Combining Careers (Clinical Psychology and FNP/PMHNP)

[Complex_Brotha]

Hello all,

I am a single 35 yo gay male who will be finishing his PhD in clinical psychology this year. I am thinking about going back to school to become a FNP or Psychiatric NP to combine with my clinical psychology degree. During my clinical internship I had a lot of conversations with patients and psychiatrists about the lack of behavioral healthcare, especially in prescribing medicine. There are only a few states that allow for psychologists to prescribe and as of now I can't commit to living that far away from my parents due to them aging.

I am also interested in working with the LGBT community (there is a lack of practitioners who are culturally sensitive with this population). With all this being said...

What are your thoughts about someone with a PhD re-entering into another healthcare field?

What challenges do you think I face?

Additionally, I have maxed out my loans so as for now I would have to either pay out of pocket or work to pay for school. Has anyone worked and gotten their nursing degree while working?

I know I have a lot of questions but I have been contemplating this a lot lately.

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[LAPsyGuy]

I sounds like you are trying to piecemeal together a career as a psychiatrist without going to medical school. Why not just go all the way, and do medical school, or accept the limitations of your graduate degree and work closely as a team with a licensed prescriber?

 

[mcvcm92]

Since you said you maxed out your loans, I would just try to get a job with your Ph.D. That's a lot of money to pay back - so you should probably not accrue more debt (NP programs are not funded as far as I know). Good luck!

 

[erg923]

What are your thoughts about someone with a PhD re-entering into another healthcare field?

I'm confused why I am suppose to have an opinion about this? This is your personal choice. Its like asking if its ok to stop working as a psychologist and become a chef. Uh, sure. If that's what you wanna do for living. What do I care?

I think you already identified your challenges: Money and time (work/life balance).

 

[OneNeuroDoctor]

The window of opportunity to do this is limited as ANP will be DNP in the near future so the Bridge programs are being discontinued. My dissertation was over this topic as there are many Psychologist who took this route the past 15 years.

I applied to a number of ANP programs that allow other MS degree applicants and you get your RN during the two-year ANP training. Primary hurdle was I needed to take 4 prerequisite courses including Anatomy and Chemistry. I checked out local universities and these courses were all in the daytime. I then checked into the RN program and they have all daytime courses and a heavy experiential component where you work in medical clinics and Hospital during daytime hours. The more I explored this option the more hurdles I discovered.

There seems to be some sort of fantasy that being a prescriber is tied in with more respect and competence. I am now licensed as a psychologist with professional status in NAN and have as much or more opportunities than most ANP and a higher income level.

To be an ANP you probably would face the same hurdles and require 2-3 years full time study. If you are just finishing up your PhD you have to do your postdoctoral and take the EPPP and this could take two-years at a low income. Once you become fully license many opportunities and a big jump in income will happen.

Hindsight being 20/20 you probably would have finished a MD/DO within the same time line as PhD except for 3-4 year residency.

You might check into the two-year postdoctoral clinical psychopharmacology training as you can prescribe in DOD, IHS, and Guam. NM, LA, and Illinois now have prescription privileges. VA will be next to have prescription privileges for psychologist. Given your young age, your State could have prescription privileges during your time span of practicing as a psychologist.

 

[Complex_Brotha]

Since you said you maxed out your loans, I would just try to get a job with your Ph.D. That's a lot of money to pay back - so you should probably not accrue more debt (NP programs are not funded as far as I know). Good luck!

I guess because NP would be a quicker route. I have heard other PhDs do so.

The window of opportunity to do this is limited as ANP will be DNP in the near future so the Bridge programs are being discontinued. My dissertation was over this topic as there are many Psychologist who took this route the past 15 years.

I applied to a number of ANP programs that allow other MS degree applicants and you get your RN during the two-year ANP training. Primary hurdle was I needed to take 4 prerequisite courses including Anatomy and Chemistry. I checked out local universities and these courses were all in the daytime. I then checked into the RN program and they have all daytime courses and a heavy experiential component where you work in medical clinics and Hospital during daytime hours. The more I explored this option the more hurdles I discovered.

There seems to be some sort of fantasy that being a prescriber is tied in with more respect and competence. I am now licensed as a psychologist with professional status in NAN and have as much or more opportunities than most ANP and a higher income level.

To be an ANP you probably would face the same hurdles and require 2-3 years full time study. If you are just finishing up your PhD you have to do your postdoctoral and take the EPPP and this could take two-years at a low income. Once you become fully license many opportunities and a big jump in income will happen.

