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dontknowanything

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Hi! Currently trying to figure out which would be best. (I am in California). I've read that there are rarely PAs in psych...I am mainly leaning towards NP but I'd have to do either a MEPN or accelerated BSN...if anyone has any advice on any of these paths I'd appreciate it!

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Past only do 6 weeks of psych in training, and when you're hired you are expected to be able to function at most places. Psych NPs have an entire training course focused around psych, and just are better prepared out of the gate. Neither can really hold up to a psychiatrist, but a psych NP can at least handle less complicated cases out of training, whereas a PA really just can't.
 
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I’m a psyche NP. I typed up a long response that covered a lot of the same stuff that I’ve said in other posts, but I’ll break it down and answer anything you want me to piecemeal. There’s a lot of threads on this subject, and plenty of discussion to wade through that might give you a lot of insight.

So California is an interesting case because PAs and NPs have some similar supervision requirements. However, NPs there are hitting the lobbying hard to push for independent status. If that happens, and I think it’s more likely it will happen soon, then that changes the calculus significantly in favor of NPs solidifying an upper hand.


As far as training, I’ve had discussions on forums with PAs who have tried to make the case that physician assistants that do a couple elective psyche rotations will rack up about as many psyche hours as psyche NPs. Those folks tend to refer to a common minimum number of hours many psyche NP programs have, which is 600 hours. I did almost double that, but that was elective for me to do. At the minimum of 600 hours, that’s still almost 16 weeks, or 4 months of rotations a PA would need to do to match. I guess it’s possible for a PA to do that, but not likely. Many PA programs don’t even require a specific psyche rotation, although I think that most do. But when you add in the fact that many to most psyche NPs have prior nursing experience, which would be gold standard pre PA health care experience, you typically end up with a new grad provider that has a lot of time under their belt interacting with people. The comfort level with that really helps with patients and potential employers when they interview.

There are tons more factors involved that I think helps at least present NPs as more prepared for the psyche realm, and I could go into them, but I do know a handful of psyche PAs, and they seem to be good providers. I’ve been involved in interviews and hiring decisions at the place I work, and can offer some insight as to why we tend to prefer NPs, and that reason is more based on practicality than specific bias against the profession. For example, I can explain to you some of the thinking behind why the organization is wary, and it has more to do with those nuts and bolts issues than any specific skill set that PAs have it don’t have. They happen to be trained very well, and when a PA candidate makes it through the gauntlet, it’s a good chance that they have done very well academically. But there is more to the psyche realm to consider, and that’s where I think they face an uphill battle.
 
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I will say that dollar for dollar, a modestly priced accelerated BSN is one of the most valuable degrees that a person can obtain in the healthcare realm. I’d much rather pay $40,000 for an ABSN than I would $110,000 for a PA degree. I can break that down too. These days, after what I’ve seen recently in the job market, I’d be hard pressed to suggest someone get a PA degree unless it’s well priced.
 
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I’m a psyche NP. I typed up a long response that covered a lot of the same stuff that I’ve said in other posts, but I’ll break it down and answer anything you want me to piecemeal. There’s a lot of threads on this subject, and plenty of discussion to wade through that might give you a lot of insight.

So California is an interesting case because PAs and NPs have some similar supervision requirements. However, NPs there are hitting the lobbying hard to push for independent status. If that happens, and I think it’s more likely it will happen soon, then that changes the calculus significantly in favor of NPs solidifying an upper hand.


As far as training, I’ve had discussions on forums with PAs who have tried to make the case that physician assistants that do a couple elective psyche rotations will rack up about as many psyche hours as psyche NPs. Those folks tend to refer to a common minimum number of hours many psyche NP programs have, which is 600 hours. I did almost double that, but that was elective for me to do. At the minimum of 600 hours, that’s still almost 16 weeks, or 4 months of rotations a PA would need to do to match. I guess it’s possible for a PA to do that, but not likely. Many PA programs don’t even require a specific psyche rotation, although I think that most do. But when you add in the fact that many to most psyche NPs have prior nursing experience, which would be gold standard pre PA health care experience, you typically end up with a new grad provider that has a lot of time under their belt interacting with people. The comfort level with that really helps with patients and potential employers when they interview.

