Psych NP + LPC

[staticshirt]

I am doing a full career change and I have been debating getting a Psych D or MD in Psychiatry.

As I weigh my options I am very passionate about the talk therapy side psychology and enjoy understanding human behavior. However my goal is to get into private practice and I would want to have autonomy be a full suite and have the ability to prescribe medication if need be. My solution to achieving this goal (i do not aspire to go to med school) is to go down the Psych NP since it’s hybrid between psychology and psychiatry route while also getting a LPC.

Looking at the cost/time in school, earning potentials and job opportunities I’m not sure is Psych D has the best ROI. I’m thinking there are more opportunities and earning potentials in the nursing world also, since I already have a bachelor’s I could prob take the ADN route and become a RN in maybe a year and a half and start making money, while actively pursing NP & LPC. Opposed to committing 5/6 years as a full time student and drowning in debt.

What are your thoughts? Is becoming a Psych NP and LPC realistic?

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[Sanman]

What good is the LPC? The psych NP allows you to engage in psychotherapy and prescribing. Just go get good psychotherapy training after your degree.

 

[WisNeuro]

What good is the LPC? The psych NP allows you to engage in psychotherapy and prescribing. Just go get good psychotherapy training after your degree.

Herein lies the rub. I have yet to meet an NP who actually did this.

 

[staticshirt]

What good is the LPC? The psych NP allows you to engage in psychotherapy and prescribing. Just go get good psychotherapy training after your degree.

I’m thinking the LPC would allow me to be well versed in the talk therapy/ psychotherapy side of things. I like the benefit of prescribing having a Psych NP but I also do not want to be limited to the “medical” side of mental health.

 

[staticshirt]

With your expertise in psychology do you see a need for Psych NPs to have the proper psychotherapy training? Or has your experience with them just been for medical needs?

 

[staticshirt]

@WisNeuro

 

[Sanman]

Herein lies the rub. I have yet to meet an NP who actually did this.

I know a few with Beck institute certifications and at least one psychoanalytic fellow, but that may be my northeast background showing.

 

[Sanman]

I’m thinking the LPC would allow me to be well versed in the talk therapy/ psychotherapy side of things. I like the benefit of prescribing having a Psych NP but I also do not want to be limited to the “medical” side of mental health.

It won't. At least not compared to a psychologist. You would be better off getting certified in a few common short term therapy protocols, like cbt for insomnia and referring out the more serious stuff to full time therapists. At least, that is how I would do it if getting an NP.

 

[EnPsychlopedia]

NPs are just not--generally speaking--well enough trained for me to feel comfortable telling someone to go for this route. LPCs are widely variable. Personally, I think anyone who wants to be an independent prescriber should put their ass in medical school, especially with psychiatric and neurologic drugs.

 

[AcronymAllergy]

It won't. At least not compared to a psychologist. You would be better off getting certified in a few common short term therapy protocols, like cbt for insomnia and referring out the more serious stuff to full time therapists. At least, that is how I would do it if getting an NP.

Agreed.

It sounds like an MD/DO might be the best fit with your career goals, even if that isn't the route you're interested in going. It gets you much more in-depth medical and pharmacological training, and depending on where you end up for residency, could get you better (or at least equivalent) psychotherapy training than an LPC or post-graduate certifications.

And a suggestion to avoid possible confusion when you're discussing with folks in the future: there's no degree known as a "Psych D," and in my experience, it's not really a common way of referring to a psychology doctorate. There is the Ph.D. and the Psy.D., the latter being Doctor of Psychology.

Finally, no, I don't think anyone would say a PhD/PsyD has the best return on investment. It's certainly possible to make a good living as a psychologist, and there's even the potential to prescribe in a handful of states with requisite training, but there are better choices if a person is prioritizing a straightforward path to high income.

 

[jdawg2017]

I would say pick one of the two angles and stay in that lane. There’s a reason why most psychologists don’t prescribe medicine (even in states where we can get psychopharmacology training and work under a physician) — it’s not our expertise or what we learn in school.

Similarly, most physicians (the exception *maybe* being psychiatrists) learn little to nothing about evidence based approaches to psychotherapy. Again, besides psychiatrists few know much if anything about assessment and diagnosis of psychological disorders. I have a very psychologist close friend who is working in a private practice right now with an MD pediatrician who magically thinks she can do therapy and diagnose psychological disorders without any formal knowledge base. This has resulted in the pediatrician diagnosing numerous kids (and parents…) with autism because they “are anxious socially.”