Hindsight being 20/20 you probably would have finished a MD/DO within the same time line as PhD except for 3-4 year residency.

You might check into the two-year postdoctoral clinical psychopharmacology training as you can prescribe in DOD, IHS, and Guam. NM, LA, and Illinois now have prescription privileges. VA will be next to have prescription privileges for psychologist. Given your young age, your State could have prescription privileges during your time span of practicing as a psychologist.

The window of opportunity to do this is limited as ANP will be DNP in the near future so the Bridge programs are being discontinued. My dissertation was over this topic as there are many Psychologist who took this route the past 15 years.

I applied to a number of ANP programs that allow other MS degree applicants and you get your RN during the two-year ANP training. Primary hurdle was I needed to take 4 prerequisite courses including Anatomy and Chemistry. I checked out local universities and these courses were all in the daytime. I then checked into the RN program and they have all daytime courses and a heavy experiential component where you work in medical clinics and Hospital during daytime hours. The more I explored this option the more hurdles I discovered.

There seems to be some sort of fantasy that being a prescriber is tied in with more respect and competence. I am now licensed as a psychologist with professional status in NAN and have as much or more opportunities than most ANP and a higher income level.

To be an ANP you probably would face the same hurdles and require 2-3 years full time study. If you are just finishing up your PhD you have to do your postdoctoral and take the EPPP and this could take two-years at a low income. Once you become fully license many opportunities and a big jump in income will happen.

Hindsight being 20/20 you probably would have finished a MD/DO within the same time line as PhD except for 3-4 year residency.

You might check into the two-year postdoctoral clinical psychopharmacology training as you can prescribe in DOD, IHS, and Guam. NM, LA, and Illinois now have prescription privileges. VA will be next to have prescription privileges for psychologist. Given your young age, your State could have prescription privileges during your time span of practicing as a psychologist.

Thank you for your response. May I ask what is NAN?

 

[OneNeuroDoctor]

National Academy of Neuropsychology. I have started process of applying for ABPP- CN Board credentials as my understanding is this will increase my opportunities of obtaining affiliated hospital staff privileges. With the Affordable Care Act most psychologist will need to be within a Medical Home system to receive services and payment of service.

 

[Complex_Brotha]

National Academy of Neuropsychology. I have started process of applying for ABPP- CN Board credentials as my understanding is this will increase my opportunities of obtaining affiliated hospital staff privileges. With the Affordable Care Act most psychologist will need to be within a Medical Home system to receive services and payment of service.

Ok. I have minimal experience with neuropsych experience. During my educational process and internship I tried to get experience but the opportunities were typically given to those strictly focused on neuropsych.

 

[deleted343839]

During my clinical internship I had a lot of conversations with patients and psychiatrists about the lack of behavioral healthcare, especially in prescribing medicine.

In my experience, skilled therapists with solid training in empirically supported psychotherapies for mental disorders are harder to find than clinicians who will write prescriptions for psychotropics. If you've taken a genuine interest in psychopharmacology or nursing practice, fine, but I can't help wondering if you're undervaluing your training in psychological assessment and intervention. You might have the potential to be a greater resource than you think you are, particularly if you are interested in serving the LGBT community.

Nursing and psychology are very different professions with distinct philosophies and ways of understanding health and behavior. In day-to-day practice these differences may be less apparent, but I've taken a few graduate-level nursing courses and this is where our differences in training become readily apparent. Also, practicing under a nursing license and a psychology license simultaneously might not be as seamless as you presume. Consider getting some years of psychological practice under your belt before you decide to commit to another career.

 

[erg923]

During my clinical internship I had a lot of conversations with patients and psychiatrists about the lack of behavioral healthcare, especially in prescribing medicine.

Most psychotropics are not prescribed by MH professionals (psychiatrists, ARNPs). I think its commonplace for PCP and FP to prescribe the psychotropics for the behavioral health disorders that are the most common (depression, anxiety, insomnia). There is certainly no shortage of psychotropic prescribing in this country. There is indeed a shortage of psychiatrists to care for the seriously and persistently mentally ill.