There are tons more factors involved that I think helps at least present NPs as more prepared for the psyche realm, and I could go into them, but I do know a handful of psyche PAs, and they seem to be good providers. I’ve been involved in interviews and hiring decisions at the place I work, and can offer some insight as to why we tend to prefer NPs, and that reason is more based on practicality than specific bias against the profession. For example, I can explain to you some of the thinking behind why the organization is wary, and it has more to do with those nuts and bolts issues than any specific skill set that PAs have it don’t have. They happen to be trained very well, and when a PA candidate makes it through the gauntlet, it’s a good chance that they have done very well academically. But there is more to the psyche realm to consider, and that’s where I think they face an uphill battle.

Wow this is extremely helpful, thank you!! From the research I’ve done it seems psych NP is the way to go over PA. Yeah, PA school will take me way less time, like 3 years including taking the rest of the pre reqs now and then getting in. However, will I be fulfilled? I feel like with psych NP it’ll give me more psych experience like you said. That gives me hope about how they are pushing for independent status. Honestly, so many states are already independent so I’m hoping it’ll be that time for California soon. The other reply about the bsn... is that the best route for me? My “end goal” is to get my DNP and be a psych NP. I believe loma linda has both a BS to DNP and MS to DNP and have a concentration in psych too. I’m just trying to figure out which would be the best. I think the acc. BSN will be way cheaper than an entry level MSN.. and if I could do the acc bsn and then go straight to DNP (after working as an RN of course) that might be better for me, I think?
 
So here’s a little secret about BS to DNP programs, or essentially what they call “direct entry” DNP programs.... you can patch together your own direct entry program by attending an accelerated BSN program, and then quickly going into NP school from there. I don’t particularly like how some direct entry programs lock you in to completing their entire program if you want to obtain your BSN. Life happens, and you could find yourself not wanting to commit to the entire length of a direct entry program, and would rather prefer to go practice as a nurse for a while. Many direct entry programs don’t have that as an option. You may have your RN, but you would not have a nursing degree to go along with it if you don’t make it through to the end of the masters or doctorate. Just something to think about. Those programs are also expensive. I think the best route is to pursue a modestly priced ABSN, then start working and start NP school at a modestly priced NP program. Additionally, if you can find a masters NP program, you can cut out about a year or more of extra fluff that it takes to get the doctorate.

I personally might go back someday to get my DNP instead of just remaining in the field with my masters degree NP. It’s a consideration, even though it’s completely not necessary for me to do to be marketable and make excellent money. But the doctorate does add a bit of prestige to the office door, and the perception of achievement, which might come into play if I want to change roles to more administrative or executive duties away from direct patient care. As it stands now, there’s no particular draw for me to pursue it, as it’s just becoming the standard for many new grads because their program phased out the masters option. But it adds time to enter an already profitable career path. If I would have delayed my graduation by a year or more, it literally would have cost me over $150,000, and maybe even over $200,000 cash.

There certainly are very distinct advantages to having fully independent practice rights as a professional. In hiring decisions, that factors in heavily. It’s something that can be helpful for the employer, and definitely for the employee. It’s the reason why in my area, psyche NPs command a wage at least 1/3 as much higher than psyche PAs, and why we have absolutely no struggle finding work, whereas the psyche PAs are finding it about as difficult as other PA job seekers and FNPs who are saturating the market. I do hear stories about psyche PAs that are killing it in other places, and I don’t doubt it, but the path to that isn’t quite as straightforward as for psyche NPs. I’ve seen desperate PA new grads (and even some FNPs) trying to break into psyche and beat the trend and seek to cash in on the psyche need, and fall flat. I personally only even look at PA candidates with proven PA experience in psyche, and no new grads, whereas I’d easily hire the right new grad psyche NP. That’s kind of how it’s been rolling for the physicians where I work too. They actually are more firm in their resolve than I am about hiring psyche NPs exclusively.

My starting wage as a psyche NP was higher than almost any PA that I know at the height of their career. The only exception to that might be one of my friends who is a PA in derm. I really can only guess what that person makes because I wouldn’t doubt it’s in their best interest to portray themself as being a high roller and a valuable player in that specialty. The customers in that realm want to think that their provider is exclusively talented, and nothing encourages that kind of thinking like believing they command high dollar salary. It wouldn’t surprise me if my friend made less than they appear to.

