NP/PhD for RxP

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bcliff

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Could joint nurse practitioner/clinical (or counseling) PhD programs be an alternative route to RxP? I know that NP programs can be rigorous, so it may not be feasible to complete one while working on a doctoral degree. Alternatively, would it be beneficial to complete an NP program after completing grad school (similarly to an MSCP)? The NP component would allow you to prescribe and provide you with a better understanding of general anatomy and physiology and the PhD would let you perform psych evals and work in research/academia?

Only reason why I feel like this would be a bad idea is that someone who is this committed to practicing medicine, conducting research, performing evaluations/psychotherapy, and working in academia should just go straight to med school, especially since some of the prereq's for an NP program are similar.

It seems like there are quite a few 'direct entry' programs that allow students to pursue an MS in nursing without any prior RN experience, but I wonder if it's even possible to combine two professions like NP & Psychologist together - I'm sure the CPT codes would be completely different, so would if be possible to bill for medication management as an NP & psychological testing as a PhD?

Thoughts?

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I'm not going to hate on nurses. My mother-in-law is a nurse, her sister is a nurse, and their mother is a nurse. My PCP is a NP, and I enjoy the intimacy of care that I receive. That said, my in-laws are RN's and my PCP was an RN for years before she was an NP. The general consensus is that direct entry NP programs are bad for nurses, bad for patients, and bad for the medical field as a whole.

If you want to Rx, go to med school, or get a pharm master's and move to NM/LA/IL or somewhere else where Rx is allowed for psych. Hell, a PA program doesn't require nursing background (though I believe that they should be used for their original purpose, as a bridge of training for past military medics), but they provide a certain quality of Rx training that will keep you (hopefully) from murdering your patients.

Sorry if it sounds harsh, just my .02.
 
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Could joint nurse practitioner/clinical (or counseling) PhD programs be an alternative route to RxP? I know that NP programs can be rigorous, so it may not be feasible to complete one while working on a doctoral degree. Alternatively, would it be beneficial to complete an NP program after completing grad school (similarly to an MSCP)? The NP component would allow you to prescribe and provide you with a better understanding of general anatomy and physiology and the PhD would let you perform psych evals and work in research/academia?

Only reason why I feel like this would be a bad idea is that someone who is this committed to practicing medicine, conducting research, performing evaluations/psychotherapy, and working in academia should just go straight to med school, especially since some of the prereq's for an NP program are similar.

It seems like there are quite a few 'direct entry' programs that allow students to pursue an MS in nursing without any prior RN experience, but I wonder if it's even possible to combine two professions like NP & Psychologist together - I'm sure the CPT codes would be completely different, so would if be possible to bill for medication management as an NP & psychological testing as a PhD?

Thoughts?

I know a few psychologists who went back to NP school to prescribe and make more money. I'm not a big fan of direct entry programs. I don't do psych testing but we can code for psychotherapy with med management and/or just psychotherapy. We do psych evals also usually 2-3 a day for me.
 
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No, I appreciate it. I've read that MD's accuse MSCP programs of not being rigorous enough to allow PhD's to 'practice medicine', so that's what made me start to look at other routes, plus NP's prescription rights are more widely accepted as compared to psychologists. Also, while an NP can practice independently, I don't think PA's can (correct?), so a PhD/NP could prescribe without direct oversight from and MD.

Is there any news for RxP in IL? I only knew of LA & NM.
 
Is there any news for RxP in IL? I only knew of LA & NM.
I think I read somewhere that they passed that. I would check the Rx thread.

As for NP's practicing independently, it depends largely on the state. What they can prescribe also depends on the state.
 
I'm not going to hate on nurses. My mother-in-law is a nurse, her sister is a nurse, and their mother is a nurse. My PCP is a NP, and I enjoy the intimacy of care that I receive. That said, my in-laws are RN's and my PCP was an RN for years before she was an NP. The general consensus is that direct entry NP programs are bad for nurses, bad for patients, and bad for the medical field as a whole.

If you want to Rx, go to med school, or get a pharm master's and move to NM/LA/IL or somewhere else where Rx is allowed for psych. Hell, a PA program doesn't require nursing background (though I believe that they should be used for their original purpose, as a bridge of training for past military medics), but they provide a certain quality of Rx training that will keep you (hopefully) from murdering your patients.

