Psych PA or PMHNP?

[DeFyYing]

---

Members do not see this ad.

Hello, I'm new here. I'm a 26M non-trad student currently in community college getting my associate's in psych. I knew I wanted to work in mental health and became a psych major when I first got out of high school, but I wanted to shift my focus towards medicine as I have a huge personal interest in psychopharmacology that began bc of my own mental health treatment. However, it seems that PMHNPs dominate midlevel psychiatric medicine compared to PAs. I absolutely know I want to go into psych and have absolutely no interest in the other specialties, but figured learning about them regardless in PA school would hopefully help broaden and round out my capacity for patient care in the case of physical comorbidities or recognition of medical side effects. As I get close to finishing my associate's degree, though, I'm starting to wonder if I should change tracks to nursing to pursue being a PMHNP with how prevalent they are in mental health.

I have a rudimentary pros and cons list regarding which path to take, and would really appreciate any advice. Unfortunately med school is out of the question as I have BP1 w/ psychotic fx and will 100% go manic/psychotic if I had to endure 24hr residency shifts or night floats on a consistent basis. Fortunately my mania has been a non-issue for some time now and it's the depression that lingers, but I do not want to risk a manic relapse that can easily destroy my life. Anyways, here goes:

PA pros:

• I can continue studying psych. Not only do I enjoy the subject matter personally, if for any reason PA school doesn't work out I could then pursue a master's in psych or social work to practice psychotherapy which would also be meaningful and fulfilling to me. By going into nursing, it seems I'd be pretty limited career-wise if it turns out I'm not suited for it.
• It's much quicker. Next semester I will have 58 credits, then one more semester after that and I will be transferring to finish undergrad for two years. Hopefully I can begin to work on gaining PCE hours during school breaks and after I get my bachelors. Again, I don't mind switching to nursing if that's the right call, it's not like I'm even THAT far into schooling like if I already was close to a bachelor's degree, but yea the PA path would allow me to practice medicine much quicker, especially considering how long I'd have to be an RN
• This might sound stupid, but I like being in school and being a student. As a non-trad student, I was rlly looking forward to transferring from community college and dorming somewhere competitive for undergrad. I've worked hard to maintain my GPA and have participated in many extracurriculars so far, but with nursing it seems the priority, at least initially, is experience rather than schooling. With the PMHNP path, if I'm doing it legit and not through accelerated programs that seem frowned upon in the nursing community, it seems the path would consist of getting my ADN, working as a nurse for at least a year (many seem to encourage many years), get my BSN partially paid for by the hospital I work at (so likely limited to online or local schools, I think?), work even longer as a nurse, THEN I can go to NP school and even begin the process of hopefully practicing and prescribing psychotropic medicine, which is the whole reason I even want to do this.
• Passion. I'm not exactly opposed to being a psych nurse, but ultimately I mostly see it as a stepping stone to what I really want to do (medicine) and so I don't even know if my heart would be in the right place by being an RN for that long. I think a nurse's role and capacity for patient care and compassion is noble, but I know it can also be emotionally exhausting, especially after years of being in-patient myself and seeing the kind of nonsense nurses have to often put up with from patients in acute psych units.

PA Cons:

• As I said, it seems PAs have a limited presence in psych. I know that mental health is the only specialty I have any interest in, and while the flexibility is nice to switch I know I will never use it. In all my years of being a patient, I've never even met a psych PA and have only been treated by PMHNPs and psychiatrists.
• Cost. PA school is expensive, and as a psych major I know I cannot even do anything psych-related with a bachelor's which will limit psych-specific sources for PCE hours (would appreciate advice for this, too). Meanwhile, after getting an ADN and getting my RN license I can immediately start working with a competitive salary, have my BSN mostly covered by a hospital, and then even NP school is significantly cheaper than PA school.
• Difficulty. As I said, I like being a student and have always been academically competitive, but I know getting into PA school is very difficult and have heard that it is worsening. Plus I still haven't taken the more advanced science prereqs that I know will be a pain and make it difficult to maintain my 4.0 GPA (organic chem and biochem). With PMHNP school, even barring the diploma mills that I'm sure most in nursing already dismiss as illegitimate, it seems getting into a respected brick-and-mortar NP school is easier than PA school, especially top ones (I live very close to Rutgers and have heard they have a very strong PA program)
• Specialization. As I said earlier, I get why a comprehensive education covering all aspects of medicine is important to PA practice and don't mean to dismiss that. Still, the truth is I just don't care about other specialties nor see myself enjoying them. Beyond that, I have heard that the psych curriculum in PA school is fairly limited, with an additional psych fellowship being recommended for psych PAs to catch up whereas I've heard PMHNPs are generally better prepared from a strictly psychiatric sense
• Independent practice. Now I don't rlly care about this on its own, in fact I actually like the idea of being subordinate to a psychiatrist that has more experience and is better qualified to treat patients. But I know this will affect hiring as more states allow independent NP practice, and I'm worried PA's marginal role in psych already will be further exacerbated by PA's inability to practice independently when looking for a job.
• International presence. This one might seem a lil out there, but it seems like NPs have had a longer and more significant presence in other countries whereas PAs seem to be a relatively recent thing with few countries having an equivalent role, or at least one that actually involves prescribing. In the case I were to ever move internationally, it seems I would have a better chance of adapting my degree and career as an NP. At least at the moment.