Another thing about NP school... it’s a pathway that can be very deliberate. By that I mean that you have a lot of control over your process. You are more likely to be able to go to school closer to where you want to live, and be less vulnerable to market trends. You could work hard on your prereqs, and due to the ultra competitiveness of the applicant pool, you might not get into a PA program for a while. And you might find yourself having invitations to go to the only places you get in. That could leave you having to spend over 2 years in some state you’ve never expected or wanted to live. Then you get to go look for a job out of school in places where you haven’t been for that 2 years. But if you go the NP route, you can plunk down in a place where you want to end up, and get a nursing job, and then network yourself. You can set up clinical sites at places you are interested in working, and then those employers will know who you are when you apply. It gives you an inside track. I had job offers from every place I did clinical training at, and I already knew which places were the better environments (all were fantastic though). I wasn’t coming back from being away for 2 years, and having to basically cold call potential employers. They came to me. Their competitors came to me. Word of mouth meant I never even filled out a single application. I had physicians I worked with as an RN inviting me to come practice with them. These folks wanted me, and wanted to pay me a good wage because they liked me and knew me, and wanted to genuinely help me, because I’d been helping them for years. So that’s an advantage that you can’t put a price on. As a PA, I wouldn’t have had that.
 
I will say that dollar for dollar, a modestly priced accelerated BSN is one of the most valuable degrees that a person can obtain in the healthcare realm. I’d much rather pay $40,000 for an ABSN than I would $110,000 for a PA degree. I can break that down too. These days, after what I’ve seen recently in the job market, I’d be hard pressed to suggest someone get a PA degree unless it’s well priced.

Can you expand a bit more on what you're referring to regarding the PA job market? Has it gotten really bad in recent years?
 
Can you expand a bit more on what you're referring to regarding the PA job market? Has it gotten really bad in recent years?

The job market for both NPs and PAs seems to be tightening quite a bit in the last 10 years, to the point where I’m seeing a lot of concern manifest by new grad PAs and NPs. I guess the term “Tightening” might be misleading, as it seems to me more a function of increased saturation of the job market. Essentially, there are a lot of PAs and NPs being churned out. For reference, there are now more NPs graduating each year than physicians. NPs have an ace in the hole vs PAs in that their nursing degree they have as RNs gives them access to a good job while they wait to get hired for a position as a prescriber. And having an RN license qualifies nurses for tons and tons of jobs... everything from hospital administrators to school nurses, to public health, to employee health, to consulting, to teaching, to insurance utilization review..... to whatever. I sat down at work and off the top of my head came up with over 50 careers that an RN license opened up that were either exclusive or almost universally exclusive to nurses. After I got my nurses license and before I was in my first nursing job, the IT department came to me and offered me close to six figures to come work for them, based on my simply having an RN license.... not even a license I’d used. They just wanted a “nurse” that was good with computers. They were required to hire nurses for a certain role, and knew I was god with computers, so they wanted to use me for other stuff, and also fill that niche they were required to fill on paper.

So what that all means is that new NPs can work, make money, and find the right job as an NP. If it takes a while, it’s ok, because they can pay the bills and live well. If (heaven forbid) they can’t find a job, they still have a masters degree, and can still work in a good career. New PAs that are desperate for work are hitting the market where there are tons of other PAs and tons more NPs, and can’t afford to sit it out while they have six figures of debt to start paying back. They take jobs that pay lower than they should, and it drives cost down. I met a PA six months ago that started at $76,000 per year salaries as a new grad in a job that would definitely require more than 40 hours per week. Their goal was to “get experience” so that they could get a better job down the road. As a new RN, I made I think like $68,000 base, and anything over my 36 was overtime. I made more than $76,000 my second year as an RN base wage.

So that’s a snapshot of what I’ve seen. I know PAs with experience that are doing well, but not the new folks. And these days, in reference to psyche, there are a lot of PAs, and even some FNPs that are hoping to move into psyche prescribing, but they are being met with skeptical potential employers that question their motives due to the tight market in the rest of the industry. Hypothetical case for me would be me wondering if a PA was really interested in seeing psyche patients, or were they just unable to land a job doing what they really wanted to do, like ER or surgery. I’d also wonder if they were in it just for the money (because psyche is a hit field right now for NPs, and sometimes PAs). I don’t wonder that about psyche NPs typically.

