Stay a psych NP or???

[psychnpgirl]

Hi everyone. I had another account on here but I forgot the password and my email got deleted. So here I am on a new account. I am 24 and a psych NP who has no debt and has 1 year and 8.5 months left in a 2 year obligation to the NURSE Corps. I became a psych NP because I was interested in therapy and med management but not really interested in physical medicine, thought I didn't like school, and basically was ambivalent about making a lifelong career choice (medical school seemed like a really major time commitment). I have a 3.8ish GPA overall from undergrad and a 3.75 GPA from grad school, probably something like a 3.7 science GPA. I am sort of interested in applying to medical school, but I'm also interested in a nursing PhD, and I'm also interested in just saying f-it and working as a psych NP and opening my own practice at some point, maybe learning more about business and investing. My only interest in going back to school stems from wanting to really learn and be an expert. I feel I really didn't learn enough in grad school. Also, I am very interested in conducting research and I recently found out how much I love attending conferences and would probably enjoy presenting/teaching too. I am an original thinker and passionate about the field, not sure I'd be okay with just having a private practice when I know there are so many systemic issues to solve. At the end of the day I care less about business and cash flow and more about making a difference. So maybe I should do a nursing PhD? Or should I try to get into med school? I do like being an adult and having money quite a bit--these last few months are my first experience not being in school. Going to med school would be inconvenient although something about the challenge seems enticing.

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[pamac]

Interesting post. I think that all of the feelings you are having are reasonable. I personally don’t have the drive to pursue avenues as an academic, but I think since you mentioned liking money, that is a good thing to look at. Going to medical school will mean you take a financial hit, and you should really discover what it is about it that really appeals to you. You’d be looking at 4 years of medical school, and at least 3 years or more of residency. Academic positions for folks with MDs aren’t as lucrative as specialty practice, so coming out of school with the expectation that you will be doing anything other than practice similar to what you do now will come at a price, further dampening your financial situation. Right now you have a great thing going with having your education reimbursed. Use that opportunity to indulge in a PHD if you feel like that’s what you want. Do your lucrative psyche Np work by day, pursue the PhD in your time off, and have time to live life. To me, med school is a bruising way to gain personal satisfaction. My drive to pursue that path would have to be fueled by something more compelling than what I’ve come across up until now. It’s the kind of challenge that comes with sacrifices on so many levels that it’s something that I thing a person like me would have to take it on very early (18 years old basically) for it to be sustainable. You give up a lot of time, and chain your career to having to repay debt. I’ve always seen medicine for me as something like this.... you spend your 20s (and into your 30s) devoted to learning the craft and accumulating significant debt, then spend your 30s trying to get established and pay down the debt you have accumulated. Then you spend your 40s and 50s trying to get ready for retirement. That formula might even be more skewed and optimistic. I know several doctors personally that are much more leveraged than myself financially. Their income potential is so much higher than my own, of course, but they are literally chained to their circumstances more than I would be comfortable with. I feel like the time commitment would have been too much for me as well given the reward.

 

[AnnoyedByFreud]

I think getting more work experience as psych NP can help you decide. I remember during my first ~6 months of practice, I felt very uncertain and wondered if it might make sense to try and go to med school. After a few years of practice I feel much more 'seasoned' if you will (I had excellent mentorship and a journal club at my work, so that definitely helped). I now work in another setting that I absolutely love and while the psychiatrists are making ridiculous bank (like 300k+), I am very well compensated and the work is much more interesting. Psychiatry jobs are weirdly diverse and it can take trying a few settings to figure out what satisfies you. I didn't realize how stressful and unfulfilling I found my old job until I took a chance on this new one.

I'd work a good 2-3 years and try to work in more than one setting, then see what you think. Not having student loans is a great feeling and the financial hit of going back to school (both in tuition and lost income) is significant.

 

[psychMDhopefully]

I think getting more work experience as psych NP can help you decide. I remember during my first ~6 months of practice, I felt very uncertain and wondered if it might make sense to try and go to med school. After a few years of practice I feel much more 'seasoned' if you will (I had excellent mentorship and a journal club at my work, so that definitely helped). I now work in another setting that I absolutely love and while the psychiatrists are making ridiculous bank (like 300k+), I am very well compensated and the work is much more interesting. Psychiatry jobs are weirdly diverse and it can take trying a few settings to figure out what satisfies you. I didn't realize how stressful and unfulfilling I found my old job until I took a chance on this new one.

