Psychiatry vs. Psychiatric NP

[mlm55]

I was on the path to a clinical psychology PhD program but am currently reconsidering my options. I was accepted into a post-bacc pre-medical program and am considering pursuing that path with the hope of becoming a psychiatrist or psychiatric mental health nurse practitioner. The primary reason I am leaning considering the nurse practitioner route is because I am already in my mid-20's and would like to have a family some day (if I do psychiatry I will be in my mid 30's by the time I would finish residency and fellowship), and would like to have time with that family and time to pursue outside interests. I have a few questions about the differences between those paths.

- What settings do PMHNP's typically work in? Searching online, alot of the job listings seem to be in community mental health settings or inpatient facilities. Currently I work in an academic medical center in research, and I really like this setting. Are jobs readily available for PMHNP's in this setting, or would I be better off going the psychiatry route?

- The psychiatrists I currently work with are involved in clinical work as well as research. This is really appealing to me because I like variety in my work and am somewhat of an introvert, although I like working with people too. However it seems like the psychiatrists who do research have very demanding schedules; is this accurate? Can PMHNPs become involved in research/ do they have variety in their work?

- Are PMHNPs able to see the interesting patients or is their job involve mostly the more routine and simple cases?

- Is it possible to specialize in child and adolescent psychiatry as a nurse practitioner? Is it easy to find jobs in this specialty?

- For either job: does it become routine and boring after a time or do you continue to be challenged and interested in what you do? Also, do you find that you have rewarding interactions with colleagues or is working one-on-one with patients isolating?

Not sure if this is the right forum for this post, but any advice would be great!

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[Nasrudin]

- Is it possible to specialize in child and adolescent psychiatry as a nurse practitioner? Is it easy to find jobs in this specialty?

These are good questions and there are pro's and con's to both. But I'm quoting this to make the point that the idea of an NP having the ability to sub-specialize in anything is ridiculous. You don't hack off most of physician training and particularly residency and then again for subspecialty fellowship to arrive at anything resembling what you have if you didn't.

A child psychiatrist is a specialized psychiatrist and a doctor. An NP in child psychiatry is filling in where there is tremendous need with vastly inferior experience and training. Better than nothing. But not something that will allow you to influence the field or become a notable researcher outside of whatever equivalent of post-graduate training seminars exists by NP's for NP's.

Good luck in discovering what path is for you. I am clearly biased and singled out this one question because I feel it is the most factual of what I could say.

 

[Atom bum]

These are good questions and there are pro's and con's to both. But I'm quoting this to make the point that the idea of an NP having the ability to sub-specialize in anything is ridiculous. You don't hack off most of physician training and particularly residency and then again for subspecialty fellowship to arrive at anything resembling what you have if you didn't.

A child psychiatrist is a specialized psychiatrist and a doctor. An NP in child psychiatry is filling in where there is tremendous need with vastly inferior experience and training. Better than nothing. But not something that will allow you to influence the field or become a notable researcher outside of whatever equivalent of post-graduate training seminars exists by NP's for NP's.

Good luck in discovering what path is for you. I am clearly biased and singled out this one question because I feel it is the most factual of what I could say.

Not disagreeing with you, but try telling this to a nurse np that practices. They would vehemently disagree with you. Our opinions don't matter because we don't make them heard.

 

[AnnoyedByFreud]

First of all, you seem to have pretty detailed questions about the career opportunities for psych NPs, and this is a forum that's pretty hostile towards them , so take that into account. You might have better luck at allnurses, though that website is also crappy in other ways. The reality is there really are not any practicing psych NPs on this website, other than zenman.

If you want to practice in child psychiatry, you can as a PMHNP. For example, a classmate of mine will be spending the next year training in a residential setting for children and adolescents who have SMI. His preceptor is a child psychiatrist. Will he be as well trained as a psychiatrist who does a C&A fellowship? No. Will he come out of school with a good understanding of child psychiatry and be ready to practice in that setting with initial mentoring? I believe so. Other classmates of mine are passionate about geriatrics, so they are going to get a significant amount of their training in that area. You absolutely can do research as an NP. There are tons of grants for NPs to earn PhDs right now. Just choose your program wisely. Go to a university-based program attached to a medical center that has strong training and research opportunities. At my university there is a lot of collaborative research going on, probably because we are near the top in NIH funding across fields. These programs typically have lots research going on as well as connections with psychiatrists and PMHNPs, so students can get matched up based on their areas of interest.