That's everything I can think of atm, I know it's a long post and thank you for anyone who read this far. I'm thinking of finishing my associates in psych anyway, even if I do decide to then pursue an ADN in nursing after, to "immortalize" my credits (I took a couple non-prereq gen-ed classes when I first got out of high school at 18 so I don't wanna risk losing those), but again appreciate any and all advice of what I should do. All I know is that it would be a dream for me to have the opportunity to work in mental health to help those dealing with similar issues that held me back for so much of my life, and my passion for psychopharmacology (which is essentially a personal hobby for me atm, I love reading clinical trials of psychotropic medications) has me keenly interested in what would be the "right" path for me to take

 

[psychnurse]

Your perspective on independent practice will most likely change after you have a couple years of work experience as a provider. PMHNPs can always collaborate with psychiatrists no matter where they are, but PAs can never practice independently. If your goal is to become a non-physician psychiatric prescriber/provider and optimize your career opportunities, PMHNP is the way to go. Get the BSN, work inpatient psych at a research hospital as a RN for 1-2 years, then get your PMHNP (FT or PT) at a solid/reputable school is what I would recommend.

 

[DeFyYing]

Your perspective on independent practice will most likely change after you have a couple years of work experience as a provider. PMHNPs can always collaborate with psychiatrists no matter where they are, but PAs can never practice independently. If your goal is to become a non-physician psychiatric prescriber/provider and optimize your career opportunities, PMHNP is the way to go. Get the BSN, work inpatient psych at a research hospital as a RN for 1-2 years, then get your PMHNP (FT or PT) at a solid/reputable school is what I would recommend.

Thank you so much, it's a shame because I thought I'd be done with community college sooner. On the bright side I suppose I'll have more time for ECs and developing my transcript before transferring. I think I'm going to finish the associate's in psych regardless just to finalize the degree before going for the ADN. Once I get the ADN, would you recommend me going straight to transferring to a 4-year school to get my BSN? Or should I complete the NCLEX first?

I have heard that if I work as an RN first, many hospitals will pay for your ADN-to-BSN bridge program. Would you advise this? As I said in one of my pros, this kind of saddens me because I was genuinely looking forward to attending an in-person 4-year university and having a traditional college experience, but from what I understand most ADN-BSN bridge programs are online.

Would these programs be at the discretion of the hospital, or do I have any say in it? I'm not even sure if a school's name and prestige for their BSN program matter for NP school, but ig I'd hate to feel like I've worked to maintain my 4.0 for nothing

 

[psychnurse]

Thank you so much, it's a shame because I thought I'd be done with community college sooner. On the bright side I suppose I'll have more time for ECs and developing my transcript before transferring. I think I'm going to finish the associate's in psych regardless just to finalize the degree before going for the ADN. Once I get the ADN, would you recommend me going straight to transferring to a 4-year school to get my BSN? Or should I complete the NCLEX first?

I have heard that if I work as an RN first, many hospitals will pay for your ADN-to-BSN bridge program. Would you advise this? As I said in one of my pros, this kind of saddens me because I was genuinely looking forward to attending an in-person 4-year university and having a traditional college experience, but from what I understand most ADN-BSN bridge programs are online.

Would these programs be at the discretion of the hospital, or do I have any say in it? I'm not even sure if a school's name and prestige for their BSN program matter for NP school, but ig I'd hate to feel like I've worked to maintain my 4.0 for nothing

The logistics of getting your RN is really up to you. It's hard for me to offer anything valuable without knowing your situation. I feel like it would not make sense to go for another associate degree after finishing an associate degree in psychology? But if you can get your ADN much more quickly and cheaply (because you're done with gen ed courses), it might not be a bad idea? Some hospitals will have tuition reimbursements. I don't believe ADN-to-BSN bridge programs are that expensive in general. Some hospitals (I heard) have direct connection to some diploma mills (albeit accredited), but I don't have first hand knowledge. There's no reason to spend $$$ to go to a prestigious ADN-BSN bridge program because nobody cares about those bridge programs given that they're mostly fluff courses. Save the money to spend on a good PMHNP program.