Does my plan make sense?

[MustIReallyThough]

Hello! I'll try to be brief. Basically I'm a psychology graduate considering options. Bit overwhelmed by all the different paths in mental health and giving each one serious thought.

What I'd really like to do is follow in the footsteps of some of my mentors and combine a PMHNP with a MSW. I feel like I'd make a great RN in the interim. However, I understand the valid concerns doctors have over PMHNP training. I have no problem working within my very limited scope of practice in this role as long as I put in the time on my own required to master that scope. I'd also plan to put in a couple years working the psych ward as a RN.

The end result would be more job freedom and financial security than a MSW would provide and more of a focus on therapy than a typical psychiatrist could expect.

Part of my reasoning is also financial. I need a solid job and to build up my resume and nursing would provide both.

What do you guys think? Am I missing anything?

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[R. Matey]

What would the MSW get you?

 

[MustIReallyThough]

Probably not much? Folks have mentioned there are other ways to get training post grad in psychotherapy as a NP. But I'd still like to undergo the training in the hopes it helps me be a better therapist

 

[R. Matey]

The MSW coursework really doesn't emphasize psychotherapy. Most people with this degree that I know end up specializing in the post-degree supervision. Also, something to think about is where you want to work. If you can do meds, you'll likely spend most, if not all, of your time doing meds because of the financial reward structure in healthcare.

 

[MustIReallyThough]

The MSW coursework really doesn't emphasize psychotherapy. Most people with this degree that I know end up specializing in the post-degree supervision. Also, something to think about is where you want to work. If you can do meds, you'll likely spend most, if not all, of your time doing meds because of the financial reward structure in healthcare.

Even the LCSW? That's what I meant specifically.

It doesn't have to be that way though right? I'm not really motivated by money, just want enough to live comfortably and invest. I'm more interested in having job options

 

[R. Matey]

Even the LCSW? That's what I meant specifically.

It doesn't have to be that way though right? I'm not really motivated by money, just want enough to live comfortably and invest. I'm more interested in having job options

You'd be in the wrong field if you were 😉

In most institutions, people typically just do one or the other. It's pretty rare to have time split doing psychotherapy if meds are involved. If you were on your own in a practice, that would of course be another story, but you may find it more financially rewarding to do one or the other.

Edit: The amount of school you'd need for both training experiences approaches psychiatry. I'm curious why you ruled that out, if you don't mind sharing.

 

[MustIReallyThough]

How would it be financially rewarding to pursue a solely psychotherapy career? Most of what I've seen is doom and gloom from masters level folks. Stuck without options in abusive, low paying agency work. I've definitely seen the potential to do well in psychology but feel doctorate education a bit out of reach. Again, "financially rewarding" in that I'd simply have enough money to invest with each paycheck for retirement.

Indeed. Not really closed off, just figured a PMHNP would lead to less debt burden and less incentive to practice solely under the medical model.

That would still be a consideration if I went to nursing school. But right now I feel the pressure to pick a path and begin to accrue experience, either medical or therapy based.

 

[R. Matey]

How would it be financially rewarding to pursue a solely psychotherapy career?

Some master's level folks do fine doing psychotherapy in PP, but you need a specialty (e.g., eating disorders). Meds do pay more, but I get the impression that you're concerned that it will be less intrinsically rewarding.

 

[MustIReallyThough]

Some master's level folks do fine doing psychotherapy in PP, but you need a specialty (e.g., eating disorders). Meds do pay more, but I get the impression that you're concerned that it will be less intrinsically rewarding.

That's part of it. And not to say that concern is an accurate assumption. But that I'm not sure, for me, it'd be as rewarding because being a therapist has always been my dream. I think I'd be good at it.

Part of it is also concern about a flooded job market. As well as being unsure I could practice solely therapy for the rest of my career and be satisfied. I see a lot of people fleeing the field and think it's only prudence to anticipate these feelings a little. And what a solution might look like (that may keep me in clinical practice).

For the record though, I'd love to specialize. Whatever path I go, I realize the ever evolving need to self teach and be very informed about scientific, evidence based practice.

 

[summerbabe]

How would it be financially rewarding to pursue a solely psychotherapy career? Most of what I've seen is doom and gloom from masters level folks. Stuck without options in abusive, low paying agency work.