Now whether or not the NP or MD route is right for you is a whole other ball of wax. There is lots of hand-waving on both sides. I have seen psych NPs practicing in a huge variety of settings (inpatient, outpatient, residential, C&L, etc.) Whether or not you will be able to do that as a psych NP depends entirely on where you practice and what the policies are of the institution. It varies widely. Try and shadow people, see what the job opportunities are, consider what your career goals are, how much sacrifice you want to make, debt concerns, etc. Try not to let the drama of the internet make decisions for you.

edit: To address your question about the types of patients pmhnps see: The psychiatry shortage is such that PMHNPs do not just see routine cases and often see the same acuity level as the psychiatrists. Also, I know a lot of PMHNPs who work entirely in community settings with some of the sickest patients both physically and mentally. While this is exciting, as a new NP it is utterly terrifying to have that level of responsibility. This is why going to a strong program and ensuring mentorship when you graduate (or doing a post-licensure NP fellowship) is crucial.

 

[Nasrudin]

First of all, you seem to have pretty detailed questions about the career opportunities for psych NPs, and this is a forum that's pretty hostile towards them , so take that into account. You might have better luck at allnurses, though that website is also crappy in other ways. The reality is there really are not any practicing psych NPs on this website, other than zenman.

If you want to practice in child psychiatry, you can as a PMHNP. For example, a classmate of mine will be spending the next year training in a residential setting for children and adolescents who have SMI. His preceptor is a child psychiatrist. Will he be as well trained as a psychiatrist who does a C&A fellowship? No. Will he come out of school with a good understanding of child psychiatry and be ready to practice in that setting with initial mentoring? I believe so. Other classmates of mine are passionate about geriatrics, so they are going to get a significant amount of their training in that area. You absolutely can do research as an NP. There are tons of grants for NPs to earn PhDs right now. Just choose your program wisely. Go to a university-based program attached to a medical center that has strong training and research opportunities. At my university there is a lot of collaborative research going on, probably because we are near the top in NIH funding across fields. These programs typically have lots research going on as well as connections with psychiatrists and PMHNPs, so students can get matched up based on their areas of interest.

Now whether or not the NP or MD route is right for you is a whole other ball of wax. There is lots of hand-waving on both sides. I have seen psych NPs practicing in a huge variety of settings (inpatient, outpatient, residential, C&L, etc.) Whether or not you will be able to do that as a psych NP depends entirely on where you practice and what the policies are of the institution. It varies widely. Try and shadow people, see what the job opportunities are, consider what your career goals are, how much sacrifice you want to make, etc. Try not to let the drama of the internet make decisions for you.

Hostility, and its progenitor, is a question of perspective. Obviously, the student doctor network psychiatry forum is not a den of entusiasm for NP-iatry. Why should it be?

OP, definitely get both sides. I may be partisan, but unlike an NP I don't disguise it for advantage.

 

[AnnoyedByFreud]

Hostility, and its progenitor, is a question of perspective. Obviously, the student doctor network psychiatry forum is not a den of entusiasm for NP-iatry. Why should it be?

OP, definitely get both sides. I may be partisan, but unlike an NP I don't disguise it for advantage.

I wasn't suggesting it should be. In fact, my point is that the OP is unlikely to receive accurate answers to their specific questions since people on this site are not NPs. I am telling the OP to consider the viewpoints of multiple individuals, and truly, to take the ones on the internet with a grain of salt.

 

[Nasrudin]

I wasn't suggesting it should be. In fact, my point is that the OP is unlikely to receive accurate answers to their specific questions since people on this site are not NPs. I am telling the OP to consider the viewpoints of multiple individuals, and truly, to take the ones on the internet with a grain of salt.

If including yours...then I agree

 

[AnnoyedByFreud]

Of course including mine.

