Questions about the field

[CJames]

Hello all,

I am currently a practicing social worker with an MSW and have been in the field for about 8 years. I recently started a part-time job working as a clinical research coordinator at a major hospital (MSW salaries are pretty bad in Virginia) and I have been shocked to find how much I am enjoying the medical field. I never really considered the profession before, but I find that I adore working with the biological side of things.

I am considering returning to school for medical training with a focus on psychiatric medication. My hope is to continue therapeutic work with trauma victims in a setting like a VA hospital or working with sexual abuse victims. I would also like to be able to prescribe to my patients so that I can provide a more rounded degree of care.

I have found several nurse practitioner programs, like that at UT Austin, that offer a 3-year program which gives non-nursing BA folk an MSN and a specialization certification. However, nursing as a field seems to strongly prefer that folks get their undergrads and continue to nursing from there. I am also considering a PA, which doesn't seem to have that bias and both programs seem to be similar length (2.5-3 years) with higher income potential, but perhaps a bit less independence.

Here are my questions:
1. Is there any benefit to the PMHNP vs specialized PA for my specific interests?
2. Is there any way to get any sort of benefit out of my MSW from any of these masters programs? I assume not, but might as well ask.
3. Do you guys have any other thoughts or advice that might help guide me through some of this? I'm at the very beginning information-gathering stage, so I am open to any thoughts.

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[CJames]

Also, many programs seem to be pushing a DNP pretty hard (Us of Arizona and Washington for example) and several sources have mentioned that DNPs will eventually be a requirement for NPs. That seems a bit unlikely, but what are folks' thoughts about that track? I would think it is a track more aimed at folks who want to teach than practice.

 

[sarjasy]

Hello all,

I am currently a practicing social worker with an MSW and have been in the field for about 8 years. I recently started a part-time job working as a clinical research coordinator at a major hospital (MSW salaries are pretty bad in Virginia) and I have been shocked to find how much I am enjoying the medical field. I never really considered the profession before, but I find that I adore working with the biological side of things.

I am considering returning to school for medical training with a focus on psychiatric medication. My hope is to continue therapeutic work with trauma victims in a setting like a VA hospital or working with sexual abuse victims. I would also like to be able to prescribe to my patients so that I can provide a more rounded degree of care.

I have found several nurse practitioner programs, like that at UT Austin, that offer a 3-year program which gives non-nursing BA folk an MSN and a specialization certification. However, nursing as a field seems to strongly prefer that folks get their undergrads and continue to nursing from there. I am also considering a PA, which doesn't seem to have that bias and both programs seem to be similar length (2.5-3 years) with higher income potential, but perhaps a bit less independence.

Here are my questions:
1. Is there any benefit to the PMHNP vs specialized PA for my specific interests?
2. Is there any way to get any sort of benefit out of my MSW from any of these masters programs? I assume not, but might as well ask.
3. Do you guys have any other thoughts or advice that might help guide me through some of this? I'm at the very beginning information-gathering stage, so I am open to any thoughts.

Direct-entry NP (a 3 year program like you mention) is probably your best route. You could go PA, but most PA programs want prior, direct patient-care experience (I doubt social work would count with most PA schools) and in many (if not most) markets NP is more marketable for psych than PA. I'm not a fan of direct-entry for NP or PA, but psych-NP is one specialty where prior experience is probably a little less needed.

 

[CJames]

I had thought the same thing initially. I have been surprised to find that most PA programs do specifically cite "MSW experience" as qualification for HCE . They also specifically cite "Clinical research Coordinator" roles, which is my current position.

That said, I still had a preference for the psych NP because of its portability and more widely-known and understood title. Plus there are way more programs and admission isn't quite so fierce. However, with the field moving to requiring a DNP for NP certification, I don't really want to risk having an MSN that I can't practice with, or where I can only practice at the BSN level. Even if they don't change the reqs in 2015 like they are threatening to, just the talk of that threat makes me want to avoid the degree.

