Psych NP Salary

[reca]

Wow... Was he/she already a RN? If not, that's kind of a 4 years endeavor...

It's a 2 year endeavor if you're not a RN. 12 months if you are.

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[Splenda88]

It's a 2 year endeavor if you're not a RN. 12 months if you are.

I was a RN and I have never heard of a 12-month psych NP program...

You can post the link if you know one.

 

[reca]

I was a RN and I have never heard of a 12-month psych NP program...

You can post the link if you know one.

You can't use google? Hint: It starts with V and rhymes with Danderbilt.

 

[Splenda88]

You can't use google? Hint: It starts with V and rhymes with Danderbilt.

Count on Vandy to screw up doctor... where 'fellowship' are available in every specialty for NP...

 

[scoopdaboop]

Count on Vandy to screw up doctor... where 'fellowship' are available in every specialty for NP...

I mean lots of "top" programs have NP trainings etc. John Hopkins for example... Makes you wonder.

 

[Sushirolls]

Academia institutions and their overlap of national societies sold out rank and file physicians. They support midlevels and their expansion. Physicians who populate national societies also populate academia institutions, typically.

 

[reca]

I know of a psychiatrist who knew he was going to lose his license (ironically for letting people practice medicine without a license) who trained as a psych NP so he could continue practicing after lol

Met a Caribbean med student who told me he was dual applying for psychiatry residency and PMHNP programs (already had a BSN from undergrad). I should look him up, this was two years ago. Might be a practicing NP by now.

 

[LimpSpatula]

I largely agree with what you're saying, but I can't imagine that an NP seeing 30+ patients per day without direct supervision while prescribing controlled substances would go unrecognized by everyone in the area. I would think that at some point another psychiatrist in the area would recognize a problem with this kind of care and have a low threshold to report to the boards if seeing inappropriate prescribing.

I realize that there's a (miniscule) possibility that the patients are being cared for in a mostly appropriate way and not put at significant risk, but given how terrible a large portion of the NP plans I've seen are from NPs seeing 8-12 patients per day, I don't have much faith that an NP seeing 2-3 times that many patients could even provide relatively competent care.

I’d venture to say that most people don’t see those patients. They usually stay in those clinics because that’s where they get their benzos. Literally all the patients I’ve taken on from private practice are on benzos and I taper them off.

Aside from my clinic,I see people on some very terrible regimens that don’t work when they come inpatient. Like DD/ID patients in group homes that have the wherewithall of a 10 year old on 20 of Haldol, 2000 depakote and 600 of Seroquel. The other people I know moonlighting in insurance clinic are just spending their time tapering benzos.

One of my mentors said of the head of the largest group in my area “He’d write you a script for Xanax in the 20 second elevator ride you would have with him.”

 

[Stagg737]

Aside from my clinic,I see people on some very terrible regimens that don’t work when they come inpatient. Like DD/ID patients in group homes that have the wherewithall of a 10 year old on 20 of Haldol, 2000 depakote and 600 of Seroquel. The other people I know moonlighting in insurance clinic are just spending their time tapering benzos.

This is more of what I'm referring to though. If they're admitted inpatient on a dangerous med regimen with no real justification, seems like reporting to the board would be justified. I understand that most of those people may just want to keep going to their candy shop, but I'd also guess that many of them would decompensate to the point of needing inpatient at some time.

 

[LimpSpatula]

This is more of what I'm referring to though. If they're admitted inpatient on a dangerous med regimen with no real justification, seems like reporting to the board would be justified. I understand that most of those people may just want to keep going to their candy shop, but I'd also guess that many of them would decompensate to the point of needing inpatient at some time.

I don't think the board would do anything, and that's never been brought up by anyone I work with. A patient like that is abandoned by their family, and they have very little independent function. As this patient had told me, their group home is their only family. They have experienced significant trauma in an already insulted brain, and have no coping skills or ideas of boundaries. The homes they go to don't have the training or resources to help them with those things. The psychiatrist puts them in the sunken place so they can live out their existence there. Every once in a while they act out and come to the inpatient unit. I lower the medication a little, but back to the sunken place they will return when DC'd. I'm guessing they die in their 50s-60s from HF/LF because I don't see them at that age.

As far as the benzo patients, they may come in for a day. I tell them "hey this isn't ideal", but the solution isn't easy. They end up staying for a day or two and get discharged to their NP who gives them their pharmaceutical courage to take on life.

