Is this feasible? NP scenario

[Moki1984]

I feel like I am asking a lot of questions lately lol here is more!

I live in NC, we are a Restricted Practice NP state. "State practice and licensure laws restricts the ability of a nurse practitioner to engage in at least one element of NP practice. State law requires career-long supervision, delegation, or team-management by another health provider in order for the NP to provide patient care"

I was day dreaming last night, imagining what I want in the future. Based off of what you have seen and know, how feasible is this.... I end up having a nice and comfy office inside of an outpatient clinic or maybe working at a MD's private practice as one of the providers available. I see clients in my office and I prescribe medication as needed, but we have actual therapy sessions as well. I am not just giving out medications, I am providing therapy alongside it. THIS is where I want to be. I would not be happy only working as medication management , I realize social workers and psychologists often take the therapy but what says a NP cannot do both. I know with my state restrictions I cannot have a private practice so no matter what happens I am under a doctor (unless I move or my state makes some changes, we have a shortage of psychiatric providers so we surely need it. )

In addition to that, if needed financially, I also work at an inpatient facility or possibly with telehealth. Focusing more on medication management, diagnosis, work with the treatment team and therapy is delegated out to the therapists. I see a NP here that works in the morning, she is always in early and they are off campus by noon to their other hospital. We have multiple here that do this actually.

Thoughts?

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[pamac]

At some point, South Carolina might be an independent practice state for nurse practitioners. They are actually introducing bills regularly to address that, and have the support of many in the political establishment, including the governor. It might take a while, but I think it will happen in at least the next 5-7 years, if not sooner. I'm not the type of person that would hold my breath about that, but every year roughly 1-2 states gains full independent practice for NP's... its that formidable of a process.

NP's aren't valuable for their therapy sessions. There are far cheaper professions that can handle that.... licensed therapists, social workers, psychologists, etc. NP's are there to handle meds. I know of NP's that work for therapy clinics owned by therapists, and the NP's make more money than any other employee, including the owners and partners. They are hired for that kind of arrangement so that the therapists have more options to treat their patients, so that they don't have to turn them away when therapy doesn't pan out. They can then make money on continued therapy sessions, as well as for the med management that the NP is doing. Its often worth it for the owners to pay the NP $100 or more an hour so that they can pay themselves $35-$40 an hour, because without the NP, they would be making $0 an hour when the patient went elsewhere to get the help they need. Therapy has its place, and I think its invaluable alongside med management. But there are folks out there that are much better equipped than NP's to sit and navigate therapy sessions.

One thing I can tell you for certain is that your return on your investment of time and money will be so much higher as an NP than you would get for becoming a therapist or psychologist.

 

[deleted480308]

If you want to do therapy you’ll get paid like a therapist for that time. Is it worth the paycut to you?

 

[VA Hopeful Dr]

At some point, South Carolina might be an independent practice state for nurse practitioners. They are actually introducing bills regularly to address that, and have the support of many in the political establishment, including the governor. It might take a while, but I think it will happen in at least the next 5-7 years, if not sooner. I'm not the type of person that would hold my breath about that, but every year roughly 1-2 states gains full independent practice for NP's... its that formidable of a process.

NP's aren't valuable for their therapy sessions. There are far cheaper professions that can handle that.... licensed therapists, social workers, psychologists, etc. NP's are there to handle meds. I know of NP's that work for therapy clinics owned by therapists, and the NP's make more money than any other employee, including the owners and partners. They are hired for that kind of arrangement so that the therapists have more options to treat their patients, so that they don't have to turn them away when therapy doesn't pan out. They can then make money on continued therapy sessions, as well as for the med management that the NP is doing. Its often worth it for the owners to pay the NP $100 or more an hour so that they can pay themselves $35-$40 an hour, because without the NP, they would be making $0 an hour when the patient went elsewhere to get the help they need. Therapy has its place, and I think its invaluable alongside med management. But there are folks out there that are much better equipped than NP's to sit and navigate therapy sessions.

One thing I can tell you for certain is that your return on your investment of time and money will be so much higher as an NP than you would get for becoming a therapist or psychologist.

I doubt that. This has been an issue every year for as long as I can remember. I don't see this changing in the next 10 years.

 

[Moki1984]

If you want to do therapy you’ll get paid like a therapist for that time. Is it worth the paycut to you?

No disrespect towards therapists, but that pay is just not sufficient. Maybe when I was 20 I would have said $ doesn't matter, but that was before I had a mortgage and a child.

If the day to day could not work in therapy, I could volunteer that out. We have refugees locally etc . I could arrange times at local Mosques and Churches to sit and talk it out with people if they need, not on an official level.

As for SC, I will wait and see. I am not opposed to the idea of moving to another state down the road if it opens up more doors.