I really could only recommend nursing and Np as a stable choice vs PA at this stage. I don’t see that changing, either.
 
The job market for both NPs and PAs seems to be tightening quite a bit in the last 10 years, to the point where I’m seeing a lot of concern manifest by new grad PAs and NPs. I guess the term “Tightening” might be misleading, as it seems to me more a function of increased saturation of the job market. Essentially, there are a lot of PAs and NPs being churned out. For reference, there are now more NPs graduating each year than physicians. NPs have an ace in the hole vs PAs in that their nursing degree they have as RNs gives them access to a good job while they wait to get hired for a position as a prescriber. And having an RN license qualifies nurses for tons and tons of jobs... everything from hospital administrators to school nurses, to public health, to employee health, to consulting, to teaching, to insurance utilization review..... to whatever. I sat down at work and off the top of my head came up with over 50 careers that an RN license opened up that were either exclusive or almost universally exclusive to nurses. After I got my nurses license and before I was in my first nursing job, the IT department came to me and offered me close to six figures to come work for them, based on my simply having an RN license.... not even a license I’d used. They just wanted a “nurse” that was good with computers. They were required to hire nurses for a certain role, and knew I was god with computers, so they wanted to use me for other stuff, and also fill that niche they were required to fill on paper.

So what that all means is that new NPs can work, make money, and find the right job as an NP. If it takes a while, it’s ok, because they can pay the bills and live well. If (heaven forbid) they can’t find a job, they still have a masters degree, and can still work in a good career. New PAs that are desperate for work are hitting the market where there are tons of other PAs and tons more NPs, and can’t afford to sit it out while they have six figures of debt to start paying back. They take jobs that pay lower than they should, and it drives cost down. I met a PA six months ago that started at $76,000 per year salaries as a new grad in a job that would definitely require more than 40 hours per week. Their goal was to “get experience” so that they could get a better job down the road. As a new RN, I made I think like $68,000 base, and anything over my 36 was overtime. I made more than $76,000 my second year as an RN base wage.

So that’s a snapshot of what I’ve seen. I know PAs with experience that are doing well, but not the new folks. And these days, in reference to psyche, there are a lot of PAs, and even some FNPs that are hoping to move into psyche prescribing, but they are being met with skeptical potential employers that question their motives due to the tight market in the rest of the industry. Hypothetical case for me would be me wondering if a PA was really interested in seeing psyche patients, or were they just unable to land a job doing what they really wanted to do, like ER or surgery. I’d also wonder if they were in it just for the money (because psyche is a hit field right now for NPs, and sometimes PAs). I don’t wonder that about psyche NPs typically.

I really could only recommend nursing and Np as a stable choice vs PA at this stage. I don’t see that changing, either.

I appreciate you spending the time to describe the job market situation for PAs in detail for me. I'm actually a fourth-year pharmacy student who will be graduating in May, and to put it simply, the job market for pharmacists throughout essentially the entire country is abysmal, so I was actually mulling over the possibility of applying to PA schools, but it sounds like the PA profession could be on track to decimating their own job market like what's happened in the pharmacy profession. I wish I had a stronger stomach, because it sounds like nursing/NP really is the safest choice to make in healthcare these days.
 
Your case is one of the few situations where I’d suggest PA school over NP. You could walk into the majority of PA programs with little to no effort, provided you had current prereqs. That would give you the opportunity to at least shoot for a cheaper PA program. You also have the pharmacy angle, and could bide your time until the right opportunity arrived where you were offered a decent PA job. Honestly, most PA school candidates wouldn’t come close to your level of health care experience (even just being a pharmacy student), and having pharmacy knowledge would be a huge plus. So scratch what I wrote, you are in a different category than the kid who is a CNA or an undergrad, because you could make this work really well for yourself. However, I imagine your debt will be rather significant after going to both programs back to back. If you are this far into the pharmacy thing, I don’t see how you come out farther ahead as a PA.

I think a good way to look at where PA is headed is to look at where pharmacy has been. I remember the day when wal mart was giving away BMWs as sign on perks, along with $120,000 salaries (which is like $153,000 now). Fast forward 12 years and it’s a different world altogether. Nobody is giving away anything like a BMW to lure in pharmacists from what I hear. I was talking to a pharmacy student 8 years ago and he was telling me how nervous he was, and how people in his class were struggling to find jobs, and I was shocked, because the last I heard was the BMW story I was talking about. So that was the canary in the coal mine I saw drop dead in front of me. Blew my mind.