Sorry if it sounds harsh, just my .02.

First of all, direct entry NP programs tend to be housed at top nursing schools (Yale, Columbia, Penn, etc.) instead of the online degree mills that many experienced RNs go to. The programs are rigorous and are highly competitive (once again, unlike schools like Capella, Walden, or whatever). Secondly, only one research study has examined whether or not RN experience is related to NP competency (as measured by physicians, no less) and it found that RN experience did not contribute to NP competency. This makes sense to me, considering how widely varied RN experience is, and what a different role being a NP is. Lastly, most people work as RNs during the MSN, so the typical direct entry grad has a few years of RN experience under their belt.

Please explain to me how a PA working in psych (with their one or two classes) is better equipped than someone whose entire education and clinical hours are focused on psych. In fact, I met a PA who told me he wanted to work in psych but lamented having only two classes (and no therapy training whatsoever) that left him feeling entirely unprepared to practice. I agree that PA training is likely superior for other fields (surgical, EM, etc.), but I would highly disagree that it's better than NP training when it comes to psych.

Not sure whose consensus you're referring to, but direct entry grads tend to do just fine around here, and the only negative things I've seen have actually been from floor RNs, not the people who are in the position of hiring or evaluating NPs. These programs aren't exactly new (mine is over 20 years old). In fact, coming from a top nursing school at a renowned medical center tends to only help employment, not hinder it. I know people are getting more critical of the online degree mills programs (as they should), but those are not direct entry, and for experienced RNs only.
 
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I agree that PA training is likely superior for other fields (surgical, EM, etc.), but I would highly disagree that it's better than NP training when it comes to psych.

Ok.

Not sure whose consensus you're referring to.

The consensus that I was referring to was from the nurses that I know and what I've read on this (and the medical) forum. Nothing keeps that consensus from being wrong.
 
Could joint nurse practitioner/clinical (or counseling) PhD programs be an alternative route to RxP? I know that NP programs can be rigorous, so it may not be feasible to complete one while working on a doctoral degree. Alternatively, would it be beneficial to complete an NP program after completing grad school (similarly to an MSCP)? The NP component would allow you to prescribe and provide you with a better understanding of general anatomy and physiology and the PhD would let you perform psych evals and work in research/academia?

Only reason why I feel like this would be a bad idea is that someone who is this committed to practicing medicine, conducting research, performing evaluations/psychotherapy, and working in academia should just go straight to med school, especially since some of the prereq's for an NP program are similar.

It seems like there are quite a few 'direct entry' programs that allow students to pursue an MS in nursing without any prior RN experience, but I wonder if it's even possible to combine two professions like NP & Psychologist together - I'm sure the CPT codes would be completely different, so would if be possible to bill for medication management as an NP & psychological testing as a PhD?

Thoughts?

I think in many ways a psych np/lcsw combination(if they have extensive therapy experience in different evidence based modalities) would be the gold standard for what a mental health practitioner would be.
 
I think in many ways a psych np/lcsw combination(if they have extensive therapy experience in different evidence based modalities) would be the gold standard for what a mental health practitioner would be.

So a psychiatrist?
 
So a psychiatrist?

If the psychiatrist is as skilled at different therapy modalities as a good lcsw, then sure, they would be the perfect provider too. It would really just depend on who between those two groups is the better therapist.

Another advantage to the lcsw is that they may be more adept at case management, finding resources, etc...which depending on the capacity one is working in could be very beneficial.
 
If the psychiatrist is as skilled at different therapy modalities as a good lcsw, then sure, they would be the perfect provider too. It would really just depend on who between those two groups is the better therapist.

Some are, others do primarily med management. I would assume this is like some psychologists do testing, some do therapy, some to consulting.

Another advantage to the lcsw is that they may be more adept at case management, finding resources, etc...which depending on the capacity one is working in could be very beneficial.

I agree that this is an area that almost every area needs to improve on. My area is counseling, specifically in rehabilitation/persons with disabilities. We have a major focus in advocacy and finding resources for our clients and many of us serve in case management positions (but we tend to have to fight the MSW's for those jobs pretty hard given their political activism).
 
