Psych Nurse to PMHNP or Psychiatrist?

[psychmurse77]

Is it worth it to pursue becoming a Psychiatrist instead of Psychiatric Mental Health Nurse Practitioner?

Some background… I’m in my mid 30’s wife with 2 kids (6&3). Navy veteran. Started out as an associate degree nurse and been working as a psych nurse for 2 years. Currently travel nursing and 9 classes away from obtaining bachelor in nursing.

My plan… Once finished with BSN start working on prerequisites (around 8-9 classes Ochem, Physics, etc). I plan on still travel nursing as I don’t travel past 300 miles from home. I group all my shifts and come home after. I plan to apply in DO school as I’ve heard they’re more friendly towards non-traditional applicants. Or USHUS because i do intend on serving back in the military. Overall completing prerequisites, MCAT, etc will take me approximately 3 years. Can’t afford to go full time in school completing prereq’s. That’ll bring me at 40ish med student & be a mid 40ish resident. I hope my background will help in some ways in landing a psych residency.

Why medical school… I want the best training. Not that PMHNP school don’t provide that I just want a more in depth training. NP vs MD/DO training is completely different. Autonomy, although NP’s can practice independently in 27 states but I feel psychiatrists still have more leeway and autonomy. Last, I just don’t want to have regrets not pursuing becoming a psychiatrist. I do not want to be a doctor for the prestige or anything like that. And I do not think any less of NP’s. It’s the overall best training for me that med school and residency can provide.

Why not PMHNP… I do understand it’s the most linear and financially feasible route. But either or I plan on asking Uncle Sam to help me with education cost. I was a Navy corpsman and know the pros and cons of military medicine. It’s a shorter route vs the medical route. I can finish sooner and make income sooner. I have a family and it’s the only thing holding me back from not pursuing medical school. I feel with PMHNP programs I’ll have much more flexibility for my young family. I’ll have more time for them and can still work part time/PRN during school. Being a PMHNP may have a different training but at the end of the day I can still diagnose, prescribe, and treat patients more than I can as a RN. It’s great career comparable to a psychiatrist despite the “looming saturation”.

PMHNP school is, i think, the smarter route to go but my heart at the moment is saying med school. I flip back and forth weighing each option. Any docs and NP’s input would be much appreciated. Thanks.

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[Angus Avagadro]

Do a ROI cost analysis. Psych NP would be more cost effective but I believe you would be somewhat limited by meds and therapy options. Med school is very expensive, like 350 400k, an armed service scholarship certainly makes sense. You have a young family and you would still need to earn an MD or DO degree to be a psychiatrist, with all of the med school and PGy 1 stuff.Both are doable, but I might lean toward Psych NP. Just my thoughts, and they are worth exactly what you paid for them. Good luck and best wishes! Thank you for your service.

 

[TragicalDrFaust]

Not all psych NPs get proper training. I’ve worked with NP students from two different schools and the difference is night and day. One of the schools, they are like medical students, just don’t know biochem and other non-clinical topics in-depth. The other, they don’t know how to do physical exams or write notes. There are also professionalism issues. Students who are current nurses would leave in the middle of the afternoon without telling anyone, for example. If you pursue an NP degree, I would select the institution carefully.

MD/DO has the advantage better working conditions, in some ways, and practice ownership. A lot of places I’ve worked, the NPs get paid less but have to cover weekends and other undesirable shifts. Although NPs can practice independently in many states, I think it’s dangerous and should be an absolute last resort for improving access to healthcare.

The time and cost of MD/DO is significant, plus the risk of an increasingly competitive psychiatry match. Most MDs who apply psych match but only about 3/4 of DOs do.

I think if you want to see patients 9-5 M-F, and are ok working under someone, NP will get the job done. If you have any other professional aspirations, it’s worth applying MD/DO.