 

[Fan_of_Meehl]

MamaPhD hit the nail on the head. Some of my best training happened under the tutelage of Dr. Jesse Wright, MD (psychiatry), PhD (psychopharmacology). Dr. Wright (along with Michael Thase and John Rush) was among the first cohort of cognitive therapists trained by Aaron T. Beck. The man--despite having earned a friggin' PhD in psychopharmacology--had tremendous respect for good psychotherapy (his particular brand was, of course, cognitive therapy). He went on to author a fairly popular text nowadays, Learning Cognitive Behavior Therapy. I remember conversations with him in which he compared a good therapist with a good surgeon in that the skill of the practitioner was absolutely critical to getting good results (and, I suppose, implying that there was an element of 'artistry/craft' to the expertise in surgery/psychotherapy vs. doing a quick differential diagnosis and prescribing a standard pharmacological intervention). Within the psychiatric clinic where he was medical director all of the psychiatrists were expected to exhibit competence in cognitive therapy and to utilize it in their work with patients (and many of them were steadily and fairly widely published in the area of cognitive therapy). It was a very unusual situation in mental health where there was quite a bit of status associated with psychotherapeutic skill with it being actually more highly valued than what was seen as the relatively straightforward practice of psychopharmacology (at least for most patients). In my experience a very small percentage of practicing mental health clinicians in most settings (say, around 5-20%?) appear to actively engage in providing specific and structured therapeutic interventions informed by good diagnostics and case formulation. I am hopeful that we will have a 'Flexner moment' at some point in the next 10-20 years and the practice of professional psychotherapy will be differentiated from 'come talk to me and I will listen and give you the diagnosis/treatment you insist that I give you because you don't want to lose your service connection for PTSD, or whatever (sorry, bit of a VA rant thrown in there).

 

[WisNeuro]

I am hopeful that we will have a 'Flexner moment' at some point in the next 10-20 years and the practice of professional psychotherapy will be differentiated from 'come talk to me and I will listen and give you the diagnosis/treatment you insist that I give you because you don't want to lose your service connection for PTSD, or whatever (sorry, bit of a VA rant thrown in there).

What should we prescribe for the increasingly prevalent SC for "traumatic brain disease?"

 

[Fan_of_Meehl]

What should we prescribe for the increasingly prevalent SC for "traumatic brain disease?"

My friend, that whole arm of the process gives me persistent headaches, insomnia, irritability, impulse control issues and, at times, even tinnitus. And, although I haven't suffered a mild TBI event, my self-report of symptoms makes sense in light of the research that's been done on folks self-reporting such symptoms at similar levels to the mTBI crowd.

The clinical/scientific issues surrounding the whole mTBI 'postconcussional syndrome' controversity are challenging enough. What makes it unbearable in the VA is the dense sociopolitical cloud surrounding it and the emotions/politics involved in granting or not granting diagnoses (PTSD and mTBI are at the top of the list). They are the 'signature headaches' for a responsible mental health clinician to try to handle. The irresponsible clinicians simply give the veteran what they want regardless of the clinical/scientific realities. They are likely to get promoted up the VA hierarchy in the future (because all their patients are happy with their 'care') and the cycle continues and deepens.

 

[WisNeuro]

Yeah, I'm wondering when I'm going to start getting pushback from my reports. I'm very explicit about the validity of the data and the expected course of recovery depending on injury characteristics. So far, so good though.

 

[Fan_of_Meehl]

It probably depends heavily on your leadership (at the Service Chief level) as well as the political administrative climate at your VA. What frustrates me, though, is that because very few clinicians seem to act (in their reports/diagnoses) in concert with what they know and discuss (in private), then those who do feel compelled to act responsibly appear to be pissing veterans off unnecessarily (from the standpoint of the 'higher-ups'), otherwise, why is Dr. X getting so many complaints lodged by veterans? This makes the responsible clinician an outlier.

 

[Fan_of_Meehl]

I had my first formal written complaint lodged last week by a veteran who, basically, placed me in a 'no-win' position where I had to go on record as doubting the validity of his self-report (in a risk assessment context). Came in to session and starts out by saying 'My PTSD is causing me to engage in risky behavior that's associated with a 95% chance of injury.' Then, when I ask what behaviors he is actually engaging in he is evasive and won't tell me. So I ask how frequently he is engaging in these behaviors. Tells me 'all the time.' Then, when I ask, 'at least once per day', he says yes, most days more often. So, for at least the past two weeks he has been engaging in risky behaviors associated with a 95% chance of injury at least once (often more) per day. So I ask if he has sustained any injuries from these activities? No. Why not? I am protected by God. (Note that he is not psychotic and has no history of being psychotic). So, I look more into the record and see that his PTSD dx was based on a C&P exam where the examiner diagnosed PTSD after noting in his report that the MMPI-2 results were invalid and reflective of over-exaggerated psychopathology. Examiner gave him PTSD anyway without blinking. So, in my note, I backed off the PTSD diagnosis (I had inherited the case from another clinician with the dx) due to concerns about reliability of self-report (and flimsy original PTSD dx) and converted it to 'rule-out' status pending further investigation/testing on my part. Patient engages in formal written complaint process and I have to explain my actions to several people and I still don't know how it is going to turn out. If I had just ignored the veteran's statements and not 'rocked the boat', all would have been okay. Also, the patient's treating psychiatrist apparently became livid at me for daring to question the diagnosis and, according to the patient advocate, began cursing me out in absentia and in front of the patient. But he claims that I am the one behaving unprofessionally by 'traumatizing' the veteran. Veteran now has a new therapist.

