Questions for psychotherapists about branching out into Psych NP

[MustIReallyThough]

In scouring this forum I've seen a couple psychologists mention going back to school to attain a psych NP to allow them the ability to prescribe. Has anyone had or known of any experiences like these? Wouldn't this make for a great business model and niche for private practice if you could find an agreeable psychiatrist to pair with? Or one could possibly work for a hospital as a nurse and pursue a small psychotherapy practice on the side...

The problem I'm facing as someone debating doctorate education vs masters is the fear of stagnation with just a masters degree and a solely psychotherapy practice. I've heard it discussed a LOT here and I don't want that to be me.

But I don't really have any interest in conducting research, teaching, or managing a large clinic. So I feel like the psychology path isn't for me. But I still fear the limitations of a masters.

I hope that makes sense. Thank you all wonderful professionals for your time. All of your previous input on other threads is very informative and invaluable to me and others I'm sure. As a freshly graduated student, the amount of choices and variance in mental health careers is...overwhelming.

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[medium rare]

Search some of my posts. I’ve talked about this a good deal on SDN.

 

[Therapist4Chnge]

What do you WANT to do day-to-day? If it is therapy, then a masters is prob a good fit for that. Doctoral training for psych is a lot of "other" stuff to get you to basically the same place if you don't pursue a fellowship in a niche area. Med school can be described similarly, though both of those paths also provide a much fuller and more in-depth training, it just depends how you want to spend your day. In an ideal world, someone who knows they want to be a prescriber should go to med school....best training and most complete, but you still need to continue to learn throughout your career. I say this as someone who has taught and lectured in med schools, Ph.D/Psy.D. programs, and tutored RN and NP students.

The PA or NP route can offer solid training, but a lot of it falls on the student to continue to pursue. PA training wasn't a good fit for me, but it can be for someone who enjoys the work, but is fine being 2nd banana on some/ a lot of stuff. In an out-pt clinic for psych there may be more autonomy, but ultimately you still need sign-off from your supervisor. This is true in some states for NPs, though I'm less familiar with this setup as all of the states I've lived in have had independant licensure for NPs.

An accelerated NP program (aka "direct entry") could be an option if you have the pre-reqs done for the RN, though I think this route takes away some of the value and training of going RN--> NP. Some of the best prescribers I know are NPs who work in niches (e.g. pain clinic, psych, ED), but they all had a number of years as RNs before pursuing brick & mortar NP training. I specify that because there are "hybrid" programs now that I guess are fine for some, I just don't think the training is the same.

As for the RxP route...it's super niche because after all of the doctoral training you have to go back and most programs are condensed, and it's like drinking from a firehose. I attended a brick & mortar program, loved it, but it was still a PITA. It took me 6+ yrs to finish because I had to take some time off to do my fellowship and then I still had to do my practica. I didn't bother getting licensed because I did it primarily as a backup plan in case I ever got bored doing neuro. I realized that most RxP jobs want you to be a glorified Rx pad, and you'd need to really make an effort to work for someone else and have it not be that. On your own, sure...you can set something up.... @medium rare can best speak to that experience.

I'm not sure that answers your inquiry, but any path you pursue will require a lot of your own learning because there is just too much out there to learn, regardless of which path you take. In your spot, if you want to prescribe, the NP is probably the clearest route, but make sure to compare NP training programs because they can vary greatly.

 

[PsyDr]

I would HIGHLY recommend interning or shadowing various mental health providers. Spend a week with a therapist, a nurse practitioner, and a psychiatrist. See what their day to day life is like. Maybe it's exactly what you imagined. Maybe it is not. But, at least, you will have a factual basis to make your decision.