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What's the prescription power of an psych nurse practitioner? Thinking of a mild-moderate severity group practice, a psych NP would be a great addition.

...but to add more to this thread, I feel like psych NPs are way better equipped to prescribe meds than psychologists. Prescribing meds is not just about knowing what's needed, but when they come in feeling an ailment, you have to know how it's contraindicated to other medication and have a broad sense of their overall physical health.
 
A number of RN/ANP have returned to earn their doctorate in Psychology. Some continue prescribing and others work as Psychologist only. My dissertation was over allowing psychologist entry into NP programs to gain skills-licensure in prescribing and it was agreed upon by all groups of psychologist except for psychologist who already were prescribing psychologist in NM, LA, DOD, BIA, or Guam.

There were some Bridge programs allowing entry into NP for individuals with a MS in another field. Most of these programs were discontinued since NP will be a Doctoral degree beginning in 2017.

I applied to two NP programs and was accepted by both. I was going to have to take 18-25 prerequisite courses mostly in the hard sciences of chemistry, anatomy, ect...

I have completed the two-year postdoctoral clinical psychopharmacology training while in my doctoral clinical psychology training but they would not allow the certificate courses to cover the requested remedial prerequisite courses.

Basically it was going to be another 3-4 years after taking the prerequisite courses. My suggestion is to go the DO/MD route.

I am now licensed as a psychologist in three States but these States have not tried to pass laws for RxP. Illinois will require PA training with the hard science prerequisites.

One of the major reason RxP trained psychologist do not favor the NP training as due to attitude that the postdoctoral clinical psychopharmacology training is superior and that NP degree is an inferior degree to PhD trained psychologist. It seems that there may eventually be a PhD degree in Clinical Psychopharmacology allow psychologist to work as prescribing psychologist and clinical psychologist. Most of the RxP trained psychologist contend that you have to be a clinical psychologist first before being a prescribing psychologist.
 
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A number of RN/ANP have returned to earn their doctorate in Psychology. Some continue prescribing and others work as Psychologist only. My dissertation was over allowing psychologist entry into NP programs to gain skills-licensure in prescribing and it was agreed upon by all groups of psychologist except for psychologist who already were prescribing psychologist in NM, LA, DOD, BIA, or Guam.

There were some Bridge programs allowing entry into NP for individuals with a MS in another field. Most of these programs were discontinued since NP will be a PhD degree beginning in 2017.

I applied to two NP programs and was accepted by both. I was going to have to take 18-25 prerequisite courses mostly in the hard sciences of chemistry, anatomy, eat...

I have completed the two-year clinical psychopharmacology training while in my doctoral clinical psychology training but they would not allow the certificate courses to cover the requested remedial courses.

Basically it was going to be another 3-4 years after taking the prerequisite courses. My suggestion is to go the DO/MD route.

I am now licensed as a psychologist in three States but these States have not tried to pass laws for RxP. Illinois will require PA training with the hard science prerequisites.

Has this actually been agreed upon and set in stone? Last I'd heard, it was still aspirational, and was not universally supported. Also, if I'm recalling correctly, I believe it's technically the DNP rather than a PhD, but I could be wrong.
 
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I am not sure about the doctoral designation, it could be a DNP. The two programs where I was accepted two-years ago is not accepting MSN students anymore and are now only accepting DNP students. Both of their DNP programs are online programs that require BSN and MSN for admissions. My guess is once they completely discontinue the MSN option, they will need to have the BSN only as being required. There are some EdD and PhD Nurse Practitioner programs.

I was looking into doing a BSN degree but discovered that most of these programs have admission requirement that are highly selective based on meeting guidelines for completing many of the pre-med curriculum. Additionally, most require full time study as you have to do clinicals year round and most are unpaid experiences making it hard to work full time at a job and do your clinicals at the same time. Additionally, almost all nursing curriculum courses are daytime courses making it difficult to hold a full time job and complete these classes unless you have a psychologist job that is evenings and weekends. BSN degrees are now similar to pre medical curriculum with requirement to complete similar courses and applicants are not fully accepted into the BSN degree until they have met these core medical course requirements.