I'd work a good 2-3 years and try to work in more than one setting, then see what you think. Not having student loans is a great feeling and the financial hit of going back to school (both in tuition and lost income) is significant.

how much do psych nps usually make

 

[pamac]

Some places are pretty low, like Florida, and other places in the south where all non physician providers are not paid really well. Overall, you can find wages that are all across he spectrum, but your best ones are going to be found in places where NPs practice independently. In places where they can’t, I’ve seen them coming to in at as low as $110k per year. In the independent practice states, I’ve seen offers consistently starting around $130k. Im west of the Mississippi, and not in California, and people around me have been taking offers as new grads for between $135k and $160k for jobs with good benefits and no call. What I’m seeing around me is that PHMNPs are actually getting offers as new grads that rival or exceed the pay of CRNAs, even CRNAs that have been in the game for many years. I’m on PHMNP Facebo**k pages where folks help each other out on tips for things ranging from clinical suggestions to job negotiations, and the rule of thumb there is to value your worth at above $120k to start, with a lot of the experienced folks getting jobs that pay around $150k. A good expectation that I’ve carried with me is to expect between $120k and $170k. That leaves a big spread, but not all jobs are created equal when it comes down to things like benefits, schedule, etc. by comparison, where I’m at, FNPs new grads typically start in the mid $90k’s. If you find one in my area making $130k, they are doing pretty well for themselves.

 

[pamac]

Another interesting thing is that the PHMNPs around me in my area are all pretty open about what they make when other PHMNPs or PHMNP students ask. The PHMNP community here is really interested in the market wages not being lowballed.

 

[AnnoyedByFreud]

how much do psych nps usually make

This entirely depends on where the location is, what the practice setting is, what the payer mix is, etc. I am in a major metro and have a few years of experience. I make ~175k currently working full time (40 hours weekly) plus full benefits (401k w/match, PTO, health insurance, etc). I work in a high acuity setting with a pretty sweet schedule. I also just picked up a side gig that is paying me a crazy amount of money (a couple grand per shift) to cover another acute unit, mostly remotely/taking call with some in person rounding. The second gig is contract and honestly I fell into it through pure luck and it seems like it's quite an anomaly in terms of pay. You can find stupid psych NPs out there who will accept crappy wages but most of us know our worth and expect to be well compensated. Another thing to keep in mind is RN wages in your area. Any Psych NP is going to want to (obviously) make significantly more than what they'd make as a psych RN, and RN wages can be higher than you'd think...

 

[pamac]

What was mentioned above is consistent with where I’m at, albeit a bit higher wage, but my metro area isn’t gigantic, and cost of living is relatively low.

That contract position does sound sweet, and even though it might be rare to find a side gig that awesome, it doesn’t shock me at all, especially if a provider is known to be competent. The average RN on a unit is costing the hospital almost $500 per shift, so having a provider cover a needed shift and save the day is worth it, because it’s just got to happen. That’s the kind of situation where the facility or provider takes out their pocket book and writes a check without thinking much of it. Even if they utilize an NP for $2000 per covered shift, and if they happened to use you quite a bit... say... 40 shifts per year (a bit less than once a week), that’s $80k for the convenience/requirement to have someone helping them. That’s still less than a full time provider, and you being there to fill in probably enhances their retention of their other providers. It also gives them a lot of flexibility that locum folks would not.

Yes.... providers that dont know their worth are dangerous to the Np field. Taking a job that pays $100k ignores how much revenue Nps generate. Even at $150k, psyche NPs are a great value. That’s why independence is so important. People hiring Nps need to know and believe that if nothing else, an Np can walk away and start working on their own if they need to. Where I’m at, that’s what helps keep the bigger entities in line. I love hearing from psyche NP friends how they were lowballed, made a counter offer, and then walked when the facility balked.... and then the position never got filled.... ever, because word got around. The people making those decisions usually are admin folks with no clue, or greedy providers. And in an independent state, those folks can watch their clients walk to NPs as well. It’s a healthy thing.

The problem for the Nps accepting low offers stems from them not thinking about the industry, talking to people, networking, and doing research. They go to school and get out and think that everything is going to be clear to them after they test the waters.

 

[EastSide]

This entirely depends on where the location is, what the practice setting is, what the payer mix is, etc. I am in a major metro and have a few years of experience. I make ~175k currently working full time (40 hours weekly) plus full benefits (401k w/match, PTO, health insurance, etc). I work in a high acuity setting with a pretty sweet schedule. I also just picked up a side gig that is paying me a crazy amount of money (a couple grand per shift) to cover another acute unit, mostly remotely/taking call with some in person rounding. The second gig is contract and honestly I fell into it through pure luck and it seems like it's quite an anomaly in terms of pay. You can find stupid psych NPs out there who will accept crappy wages but most of us know our worth and expect to be well compensated. Another thing to keep in mind is RN wages in your area. Any Psych NP is going to want to (obviously) make significantly more than what they'd make as a psych RN, and RN wages can be higher than you'd think...

omg... 175k..?!
That's insane.
Happy for you tho!

