Does it make sense to go the PA route if primarily interested in Psychiatry?

[tinyhandsbob]

I am interested in going either the PA or NP route and my primary area of interest is Psychiatry. I know that there are vastly more opportunities to work in psych as an NP. I am wondering if it's a waste of time (job opportunity / job security wise) to become a PA if I am specifically targeting a career in psych? I would like to get some feedback about this from anyone who works/worked in Psych as a provider. Also, curious if the trajectory the psych job market for PAs-- are more opportunities coming online than in the past, is it stagnant or is the share of psych NP jobs continuing to grow?

For context, I'd prefer the PA route since I already have all the pre requisites done, come from a heavier science background and would not need to become an RN first. I am only considering the NP route because of how many more job opportunities in Psych are available for psych NPs compared to PAs. Your input is appreciated.

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[Mad Jack]

You're much better off going psych NP. I don't think I've ever met a PA in psych and I've been in the field for 5 years and practiced in 3 states and various clinics and hospitals. Psychiatric training is very specialized in a manner that doesn't mesh well with the brief experience offered in PA school and would basically require an intense period of training that lasted a year or two in order to get you up to speed. Psych NPs learn a bit of psych across the board throughout the entirety of their training. They may not be anywhere near as well trained as a physician out of the gate, but generally they'll know a lot of the risks, benefits, indications, and side effects of various medications, as well as have some training in psychiatric assessment and treatment planning that theoretically lets them be functional right out of training, even if most will need considerable guidance early on.

Tl;dr psych would be very hard to crack into as a PA for various reasons and your career options would be limited in the field.

 

[Splenda88]

No...

#1 MD/DO.

#2 NP

#3 PA (a distant #3)


If you have PA prereqs, go MD/DO assuming that grades are good and you can do well on the MCAT.

 

[precisiongraphic]

If you can't go the MD/DO route, I'd go to an accelerated RN/MSN psychiatric nurse practitioner program, called a direct-entry Psychiatric NP MSN program. This would combine the RN coursework with the PMHNP coursework. This has a much better return on investment ROI, less opportunity cost, because although it may be more expensive up front, you get through the coursework faster and you don't have to spend time going to the beside first, getting a job, getting references, applying to an MSN/NP program etc etc - all of that is time-consuming and a detour. Direct Entry has less wasted effort.

I don't really like nurses that go directly from MSN to NP in, say, primary care or gerontological because there are skills at the bedside that are needed to make someone a well-rounded, experienced NP able to practice independently. Skipping from BA/BS to MSN/NP is too fast. But for psych, I think that it is different because PNHNP is a different skill-set than a bedside RN.

Vanderbilt has one, Yale, Ohio State that's just off the top of my head. There aren't as many so you may have to move.

If you can't find a direct-entry Master's level program near you and can't move, get an accelerated BSN and concurrently apply to PMHNP Programs to enter upon graduation. 1-year to 16-month accelerated BSNs are available at really good schools - University of Washington, MGH, Loyola.

If you have done all the PA pre-requisites and decent grades, you likely have all the requirements for a RN direct entry program.

Good luck.

​

.

 

[tinyhandsbob]

If you can't go the MD/DO route, I'd go to an accelerated RN/MSN psychiatric nurse practitioner program, called a direct-entry Psychiatric NP MSN program. This would combine the RN coursework with the PMHNP coursework. This has a much better return on investment ROI, less opportunity cost, because although it may be more expensive up front, you get through the coursework faster and you don't have to spend time going to the beside first, getting a job, getting references, applying to an MSN/NP program etc etc - all of that is time-consuming and a detour. Direct Entry has less wasted effort.

I don't really like nurses that go directly from MSN to NP in, say, primary care or gerontological because there are skills at the bedside that are needed to make someone a well-rounded, experienced NP able to practice independently. Skipping from BA/BS to MSN/NP is too fast. But for psych, I think that it is different because PNHNP is a different skill-set than a bedside RN.