 

[AcronymAllergy]

I had my first formal written complaint lodged last week by a veteran who, basically, placed me in a 'no-win' position where I had to go on record as doubting the validity of his self-report (in a risk assessment context). Came in to session and starts out by saying 'My PTSD is causing me to engage in risky behavior that's associated with a 95% chance of injury.' Then, when I ask what behaviors he is actually engaging in he is evasive and won't tell me. So I ask how frequently he is engaging in these behaviors. Tells me 'all the time.' Then, when I ask, 'at least once per day', he says yes, most days more often. So, for at least the past two weeks he has been engaging in risky behaviors associated with a 95% chance of injury at least once (often more) per day. So I ask if he has sustained any injuries from these activities? No. Why not? I am protected by God. (Note that he is not psychotic and has no history of being psychotic). So, I look more into the record and see that his PTSD dx was based on a C&P exam where the examiner diagnosed PTSD after noting in his report that the MMPI-2 results were invalid and reflective of over-exaggerated psychopathology. Examiner gave him PTSD anyway without blinking. So, in my note, I backed off the PTSD diagnosis (I had inherited the case from another clinician with the dx) due to concerns about reliability of self-report (and flimsy original PTSD dx) and converted it to 'rule-out' status pending further investigation/testing on my part. Patient engages in formal written complaint process and I have to explain my actions to several people and I still don't know how it is going to turn out. If I had just ignored the veteran's statements and not 'rocked the boat', all would have been okay. Also, the patient's treating psychiatrist apparently became livid at me for daring to question the diagnosis and, according to the patient advocate, began cursing me out in absentia and in front of the patient. But he claims that I am the one behaving unprofessionally by 'traumatizing' the veteran. Veteran now has a new therapist.

Very unfortunate, but obviously not unusual. I can say it's not ubiquitous to all VAs, though. Where I work, while there are a couple clinicians who will take everyone at their word, regardless what testing and/or critical thinking might indicate (i.e., they'll try and explain away such findings), most folks understand the various complexities of the reinforcing systems at play, and appreciate that not everyone who comes in claiming to have a condition is actually experiencing significant resulting impairment, or even has the condition, just because they say so.

 

[Complex_Brotha]

I had my first formal written complaint lodged last week by a veteran who, basically, placed me in a 'no-win' position where I had to go on record as doubting the validity of his self-report (in a risk assessment context). Came in to session and starts out by saying 'My PTSD is causing me to engage in risky behavior that's associated with a 95% chance of injury.' Then, when I ask what behaviors he is actually engaging in he is evasive and won't tell me. So I ask how frequently he is engaging in these behaviors. Tells me 'all the time.' Then, when I ask, 'at least once per day', he says yes, most days more often. So, for at least the past two weeks he has been engaging in risky behaviors associated with a 95% chance of injury at least once (often more) per day. So I ask if he has sustained any injuries from these activities? No. Why not? I am protected by God. (Note that he is not psychotic and has no history of being psychotic). So, I look more into the record and see that his PTSD dx was based on a C&P exam where the examiner diagnosed PTSD after noting in his report that the MMPI-2 results were invalid and reflective of over-exaggerated psychopathology. Examiner gave him PTSD anyway without blinking. So, in my note, I backed off the PTSD diagnosis (I had inherited the case from another clinician with the dx) due to concerns about reliability of self-report (and flimsy original PTSD dx) and converted it to 'rule-out' status pending further investigation/testing on my part. Patient engages in formal written complaint process and I have to explain my actions to several people and I still don't know how it is going to turn out. If I had just ignored the veteran's statements and not 'rocked the boat', all would have been okay. Also, the patient's treating psychiatrist apparently became livid at me for daring to question the diagnosis and, according to the patient advocate, began cursing me out in absentia and in front of the patient. But he claims that I am the one behaving unprofessionally by 'traumatizing' the veteran. Veteran now has a new therapist.

Are you a neuropsychologist?

 

[Fan_of_Meehl]

Are you a neuropsychologist?

No.