 

[SteinUmStein]

To the original poster - it sounds like you have a strong bent toward academics and the research end of psychiatry. It would be misleading at best to say that PMHNPs have the same opportunities as an MD/DO for a career in research at an academic medical center. If that is a real interest of yours I would strongly suggest the MD/DO route with the potential for a PhD or research track/research fellowship down the line. Mid-20s is nothing, many medical students are in their 30s, 40s, and beyond. PMHNPs can do research but go ahead and pull out any of the influential journals in the field and take a look at the training background of the authors. If research is the focus, a PhD alone is probably a better use of your time than a nursing degree. If a blend of research and clinical practice is the focus, a medical degree is your best starting point IMO. If you'd like to see patients and get to work ASAP, a PMHNP will get you there, but PMHNP+PhD is not a fast track by any means.

 

[BestDoctorEver]

@mlm55 ... The worst that can happen is for you to do that psych NP and later on discover that it does not fulfill your career goals... From your post, one can see that you are very interested in research. Therefore, MD/DO might be a safe bet as far as opportunity. You are relatively young, so I don't think age should be a big deterrent here. For perspective, I am in my mid 30s and will start medical school in 2 months.

 

[Nasrudin]

On the otherhand, the lifestyle of forgoing medical school and residency is not without its benefit for having more time to parent or enjoy one's life in whatever way one sees fit. No shame in that.

 

[Therapist4Chnge]

It is important to note that completing an MD/DO program will not sufficiently prepare you to conduct independent research (as a PI/Primary Investigator). There is obviously a variance in training opportunities during medical school and residency/fellowship, though both MD and DO programs are setup to train clinicians, not researchers. If you want to do mostly collaborative work (with someone else being the PI), then this is less of an issue.

 

[Zenman1]

I'm a PMHNP. Right now you have to do child and adolesecent training in PMHNP school as they are all going to Family PMHNP. Luckily, I finished before that as I don't like kids except for looking at them from a distance. I went straight into locums work after school in a community mental health center and then a dentention center. I then did inpatient, outpatient, CL at a hospital. I'm currently in the last setting I want to work in, which is with the military. I have no interest in research, other than reading it, as most is hardly worth the paper it's written on. Journal editors will even tell you as much. My mornings are spent in a walk-in clinic where I see Soldiers who typically have run out of meds, having side effects, need to get on meds now prior to seeing someone for an intake, suicidal or homicidal, etc.. I may also clear a patient from med-surg floor. I've been doing this clinic for over a year and I'm probably the only person that likes it as I see everyone's patients and what they are doing. As such I'll probably have this clinic as long as I want it. In the afternoons I have my own patients. I prefer this population as I don't like dealing with homeless psychotics, for example. Soldiers will occasionally have their first psychotic break, or like one last week, become delusional. There are enough challenges though to keep you happy, with OCD, Bipolar disorders, Borderlines, binging, purging, or a combo. I also see lot's of Soldiers with PTSD. The dependents are really challenging, usually with lot's of medical problems also, although you can be seeing Soldiers who are being med-boarded with both medical and psych problems. For some reason, many Soldiers tend to pick spouses at the wrong end of the scale. That might be a good topic for research! Choosing a spouse who is instantly your soul mate and after two weeks of great non-stop sex you find yourself married is typical for some. One afternoon a week I teach a medical qigong class for Soldiers in a Functional Restorative Program. For some reason my Grand Rounds topics seem to be in demand as I've done 6 in 1.5 years and have another planned. In short, I wouldn't change jobs for anything and intend to die at my desk, hopefully many years from now.

 

[mlm55]

Thank you for the information. Can anyone speak to what the lifestyle is like in academic psychiatry? The psychiatrist I currently work with definitely works more than 40 hours a week and always seems stressed out. Is this area of the field more demanding in general, or is it possible to balance with family?
The part of research that I enjoy is program and intervention design and development and the opportunity to be creative. Also, I enjoy the time away from people and to work at a slower pace for a while. If there are other ways I could incorporate this into my career, I am open to suggestions.

 

[smalltownpsych]

Thank you for the information. Can anyone speak to what the lifestyle is like in academic psychiatry? The psychiatrist I currently work with definitely works more than 40 hours a week and always seems stressed out. Is this area of the field more demanding in general, or is it possible to balance with family?
The part of research that I enjoy is program and intervention design and development and the opportunity to be creative. Also, I enjoy the time away from people and to work at a slower pace for a while. If there are other ways I could incorporate this into my career, I am open to suggestions.