Seems like most things in life come with a catch. My dentist friends have fat debt because you need to start a practice or buy in. My physician friends have heavy debt, and sacrificed quite a bit in terms of time away from loved ones while training. My PA friends have debt and a market facing saturation (which it sounds like pharmacy has both of those things too). Physical therapy.... kind of like pharmacy.... expensive school, market forces changing the employment landscape. NPs have their RN licenses and cheap school going for them, but saturation is a thing for us too. It used to be that the medical field was the shelter from the storm, but it’s complicated by things like consolidation. Everyone wants to make us employees and treat us like everyone else they employ. We are replaceable because of the numbers being churned out, and schools know that they can charge top dollar for seats, because they get tons of applicants for each seat in their professional programs.

Tough call. But I’d think hard before I jumped off the pharmacy train to find gold in another valley, because you might be arriving just in time to see the last wagon train move out of town. I think I arrived in the psyche NP realm in time to get enough experience to be marketable. I don’t know how it’s going to be for my friends in the pipeline, even now. The ones graduating right now should be good. I see things that worry me on the horizon. I think the mindset needs to be that living frugal should be the norm, because you’ll work for every dime. The days of 3 and a half days of work for dentists might be over. So might being able to plant down and get everything you want as a nonphysician provider.

3 years ago, the folks on the PA forum website used to repeat a well worn saying: “as a new PA, you could pick 2 of 3 of the following, but not all 3... the location you want, the specialty you want, or the salary you want”. Guess what everyone there is reading that new grads are facing? New grads consider themselves lucky to get ANYTHING. If they even get one of the three of those things, they are thrilled.

This all seems crazy to me because here we are in an amazing economy. It was the economic crash in ‘08 that sent everyone fleeing to healthcare to find steady work. Nursing was competitive as anything. Everyone was openly coveting the “three day work weeks” nurses had. Everyone was using the retraining money they got after being laid off to go back to school to become a nurse. Now all those folks want to be NPs because bedside nursing is tough, and 3 day weeks aren’t worth it when all you do those three days is work, and all you do on 4 days off is recover and dread going back for three more days of stress and toil. But during the downturn, companies consolidated and streamlined. Schools ramped up expensive seats for laid off economic refugees and their kids who didn’t want to end up laid off like their parents. Now we have lots of providers of all types. And providers now are more into finding a job that supports their lifestyle with free time from work, and employers think that’s great because they think use that as an opportunity to offer less wages. The providers still end up getting screwed by the bait and switch. I see this happening to some newer doctors lately.

Anyway.... my answer was more than you probably bargained for, bit that’s what I’m seeing. The way to avoid this is to just expect to keep working hard. Maybe the new mantra is to pick either a decent amount of money, a decent amount of free time, or a decent amount of job security, but not any more than one of those. One could substitute “stress free work environment” in for job security.
 
Your case is one of the few situations where I’d suggest PA school over NP. You could walk into the majority of PA programs with little to no effort, provided you had current prereqs. That would give you the opportunity to at least shoot for a cheaper PA program. You also have the pharmacy angle, and could bide your time until the right opportunity arrived where you were offered a decent PA job. Honestly, most PA school candidates wouldn’t come close to your level of health care experience (even just being a pharmacy student), and having pharmacy knowledge would be a huge plus. So scratch what I wrote, you are in a different category than the kid who is a CNA or an undergrad, because you could make this work really well for yourself. However, I imagine your debt will be rather significant after going to both programs back to back. If you are this far into the pharmacy thing, I don’t see how you come out farther ahead as a PA.

I think a good way to look at where PA is headed is to look at where pharmacy has been. I remember the day when wal mart was giving away BMWs as sign on perks, along with $120,000 salaries (which is like $153,000 now). Fast forward 12 years and it’s a different world altogether. Nobody is giving away anything like a BMW to lure in pharmacists from what I hear. I was talking to a pharmacy student 8 years ago and he was telling me how nervous he was, and how people in his class were struggling to find jobs, and I was shocked, because the last I heard was the BMW story I was talking about. So that was the canary in the coal mine I saw drop dead in front of me. Blew my mind.