 

[DO2015CA]

Not all psych NPs get proper training. I’ve worked with NP students from two different schools and the difference is night and day. One of the schools, they are like medical students, just don’t know biochem and other non-clinical topics in-depth. The other, they don’t know how to do physical exams or write notes. There are also professionalism issues. Students who are current nurses would leave in the middle of the afternoon without telling anyone, for example. If you pursue an NP degree, I would select the institution carefully.

MD/DO has the advantage better working conditions, in some ways, and practice ownership. A lot of places I’ve worked, the NPs get paid less but have to cover weekends and other undesirable shifts. Although NPs can practice independently in many states, I think it’s dangerous and should be an absolute last resort for improving access to healthcare.

The time and cost of MD/DO is significant, plus the risk of an increasingly competitive psychiatry match. Most MDs who apply psych match but only about 3/4 of DOs do.

I think if you want to see patients 9-5 M-F, and are ok working under someone, NP will get the job done. If you have any other professional aspirations, it’s worth applying MD/DO.

Lots of facts here but with the OPs specific situation, I’d recommend NP. But that’s with the caveat of being aware there is a knowledge gap here. Being a mid 30s person with kids myself, I couldn’t imagine embarking on the journey now. It’s a long expensive journey. Granted they plan to do military fwiw. The one thing I would add is psych is one of those fields that they value someone wanting to do psych genuinely above board scores. So an ex-psych nurse turned psych applicant has a big leg up and unless they fail multiple classes/steps then they would have a good chance matching despite rising competitiveness

 

[DOlor]

I was mil med for many years. I recommend the VA HPSP to pay for school or Veterans benefits (PM Me) so you still work with the veteran/military demographic. In the future you could also just work at a military base if you miss mil med, but getting paid good Dr pay. It sounds like you are one of those people who doesn't want to be the person who doesn't know what they don't know. I'm the same way. Same age starting medical school this fall for me it was worth it however I wasn't a nurse before hand so it depends how much you're willing to sacrifice with a family and what kind of support you will have.

 

[AlbinoHawk DO]

Clearly, medical school would be a terrible economic choice. I also can't advise anyone to go the NP route; the education is simply too poor, even coming from the "prestigious" programs

 

[VelmaBoots]

I’m an ADN/BSN to NP to MD student!
I also thought I’d be happy being able to treat / diagnose patients as an NP … I’m not. It just made me want to be an MD even more. I had wanted to be an MD for years and just haven’t been happy stopping short of that goal.
Even as an NP, I do not support full independent NP practice - the knowledge gap is ridiculous. I think that NP schooling in general needs a major overhaul — especially if we want to be taken seriously as practitioners. As you can tell from reading through some threads, we (NPs) often get very little respect for what we are trained to do. I’m not sure if that will ever change, unfortunately - so make sure it’s something you could live with for the next 30 years of your career. As someone else pointed out, if you do choose NP make sure it’s a good school! If you’re trained well and willing to work hard/learn you migh get lucky and find an MD willing to teach you (I found some of these at my job!). There are also some NP fellowships out there (not sure about psych) which might be great if you decide the NP route.
However, If you really want to “know your stuff” and want to practice safely & independently —— go MD/DO.
As a side note, I’ll be 44 in a couple weeks, I have 3 kids, and I am starting med school in July … so don’t let your age trip you up in your journey!

 

[Splenda88]

Clearly, medical school would be a terrible economic choice. I also can't advise anyone to go the NP route; the education is simply too poor, even coming from the "prestigious" programs

Why would it be a terrible economic choice?

It depends on the specialty you choose. I was a RN for ~8 yrs and decided to go med schools after I took a few NP classes which I thought were ridiculous.

Finished IM residency in my early 40s and now working as a hospitalist making (2.7)X of what NP/PA in my company make (albeit they see less # of patients with lower acuity). I actually think it was one of the best financial decisions I made.

If you are talking about CRNA vs MD, that is a different story since CRNA salary is closer to MD's.

I would always advise people to do MD/DO as opposed to NP especially for three main reason. First one is knowledge base, second is flexibility and 3rd reason is financial.