 

[pamac]

I’m hearing tales of $175k in my neck of the woods for folks without a lot of experience. It’s happening. That is a lot of money, but there is a lot of need, and PMHNPs bring in tons of dough. The difference between $175 and $140k (the latter being a more down to earth yearly wage) is simply a boss who is deperate enough, and reasonable enough to plunk down $35k more than they already are, which still leaves the employer with almost 3 times that amount billed. If enough local hires turn you down enough, you start to hurt while you wait for a provider to come in and earn you money.

 

[AnnoyedByFreud]

175k for a couple years of experience is doing pretty well but not atypical for my HCOL area. However my contract gig is definitely much higher pay than is typical. I also negotiate my pay which has helped me. Unless you're in a relatively saturated area (Manhattan, for example, I hear is pretty saturated), you pretty much have employers over a barrel. I do tend to talk a lot with fellow PMHNPs and my psychiatrist friends about opportunities, pay, etc. I am the type to always keep 'feelers' out for better opportunities. If I work full time I'll make ~220k next year with the main job and the extra one (with both positions I would average 42 hours per week), though I'm considering cutting back on my hours at my main job. I'd rather work <40 hours weekly if possible overall. I paid off my student loans at the end of last year so I also don't have the pressure of debt hanging over my head.

I worry about PMHNP saturation though, I know of many FNPs who are going back for their psych certs, plus it seems like psychiatry is becoming a more popular specialty for MDs/DOs. However the shortage of psychiatrists is so massive that I don't see it affecting us any time soon. I am trying to make sure I have a lot of experience in a variety of settings (psych ER, inpatient, C&L, outpatient) so I can broaden my skill set and keep my resume attractive to employers. Plus I hate outpatient, hah.

 

[EastSide]

175k for a couple years of experience is doing pretty well but not atypical for my HCOL area. However my contract gig is definitely much higher pay than is typical. I also negotiate my pay which has helped me. Unless you're in a relatively saturated area (Manhattan, for example, I hear is pretty saturated), you pretty much have employers over a barrel. I do tend to talk a lot with fellow PMHNPs and my psychiatrist friends about opportunities, pay, etc. I am the type to always keep 'feelers' out for better opportunities. If I work full time I'll make ~220k next year with the main job and the extra one (with both positions I would average 42 hours per week), though I'm considering cutting back on my hours at my main job. I'd rather work <40 hours weekly if possible overall. I paid off my student loans at the end of last year so I also don't have the pressure of debt hanging over my head.

I worry about PMHNP saturation though, I know of many FNPs who are going back for their psych certs, plus it seems like psychiatry is becoming a more popular specialty for MDs/DOs. However the shortage of psychiatrists is so massive that I don't see it affecting us any time soon. I am trying to make sure I have a lot of experience in a variety of settings (psych ER, inpatient, C&L, outpatient) so I can broaden my skill set and keep my resume attractive to employers. Plus I hate outpatient, hah.

Appreciate your response!
Congrats on paying off your debt!

Just curious, however, do you ever grow almost "bored" with the responsibilities of a PA?
Or at this point, does it not phase you on what acuity of patient you receive?

I'm contemplating PA vs DO atm, and it has indeed been a very long and arduous dilemma...

 

[AnnoyedByFreud]

I'm not a PA, I'm a psych NP. Honestly, I'm earlier on in my career and while many things seem rote, there is still a lot to learn and master. I see complex patients and having my psychiatrist buddies available has been essential. There's a lot to psychiatry, especially when you're working in acute settings and caring for patients who are medically fragile with many comorbidities, not responding to meds as you'd expect, having odd side effects, etc. I'd be very afraid to practice without physician support. It's possible that in 10 years I will tire of being a psych NP but then I could always go into teaching or management, or do something else altogether. I imagine things get rather boring for everyone after practicing for a while.

I think physician or PA (or NP) all have their positives and negatives. As an NP there is much less sacrifice involved (with respect to both money and time), which for me has been a positive. You're locked in less, you can leave and go do something else more easily/without giving up as much, etc. Of course there is obvious prestige and eventual monetary benefit in becoming a physician. Patients are always happy to be seeing the doctor, and you have to 'prove yourself' much more if you're not the doc. If you know medicine is for you and don't think you could do anything else, go for it and become a doc.