Seems like most things in life come with a catch. My dentist friends have fat debt because you need to start a practice or buy in. My physician friends have heavy debt, and sacrificed quite a bit in terms of time away from loved ones while training. My PA friends have debt and a market facing saturation (which it sounds like pharmacy has both of those things too). Physical therapy.... kind of like pharmacy.... expensive school, market forces changing the employment landscape. NPs have their RN licenses and cheap school going for them, but saturation is a thing for us too. It used to be that the medical field was the shelter from the storm, but it’s complicated by things like consolidation. Everyone wants to make us employees and treat us like everyone else they employ. We are replaceable because of the numbers being churned out, and schools know that they can charge top dollar for seats, because they get tons of applicants for each seat in their professional programs.

Tough call. But I’d think hard before I jumped off the pharmacy train to find gold in another valley, because you might be arriving just in time to see the last wagon train move out of town. I think I arrived in the psyche NP realm in time to get enough experience to be marketable. I don’t know how it’s going to be for my friends in the pipeline, even now. The ones graduating right now should be good. I see things that worry me on the horizon. I think the mindset needs to be that living frugal should be the norm, because you’ll work for every dime. The days of 3 and a half days of work for dentists might be over. So might being able to plant down and get everything you want as a nonphysician provider.

3 years ago, the folks on the PA forum website used to repeat a well worn saying: “as a new PA, you could pick 2 of 3 of the following, but not all 3... the location you want, the specialty you want, or the salary you want”. Guess what everyone there is reading that new grads are facing? New grads consider themselves lucky to get ANYTHING. If they even get one of the three of those things, they are thrilled.

This all seems crazy to me because here we are in an amazing economy. It was the economic crash in ‘08 that sent everyone fleeing to healthcare to find steady work. Nursing was competitive as anything. Everyone was openly coveting the “three day work weeks” nurses had. Everyone was using the retraining money they got after being laid off to go back to school to become a nurse. Now all those folks want to be NPs because bedside nursing is tough, and 3 day weeks aren’t worth it when all you do those three days is work, and all you do on 4 days off is recover and dread going back for three more days of stress and toil. But during the downturn, companies consolidated and streamlined. Schools ramped up expensive seats for laid off economic refugees and their kids who didn’t want to end up laid off like their parents. Now we have lots of providers of all types. And providers now are more into finding a job that supports their lifestyle with free time from work, and employers think that’s great because they think use that as an opportunity to offer less wages. The providers still end up getting screwed by the bait and switch. I see this happening to some newer doctors lately.

Anyway.... my answer was more than you probably bargained for, bit that’s what I’m seeing. The way to avoid this is to just expect to keep working hard. Maybe the new mantra is to pick either a decent amount of money, a decent amount of free time, or a decent amount of job security, but not any more than one of those. One could substitute “stress free work environment” in for job security.

The problem with the pharmacist job market is that it's so saturated it's literally impossible to find a job in certain regions/states, even for applicants who have completed a residency and/or who have previous pharmacist work experience. For example, hospitals are receiving literally 40+ applications for pharmacist positions posted for hospitals in medium-sized cities (not even large metropolitan cities). So in other words, it's not necessarily a case of voluntarily choosing to pursue something else besides pharmacy -- it's moreso the case that many pharmacy school graduates will have no choice but to do so, simply because there aren't nearly enough jobs to accommodate the 15,000 - 16,000 graduates being pumped out by schools every year.

I wonder just how saturated the PA job market is? Whenever I do a job search on Indeed.com for PA jobs in large, desirable cities, it seems like there are at least 3-4 pages worth of job openings, but it could be the case that only experienced PA's are being considered for those positions.
 
The problem with the pharmacist job market is that it's so saturated it's literally impossible to find a job in certain regions/states, even for applicants who have completed a residency and/or who have previous pharmacist work experience. For example, hospitals are receiving literally 40+ applications for pharmacist positions posted for hospitals in medium-sized cities (not even large metropolitan cities). So in other words, it's not necessarily a case of voluntarily choosing to pursue something else besides pharmacy -- it's moreso the case that many pharmacy school graduates will have no choice but to do so, simply because there aren't nearly enough jobs to accommodate the 15,000 - 16,000 graduates being pumped out by schools every year.