One area of conflict is use of the title "Doctor" by ANP and it becomes confusing in a hospital setting. Since I left my postdoct, four of the MD/DO psychiatrist have also left and now there is only one MD and they have hired ANP to replace the four departing MD/DO. This is becoming the trend in psychiatry that ANP are replacing MD/DO who leave to work in private practice or in a general psychiatric hospital setting.

Two of the MD trained psychiatrist where I completed my postdoctoral, were RN's before returning to complete their MD degree and it is my understanding that the RN curriculum is very similar to pre-med curriculum now with the advantage of having clinical experiences during BSN training program that the pre-med curriculum does not provide.
 
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I am not sure about the doctoral designation, it could be a DNP. The two programs where I was accepted two-years ago is not accepting MSN students anymore and are now only accepting DNP students. Both of their DNP programs are online programs that require BSN and MSN for admissions. My guess is once they completely discontinue the MSN option, they will need to have the BSN only as being required. There are some EdD and PhD Nurse Practitioner programs.

I was looking into doing a BSN degree but discovered that most of these programs have admission requirement that are highly selective based on meeting guidelines for completing many of the pre-med curriculum. Additionally, most require full time study as you have to do clinicals year round and most are unpaid experiences making it hard to work full time at a job and do your clinicals at the same time. Additionally, almost all nursing curriculum courses are daytime courses making it difficult to hold a full time job and complete these classes unless you have a psychologist job that is evenings and weekends. BSN degrees are now similar to pre medical curriculum with requirement to complete similar courses and applicants are not fully accepted into the BSN degree until they have met these core medical course requirements.

One area of conflict is use of the title "Doctor" by ANP and it becomes confusing in a hospital setting. Since I left my postdoct, four of the MD/DO psychiatrist have also left and now there is only one MD and they have hired ANP to replace the four departing MD/DO. This is becoming the trend in psychiatry that ANP are replacing MD/DO who leave to work in private practice or in a general psychiatric hospital setting.

Two of the MD trained psychiatrist where I completed my postdoctoral, were RN's before returning to complete their MD degree and it is my understanding that the RN curriculum is very similar to pre-med curriculum now with the advantage of having clinical experiences during BSN training program that the pre-med curriculum does not provide.

I don't know if I'd yet say it's a universal trend; our psychiatrist colleagues might have a better vantage point, but I can say that at each of the hospitals at which I've worked (which were VA or academic medical centers), psychiatrists outnumbered psychiatric NPs by a large margin (3 or 4 to 1, if not more). The same holds true at my current outpatient clinic. Although at this point, we're just trading anecdotal experiences. I'm sure there's some data out there looking at this, but last I heard, psychiatrists were still in very high demand just about everywhere, even with NPs being available.

All that being said, of the two prescribing options (NP vs. MD/DO), the NP route of course offers the shorter alternative to psychologists looking to prescribe in a non-RxP state. And particularly for folks planning on prescribing to predominantly milder severity cases, it probably also represents a more pragmatic approach, especially if a relationship already exists with psychiatry.
 
The VA and Medical Centers have options available for MD/DO and many are still doing private practice or doing adjunct work at Medical Schools. Private Psychiatric Hospitals and CMHC do not have the funding of the VA or Medical Centers, so they hire two ANP for the salary of one MD/DO. It boils down to a numbers and finance equation. Most ANP make under $100,000 a year whereas most MD/DO are over $200,000 per year. Many Psychologist make over $100,000 per year, so from an income perspective versus liability perspective it does not necessarily make income sense for a Psychologist to gain prescription privileges as a ANP to have reduced income. When I was living in Louisiana, the general opinion of the salary for Medical Psychologist was in the $200,000 range. This is one reason most of the RxP psychologist in my study were against having ANP as an option for becoming Medical Psychologist due to the fear of it would actually water down the qualifications, and therefore, reduce the potential income for Medical Psychologist.

In the broad scheme of psychiatry, the VA/DOD and General Medical Facilities are outliers and most DO/MD Psychiatrist do not work in these facilities. From my Psychiatrist friends the VA and Medical Facilities are only preferred for beginning jobs or residency training and most prefer private practice options where the income is significantly higher.
 
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