 

[pamac]

175k for a couple years of experience is doing pretty well but not atypical for my HCOL area. However my contract gig is definitely much higher pay than is typical. I also negotiate my pay which has helped me. Unless you're in a relatively saturated area (Manhattan, for example, I hear is pretty saturated), you pretty much have employers over a barrel. I do tend to talk a lot with fellow PMHNPs and my psychiatrist friends about opportunities, pay, etc. I am the type to always keep 'feelers' out for better opportunities. If I work full time I'll make ~220k next year with the main job and the extra one (with both positions I would average 42 hours per week), though I'm considering cutting back on my hours at my main job. I'd rather work <40 hours weekly if possible overall. I paid off my student loans at the end of last year so I also don't have the pressure of debt hanging over my head.

I worry about PMHNP saturation though, I know of many FNPs who are going back for their psych certs, plus it seems like psychiatry is becoming a more popular specialty for MDs/DOs. However the shortage of psychiatrists is so massive that I don't see it affecting us any time soon. I am trying to make sure I have a lot of experience in a variety of settings (psych ER, inpatient, C&L, outpatient) so I can broaden my skill set and keep my resume attractive to employers. Plus I hate outpatient, hah.

I think about a lot of the same issues as you do, particularly the flight of FNPs going back for their psyche NP. It’s definitely happening, and I’m seeing it in its early stages.


My concern about switchers is tempered by a couple things. A few FNP switchers are folks that are fed up about wages and workload. Many have significant knowledge of psyche from treating it through their dealings with their patients as primary care providers, which is reasonable if done judiciously and sparingly (often, there’s not a psyche provider available). So they make the jump to formalized psyche. I’ve known someone who was an FNP who had a role in addiction medicine, and would essentially maintain that role with the new Psyche NP they were going back to school for. I don’t know if there will be a mass exodus, though. Going back to school for a year or more and finding time away from work to get the clinical hours is a decent speed bump. People become relatively complacent, especially after already completing grad school and working in their career for a while. New FNPs often are busy enough that going back is especially unappealing, and experienced FNPs would probably be less interested with each year that goes by. The prospect of going back to the student life, as well as them tending to become more familiar with their jobs make a large transition more difficult. They would go from having built up their experience level, and then starting out fresh in a new specialty. Also, many folks outside of psyche complain constantly about their interactions with patients they feel have psyche issues that make their 15 minute appointments for physical ailments difficult. The thought of those same providers deciding to take on more of the patients that they complain about leads me to conclude that the specialty is safe from switchers unless primary care utterly tanks as far as salary. You don’t see legions of folks opting to pursue CRNA under those terms either, and that’s just one more year of school.

 

[pamac]

I'm not a PA, I'm a psych NP. Honestly, I'm earlier on in my career and while many things seem rote, there is still a lot to learn and master. I see complex patients and having my psychiatrist buddies available has been essential. There's a lot to psychiatry, especially when you're working in acute settings and caring for patients who are medically fragile with many comorbidities, not responding to meds as you'd expect, having odd side effects, etc. I'd be very afraid to practice without physician support. It's possible that in 10 years I will tire of being a psych NP but then I could always go into teaching or management, or do something else altogether. I imagine things get rather boring for everyone after practicing for a while.

I think physician or PA (or NP) all have their positives and negatives. As an NP there is much less sacrifice involved (with respect to both money and time), which for me has been a positive. You're locked in less, you can leave and go do something else more easily/without giving up as much, etc. Of course there is obvious prestige and eventual monetary benefit in becoming a physician. Patients are always happy to be seeing the doctor, and you have to 'prove yourself' much more if you're not the doc. If you know medicine is for you and don't think you could do anything else, go for it and become a doc.

I think practicing outpatient, despite your dislike of the environment, might make you feel less reliant (don’t know if that’s the best word) on the physicians. Right now you are the tip of the spear as far as tackling high acuity with multiple complicated comirbidities, and it just seems natural to have some heavy hitters back you up. In inpatient roles, even the physicians are bouncing ideas off other providers because they are in proximity. Everyone is used to that, because it’s like running a circus without a net... your more likely to fall when you have 4 shows per day vs one per week (not because you aren’t well practiced, just that with more shows, there’s more likelihood to fall). The brain adapts to not having someone close by to collaborate with, and it steps up to the challenge. Before long, you’ll utilize others less and less where you are at now.

 

[AnnoyedByFreud]

I practiced outpatient for two years and did not enjoy it for a variety of reasons. All newer psych NPs should be reliant on physicians or experienced NPs to some degree, given the brevity of our training.

 

[pamac]

I see what you are saying.