 

[AlbinoHawk DO]

Why would it be a terrible economic choice?

It depends on the specialty you choose. I was a RN for ~8 yrs and decided to go med schools after I took a few NP classes which I thought were ridiculous.

Finished IM residency in my early 40s and now working as a hospitalist making (2.7)X of what NP/PA in my company make (albeit they see less # of patients with lower acuity). I actually think it was one of the best financial decisions I made.

If you are talking about CRNA vs MD, that is a different story since CRNA salary is closer to MD's.

I would always advise people to MD/DO as opposed to NP especially for three main reason. First one is knowledge base, second is flexibility and 3rd reason is financial.

The short of it is this person will be around 50 by the time they finish with looming retirement and massive new debt. 2 kids that will probably get nothing from their parent because mom is working for mohela

 

[Splenda88]

The short of it is this person will be around 50 by the time they finish with looming retirement and massive new debt

I did not see that.

I think starting MD/DO school at age < 35 worth it financially assuming there won't be big cuts in physician's salary in the next 15+ yrs

 

[VelmaBoots]

Why would it be a terrible economic choice?

It depends on the specialty you choose. I was a RN for ~8 yrs and decided to go med schools after I took a few NP classes which I thought were ridiculous.

Finished IM residency in my early 40s and now working as a hospitalist making (2.7)X of what NP/PA in my company make (albeit they see less # of patients with lower acuity). I actually think it was one of the best financial decisions I made.

If you are talking about CRNA vs MD, that is a different story since CRNA salary is closer to MD's.

I would always advise people to MD/DO as opposed to NP especially for three main reason. First one is knowledge base, second is flexibility and 3rd reason is financial.

Same! Starting med school in early 40s

 

[VelmaBoots]

The short of it is this person will be around 50 by the time they finish with looming retirement and massive new debt. 2 kids that will probably get nothing from their parent because mom is working for mohela

There is nothing wrong with a 50 year old female starting a new career!! Hopefully she has a spouse who is able/willing to share the parenting of the children they had and the work to keep up the home they live in. Good luck to the OP in whatever decision she makes!

 

[Splenda88]

Same! Starting med school in early 40s

You will be ok at the end of the day. I think it will worth it financially if you plan to work for 15+ yrs

 

[VelmaBoots]

You will be ok at the end of the day. I think it will worth it financially if you plan to work for 15+ yrs

That’s what I was thinking!!
While I do agree at some point age has to be factored in … I was still willing to give it a go in my early 40s. I will do IM or nephrolgy so I think working to 65ish should be doable! And I think that the journey will be so worth it!
There’s a very good post I ran across about a PA to MD in his 30s. I was so encouraged reading through it. Basically discussed how “worth it” the journey and the education was and that having the mid-level background was a huge help during med school (which I assumed it would be).

 

[Mr.Smile12]

PA to MD story

From PA to MD: An appreciation for physician education

It was common, and I am sure it still is, for us, as PA students, to talk of PA school as comparable to medical school.

www.kevinmd.com

 

[AlbinoHawk DO]

There is nothing wrong with a 50 year old female starting a new career!! Hopefully she has a spouse who is able/willing to share the parenting of the children they had and the work to keep up the home they live in. Good luck to the OP in whatever decision she makes!

What does female have to do with anything? This is a purely economic decision

 

[VelmaBoots]

The short of it is this person will be around 50 by the time they finish with looming retirement and massive new debt. 2 kids that will probably get nothing from their parent because mom is working for mohela

What does female have to do with anything? This is a purely economic decision

You're right, female shouldn't have anything to do with it.

 

[AlbinoHawk DO]

You're right, female shouldn't have anything to do with it.

Yeah, and if it had been a man, the comment would say "because dad is working for mohela." I'm saying this in the most sincere and respectful way possible, but you need to re-examine how you interpret the world. This is not the 1950s. Everyone in the work force is used to women having jobs