I wonder just how saturated the PA job market is? Whenever I do a job search on Indeed.com for PA jobs in large, desirable cities, it seems like there are at least 3-4 pages worth of job openings, but it could be the case that only experienced PA's are being considered for those positions.

It’s like that now? If it is, then I would suggest that no, it’s not that bad for PAs and NPs yet.

Physicians are still in demand, and are considered a good investment. Facilities can get a lot out of a doctor that is hired on staff. I’ve noticed that everyone really wants to hire doctors, they just would love them to be a cheaper option (as you would expect any employer to wish). The bottleneck is physician residency positions. So that helps keep salaries reasonably high, which is great because I think they put in enough time into their training to deserve a large piece of the pie.

PAs and NPs don’t really have quite the same bottleneck, and could end up like pharmacy because of that. As it is now, I think there are jobs for everyone looking, and certainly for everyone that is a good hire that networks properly. But where you used to see a greater ability to be picky, the market is forcing folks to look further off the beaten path to find jobs. What I haven’t seen yet is what you seemed to suggest, which is that there is a significant number of people forced to search outside of their chosen career role in order to find work. That’s pretty bad if that happens, and usually you don’t see that until wages have totally tanked. I think we are just at the phase where poor job candidates are being filtered out in favor of the ones folks think will do well.

I guess the concern for you is what the landscape will be like in 3 or 4 years when you would be hitting the job market. My gut says you’d find work, but the wages would be such that the debt you would have accrued would be unmanageable on the typical wages. Apart from outliers, I feel that pay is going down. Where I’ve seen other industries salaries heading up over time, I’m conversely seeing PAs and FNPs still excited to take jobs that pay $100,000, which essentially means that pay isn’t keeping up with inflation. $100,000 ten years ago is like $120,000 today. I recently read a few threads online where folks were flashing high new grad salaries around, and quite a few of us were perplexed by them, feeling they were outliers or wages based in uniquely high COL locales, which the mostly were. But $106,000 a year doesn’t go as far as it used to. I’ve seen PAs Try to make the case that few jobs are awesome enough to have 100,000 starting wages, and while that is true, I’d argue that there is a narrow range of pay that typical PAs and NPs operate in, which seems to be static year to year, and is within that $100k to $120k sweet spot, year after year. Meanwhile, I see jobs that aren’t as demanding creeping up, as well as demanding jobs as nurses, police officers, engineers, etc moving into that $100,000 range (or close enough to it that you have to wonder if expensive school is worth it). With inflation, raises, and improved productivity, you’d expect the PA that started at $90k to be making $130k ish plus at around ten years after starting, but I’m not seeing that. Salaries seem to have stayed the same, and the market has gotten tighter.

So anyway, stuff to consider. I think before I took my pharmacy degree to PA school and spent $100k on tuition, and $70k on living expenses for two years, and added that to my existing debt, I’d try pharmaceutical sales, or just about anything else. The alternative is becoming a PA and being forced to work in a fast-paced-but-lucrative job to pay off your debt, and that’s just another kind of bondage. Believe me, I know PAs and FNPs that make really good money for the field, and they are like a hamster on a wheel. They work overtime and are excited to make $180k, and it consumes them. I’d rather live on $110k and have a life outside of work.
 
PMHNP is a great job in terms of opportunities and salary. You can't go wrong with it especially if you do NURSE Corps or NHSC. In full practice authority states the salaries go much higher than NP national averages (take a look at indeed for more info or talk to people in private practice). The main issue I see is that the education doesn't really prepare you (IMHO) for this level of responsibility, so you have to find a good first job and mentorship. I definitely don't regret going the PMHNP route but it has been very challenging. If you are already a pharmacist you would be in a much better position.
 
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PMHNP is a great job in terms of opportunities and salary. You can't go wrong with it especially if you do NURSE Corps or NHSC. In full practice authority states the salaries go much higher than NP national averages (take a look at indeed for more info or talk to people in private practice). The main issue I see is that the education doesn't really prepare you (IMHO) for this level of responsibility, so you have to find a good first job and mentorship. I definitely don't regret going the PMHNP route but it has been very challenging. If you are already a pharmacist you would be in a much better position.