 

[sloh]

I don't think the board would do anything, and that's never been brought up by anyone I work with. A patient like that is abandoned by their family, and they have very little independent function. As this patient had told me, their group home is their only family. They have experienced significant trauma in an already insulted brain, and have no coping skills or ideas of boundaries. The homes they go to don't have the training or resources to help them with those things. The psychiatrist puts them in the sunken place so they can live out their existence there. Every once in a while they act out and come to the inpatient unit. I lower the medication a little, but back to the sunken place they will return when DC'd. I'm guessing they die in their 50s-60s from HF/LF because I don't see them at that age.

As far as the benzo patients, they may come in for a day. I tell them "hey this isn't ideal", but the solution isn't easy. They end up staying for a day or two and get discharged to their NP who gives them their pharmaceutical courage to take on life.

This is pretty eye opening...and sad

 

[AnnoyedByFreud]

Ok this is all a meme anyways, there is no reason for any licensed psychiatrist or anyone making more than 300k a year to do PMHNP because you won't make that much anyways, but it MIGHT make sense for FM/ER/IM trained docs who want to take it easy... but then you have to be a RN so it doesn't make sense following that route, but if psychiatrists were to allow FM/ER/IM basically general medicine docs to get a 1-2 psych certificate that would be feasible.... but they would never allow that lol.

You might be surprised.

 

[LABrondo]

Ahh ok, then it doesn't make sense for any physician to do it.

It does if they weren’t able to get residency

 

[hallowmann]

This is pretty eye opening...and sad

I mean its not universally true. I've seen plenty of people who still have support from families despite living in group homes, parents that strive to get their kids better care even from afar, and individuals that improve, take less medications, and ultimately get out of group homes. I've certainly seen patients like were described, but that's not everyone.

 

[LimpSpatula]

I mean its not universally true. I've seen plenty of people who still have support from families despite living in group homes, parents that strive to get their kids better care even from afar, and individuals that improve, take less medications, and ultimately get out of group homes. I've certainly seen patients like were described, but that's not everyone.

While it’s not universally true, in community settings it is the vast majority.

 

[Stagg737]

I don't think the board would do anything, and that's never been brought up by anyone I work with. A patient like that is abandoned by their family, and they have very little independent function. As this patient had told me, their group home is their only family. They have experienced significant trauma in an already insulted brain, and have no coping skills or ideas of boundaries. The homes they go to don't have the training or resources to help them with those things. The psychiatrist puts them in the sunken place so they can live out their existence there. Every once in a while they act out and come to the inpatient unit. I lower the medication a little, but back to the sunken place they will return when DC'd. I'm guessing they die in their 50s-60s from HF/LF because I don't see them at that age.

As far as the benzo patients, they may come in for a day. I tell them "hey this isn't ideal", but the solution isn't easy. They end up staying for a day or two and get discharged to their NP who gives them their pharmaceutical courage to take on life.

The social situation and support of the patient shouldn't hold any bearing on whether a psychiatrist is reporting another prescriber to the board for reckless treatment. I understand that many of these patients are in dire circumstances, but circumstances are irrelevant if someone is prescribing Xanax 8mg TID to a suicidal patient on massive doses of Opiates and muscle relaxers. When egregious levels of neglect or malpractice are noticed they should be reported, even if the boards that are reported to are useless.

 

[LimpSpatula]

The social situation and support of the patient shouldn't hold any bearing on whether a psychiatrist is reporting another prescriber to the board for reckless treatment. I understand that many of these patients are in dire circumstances, but circumstances are irrelevant if someone is prescribing Xanax 8mg TID to a suicidal patient on massive doses of Opiates and muscle relaxers. When egregious levels of neglect or malpractice are noticed they should be reported, even if the boards that are reported to are useless.

When that fictional patient comes to me I’ll report it to the board.

 

[Stagg737]

When that fictional patient comes to me I’ll report it to the board.

I'll send some of my patients your way then. Just let me know the address

 

[LimpSpatula]

I'll send some of my patients your way then. Just let me know the address

Send em over I’ll just hold all meds and transfer to medicine for concern for DTs.

 

[clausewitz2]

I understand that most of those people may just want to keep going to their candy shop

You might be surprised. Some of those folks keep going to the candy shop because they're afraid the alternative is that someone else is just going to make them get off the benzos they've been on for a decade in like a week and expect that to go well. They often recognize this is a problem but feel like they don't have an alternative. A high percentage of people I have inherited on chronic high-dose benzos are actually eager to get off them when I explain that I do it Ashton-style and it is a process of months rather than days. Most of the time when we get a ways down that path they start to notice they feel better and start pushing to taper faster, to be honest.