Vanderbilt has one, Yale, Ohio State that's just off the top of my head. There aren't as many so you may have to move.

If you can't find a direct-entry Master's level program near you and can't move, get an accelerated BSN and concurrently apply to PMHNP Programs to enter upon graduation. 1-year to 16-month accelerated BSNs are available at really good schools - University of Washington, MGH, Loyola.

If you have done all the PA pre-requisites and decent grades, you likely have all the requirements for a RN direct entry program.

Good luck.

​

.

No...

#1 MD/DO.

#2 NP

#3 PA (a distant #3)


If you have PA prereqs, go MD/DO assuming that grades are good and you can do well on the MCAT.

You're much better off going psych NP. I don't think I've ever met a PA in psych and I've been in the field for 5 years and practiced in 3 states and various clinics and hospitals. Psychiatric training is very specialized in a manner that doesn't mesh well with the brief experience offered in PA school and would basically require an intense period of training that lasted a year or two in order to get you up to speed. Psych NPs learn a bit of psych across the board throughout the entirety of their training. They may not be anywhere near as well trained as a physician out of the gate, but generally they'll know a lot of the risks, benefits, indications, and side effects of various medications, as well as have some training in psychiatric assessment and treatment planning that theoretically lets them be functional right out of training, even if most will need considerable guidance early on.

Tl;dr psych would be very hard to crack into as a PA for various reasons and your career options would be limited in the field.

That's what I've come across as well (about 10x less job ads for psych PAs compared to psych NPs) but they still exist if you look. In my case, I have 4-5 years of clinical experience in psych and have done evals/assessments, have familiarity with med management/indications etc, so the learning curve wouldn't be as steep. But the lower number of jobs out there & disadvantages in the laws (not being seen as a specialist legally even if you specialize by taking the CAQ psych exam) is the downside. I had the opportunity to go MD/DO but it didn't make sense for a few reasons, including that I'm a much older applicant doing this a second career and would be closer to retirement age than college age by the time I'd finish residency.

 

[pamac]

That's what I've come across as well (about 10x less job ads for psych PAs compared to psych NPs) but they still exist if you look. In my case, I have 4-5 years of clinical experience in psych and have done evals/assessments, have familiarity with med management/indications etc, so the learning curve wouldn't be as steep. But the lower number of jobs out there & disadvantages in the laws (not being seen as a specialist legally even if you specialize by taking the CAQ psych exam) is the downside. I had the opportunity to go MD/DO but it didn't make sense for a few reasons, including that I'm a much older applicant doing this a second career and would be closer to retirement age than college age by the time I'd finish residency.

You don’t have to go to an accelerated NP program, just build your own by finding an accelerated RN program that is a year long, then go to NP school. That approach is much more flexible than a direct entry NP program, and likely cheaper as well.

I’m a psyche NP, and I do know PAs that work in psyche, but they rarely have enough leverage over their role (ability to practice independent of being under a physician or attached to a clinic) to be able to end up with higher wages. They also usually lack the interactions from their background to perform as well, particularly early on. It’s not just about evaluating, it’s familiarity with interacting with patients at a high level of responsibility. Few things compare to the day in and day out regularity of having to follow high stakes policies that hang over your whole work day. It really does add up. When you fail as a doctor or a nurse, you bring down hellfire. That same pucker factor hangs over my work as a provider, but it’s usually new to new PAs that had previous healthcare experience even as significant as paramedics, and certainly more than CNAs or the like. As a nurse, I spent all day reading people, even when I worked in ICU, ER, etc, not just when I was evaluating them. Not every nurse is sharp, so it’s not a guarantee that RN experience is any kind of high standard, but it’s a better bet. I have the complete premed undergraduate degree(s) in the hard sciences along with my nursing degrees, but most of my day and interactions draws from critical thinking skills I gained as a nurse. But I do know some experienced PAs who work in psyche that seem to do ok, but even then, I know several that aren’t. There are plenty of psyche NPs who are “out there” as well, and maybe even worse in some different ways.