility that I will have to look elsewhere ?

Come to the mid-Atlantic region. All you have to do is throw a stone and there are tons of jobs.

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13 hours ago, USA987 said:

I do think it is supply and demand at this time, HOWEVER, we are seeing a shift in this in my region. I go to a local brick and mortar, and my program alone has over 100 students enrolled in the PMHNP track--whether it be for a new MSN degree or a post-masters cert. I work for one of the largest healthcare systems in my state in an outpatient behavioral health clinic. I am graduating in 7 months and was just told by my employer that they presently have NO PMHNP positions open, so there may be a possibility that I will have to look elsewhere ?

Over 100 new PMHNPs and not a single local job. This sounds like my nightmares.

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Specializes in mental health / psychiatic nursing.
15 hours ago, USA987 said:

I do think it is supply and demand at this time, HOWEVER, we are seeing a shift in this in my region. I go to a local brick and mortar, and my program alone has over 100 students enrolled in the PMHNP track--whether it be for a new MSN degree or a post-masters cert. I work for one of the largest healthcare systems in my state in an outpatient behavioral health clinic. I am graduating in 7 months and was just told by my employer that they presently have NO PMHNP positions open, so there may be a possibility that I will have to look elsewhere ?

A 100 students! Yikes! My brick and mortar PMHNP program just graduated 11 of us, and everyone locally is in a titter because they are expanding to accepting 15 students a year! Suffice to say clinicals were arranged by the school and none of us have had any difficulties finding employment post-graduation.

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21 hours ago, USA987 said:

I do think it is supply and demand at this time, HOWEVER, we are seeing a shift in this in my region. I go to a local brick and mortar, and my program alone has over 100 students enrolled in the PMHNP track--whether it be for a new MSN degree or a post-masters cert. I work for one of the largest healthcare systems in my state in an outpatient behavioral health clinic. I am graduating in 7 months and was just told by my employer that they presently have NO PMHNP positions open, so there may be a possibility that I will have to look elsewhere ?

Wow 100 graduates! We had a local PMHNP program that lost their credentialing and we are so in need of PMHNPs. Noone I know wants to work in psych and they find it very demanding so the pay for PMHNPs are higher in our area than FNPs.

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On 9/22/2019 at 2:14 PM, The0Walrus said:

I would have assumed that the FNP would be able to work with any patient since they deal with all ages

This is a huge misconception, and it's part of the reason for the Consensus Model. Just because FNPs can care for all ages doesn't mean that they have the capacity to care for all patients. FNPs are generalists, and therefore don't have sufficient training to work in highly-specialized areas like psych (as many other PPs have pointed out). Another example is ED; while some FNPs have historically worked in emergency care, the consensus model is forcing experienced FNPs out of the hospital setting since the acute care patients frequently seen in ED are outside of their scope. In medicine on the whole, primary care (the most common setting for FNPs) tends not to be as well reimbursed as certain specialties; this is especially true when the supply of generalists (FNPs) is high and the supply of specialists (PMHNPs, NNPs, PNP-ACs, for instance) is low.

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Specializes in Nurse Scientist-Research.

I'm going to have to go with market forces. Market forces affect several aspects. One thing is that (it seems) that about 80% of new RN (or at least BSN) grads are already picking out their FNP program when they get their first job. Surveys seem to confirm this perception in that there were twice as many NPs in the market in 2018 as there were 10 years before and at least 2/3 are FNPs. While the market does appear to be strong, primary care has never paid like specialities have in any field of healthcare. Just go compare the homes of your average CT surgeon to that of the average family practice MD even in the same urban/suburban area.

Other market factors include the increase in the psychiatric field. There is still a lot of stigma around psychiatric care, but much less than in years past so people are more willing to seek treatment.

Another factor that increases the market of psych patients is the availability of telehealth. While some telehealth services are available with many specialties, psychiatric services are very well suited to this form of care delivery. A PHMNP can video chat with a patient then electronically send medication adjustments to the patient's local pharmacy. This allows patients in more rural areas to access psychiatric care that was not previously available to them.

https://www.aanp.org/news-feed/nurse-practitioner-role-continues-to-grow-to-meet-primary-care-provider-shortages-and-patient-demands

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