There are people in community mental health jobs that pay less than parts of the service industry. Often times, people work these jobs as they are in the process of getting licensed and need the supervision hours and/or they live in a community where job opportunities are low (rural Nebraska vs Manhattan).

But not all agency jobs are terrible. For example, I work in VA and master's levels can make a nice salary and get federal benefits (but workload and policies can be very burdensome).

As for making a stable paycheck via private practice, look into insurance reimbursement rates for your state. Cash pay is likely above that amount. Demand for services is high right now and will likely remain high in the future so you'd probably be able to fill up quickly. Telehealth state licensure reciprocity is also likely relevant.

If you work for a group practice that handles things like office space, billing, referrals, etc and provide benefits like health insurance, retirement, and possible bonuses for exceeding productivity expectations, they will take a healthy split of whatever you're bringing in hourly.

As well as being unsure I could practice solely therapy for the rest of my career and be satisfied. I see a lot of people fleeing the field and think it's only prudence to anticipate these feelings a little.

Doing therapy full-time is not easy. Doing therapy well full-time is even more difficult so these are valid concerns.

People definitely leave the field or in many other cases, they try to change what they do, especially if the overall congruence between doing therapy for a living is stronger with their interest/skills/needs.

Maybe it's moving to a different job. Or going into a different setting (outpt to IOP). Maybe it's starting a practice and hiring others and trying to run a business. Maybe it's admin in a larger system. Some adjunct teaching and lessen their therapy load those terms.

The end result would be more job freedom and financial security than a MSW would provide and more of a focus on therapy than a typical psychiatrist could expect.

Two things to consider are time and who is footing the bill. Depending on the setting, prescribers may get as little as 15 mins of face to face time with the patient so even if you have the desire and skills to provide therapy, it might be challenging or impossible. Even if you have 30 mins (which might include your documentation/admin time) but you are seeing this patient once every 2 months, you're essentially doing some version of being supportive/validating and maybe engaging in some brief problem solving or teaching a basic coping skill. That could be very to minimally rewarding.

You could certainly carry some therapy only patients and practice with the MSW but from a purely financial perspective, that would probably be a net loss but could help you sustain a career by tapping into other parts of job satisfaction. A question would be whether the upfront money and time costs are worth it to pursue 2 degrees, 2 sets of licenses, etc. Good luck!

 

[MAClinician]

How would it be financially rewarding to pursue a solely psychotherapy career? Most of what I've seen is doom and gloom from masters level folks. Stuck without options in abusive, low paying agency work. I've definitely seen the potential to do well in psychology but feel doctorate education a bit out of reach. Again, "financially rewarding" in that I'd simply have enough money to invest with each paycheck for retirement.

Indeed. Not really closed off, just figured a PMHNP would lead to less debt burden and less incentive to practice solely under the medical model.

That would still be a consideration if I went to nursing school. But right now I feel the pressure to pick a path and begin to accrue experience, either medical or therapy based.

That's part of it. And not to say that concern is an accurate assumption. But that I'm not sure, for me, it'd be as rewarding because being a therapist has always been my dream. I think I'd be good at it.

Part of it is also concern about a flooded job market. As well as being unsure I could practice solely therapy for the rest of my career and be satisfied. I see a lot of people fleeing the field and think it's only prudence to anticipate these feelings a little. And what a solution might look like (that may keep me in clinical practice).

For the record though, I'd love to specialize. Whatever path I go, I realize the ever evolving need to self teach and be very informed about scientific, evidence based practice.

This can be regionally dependent. Some areas the job market is more flooded (CA) than others. In my region, there is a major need for providers.

As for being “stuck” doing therapy forever with a masters, that is also region dependent. In my state there are LICSWs and LMHCs working In administration roles at insurance companies and state agencies. Our state commissioner for the Dept of mental health is an LMHC, not a psychologist or psychiatrist! I’ve seen LICSW and LMHCs as program directors and higher ups in hospitals and other agencies. Some people will offer workshops or parent coaching or other activities outside of therapy cases they have. Depending on where you live, it doesn’t have to be doom and gloom. Good luck!

 

[singasongofjoy]

Did not read all the posted reply but agree with the one directly above that saturation of market is HIGHLY dependent. If you specialize then even moreso. In my area, several organizations have positions posted including a few of the clinics associated with my workplace and it is difficult to find LCSWs (which in my state are frankly preferable because can bill more insurances and services than other master's level degrees). Perhaps because it's a specialty area, idk? But we do have several LCSWs on staff who are excellent. I've also seen LCSWs in higher level administration various places I've worked.

