Why would anyone care about becoming a Psychiatric-Mental Health Nurse Practitioner (Psych NP and PMHNP will be used interchangeably)?
If you want to be a player in the psychiatric prescribing workforce, I’d recommend the Psychiatric-Mental Health Nurse Practitioner route.
Just how big of a player will you be? Here’s a breakdown of the number of different types of prescribers in mental health:
The number of psychiatrists in the US: 28,000 (1)
The number of Psychiatric-Mental Health Nurse Practitioners in the US: 13,815 (2)
The number of psychiatric PAs in the US: 1,033 (2)
The number of board certified psychiatric pharmacists in the US: 955 (2)
The number of prescribing psychologists in the US: 1,875 (see appendix A for how I came up with this answer)
The total number of mental health clinicians with prescriptive authority is 45,678. Using our 13,815 stat above, we know that PMHNPs comprise at least 30% of the prescriptive players in the game right now.
Take a moment and think about what I just said. That’s right: PMHNPs represent ALMOST ONE-THIRD of the prescriptive force in mental health.
The PMHNP role is appealing for three main reasons:
-It’s a way to have a six digit income (4).
-As of right now, you only have to get a Masters degree and become certified as a PMHNP through your state’s board of nursing in order to have the title of PMHNP. Then, you get to do the work of a MD psychiatrist. So does this mean PMHNPs do the work of psychiatrists without getting medical degrees? YES. Click here to see how pissed off doctors are that PMHNPs are doing MD jobs.
-The field is burgeoning. By 2025, there will be 17,900 PMHNPs in the US, which represents a growth rate of 29.6% for PMHNPs (5).
How much money does a Psychiatric-Mental Health Nurse Practitioner make?
In 2015, Psych NPs earned an average salary of $106,033, which jumped to $125,979 when bonuses were taken into account (6).
In 2018 Psych NPs made, on average, $101,000 per year (4). Notice that the numbers are different. Nevertheless, we’re talking about a six digit income.
Everyone says Psych NPs are in demand. But what is the EXACT projected growth rate?
As of 2017, there are 13,815 Psych NPs in the US. By 2025, it is estimated that there will be 17,900 Psych NPs. The projected growth rate is 29.57% (2).
What’s the difference between the work of a Psych NP and the work of a MD?
Obviously, the training involved in both routes are different in scope and length. That said, the actual, day to day work of Psych NPs is essentially the same as that of psychiatrists.
Now why would I ever say that? Take a look at this publication.
Scroll down to Table 1 and observe the differences between the scope of practice of a psychiatrist and that of an Advanced Practice Psychiatric Nurse.
I can’t see any difference in scope of practice.
The differences in scope, then, come down to opinion. MDs will say they that docs take care of sicker patients, while NPs take care of healthy ones. NPs will jab back and say that NPs cover for MDs all the time. Some NPs will even say that the MD supervisory role is simply a formality. The turf war can get heated.
Looking for a neutral, third party source? These are the job responsibilities of a psychiatrist:
- Reviewing patient files
- Ordering medical tests
- Assessing and diagnosing patients
- Preparing a treatment plan
- Prescribing medication
- Consulting other medical professionals about treatments
According to the same site, “the general duties of a psychiatrist and psychiatric [advanced practice] nurse are comparable.”
Ok, that’s enough doctor bashing. Want to hear some nurse bashing? The Student Doctor Network has great content from the MD/medical student side.
I’ll summarize the content in one sentence. MDs and medical students are pissed that nurses do “doctor work” without having medical degrees. Let’s call a spade a spade.
To summarize this entire section, both psychiatrists and Psych NPs diagnose, provide psychosocial treatment, prescribe, and talk. The main difference (other than pay) is that the psychiatrist holds a superior position in the dominance hierarchy. This means that psychiatrists have almost no limitations on practice. On the other hand, Psych NPs in some states require a “collaborative” agreement or “supervision” with psychiatrists, thus limiting the scope of practice of NPs. For instance, in California, a Psych NP must be able to consult with a psychiatrist by telephone for any patient.