There are still people who don't go for it but as long as they understand a) i am never going to be increasing their dose for any reason b) i am going to have zero patience for early refills/multiple scripts and c) if their problems are a typical and expected side effect of chronic benzos they are not going to improve given the status quo, I can work with them. Those folks are rarely living a life they're very satisfied with, and I'd say a majority of the people who hard pass the first time I bring up taper come around to thinking it might be worth trying after they have a couple months to think about it after the initial come-to-jesus.

If there was a way I could advertise my willingness to work with people in gently tapering benzos without falsely implying I am an addictions specialist or having it become my entire caseload, i would. It is often very satisfying, I feel like it is genuinely practicing at the top of my license.

 

[robellis]

You might be surprised. Some of those folks keep going to the candy shop because they're afraid the alternative is that someone else is just going to make them get off the benzos they've been on for a decade in like a week and expect that to go well. They often recognize this is a problem but feel like they don't have an alternative. A high percentage of people I have inherited on chronic high-dose benzos are actually eager to get off them when I explain that I do it Ashton-style and it is a process of months rather than days. Most of the time when we get a ways down that path they start to notice they feel better and start pushing to taper faster, to be honest.

There are still people who don't go for it but as long as they understand a) i am never going to be increasing their dose for any reason b) i am going to have zero patience for early refills/multiple scripts and c) if their problems are a typical and expected side effect of chronic benzos they are not going to improve given the status quo, I can work with them. Those folks are rarely living a life they're very satisfied with, and I'd say a majority of the people who hard pass the first time I bring up taper come around to thinking it might be worth trying after they have a couple months to think about it after the initial come-to-jesus.

If there was a way I could advertise my willingness to work with people in gently tapering benzos without falsely implying I am an addictions specialist or having it become my entire caseload, i would. It is often very satisfying, I feel like it is genuinely practicing at the top of my license.

You’re never going to increase their dose for any reason? You don’t increase and taper more slowly if they have severe side effects?

 

[sloh]

. Those folks are rarely living a life they're very satisfied with, and I'd say a majority of the people who hard pass the first time I bring up taper come around to thinking it might be worth trying after they have a couple months to think about it after the initial come-to-jesus.

How do you find these patients where the majority are willing to try tapering?!

 

[SmallBird]

Just saying, this forum has been a place where everyone freaks out about this issue since I was a medical student (tragically, 10 years ago!). Back then the state hospital was posting a full time psych attending position for $150k per year and the academic hospital was paying about $120k. The state hospital is now offering $260k and the academic hospital $200k. So IDK, I think it might not be such a disaster. Everyone kept saying that once people ‘found out’ that NPs can do the ‘same job’ as psychiatrist or would depress wages but I work somewhere where we have NPs and MDs in similar roles and that just isn’t how it’s worked out. Individual cases may exist but I just don’t think it’s as much of a catastrophe as some are making it out to be.

 

[clausewitz2]

You’re never going to increase their dose for any reason? You don’t increase and taper more slowly if they have severe side effects?

The kind of taper I am talking about involves extremely gradual steps, e.g. equivalent of 2 mg diazepam per day each 1-2 weeks. Discomfort they are experiencing from a decrease like that has 0% chance of being medically dangerous, so I am happy to hold the line for a while and put the taper on hold but we are not going in the wrong direction.

For someone with a meaningful anxiety disorder on chronic benzodiazepenes, the benzos are not treating the anxiety, they are at best entrenching it and at worst exacerbating it. They also definititely interfere in the most effective forms of therapy we have for these conditions. What would increasing the dose accomplish?

Most people barely notice any changes at the rate we go, which of course is the point to some extent.

 

[Penguin10]

The kind of taper I am talking about involves extremely gradual steps, e.g. equivalent of 2 mg diazepam per day each 1-2 weeks. Discomfort they are experiencing from a decrease like that has 0% chance of being medically dangerous, so I am happy to hold the line for a while and put the taper on hold but we are not going in the wrong direction.

For someone with a meaningful anxiety disorder on chronic benzodiazepenes, the benzos are not treating the anxiety, they are at best entrenching it and at worst exacerbating it. They also definititely interfere in the most effective forms of therapy we have for these conditions. What would increasing the dose accomplish?

Most people barely notice any changes at the rate we go, which of course is the point to some extent.