Your interests sound more closely in line with a psychologist than a psychiatrist. Have you considered that career path?

 

[SmallBird]

The comment I would make is that something that may be a little more difficult in psychiatry, and justifies a longer period of training, is formulating complex cases. It may be easy for anyone to treat depression that presents clearly as such, and PMHNP may be well suited to act in this role. I believe that more experience is required in understanding cases that require consideration of longitudinal factors (Such as patients with co-morbid substance abuse), where understanding the relative contribution of this and other factors may be of importance in treatment planning. This is not to suggest that PMHNP or anyone else are inherently less able to handle these cases, but I do believe they justify greater experience.

In Child and Adolescent Psychiatry, the developmental context adds an additional layer of complexity. I have seen both adult psychiatrists and PMHNP's diagnose patients with 'Autism and Schizophrenia' owing to an inability to understand certain unusual behaviors as being developmentally appropriate (if all of these cases were in fact examples of the comorbidity it would suggest that our epidemiological data is very inaccurate). I think that developing the ability to formulate these cases well requires a ton of experience. PMHNP's could no doubt accumulate this experience, but I certainly don't see it as low hanging fruit in the effort to task shift to practitioners with less training.

 

[Caldwell-Luc]

I was on the path to a clinical psychology PhD program but am currently reconsidering my options. I was accepted into a post-bacc pre-medical program and am considering pursuing that path with the hope of becoming a psychiatrist or psychiatric mental health nurse practitioner. The primary reason I am leaning considering the nurse practitioner route is because I am already in my mid-20's and would like to have a family some day (if I do psychiatry I will be in my mid 30's by the time I would finish residency and fellowship), and would like to have time with that family and time to pursue outside interests. I have a few questions about the differences between those paths.

- What settings do PMHNP's typically work in? Searching online, alot of the job listings seem to be in community mental health settings or inpatient facilities. Currently I work in an academic medical center in research, and I really like this setting. Are jobs readily available for PMHNP's in this setting, or would I be better off going the psychiatry route?

- The psychiatrists I currently work with are involved in clinical work as well as research. This is really appealing to me because I like variety in my work and am somewhat of an introvert, although I like working with people too. However it seems like the psychiatrists who do research have very demanding schedules; is this accurate? Can PMHNPs become involved in research/ do they have variety in their work?

- Are PMHNPs able to see the interesting patients or is their job involve mostly the more routine and simple cases?

- Is it possible to specialize in child and adolescent psychiatry as a nurse practitioner? Is it easy to find jobs in this specialty?

- For either job: does it become routine and boring after a time or do you continue to be challenged and interested in what you do? Also, do you find that you have rewarding interactions with colleagues or is working one-on-one with patients isolating?

Not sure if this is the right forum for this post, but any advice would be great!

You may also consider physician assistant programs too. The difference between the NP and PA is that PAs are trained in the medical model as physicians are. But, the path to PA is shorter than MD/DO.

You are still young. Either way, you can have a nice lifestyle as a psychiatrist. I know many that do.

 

[vistaril]

I'm a PMHNP. Right now you have to do child and adolesecent training in PMHNP school as they are all going to Family PMHNP. Luckily, I finished before that as I don't like kids except for looking at them from a distance. I went straight into locums work after school in a community mental health center and then a dentention center. I then did inpatient, outpatient, CL at a hospital. I'm currently in the last setting I want to work in, which is with the military. I have no interest in research, other than reading it, as most is hardly worth the paper it's written on. Journal editors will even tell you as much. My mornings are spent in a walk-in clinic where I see Soldiers who typically have run out of meds, having side effects, need to get on meds now prior to seeing someone for an intake, suicidal or homicidal, etc.. I may also clear a patient from med-surg floor. I've been doing this clinic for over a year and I'm probably the only person that likes it as I see everyone's patients and what they are doing. As such I'll probably have this clinic as long as I want it. In the afternoons I have my own patients. I prefer this population as I don't like dealing with homeless psychotics, for example. Soldiers will occasionally have their first psychotic break, or like one last week, become delusional. There are enough challenges though to keep you happy, with OCD, Bipolar disorders, Borderlines, binging, purging, or a combo. I also see lot's of Soldiers with PTSD. The dependents are really challenging, usually with lot's of medical problems also, although you can be seeing Soldiers who are being med-boarded with both medical and psych problems. For some reason, many Soldiers tend to pick spouses at the wrong end of the scale. That might be a good topic for research! Choosing a spouse who is instantly your soul mate and after two weeks of great non-stop sex you find yourself married is typical for some. One afternoon a week I teach a medical qigong class for Soldiers in a Functional Restorative Program. For some reason my Grand Rounds topics seem to be in demand as I've done 6 in 1.5 years and have another planned. In short, I wouldn't change jobs for anything and intend to die at my desk, hopefully many years from now.