 

[MustIReallyThough]

What do you WANT to do day-to-day? If it is therapy, then a masters is prob a good fit for that. Doctoral training for psych is a lot of "other" stuff to get you to basically the same place if you don't pursue a fellowship in a niche area. Med school can be described similarly, though both of those paths also provide a much fuller and more in-depth training, it just depends how you want to spend your day. In an ideal world, someone who knows they want to be a prescriber should go to med school....best training and most complete, but you still need to continue to learn throughout your career. I say this as someone who has taught and lectured in med schools, Ph.D/Psy.D. programs, and tutored RN and NP students.

The PA or NP route can offer solid training, but a lot of it falls on the student to continue to pursue. PA training wasn't a good fit for me, but it can be for someone who enjoys the work, but is fine being 2nd banana on some/ a lot of stuff. In an out-pt clinic for psych there may be more autonomy, but ultimately you still need sign-off from your supervisor. This is true in some states for NPs, though I'm less familiar with this setup as all of the states I've lived in have had independant licensure for NPs.

An accelerated NP program (aka "direct entry") could be an option if you have the pre-reqs done for the RN, though I think this route takes away some of the value and training of going RN--> NP. Some of the best prescribers I know are NPs who work in niches (e.g. pain clinic, psych, ED), but they all had a number of years as RNs before pursuing brick & mortar NP training. I specify that because there are "hybrid" programs now that I guess are fine for some, I just don't think the training is the same.

As for the RxP route...it's super niche because after all of the doctoral training you have to go back and most programs are condensed, and it's like drinking from a firehose. I attended a brick & mortar program, loved it, but it was still a PITA. It took me 6+ yrs to finish because I had to take some time off to do my fellowship and then I still had to do my practica. I didn't bother getting licensed because I did it primarily as a backup plan in case I ever got bored doing neuro. I realized that most RxP jobs want you to be a glorified Rx pad, and you'd need to really make an effort to work for someone else and have it not be that. On your own, sure...you can set something up.... @medium rare can best speak to that experience.

I'm not sure that answers your inquiry, but any path you pursue will require a lot of your own learning because there is just too much out there to learn, regardless of which path you take. In your spot, if you want to prescribe, the NP is probably the clearest route, but make sure to compare NP training programs because they can vary greatly.

To be honest, prescribing isn't my first thought when I envision a long term career. I do have an interest in SMI though and feel like this would be a great way to reach more people. As well as provide the option of a more holistic treatment approach in PP by combining psychotherapy and med management (and with the pay that comes with a NP I actually have room to possibly make treatment more affordable!). I'd be happy playing second fiddle in regard to the latter.

I do envision a primarily psychotherapy practice though. The problem I'm facing is that I realize conducting therapy for the rest of my life is not exactly a realistic expectation. It seems to burnout the best of us. So I feel like it's necessary to map out ways in which to branch out clinically now as opposed to later before I'm stuck with a terminal masters and nowhere else to go with it. The two options I'm considering are the niche areas in psych and a psych NP.

 

[Sanman]

To be honest, prescribing isn't my first thought when I envision a long term career. I do have an interest in SMI though and feel like this would be a great way to reach more people. As well as provide the option of a more holistic treatment approach in PP by combining psychotherapy and med management (and with the pay that comes with a NP I actually have room to possibly make treatment more affordable!). I'd be happy playing second fiddle in regard to the latter.

I do envision a primarily psychotherapy practice though. The problem I'm facing is that I realize conducting therapy for the rest of my life is not exactly a realistic expectation. It seems to burnout the best of us. So I feel like it's necessary to map out ways in which to branch out clinically now as opposed to later before I'm stuck with a terminal masters and nowhere else to go with it. The two options I'm considering are the niche areas in psych and a psych NP.

A couple of points, an NP can practice independently in some states (both medication management and paychotherapy). There are options outside of psychotherapy in psychology, SW, and nursing. The other question is what is a tolerable income for you. One can certainly do psychotherapy in PP for a career. It is a question of how much work do you want to do and how much money do you want to make. I personally have done a lot more hours of therapy in a week than the average person. So, I certainly can make a living at it.