Do you typically convert to diazepam and then taper or just gradually reduce whatever they're taking?

 

[Stagg737]

You might be surprised. Some of those folks keep going to the candy shop because they're afraid the alternative is that someone else is just going to make them get off the benzos they've been on for a decade in like a week and expect that to go well. They often recognize this is a problem but feel like they don't have an alternative. A high percentage of people I have inherited on chronic high-dose benzos are actually eager to get off them when I explain that I do it Ashton-style and it is a process of months rather than days. Most of the time when we get a ways down that path they start to notice they feel better and start pushing to taper faster, to be honest.

There are still people who don't go for it but as long as they understand a) i am never going to be increasing their dose for any reason b) i am going to have zero patience for early refills/multiple scripts and c) if their problems are a typical and expected side effect of chronic benzos they are not going to improve given the status quo, I can work with them. Those folks are rarely living a life they're very satisfied with, and I'd say a majority of the people who hard pass the first time I bring up taper come around to thinking it might be worth trying after they have a couple months to think about it after the initial come-to-jesus.

If there was a way I could advertise my willingness to work with people in gently tapering benzos without falsely implying I am an addictions specialist or having it become my entire caseload, i would. It is often very satisfying, I feel like it is genuinely practicing at the top of my license.

Oh, I’m fully aware that many people don’t want to be on them and just have a very severe psychological dependence from years of use. I’m working with several on slow tapers (like, tapers taking over a year). However, I also encounter a large percentage of patients who either just want to be sedated from their anxiety or are legitimately abusing. This was evidenced when our CMHC made a policy that we no longer prescribe Xanax and my patient load noticeably lightened.

 

[Jules A]

I have a lot of respect for the The Psych NP (from YouTube). Not only did he have the balls to start his own practice, he is super transparent with his numbers:

gross: $300k+
profit: $250k

work:
- 30 hrs / week (3 days / week and 10 hrs / day)
- 10 - 12 pts / day

For those who are interested in private practice, I would include his channel as a learning source regarding the business aspect of private practice.

I'm always a fan of transparency. On a side note he got hosed agreeing to work for $130,000 as a new grad in psych in Maryland.

 

[AnnoyedByFreud]

Just saying, this forum has been a place where everyone freaks out about this issue since I was a medical student (tragically, 10 years ago!). Back then the state hospital was posting a full time psych attending position for $150k per year and the academic hospital was paying about $120k. The state hospital is now offering $260k and the academic hospital $200k. So IDK, I think it might not be such a disaster. Everyone kept saying that once people ‘found out’ that NPs can do the ‘same job’ as psychiatrist or would depress wages but I work somewhere where we have NPs and MDs in similar roles and that just isn’t how it’s worked out. Individual cases may exist but I just don’t think it’s as much of a catastrophe as some are making it out to be.

Agree very strongly with this. Yes, I make a great living as a psych NP, but my attendings make even more. The psychiatry shortage is real and while there are now more providers now, jobs seem to be growing as well.

 

[PikminOC]

I largely agree with what you're saying, but I can't imagine that an NP seeing 30+ patients per day without direct supervision while prescribing controlled substances would go unrecognized by everyone in the area. I would think that at some point another psychiatrist in the area would recognize a problem with this kind of care and have a low threshold to report to the boards if seeing inappropriate prescribing.

I realize that there's a (miniscule) possibility that the patients are being cared for in a mostly appropriate way and not put at significant risk, but given how terrible a large portion of the NP plans I've seen are from NPs seeing 8-12 patients per day, I don't have much faith that an NP seeing 2-3 times that many patients could even provide relatively competent care.

Nursing board doesn't care

 

[Jules A]

Nursing board doesn't care

Board of Physicians doesn't seem to be much better in my state.

 

[vistaril]

I spoke about the psych np threat many many years ago and many in this forum minimized it. Now we're starting to see the fruits of it, and the sad thing is the worst is yet to come.....the number of psych np grads these programs are pumping out now is amazing. It seems like every youngish psych rn is also currently in psych np school.

our group pay our psych nps 110k on average and the hospitals love them. In many cases they do better work(imo) than the inpatient psychs. I mostly see my own patients without psych np(thats how I can keep my daily cencus to 35-40 inpatients), but there are psychs in our group who 'see' 120-130 a day and it's all with nps. basically they are supervising 3 or so nps and just reviewing their notes and signing them as their day. Technically the psych has to see the patient too, but with those numbers its obviously a very quick interaction.