curious...what do you get per hour at this latest outpt(I am assuming as a civilian contractor) gig? Is it a w2 or 1099?

I'm noticing a lot of govt contract outpt gigs doled out to psych nps? Psych nps don't have as much training, but you also have the upside of essentially no imgs/language or cultural issues.

 

[AcronymAllergy]

curious...what do you get per hour at this latest outpt(I am assuming as a civilian contractor) gig? Is it a w2 or 1099?

I'm noticing a lot of govt contract outpt gigs doled out to psych nps? Psych nps don't have as much training, but you also have the upside of essentially no imgs/language or cultural issues.

I can't speak to Zenman's experience of course, but I can say that from what I've heard, VA and other government contractors get paid very well if you can finagle such a position (and if you're ok with the temp nature of the work). I believe it's 1099 work, though, so you're on your own for benefits, and taxes can be rough if you aren't careful.

 

[vistaril]

I can't speak to Zenman's experience of course, but I can say that from what I've heard, VA and other government contractors get paid very well if you can finagle such a position (and if you're ok with the temp nature of the work). I believe it's 1099 work, though, so you're on your own for benefits, and taxes can be rough if you aren't careful.

well I think they're easy to get because if there was more demand to work at that particular VA it wouldn't need to be a temp'd out position, likely through an agency.
If it's a position that is desired, the VA is just going to be able to hire someone for it(assuming the need is perm)
Most of these VA positions are just going through temp/locums agencies.....loyalgovernment services(or some other name like that) being the biggest. Whatever *you* are getting to work there, you can bet that they(or onyx or whoever) is getting another nice chunk as well to place you. VA is paying the money to them and they are paying you in some of these cases.

Also, most agency/temp workers at the VA have to work a good bit harder than the regular employees there. Yes, they are making more per hour through the agency, but it's not the same level of cushiness either.

 

[Zenman1]

I can't speak to Zenman's experience of course, but I can say that from what I've heard, VA and other government contractors get paid very well if you can finagle such a position (and if you're ok with the temp nature of the work). I believe it's 1099 work, though, so you're on your own for benefits, and taxes can be rough if you aren't careful.

curious...what do you get per hour at this latest outpt(I am assuming as a civilian contractor) gig? Is it a w2 or 1099?

I'm noticing a lot of govt contract outpt gigs doled out to psych nps? Psych nps don't have as much training, but you also have the upside of essentially no imgs/language or cultural issues.

W2 with benefits and insurance provided by contracting company. Make over 100K. Going to GS 13 position though after contract is over.

 

[vistaril]

W2 with benefits and insurance provided by contracting company. Make over 100K. Going to GS 13 position though after contract is over.

so you are at like 55/hr or so + benefits.....eh thats not so good for outpt med mgt. not terrible either. I'd be curious to know what the military pays the contracting company though....I bet there is a big fat slice(and then some) they are taking out as the middle man.

I know that mhm(the agency that has all those correctional contracts now) pays their psychiatrists 180-210/yr + bennies(not not that lucrative of bennies) for fairly crappy volumish work in obviously not the best environments.....but that the amount of profit in that contract for them from the corrections depts is massive. The prison is paying *a ton* to have everything farmed out to an agency, and the agency is taking most of the loot....

 

[Zenman1]

so you are at like 55/hr or so + benefits.....eh thats not so good for outpt med mgt. not terrible either. I'd be curious to know what the military pays the contracting company though....I bet there is a big fat slice(and then some) they are taking out as the middle man.