 

[Moki1984]

At some point, South Carolina might be an independent practice state for nurse practitioners. They are actually introducing bills regularly to address that, and have the support of many in the political establishment, including the governor. It might take a while, but I think it will happen in at least the next 5-7 years, if not sooner. I'm not the type of person that would hold my breath about that, but every year roughly 1-2 states gains full independent practice for NP's... its that formidable of a process.

NP's aren't valuable for their therapy sessions. There are far cheaper professions that can handle that.... licensed therapists, social workers, psychologists, etc. NP's are there to handle meds. I know of NP's that work for therapy clinics owned by therapists, and the NP's make more money than any other employee, including the owners and partners. They are hired for that kind of arrangement so that the therapists have more options to treat their patients, so that they don't have to turn them away when therapy doesn't pan out. They can then make money on continued therapy sessions, as well as for the med management that the NP is doing. Its often worth it for the owners to pay the NP $100 or more an hour so that they can pay themselves $35-$40 an hour, because without the NP, they would be making $0 an hour when the patient went elsewhere to get the help they need. Therapy has its place, and I think its invaluable alongside med management. But there are folks out there that are much better equipped than NP's to sit and navigate therapy sessions.

One thing I can tell you for certain is that your return on your investment of time and money will be so much higher as an NP than you would get for becoming a therapist or psychologist.

I compared the average pay of psychologist to psych NP....yea...it is no question NP will be the biggest return. I got a hold of someone that works with the local ABSN program, they are reviewing my transcripts. I think I know what I need for them, but I would rather be 100% so waiting for them to get back to me.

 

[pamac]

I doubt that. This has been an issue every year for as long as I can remember. I don't see this changing in the next 10 years.

It is a southern state with a strong tendency towards physician protectionism. It had the guts to reject expanding Medicaid as well, so that signals to me that they don’t have the bleeding heart “increase access to providers at any cost” attitude that seems to be the fuel that independent NP practice legislation thrives on..... so you are probably right that it will be among the last holdouts. But we are halfway through the states, so I figured that it’s a good possibility when you have some politicians talking about it. I certainly wouldn’t hold my breath.

 

[VA Hopeful Dr]

It is a southern state with a strong tendency towards physician protectionism. It had the guts to reject expanding Medicaid as well, so that signals to me that they don’t have the bleeding heart “increase access to providers at any cost” attitude that seems to be the fuel that independent NP practice legislation thrives on..... so you are probably right that it will be among the last holdouts. But we are halfway through the states, so I figured that it’s a good possibility when you have some politicians talking about it. I certainly wouldn’t hold my breath.

McMaster is a jackass who works even less well with the General Assembly than Haley did. The only other person who talks about this is Tom Davis and he's more libertarian than Ron Paul.

 

[pamac]

The fact that they are talking about it is several steps up from it being obscure and unthinkable, like what you’d see in Florida. I’d put odds on South Carolina independence within 10 years as 50/50. I think anyone pegging long term plans in a state on the notion of it happening is akin to wishing upon a star, but each year one state in the US becomes an independent practice state, and sometimes more than just one. The better money is to just leave for one of the independent states... mostly in the western US, and live well at a fair wage. Or stay where you are and make just a little bit more than RNs make, and tell yourself that it’s ok because you have a better schedule and like the job better. That’s not my thing, though. I’ll stay independent, thank you.

 

[VA Hopeful Dr]

The fact that they are talking about it is several steps up from it being obscure and unthinkable, like what you’d see in Florida. I’d put odds on South Carolina independence within 10 years as 50/50. I think anyone pegging long term plans in a state on the notion of it happening is akin to wishing upon a star, but each year one state in the US becomes an independent practice state, and sometimes more than just one. The better money is to just leave for one of the independent states... mostly in the western US, and live well at a fair wage. Or stay where you are and make just a little bit more than RNs make, and tell yourself that it’s ok because you have a better schedule and like the job better. That’s not my thing, though. I’ll stay independent, thank you.

If your NPs aren't getting paid much better than your RNs, your job sucks.

My NP hourly makes just over double what the hospital RNs make.

 

[pamac]

I agree. I’ve read posts from Nps in southern non independent states that claim RNs work for $40k. That would make 2x those wages $80k. Then there are NPs in places like California, also not independent, where they say the RNs make $80-100k, and they get offers for around $100k. I’d rather work 3 days a week as an RN with decent hospital benefits than 5 days a week for a clinic where I have a lot more responsibility.

Part of low wages for NPs is the glut of NPs coming out of school, and the need for independence isn’t to blame. But the NP powers that be are betting that high numbers of NPs out in the world will be more valuable to advancing the role. And if they stop now, there are boatloads of PA schools opening up to step in and do the same thing. So I think there is logic in moving ahead with building an army of advanced practice providers and getting a corner on the market.