This is what we are trending to as a field....it's already here in many places, but in the areas it isn't it's coming.

The reality is that there are enough psychs who don't mind 'signing off' on extremely large numbers of np inpatient charts that our leverage is about to decline dramatically. Because when one psych doesn't mind 'signing off' on 130 inpatient charts daily with pts seen by nps, well.....that knocks out a lot of the inpatient psychiatric needs and hospitals then have the leverage.

There is a 120 bed psychiatric hospital in my area(the hospital has 500 or so medical/surgery beds, maybe a little more) and they are following this model. One psychiatrist manages 3-4 psych nps who see the 120 pts. The hospital is happy because the nps do good work in their mind and they still have the psych name on charts to meet that minimum standard. And obviously they only have to find 1 psychiatrist to take the contract....not 4 or 5. It's win-win....for everyone except the other psychs in the community who may have wanted to do inpatient work themselves and are left out in the cold holding the bag.....

I realize this is not the standard in some places now. But it's coming......to act like it's not is ignorance

 

[vistaril]

Nursing board doesn't care

I largely agree with what you're saying, but I can't imagine that an NP seeing 30+ patients per day without direct supervision while prescribing controlled substances would go unrecognized by everyone in the area. I would think that at some point another psychiatrist in the area would recognize a problem with this kind of care and have a low threshold to report to the boards if seeing inappropriate prescribing.

lol......30? Hell Ive seen more than that.

NOBODY cares. Yes there may be some psychs(like me) who care because it negatively impacts us and our opportunities, but there isn't anything we can do about it. Neither the nursing boards or medicine boards are going to do anything about it.....

 

[PikminOC]

lol......30? Hell Ive seen more than that.

NOBODY cares. Yes there may be some psychs(like me) who care because it negatively impacts us and our opportunities, but there isn't anything we can do about it. Neither the nursing boards or medicine boards are going to do anything about it.....

The med board comes down hard on Physician's. They have no say over nurses.

 

[Mad Jack]

I've a serious question. Can I do online nursing school and PHMNP course all online on my weeks off as hospitalist? That way in 4 years I can be dual boarded in IM and Psych (nursing board). Outpatient psych private practice is making lot of $$$ these days. If I choose psych residency it's the same BS with getting LORs, match process, working long hrs for 50k, conference, research, presentation and ****. I will still be a doctor and can still be called a psychiatrist. I wish I can be shameless enough to do this to make mockery of this system.

Another advantage of PMHNP pathway for MD is the lifespan crap where I can treat mental health problems from birth to death without any BS child psych or geri psych fellowships

I thought about this with regard to CRNAs as well. Like, why don't some people just go FM to CRNA since the lifestyle is better

 

[vistaril]

The med board comes down hard on Physician's. They have no say over nurses.

I was referring to one of the above posters who implied the nursing board might discipline the nurses or the med board might discipline the docs who have these collaborative agreements. The reality is neither cares, and when they are aware of it they are fine with it.

Race to the bottom(and we have a long way to go...but it's coming)

 

[robellis]

I was referring to one of the above posters who implied the nursing board might discipline the nurses or the med board might discipline the docs who have these collaborative agreements. The reality is neither cares, and when they are aware of it they are fine with it.

Race to the bottom(and we have a long way to go...but it's coming)

When it really reaches the bottom (or if) we will have a 2 tiered healthcare structure where people with money can afford physicians and the masses/poor are gonna have to put up with care that you and others provide..very sad but it seems the way it’s going

 

[vistaril]

When it really reaches the bottom (or if) we will have a 2 tiered healthcare structure where people with money can afford physicians and the masses/poor are gonna have to put up with care that you and others provide..very sad but it seems the way it’s going

But in psychiatry a lot of the people with money are fine with an np. I don't mean high end manhattan analyst practices that are obviously cash pay. I'm talking about an upper middle class radiologist who takes ADHD medicine. She's more than happy to pop into a psych np and get what she needs.....she wouldn't feel the same way about her internist, for example.

 

[PikminOC]

I was referring to one of the above posters who implied the nursing board might discipline the nurses or the med board might discipline the docs who have these collaborative agreements. The reality is neither cares, and when they are aware of it they are fine with it.

Race to the bottom(and we have a long way to go...but it's coming)

I've seen Physician's get in board trouble for this mid-level supervision

 

[calvnandhobbs68]

But in psychiatry a lot of the people with money are fine with an np. I don't mean high end manhattan analyst practices that are obviously cash pay. I'm talking about an upper middle class radiologist who takes ADHD medicine. She's more than happy to pop into a psych np and get what she needs.....she wouldn't feel the same way about her internist, for example.