I know that mhm(the agency that has all those correctional contracts now) pays their psychiatrists 180-210/yr + bennies(not not that lucrative of bennies) for fairly crappy volumish work in obviously not the best environments.....but that the amount of profit in that contract for them from the corrections depts is massive. The prison is paying *a ton* to have everything farmed out to an agency, and the agency is taking most of the loot....

Salary is 66/hr plus time and half for OT, which is on-call pay, usually about once every 3 months. Agencies make a killing for little work. I used to work for one in the 80's and they charged 2.5 times what the employee was getting.

 

[gabafan]

Practicing PMHNP here. Another option if you're interested in research is to go back to school to get your PhD in nursing to pursue research or teaching. For me, the PMHNP option was best, as this was a less expensive degree (put myself through grad school while working as a psych RN) and allowed more freedom to do other things.

 

[BestDoctorEver]

Practicing PMHNP here. Another option if you're interested in research is to go back to school to get your PhD in nursing to pursue research or teaching. For me, the PMHNP option was best, as this was a less expensive degree (put myself through grad school while working as a psych RN) and allowed more freedom to do other things.

Wouldn't that take the same amount of years? I am not even sure OP is even a RN. Therefore, he/she would have to get a BSN, then psych NP, then a PhD. That is about 8+ years.

As a RN, I thought about doing the psych NP, but NPs are not allowed to prescribe narcotics in the state I want to practice... I believe a psych NP is somewhat limited if he/she can prescribe narc. Am I wrong?

 

[PikminOC]

Not disagreeing with you, but try telling this to a nurse np that practices. They would vehemently disagree with you. Our opinions don't matter because we don't make them heard.

We don't have time to fight them. We are too busy getting educations, reading, doing residency, board certifications, MOC's and treating patients.

 

[PikminOC]

I wasn't suggesting it should be. In fact, my point is that the OP is unlikely to receive accurate answers to their specific questions since people on this site are not NPs. I am telling the OP to consider the viewpoints of multiple individuals, and truly, to take the ones on the internet with a grain of salt.

OP can look at the facts of the training requirements to determine which path is the most thorough in knowledge and exposure to patients.
If he wants to be able to practice completely independently with his name being sought out on research grants and papers, the MD is the way to go.

 

[PikminOC]

I'm a PMHNP. Right now you have to do child and adolesecent training in PMHNP school as they are all going to Family PMHNP. Luckily, I finished before that as I don't like kids except for looking at them from a distance. I went straight into locums work after school in a community mental health center and then a dentention center. I then did inpatient, outpatient, CL at a hospital. I'm currently in the last setting I want to work in, which is with the military. I have no interest in research, other than reading it, as most is hardly worth the paper it's written on. Journal editors will even tell you as much. My mornings are spent in a walk-in clinic where I see Soldiers who typically have run out of meds, having side effects, need to get on meds now prior to seeing someone for an intake, suicidal or homicidal, etc.. I may also clear a patient from med-surg floor. I've been doing this clinic for over a year and I'm probably the only person that likes it as I see everyone's patients and what they are doing. As such I'll probably have this clinic as long as I want it. In the afternoons I have my own patients. I prefer this population as I don't like dealing with homeless psychotics, for example. Soldiers will occasionally have their first psychotic break, or like one last week, become delusional. There are enough challenges though to keep you happy, with OCD, Bipolar disorders, Borderlines, binging, purging, or a combo. I also see lot's of Soldiers with PTSD. The dependents are really challenging, usually with lot's of medical problems also, although you can be seeing Soldiers who are being med-boarded with both medical and psych problems. For some reason, many Soldiers tend to pick spouses at the wrong end of the scale. That might be a good topic for research! Choosing a spouse who is instantly your soul mate and after two weeks of great non-stop sex you find yourself married is typical for some. One afternoon a week I teach a medical qigong class for Soldiers in a Functional Restorative Program. For some reason my Grand Rounds topics seem to be in demand as I've done 6 in 1.5 years and have another planned. In short, I wouldn't change jobs for anything and intend to die at my desk, hopefully many years from now.