 

[MustIReallyThough]

A couple of points, an NP can practice independently in some states (both medication management and paychotherapy). There are options outside of psychotherapy in psychology, SW, and nursing. The other question is what is a tolerable income for you. One can certainly do psychotherapy in PP for a career. It is a question of how much work do you want to do and how much money do you want to make. I personally have done a lot more hours of therapy in a week than the average person. So, I certainly can make a living at it.

Can I ask how you fare with burnout? Is therapy something you can see yourself doing until retirement?

Tolerable income is a good question. I'd like it to be some balance of ok money and affordable rates. I have a decent work ethic, but I'm not sure how well that translates to therapy. I like to think I'd put in the hours necessary to be successful though. It's all I've ever really wanted to do.

I'd be more interested in the niche areas of psychology than anything related to SW. But really, I just want to master the art of therapy (as much as possible, I realize it's a never ending process with a lot of it self taught as therapist 4change mentioned). Then tackle something else like prescribing (but still related to direct patient care) later on down the road in the event I burn completely out.

 

[MustIReallyThough]

I would HIGHLY recommend interning or shadowing various mental health providers. Spend a week with a therapist, a nurse practitioner, and a psychiatrist. See what their day to day life is like. Maybe it's exactly what you imagined. Maybe it is not. But, at least, you will have a factual basis to make your decision.

Will do. I definitely need that factual basis. There's a counselor in town that offered a volunteer position once COVID let up. I'm not really sure what he means by that, but I can probably shadow at least. There's also a medical school close.

 

[futureapppsy2]

A lot of professionals that are trained/qualified/licensed to both prescribe and conduct psychotherapy rarely end up doing psychotherapy because the pay per chunk of time is so much lower versus prescribing that either their employer doesn't want them doing it or they can't justify the decrease in income themselves.

 

[MustIReallyThough]

A lot of professionals that are trained/qualified/licensed to both prescribe and conduct psychotherapy rarely end up doing psychotherapy because the pay per chunk of time is so much lower versus prescribing that either their employer doesn't want them doing it or they can't justify the decrease in income themselves.

Very true. I'd like to think I'd be different and run a private practice based on the specific need of the client. But I realize how idealistic this sounds and how stark the pay difference is.

Still, that freedom is alluring. I'd love to be able to do some pro bono work of my choosing later on in retirement. Volunteering is very important to me.

I work as a manager of a food pantry in a very poor, rural county and see first hand how much people struggle. It's weighed on me. And I truly want to believe that one day I'll structure a practice in a way that can reach some of these folks through both quality and affordable care.

 

[Sanman]

Can I ask how you fare with burnout? Is therapy something you can see yourself doing until retirement?

Tolerable income is a good question. I'd like it to be some balance of ok money and affordable rates. I have a decent work ethic, but I'm not sure how well that translates to therapy. I like to think I'd put in the hours necessary to be successful though. It's all I've ever really wanted to do.

I'd be more interested in the niche areas of psychology than anything related to SW. But really, I just want to master the art of therapy (as much as possible, I realize it's a never ending process with a lot of it self taught as therapist 4change mentioned). Then tackle something else like prescribing (but still related to direct patient care) later on down the road in the event I burn completely out.

I don't see many patients anymore due to my current job. Volume of patients was never a cause of burnout. Non-clinical factors are a different story. I would challenge your beliefs here as they are a bit idealistic. Prescribing for most will entail getting a new degree and many will not do that. Making money by "mastering therapy" generally involves charging significant and unaffordable rates for many people (cash rates because insurance does not pay for mastery). If you want your rates affordable, you are going for volume not necessarily quality to make a good living. That brings us back to what is an adequate salary because some of what you mention is unlikely unless you are practicing as more of a hobby than a vocation.