One could argue that this same stable ADHD patient should be treated by her internist/FM doc anyway.

Conversely in terms of my side of things, you think the radiologist is going to want her kid to see an NP when she needs a psych referral for depression/anxiety/adhd/ocd/whatever? I don’t think so either.

 

[clausewitz2]

But in psychiatry a lot of the people with money are fine with an np. I don't mean high end manhattan analyst practices that are obviously cash pay. I'm talking about an upper middle class radiologist who takes ADHD medicine. She's more than happy to pop into a psych np and get what she needs.....she wouldn't feel the same way about her internist, for example.

Yeah, you're right. If all you can provide to that the radiologist is a stimulant, what the hell do they need to see you for? NPs can also use a pen/keyboard.

 

[robellis]

Yeah, you're right. If all you can provide to that the radiologist is a stimulant, what the hell do they need to see you for? NPs can also use a pen/keyboard.

What else would you provide for a stable adhd patient on a stimulant

 

[michaelrack]

One could argue that this same stable ADHD patient should be treated by her internist/FM doc anyway.

One could argue that, but in most cases primary care providers don't want to treat adult ADHD

 

[vistaril]

One could argue that this same stable ADHD patient should be treated by her internist/FM doc anyway.

Conversely in terms of my side of things, you think the radiologist is going to want her kid to see an NP when she needs a psych referral for depression/anxiety/adhd/ocd/whatever? I don’t think so either.

as to the first, lots of internists don't want to deal with that.

As to the sec, it depends on a lot of factors. A lot of times patients feel a lot more comfortable being treated for mood/anxiety d/os with someone who is of the same culture, first language,etc. I've seen cases where upper middle class patients didn't want to see good(imo) psychiatrists because they aren't as easy to understand than the girl who grew up 15 minutes from then. The np may not know as much about receptor binding profiles for cymbalta vs effexor, but thats less important(to the patient) than the patient feeling that they can relate better in other ways....

Not saying it's right(or wrong), but that happens. But of course obviously not all psychs(or even most) our IMGs.

 

[NPDude362]

Been following this guy on Youtube since the beginning. His content is great and he seems like he is a genuinely good person who has the patients best interests in mind.

I am a current Family Nurse Practitioner and will be done with a PMHNP Post-Masters Certificate in 5 months and am looking to go a similar route.

 

[MedMan80]

I don't think it's doom and gloom but neither is the NP threat non existent. I was the last psychiatrist hired at my rural medicaid clinic (2 years ago), since we've had 3 NP's join and multiple more applying and also serval RN's becoming NP's (leading to an RN shortage lol). At the minimum i feel like our reimbursement will be somewhat diluted in the future, but we will never "be out of work".

 

[comp1]

It's definitely not doom and gloom. There's still a limit of how many people, MD, NP or even PA want to do mental health compared to the vast need. I think even the reimbursement dilution is unlikely.

 

[Sushirolls]

It's definitely not doom and gloom. There's still a limit of how many people, MD, NP or even PA want to do mental health compared to the vast need. I think even the reimbursement dilution is unlikely.

Because dilution has already happened in many areas? I see posters here on SDN talking about rates barely better than medicare.

In my area I have good/okay rates, but yet they are still notably less than other medical specialists.

 

[DownJonesIndustrial]

Came across this video as I was surfing Youtube:



Is this right? Does a Psych NP in private practice make $250K+?

Easily.

 

[DownJonesIndustrial]

And they haven't been reported to their respective boards how? Is this an FPA state?

Here it's more typical for psychiatrists to prescribe with those habits. I've received a patient on both Adderall and Provigil as well as Valium "to take the edge off." I know another who began receiving disability benefits and stopped working who was prescribing morphine supposedly for anxiety. A few weeks ago at the hospital, I had a patient taking Adderall QID. These doctors span a large area. It's not just local, and I operate over three states. The first week I ever practiced I took in a patient with TID Klonopin and TID PRN Xanax plus some Restoril at night for good measure. Most NPs I've worked around are phobic of controlled substances.

 

[DownJonesIndustrial]

A PMHNP doing therapy without additional training = lol

Interesting perspective but I agree. I talk with NPs who really enjoy "talking with the patient" and describe this as therapy and love it. It's supportive counseling or education at best. I personally wouldn't want to occupy a psychotherapy role. To each their own.