Psychiatrists do at least 3 months of rotations in child and adolescent inpatient psychiatry per ACGME standards. However, the fellowship is much more thorough with 2 full years of training in addition. This is of course after 4 years of medical school and 3-4 years of residency. Lots of exposure to clinical cases and supervision with psychiatrists.

 

[PikminOC]

The comment I would make is that something that may be a little more difficult in psychiatry, and justifies a longer period of training, is formulating complex cases. It may be easy for anyone to treat depression that presents clearly as such, and PMHNP may be well suited to act in this role. I believe that more experience is required in understanding cases that require consideration of longitudinal factors (Such as patients with co-morbid substance abuse), where understanding the relative contribution of this and other factors may be of importance in treatment planning. This is not to suggest that PMHNP or anyone else are inherently less able to handle these cases, but I do believe they justify greater experience.

In Child and Adolescent Psychiatry, the developmental context adds an additional layer of complexity. I have seen both adult psychiatrists and PMHNP's diagnose patients with 'Autism and Schizophrenia' owing to an inability to understand certain unusual behaviors as being developmentally appropriate (if all of these cases were in fact examples of the comorbidity it would suggest that our epidemiological data is very inaccurate). I think that developing the ability to formulate these cases well requires a ton of experience. PMHNP's could no doubt accumulate this experience, but I certainly don't see it as low hanging fruit in the effort to task shift to practitioners with less training.

I hope you know physicians who are board certified. When I completed board certs, it took two years. Part one was a rigorous written exam (after passing all three US Medical licensing exams) and the second part was a strenuous Oral Boards. We know how to formulate complex cases and anything that walks through the door. You'd be surprised how many "simple" cases are really not so simple. Our educations lay the groundwork for cases. And we evaluate patients from all aspects, including medical as we are physicians first.

 

[PikminOC]

Salary is 66/hr plus time and half for OT, which is on-call pay, usually about once every 3 months. Agencies make a killing for little work. I used to work for one in the 80's and they charged 2.5 times what the employee was getting.

If you can tolerate the bureaucracy of the VA and inefficiencies.
These are great places for NP's to work (as is the DOD) since the systems are integrated and access to and collaboration with physicians is easy.

 

[Zenman1]

If you can tolerate the bureaucracy of the VA and inefficiencies.
These are great places for NP's to work (as is the DOD) since the systems are integrated and access to and collaboration with physicians is easy.

I don't work for the VA but on an Army post treating active duty Soldiers and a few dependents.

 

[PikminOC]

I don't work for the VA but on an Army post treating active duty Soldiers and a few dependents.

If that's where you want to work more power to you.
Thank you for taking care of our soldiers.

 

[st2205]

I tried to respond to this thread last week but ended up losing my post, but I guess I'll try to chime in again.

Had I known about the PMHNP programs before going to medical school, it would have been a tempting decision. Back then, I was really just familiar with the NP and wasn't really aware of specialty tracks or that there was one for mental health. I'll add qualifiers to this that I am married with three kids (just about to be three, at least). The only drawbacks I saw about going into medicine followed by psychiatry would be the length of training, the debt accrued and the time constraints this would place on my family (though this one would minimize after getting toward the end of residency). The NP pathway is significantly shorter and significantly cheaper. Currently, I've got three years left of residency. Contrast this with the fact that I could have been out and working, making good money, for the past three years or so. From a purely practical standpoint, that's pretty hard to beat. In the long-run, however (thinking 10+ years out), the financial edge will go to MD/DO.

That being said, from a professional point of view, there is no debate. It's almost not even worth discussing. While there are lots of valid concerns posters here such as vistaril raise, such as the limitations of a lot of our medications or the fact that borderlines continue the psychopharmacology carousel, and that it doesn't take a genius to do some of the work we do, I think these are actually good arguments for having a more well-rounded exposure. Knowing when not to do something is often more valuable than knowing a theoretical intervention that could be utilized. This isn't to say that NPs can't recognize that or that all psychiatrists do, just that with more exposure and experience you'll have a lot more to draw from... and the difference in exposure and experience between a graduating psychiatry resident and a graduating PMHNP student is gigantic. Having to complete medical school plus another half-year of medicine before really starting psychiatry training gives a much deeper foundation and framework with which to be able to begin learning psychiatry within that context. I know this often isn't appreciated by people as it's easy to not realize what contributes to your learning in full, but the experiences in medical school and residency shape the way you approach things without truly realizing it most of the time. The general medical exposure in a PMHNP program is essentially non-existent and I would encourage you to look at a number of different programs and curricula to determine if you agree with that assessment. This is to say nothing of the exposure/experience difference in psychiatry and its sub-specialties.