Check this site out for more information on your state’s NP practice environment in terms of restriction.
Why would I want to be a Psych NP if I could just be a psychiatrist?
The short answer is that if you become a Psych NP, you can do a psychiatrist’s job without having to go to medical school. You will be paid less than a doctor, but you will be doing the job of a doctor.
The long answer will require that you deeply answer this question: do you want to be a doctor or nurse? My personal answer to this question is that I’d rather be a high quality nurse. Working in different hospitals in California, I’ve observed that some doctors are TERRIBLE at their jobs. I’ve seen doctors fabricate assessments, copy and paste other doctor’s notes, and bill patients they don’t physically see. I’ve seen the same type of incompetence from nurses. So to me, one’s title isn’t as important as one’s effort.
Back to the nurse vs doctor debate in psych: if both players (psychiatrists and Psych NPs) basically do the same thing, then let’s dive into the numbers to see which route makes better financial sense.
The mean annual wage for a psychiatrist is $216,090 (3). The mean annual wage for a Psych NP is $101,000 (4). That means that a psychiatrist typically makes 114% more than a Psych NP.
There’s a fundamental discord. If Psych NPs and psychiatrists do essentially the same jobs, then their difference in pay is not justified. Does a psychiatrist really bring 114% more value to the marketplace than a Psych NP? If this were true, then the profession of the Psych NP wouldn’t exist. Because the roles of the two players are very similar, I would say the pay difference is not justified.
On the other hand, let’s look at the years of schooling required:
Psychiatrist: 4 year bachelor degree +4 year medical degree + 3-4 years of residency = 11-12 years of formal training/schooling.
Psych NP: 4 year bachelor degree in nursing + 2 year Masters degree = 6 years of formal training/schooling.
Therefore, the fact that psychiatrists get paid more than double the amount that Psych NPs make is justified by the fact that psychiatrists take twice as long to get trained.
In summary, psychiatrists’ superior salaries over that of Psych NPs is justified when you analyze the difference in length of training. However, the difference in salary is not justified when you analyze the value the players bring to the table, since both players do the same job.
What personality traits do I need in order to excel in this role?
For the purposes of this question, the psychiatrist and the PMHNP will be one and the same.
According to a psychiatrist with 30 years of experience, ideal personal attributes include (this is your chance to slow down your reading and to genuinely ask yourself if you have the following traits):
- The ability to listen “actively” and observe “comprehensively”
- Psychological mindedness and curiosity
- Compassion and empathy, but pragmatic firmness about boundaries
- Nonjudgmental stance and cognizance of one’s own limitations
- Impeccable integrity and ethical conduct
Also, here are some other questions to ponder:
-Are you an incredibly patient person?
-When people talk to you about their deepest problems, do you empathize them, or do you judge them?
-Do you like listening to people talking about their problems?
-Do you like being in one on one situations rather than being in a group?
-Do you like letting other people lead conversations?
-Can you maintain composure under stress or duress?
-Do you like having people place their trust in you?
-Are you interested in the human mind and the various effects medication has in restoring or repairing it to its optimum form?
-Are you interested in learning more about mental disorders such as schizophrenia or PTSD?
-Are you good at memorizing?
-Do you like to diagnose problems?
It’s up to you to be honest when assessing yourself. I’m just here to help.
What Do You Do Each Day as a PMHNP?
1) Monitor patients’ medication usage and results
2) Document patients’ medical and psychological histories, physical assessment results, diagnoses, treatment plans, prescriptions, or outcomes
3) Diagnose psychiatric disorders and mental health conditions
4) Evaluate patients’ behavior to formulate diagnoses or assess treatments
5) Distinguish between physiologically and psychologically based disorders and diagnose appropriately
What degree do you need?
You need a Master of Science (MS) in nursing, which generally requires 2 years of coursework and clinical hours (generally 500 or more). The DNP is not yet a requirement for entry level practice (https://www.apna.org/files/public/The_Mental_Health_Workforce-A_Primer.pdf).