It’s very difficult to be a jack/jill of all trades. I’d really recommend thinking about what you like the most, see in what you might be paid vs the debt to earn the training, and stick with that.

 

[PsyDr]

1) I find that it’s usually better to not half ass things. You want to be a psychiatrist, so be a psychiatrist. Better job opportunities, better geographic flexibility, better pay.

2) I have never seen records from a competent LPC. Ever.

3) There is a difficulty in marketing yourself as multiple things. If you’re a NP, people will want you to prescribe. Consider the market: I’m depressed and want to get help. I look at all the options and choose an NP. Why? Why did I not choose a therapist? It’s because I wanted medication. Maybe I’m not psychologically minded, maybe I don’t have any PTO, maybe I think “if I can just get some Adderall, I’ll get skinny and get all my chores down, and add more, and my problems are solved even though I don’t have adhd. Plus I’ve heard that psychiatrists are hard to talk into prescribing addy”. Now imagine if I walk into a place expecting medication and this person starts talk therapy. Or imagine you’re a hospital employee whose productivity targets are based upon prescribing, and some new employee does 1/3rd of my expectations.

4) based upon the usual and customary financial outcomes: your NP plan is illogical. Look at the median salary for psych NPs, times that by 30. Now look at the median salary for psychiatrists, times 30. The extra years of income as an NP are not worth it.

 

[Therapist4Chnge]

I did the psych RxP training at the same time my friend did her NP from a quality program…and their training was definitely lacking in differential diagnosis, understanding Y1 & Y2 stuff like psychopathology, and interviewing/info gathering was nonexistent. Foundational psych knowledge was minimal. We shared all of our training materials, syllabi, etc. I would do small group reviews w her classmates and the knowledge gaps were…substantial.

I also prev tutored RNs pursuing NPs, lectured in NP & MD programs, did didactics for NPs, MDs, & DOs in training….and the foundational knowledge was noticeably different. Direct entry (RN + NP) trainees were at significant disadvantage too.

I used to be very pro Psych-RxP and also NP, but I’m much more conservative after 12+ years working in the field, especially doing legal work. If you want to prescribe and do any talk therapy, pursue psychiatry (MD/DO).

I still am not impressed by the “average” psych clinician across training types, but the floor of competency is higher for physicians and the variance in NP programs is much wider than MD/DO programs.

FWIW…I think the avg psych-RxP is better prepared than Psych NP, but that has mostly to do with diagnostic differential and consuming RxP research, and less to do w day to day work. Talk Therapy training in NP programs was a joke, but so was most psychiatry residency training, but at least their differential dx was better.

 

[Psycho Bunny]

I did the psych RxP training at the same time my friend did her NP from a quality program…and their training was definitely lacking in differential diagnosis, understanding Y1 & Y2 stuff like psychopathology, and interviewing/info gathering was nonexistent. Foundational psych knowledge was minimal. We shared all of our training materials, syllabi, etc. I would do small group reviews w her classmates and the knowledge gaps were…substantial.

I also prev tutored RNs pursuing NPs, lectured in NP & MD programs, did didactics for NPs, MDs, & DOs in training….and the foundational knowledge was noticeably different. Direct entry (RN + NP) trainees were at significant disadvantage too.

I used to be very pro Psych-RxP and also NP, but I’m much more conservative after 12+ years working in the field, especially doing legal work. If you want to prescribe and do any talk therapy, pursue psychiatry (MD/DO).

I still am not impressed by the “average” psych clinician across training types, but the floor of competency is higher for physicians and the variance in NP programs is much wider than MD/DO programs.

FWIW…I think the avg psych-RxP is better prepared than Psych NP, but that has mostly to do with diagnostic differential and consuming RxP research, and less to do w day to day work. Talk Therapy training in NP programs was a joke, but so was most psychiatry residency training, but at least their differential dx was better.

Was your advantage in differential diagnosis compared to your friend in the NP program a result of superior psychopharmacology training in the RxP program or do you think it was mostly from your background of being a psychologist? Because it seems like a more fair comparison would be a psychologist doing rxp training vs a psychologist going the psych NP route. Unless you were actually talking about the rxp training in isolation being objectively better?