All of that true. When you graduate, there are all sorts of folks that want to buddy up to you and make money off of you. You need to find good employment at a place that helps you learn. Money isn’t everything, but it also isn’t “nothing”. Some places will pay you a lot as a new grad and throw you out on your own. Some will throw you out on your own while paying you peanuts, too. Need to steer clear of both of those kinds of employers and find the place that has a long term vision for you that includes training you well. Those kinds of job opportunities require networking well before you start your first job. The PMHNP pathway doesn’t start the moment you graduate, it starts before you even get into PMHNP school (at least if you want to have smooth travel).
 
All of that true. When you graduate, there are all sorts of folks that want to buddy up to you and make money off of you. You need to find good employment at a place that helps you learn. Money isn’t everything, but it also isn’t “nothing”. Some places will pay you a lot as a new grad and throw you out on your own. Some will throw you out on your own while paying you peanuts, too. Need to steer clear of both of those kinds of employers and find the place that has a long term vision for you that includes training you well. Those kinds of job opportunities require networking well before you start your first job. The PMHNP pathway doesn’t start the moment you graduate, it starts before you even get into PMHNP school (at least if you want to have smooth travel).

This is good advice. I'll be graduating in a few months and hopefully either enter a psych NP residency or an inpatient unit where I can work and learn. How do you feel about starting out in an inpatient unit or Psych ED?
 
This is good advice. I'll be graduating in a few months and hopefully either enter a psych NP residency or an inpatient unit where I can work and learn. How do you feel about starting out in an inpatient unit or Psych ED?

Starting on an inpatient unit might be nice because you’d get some time to step back and use resources to finalize plans. In an outpatient setting, you talk to the patient and then have to have an approach ready to go. Every once in a while, you can sit there and tell the patient that you want to look into something so you can get things right for them, but that can’t happen very often. But in the inpatient setting, you can sit and assess, and then dismiss the patient, then go to work on deciding what to do. That’s helps offset the high acuity that you typically see inpatient, but it also equates to being a good early learning environment. I think psyche ED might get mundane. I don’t know much about them, but it seems like you could easily end up doing routine formulas for care that wouldn’t give you much diverse skills. You’d see a lot of the acute syndrome, and less of the follow up and adaptation that is part of getting a good broad knowledge of what’s going on. Kind of how ER nurses think they are the big stuff for getting things stabilized and then shipping them out, but never seem to see much farther than that aspect of care. With your professional career, you want to have a bigger window to look out of.

Like I say, if you have a shot at inpatient, don’t be intimidated by the high acuity aspect, because you’ll have time to breath. In the clinic you will start out gasping for air because you’ll be seeing patients, coming up with plans, explaining it, and documenting... all in half an hour or less if it’s a follow up. Hopefully you’ll have at least an hour on your initial eval. It would be nice to be able to take 20 minutes on a complex case to make a phone call or look some things up before you write a script like you can in many inpatient settings.
 
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Hi! Currently trying to figure out which would be best. (I am in California). I've read that there are rarely PAs in psych...I am mainly leaning towards NP but I'd have to do either a MEPN or accelerated BSN...if anyone has any advice on any of these paths I'd appreciate it!
Or be a real doctor not some np with maybe as much psych training as an oms3
 
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Or be a real doctor not some np with maybe as much psych training as an oms3

Maybe that’s profound advice (not really), but it’s not what they asked.
 
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The poster is graduating from a psyche NP program in 3 months and asking for some advice as to where they should work. You claim to be an expert, and could provide excellent insight if that’s the case. You chose to say this:

Or be a real doctor not some np with maybe as much psych training as an oms3

Not much else to say because you said it all right there. I bet you are a blast to sit with. I bet you are different with your patients, though.....
 
The poster is graduating from a psyche NP program in 3 months and asking for some advice as to where they should work. You claim to be an expert, and could provide excellent insight if that’s the case. You chose to say this:



Not much else to say because you said it all right there. I bet you are a blast to sit with. I bet you are different with your patients, though.....
I thought he was asking pa vs np

Hi! Currently trying to figure out which would be best. (I am in California). I've read that there are rarely PAs in psych...I am mainly leaning towards NP but I'd have to do either a MEPN or accelerated BSN...if anyone has any advice on any of these paths I'd appreciate it!
 
This is good advice. I'll be graduating in a few months and hopefully either enter a psych NP residency or an inpatient unit where I can work and learn. How do you feel about starting out in an inpatient unit or Psych ED?

We were referring to different posters.
 
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