Here’s a list of the top 10 psychiatric nurse practitioner programs in 2018:
What EXACTLY DO I NEED to get a PMHNP job?
-A Nurse Practitioner license issued by your state’s Board of Registered Nursing (BRN)
-A Nurse Practitioner medication furnishing number issued by your state’s BRN
-A license to practice as a Registered Nurse issued by your state’s BRN
-A Controlled Substance Registration Certificate issued by the United States Department of Justice Drug Enforcement Administration (DEA), assuming you want to prescribe controlled substances
-Certification as a Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan), issued by the American Nurses Credentialing Center
All these requirements assume you will graduate from an accredited graduate program.
What kind of work experience is required to get into graduate school?
I hate saying this, but you just need to call each graduate school to verify what type of experience is required. To be safe, I’d recommend getting a psych job as a RN. It’s better to have some experience than no experience.
If you live in California, a good site is: http://www.rn.ca.gov/education/apprograms.shtml.
This site allows you to see all the NP programs in the state. If you’re a non-Californian, your state probably has a similar site.
What proportion of NPs practice in the Psych/Mental Health field?
What’s the deal with Psychiatric Nurse Practitioner residency programs?
Nursing residency programs are designed to provide an extra layer of training for NPs. The upside is that NPs get more supervision and formal training, facilitating their transitions to competent NPs. The downside is that residency programs often don’t pay as much as full time salaried positions.
A quick google search of “california psychiatric nurse practitioner residency program” yielded these results:
If you’re oriented toward the bottom line, then forget about the NP residencies. But if you’re interested in growth and learning, the NP residency might be for you.
An article put it very well:
“As for job satisfaction, two researchers conducting a survey of 254 NPs found that almost 70% of those completing residencies were “satisfied” or “very satisfied” whereas just over 50% of those without post-graduate education rated themselves that way.”
The NP residency appears to be associated with job satisfaction.
What does the literature have to say about the safety of PMHNPs?
I couldn’t find many articles pitting PMHNPs against psychiatrists. But here are some interesting studies:
-An investigation surveyed both PMHNPS and doctors to see what they thought of the PMHNP’s ability to prescribe. The conclusion: “our research project confirms that the various stakeholders are satisfied with the prescribing practices of NPS. A follow-up study is needed in order to ascertain whether there are qualitative differences between the prescriptions of NPS and those of doctors.”
-The objective of another study was to compare the quality of prescribing practices of physicians and nonphysician providers, including NPs. A total of 701,499 sampled patient visits were included during the study period, representing ~8.33 billion visits nationwide. The conclusion:
“the quality of care delivered by nonphysicians and physicians was generally comparable.”
I encourage you to do your own pubmed search. I like to think of it this way: if psychiatrists had superior prescriptive skills, then the psychiatric NP wouldn’t exist. In other words, there’s a reason the Psychiatric-Mental Health Nurse Practitioner exists; he has the ability to safely prescribe!
There are only five states that allow psychologists to prescribe: New Mexico, Illinois, Louisiana, Iowa, and Idaho.
-Number of active psychologists in New Mexico: 1,250
-Number of active psychologists in Illinois: 4,450
-Number of active psychologists in Louisiana: 720
-Number of active psychologists in Iowa: 640
-Number of active psychologists in Idaho: 440
The sum is 7,500, which means that there are a total of 7,500 psychologists in these states. So how many of these psychologists can actually prescribe? I don’t know the exact number, but I do know that the MAXIMUM number of psychologists with prescriptive authority is 7,500. Because psychologists who desire prescriptive authority must undergo additional training, it’s safe to say that there are less than 7,500 prescribing psychologists. As an estimate, let’s say that 25% of the 7500 psychologists actually went through additional training and can therefore prescribe. We therefore come up with a total of 1,875 prescribing psychologists. This number is likely a gross overestimate.