 

[deleted6669]

IF you got the msn and a state license you would be grandfathered in and not have to meet a dnp requirement. there were certificate/A.S./B.S. Nps working long after the switch to an msn "requirement", in fact I have a friend who is a certificate level np who still works using that credential (he also has a bs in pa but uses whichever credential works better at any given time/situation).

 

[CJames]

Yeah, but given that I am just now starting pre-reqs, I wouldn't even start an MSN program until two years from this coming August. Then it would be 2-3 years (generally 3 it seems for the MSN instead of the CNL) to complete a direct-entry MSN program. They would have to delay the transition like crazy for me to be able to apply even for the certificate with an MSN. Does that information sound correct? I'm just going off of what I'm hearing from the folks here at the hospital.

 

[futurepsych0]

IMHO, No state will REQUIRE a mandatory doctorate for entry level NP practice anytime soon. That would not be a concerning factor for me if I were in your shoes. Hell, they still haven't been able to make a bachelors the mandatory entry level for being a RN. The only nurse specialty that will mandate a doctorate anytime soon is CRNA. (I think I read that somewhere, please correct me if I am mistaken)

 

[AnnoyedByFreud]

If you want to practice in psych, then PMHNP is clearly the superior choice compared to PA. I would not worry about the DNP becoming a requirement to practice any time soon (Penn, one of the leading schools in the field, is refusing to even consider adopting it), but you might want to chop chop and get into an MSN PMHNP program (direct entry or otherwise) since many are switching to DNP (but not all!) I'd apply to UT's program. Also, PAs do not make more than PMHNPs... in fact, the reason why PAs tend to have higher salaries is because they work in more lucrative fields (EM, surgery) and a higher proportion of them are male. PMHNPs make a very competitive salary.

Because you have an MSW you might be able to get out of some of the BS public health classes we are forced to take. I am in PMHNP school currently and there are several MSWs in my class. If you have questions, feel free to PM me!

 

[CJames]

Thanks for your advice everyone. I've been talking to a friend who is a PMHNP and she agrees with you guys. As a result, I'll go back and ask this question instead- PHMNP (3+ish yr MSN) or Psych PA (with 1yr residency after 2+ish yr program)?

Many/Most of the threads I have seen have folks worried about whether or not they can practice therapy with their degree. I don't need to worry about that. What I would love help figuring out is which of these roles would allow me to retain the greatest flexibility and the most reasonable work load?

• I am aiming for as close to a 40-hour week as I can get. I've been doing 70-80 hour weeks with 24/7 on-call for 30k/yr since I graduated and I'm ready to stop that. I don't mind some extra work, but every week is too much.
• I would also really like to be able to roll into town and be able to find a job reasonably quickly. In this economy, being able to find a job matters.
• I also want to be able to practice in a variety of areas and not be limited to just one, (i.e. severe illness). I like to mix things up from time to time. I figure every demographic has psych needs, and I'd like to be able to try a few different demographics to see where I best fit and not be pinned to just one. Eg- psych trauma, ER, psych inpatient, wounded-well, kids in schools/group-homes, etc.

Mostly I'm hoping to augment my MSW so that I can provide a full range of care to my clients, covering all aspects of their lives. The PA is appealing because its medical focus would seem to best cover my biggest area of weakness. My existing experience seems to be a better fit for the program requirements (Nurse programs value RN experience and BSNs very highly and there is a stigma for folks who do direct entry. Not so for PAs). A PA program, even with a psych residency, would be as fast or faster than most direct entry MSNs I have seen.

However, many folks are telling me that the PMHNP is far more flexible, especially in psych, than the PA. Others say that with a year's residency, they are equivalent and the PA has a stronger grasp of medicine. However, if becoming a PA limits be to only being able to work in inpatient psych wards and denies any sort of independent practice, I am much less interested than I would be in a degree that allows me to practice in a variety of environments and with a bit more autonomy. Either position is certainly well-respected enough that any difference is of minimal importance. The same goes for income over 75k/yr Can anyone give me any insight on these differences?