The only real answer is to figure out what you're looking for and what kind of compromises, on either end, you're willing to make. If you're wanting to do research, you theoretically could do that from an NP, but this would also be the same type of theoretical as if you were wanting to teach neurobiology with a degree in sociology. One thing I would keep in mind, however, is that during undergraduate, you're really just exposed to researchers (professors) and so most people come out of that with the bias that they want to do research, when they've been exposed to so little of the options out there. Most people wanting to do research in undergrad don't end up wanting to do it later (my observation, no data to support this). I was one of them. As I look back in hindsight, it's kind of funny.

 

[BestDoctorEver]

@st2205 ... If a psych resident is able moonlight to augment his/her salary during residency, should not that offset a little bit the advantage a psych NP might have finacially... If someone has their degree in nursing, I think it would make more sense financially. But if the degree in not in nursing, it will take that person 5+ years to become a psych NP and that benefit is not that big IMO.

Maybe I am trying to justify my decision to go to med school... Lol. But again my decision had more to do with scope of practice than salary...

 

[PikminOC]

There were some very rough times going the med school, residency, board certs pathway. But now that I've been doing this for a while, I wouldn't trade it for anything. There are so many opportunities out there, and it's nice to be able to find your own path.

 

[gabafan]

Wouldn't that take the same amount of years? I am not even sure OP is even a RN. Therefore, he/she would have to get a BSN, then psych NP, then a PhD. That is about 8+ years.

As a RN, I thought about doing the psych NP, but NPs are not allowed to prescribe narcotics in the state I want to practice... I believe a psych NP is somewhat limited if he/she can prescribe narc. Am I wrong?

It's important to take into consideration the variations in state policy when it comes to prescribing for NP's. My state allows me to write for controlled substances; some states do not allow this. Also, NP's cannot write for Suboxone for opiate dependence.

If the OP has a BS in another field, s/he could do a direct entry program in 3 years to get a MSN as a psych NP. Personally, I worked as an RN, which I felt provided relevant experience, before I obtained my MSN. And yes, if interested in research, 5 more years to obtain a PhD in nursing. I assume that physicians who specialize in research would need to eventually obtain the terminal degree, and not simply do research with their professional degree (MD or DO). But perhaps this is not what happens in practice. Hope that helps!

 

[Nasrudin]

It's important to take into consideration the variations in state policy when it comes to prescribing for NP's. My state allows me to write for controlled substances; some states do not allow this. Also, NP's cannot write for Suboxone for opiate dependence.

If the OP has a BS in another field, s/he could do a direct entry program in 3 years to get a MSN as a psych NP. Personally, I worked as an RN, which I felt provided relevant experience, before I obtained my MSN. And yes, if interested in research, 5 more years to obtain a PhD in nursing. I assume that physicians who specialize in research would need to eventually obtain the terminal degree, and not simply do research with their professional degree (MD or DO). But perhaps this is not what happens in practice. Hope that helps!

Suboxone is its own extra license added to your DEA# with an extra application and training process. Most doctors don't have one either. It's not something everyone wants to do I imagine.

Also there a many PI's who don't have a phd but are just MD's. Career research is more like getting a notable publishing output then obtaining funding and being able to successfully maintain that funding. The phd gives you depth in a very specific area of clinical or bench science. I have no idea what that means in the nursing model.

 

[BestDoctorEver]

@gabafan
I am aware of that fact that some states do not allow NP to prescribe certain drugs, hence my reason for choosing medicine as opposed to psych NP/PA even if I already had a BSN. From I have read in SDN, a MD/DO physician does not necessarily need a terminal degree to conduct research, but my guess is that having a PhD on top of the MD/DO might be better... At the end of the day, OP has to decide what he/she wants to make out of his/her career and make a choice accordingly, but again I don't think age should play a big role in the decision since OP is only 25.