 

[MustIReallyThough]

I don't see many patients anymore due to my current job. Volume of patients was never a cause of burnout. Non-clinical factors are a different story. I would challenge your beliefs here as they are a bit idealistic. Prescribing for most will entail getting a new degree and many will not do that. Making money by "mastering therapy" generally involves charging significant and unaffordable rates for many people (cash rates because insurance does not pay for mastery). If you want your rates affordable, you are going for volume not necessarily quality to make a good living. That brings us back to what is an adequate salary because some of what you mention is unlikely unless you are practicing as more of a hobby than a vocation.

Non-clinical factors? How so? Billing/paperwork?

That's good to hear. I'd love to feel fulfilled for the rest of my life doing therapy, but I just don't know if that's realistic. But I'm glad to hear someone say volume never bothered them. What about the repetitive nature of therapy I've heard about?

I understand, that all makes a lot of sense. My pro bono aspirations will probably have to be saved for retirement.

Adequate money? Hard to say with this economy. I guess I'd be satisfied long term with 50+. Which seems do-able with a moderate client load in PP if I understand correctly. I'd want to manage a high volume if I could swing it though. Big believer in investing as early as possible.

 

[Sanman]

Non-clinical factors? How so? Billing/paperwork?

That's good to hear. I'd love to feel fulfilled for the rest of my life doing therapy, but I just don't know if that's realistic. But I'm glad to hear someone say volume never bothered them. What about the repetitive nature of therapy I've heard about?

I understand, that all makes a lot of sense. My pro bono aspirations will probably have to be saved for retirement.

Adequate money? Hard to say with this economy. I guess I'd be satisfied long term with 50+. Which seems do-able with a moderate client load in PP if I understand correctly. I'd want to manage a high volume if I could swing it though. Big believer in investing as early as possible.

Spend a few hours per day arguing with an insurance company to get paid for work you have already done while the people on the other end of the phone are paid to waste your time. Listen to them suggest that you do more work for free so that they can decide if they will pay you. Then decide if you want to be part of that system so that clients can retain affordability.

$50+k a year? That is easily doable, but it is unlikely you will ever be retiring or providing pro bono work, especially if you have a family.

 

[MustIReallyThough]

Spend a few hours per day arguing with an insurance company to get paid for work you have already done while the people on the other end of the phone are paid to waste your time. Listen to them suggest that you do more work for free so that they can decide if they will pay you. Then decide if you want to be part of that system to that clients can retain affordability.

$50+k a year? That is easily doable, but it is unlikely you will ever be retiring or providing pro bono work, especially if you have a family.

My dear Sanman, I think I just got burnt out and I haven't even started yet 😂

I hear you, for sure. Could you work in a group practice or hire an assistant for billing? That brings it's own set of problems though.

Very true. I worry about retirement. Makes a NP salary with a psychotherapy practice on the side very appealing. But that's a helluva lot of work and, like you said, most won't go back to school for another masters.

Do you recommend the PhD in psych in general for the increased opportunity?

 

[Sanman]

My dear Sanman, I think I just got burnt out and I haven't even started yet 😂

I hear you, for sure. Could you work in a group practice or hire an assistant for billing? That brings it's own set of problems though.

Very true. I worry about retirement. Makes a NP salary with a psychotherapy practice on the side very appealing. But that's a helluva lot of work and, like you said, most won't go back to school for another masters.

Do you recommend the PhD in psych in general for the increased opportunity?

I worked in a large group practice with billing support and supervised a number of clinicians then. Insurance company audits/authorizations often require them to speak with the treating clinician.

My recommendations really depend on what you want to do and echo what others have said.

Psychologists can do other things besides general therapy. Do you want to do those things? If not it can be extra time, money, and relocation headaches for you without much reason.

Are you in a state or do you want to live in a state where a psych NP can practice independently? Are you in a state where psychologists can prescribe?

Do you want to limit your practice to a smaller higher paying psychotherapy clientele or work with those in need?

All of these goals necessitate a different plan because otherwise you might find yourself with $200K in debt making $50k/yr with too much education and no interest in earning more money. Take some time and get some exposure before making the big decisions.