 

[Goobernut]

Yes, market saturation is highly dependent on area. Right now, we have a shortage of psychotherapists, and there is a 3-6 month wait to see a therapist that is not in a community mental health setting. However, this has also recently driven salaries up, so two of our larger local community mental health centers have started hiring new graduates under supervision for licensure at 70-80K a year. I made substantially more than that in my full time therapy position in an oncology practice. with benefits and retirement, but that is on the high end of what to expect in my area. I was oncology certified at the time, which is a rarity in my state. This is in an area with very low cost of living, and all of us master's level mental health folk are living our best life right now. In private practice, masters level therapists make around 90K in PP with no benefits or retirement. Our VA recently had to do a regional increase (which is unheard of for our area because our cost of living is always in the pit) to become more competitive again. Our GS-12s at the VA are doing really well right now.

RE: for a psych nurse practitioner vs. therapist etc. I previously worked for a department of psychiatry at my university. I worked with several other psychotherapists (LCSWs only we didn't hire LMHP (we call them LPC's here) due to needing to take Medicare). We hired an NP who had his FNP (family practice certification) and was working on his PMHNP. He confirmed that he got minimal therapy education, but that it was very surface level. However, to be honest, I'm not sure it was much different than the MSW psychotherapy education I received back in 2015 hahaha. I had to make sure that I had a good clinical supervisor and supplemented my psychotherapy education in order to be what I felt was competent. I agree with the previous poster that says a PMHNP would most often be forced to provide medical services instead of therapy. I'll be honest, they will want to pay you to pump out prescriptions. My former NP co-worker is doing just that for $120k a year. So they clearly do make more money than a psychotherapist. He finds it to be difficult and frustrating work because of the high need of the population he works with.

In my state we also hire LCSWs for our outpatient integrated behavioral health positions, where I see a lot of informed posters on this board mention that in their area they only hire health psychologists for those same positions. The point of this unending ramble is that you really need to find out what is going on locally. You can get advice from me, and it be all wrong for your area.

 

[lily_pad]

I’m finishing my MSW and I slightly disagree that MSW programs don’t teach you how to become a therapist. I’m not sure where you are located but if you choose a program that is specifically clinical and seek out internship opportunities that will allow you to do therapy (as opposed to just case management), I think you can actually graduate with a pretty good foundation. I just completed my second year internship training at a psychoanalytic institute and got amazing clinical experience/supervision.

 

[R. Matey]

I’m finishing my MSW and I slightly disagree that MSW programs don’t teach you how to become a therapist. I’m not sure where you are located but if you choose a program that is specifically clinical and seek out internship opportunities that will allow you to do therapy (as opposed to just case management), I think you can actually graduate with a pretty good foundation. I just completed my second year internship training at a psychoanalytic institute and got amazing clinical experience/supervision.

The bolded part is the critical element. On the other side of spectrum, I remember working with a practicing social worker that received zero diagnostic training in her graduate program.

 

[R. Matey]

However, this has also recently driven salaries up, so two of our larger local community mental health centers have started hiring new graduates under supervision for licensure at 70-80K a year.

In my area, it's about $55k for licensed positions in CMHCs, but we're really saturated.

 

[Goobernut]

In my area, it's about $55k for licensed positions in CMHCs, but we're really saturated.

It was just a tad lower here (45-50k for someone under supervision) right up until 2020-2021. However this week, a local hospital hired one of my practicum students for the ED and offered her 64k for a case management position.

 

[R. Matey]

It was just a tad lower here (45-50k for someone under supervision) right up until 2020-2021. However this week, a local hospital hired one of my practicum students for the ED and offered her 64k for a case management position.

That's incredible, but on the other hand it makes sense in this era of high inflation and high bar to access mental health services. Our state is one of the worst in country on several mental health indicators, but state-funded agencies have also been slow to raise wages for front line workers. It's nice to hear that other places are a bit more progressive, or, at least responsive to high service demands.

 

[lioneljohn]

Combining these degrees will give you a broad skill set, allowing you to offer both medical and therapeutic interventions but both programs require significant time and financial resources.