 

[AnnoyedByFreud]

Hmmm. If you want to practice general med w/different populations (peds, IM, etc.) then PA is a great option. If you mean you want to practice psych across different populations, then yeah, PMHNP. I mean, just compare the curriculum and psych training of a PA program to that of a PMHNP program. Now if you do a PA residency you might get more training and be able to catch up, but those residencies do not offer the didactic coursework. And yes, you're right, the PMHNP is far more flexible. I have read stories of PAs even with a psych background not being able to get hired in psych, billing for their services being more complicated (not sure what state this was in), etc. Anyway, at the end of the day you need to look at where you want to live. Are there PAs working in psych in that area? Or is it dominated by psych NPs? That's the most important question to answer.

Also, if you ever want to have your own practice (I know several psych NPs who have their own), then the NP license is obviously going to make things far easier. Do you have any interest in teaching, research, or policy? Think about what you want for your career in the long run and don't rush into one role just because it might save you time up front, I'd carefully consider the pros and cons of both. Have you tried asking this question at the paforum website and allnurses? You'll probably get more useful info than on a site for med students. Psych NPs start at 100k+ in my experience. Best of luck deciding!

 

[CJames]

Thanks a lot for all of your help, and for the fantastic screenname Freud.

I suppose one more question would be, is there a direct path from no nursing background to PMHNP? Almost all of the programs I am seeing are direct entry nursing (CNL or equivalent) which do not allow you NP licensure or specialization without getting a second masters. I really don't want to spend 5 years (plus two more to collect prereqs) and hundreds of thousands of dollars getting a two more masters degrees. Also, how portable are those direct PMHNP degrees outside of their own state?

 

[deleted6669]

in fact, the reason why PAs tend to have higher salaries is because they work in more lucrative fields (EM, surgery) and a higher proportion of them are male.

This might have been true 20 years ago but something like 65% of working PAs are now women and probably 75% of most newly admitted pa students are women. lots of folks figured out that PA can be a "shortcut to practicing medicine" ,so women who otherwise would have applied to med school are going PA to be able to work sooner and have families earlier. the traditional pa school applicant being a 30 yr old male paramedic or RT with 5-10 years HCE has undergone a significant paradigm shift with these folks now having to apply to a quickly decreasing # of programs which appreciate their HCE and life experience. Too many programs today look only at gpa and gre scores.
When done with my current graduate program I hope to teach at one of the few remaining programs which looks for traditional applicants.

 

[AnnoyedByFreud]

Interesting. Are you worried that salaries for PAs might start dropping?

 

[AnnoyedByFreud]

Thanks a lot for all of your help, and for the fantastic screenname Freud.

I suppose one more question would be, is there a direct path from no nursing background to PMHNP? Almost all of the programs I am seeing are direct entry nursing (CNL or equivalent) which do not allow you NP licensure or specialization without getting a second masters. I really don't want to spend 5 years (plus two more to collect prereqs) and hundreds of thousands of dollars getting a two more masters degrees. Also, how portable are those direct PMHNP degrees outside of their own state?

Yes. I am in one of those programs. There are many direct entry programs that lead to NP licensure: Seattle U, UCSF, OHSU, Yale, Columbia, Rochester, Penn, etc. You'd be better off looking into this on allnurses, as there are many many threads on direct entry NP programs on that site. However, allnurses is mostly garbage, but the threads for the direct entry applicants are pretty helpful. All NP licenses are portable in the sense that you don't have to take the test again (it's national), but transferring your license from state to state usually includes a certain amount of paperwork and $$.

 

[deleted6669]

Interesting. Are you worried that salaries for PAs might start dropping?

NOPE, PA salaries for both new grads and experienced PAs continue to increase by 2-5k/yr in competitive markets. when I graduated pa school 40k was considered an ok starting salary for a new grad. now it is double that. I made more in 2013 than in any single prior year except 2002 when I had 2 full time jobs and 1 per diem job.