RN to Psych MD?

[MD OR RN?]

I have thought this was the route I am going to take. It is a long and it might not happen but I like the possibiltes with my drive to help psych patients as much as possible.

2 year ASNursing, work as RN in psych setting for enough time to save money, attain BSN in Nursing or another related field in science from there apply to some west coast MD schools. That is as far as I have gotten but I figure I could be a Psych MD in about 10-12 years.

Would anyone suggest going this route or would I be better of becoming a Nurse practitoner in the Psych setting?

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[SupportingOccam]

You could also consider being a PA....just a thought to consider.

 

[BPKurtz]

There are lots of ways to help psych patients, most are not as convoluted as the scenario you devised. Although what you suggested is technically possible, it doesn't sound like anyone I know in medical school or in the mental health field. I don't know you so don't take this personally, but I would worry that you wouldn't get all the way there before you just got frustrated with all the training you needed and hoops you had to jump through.

Other possibilities include nurse practitioner, which you mentioned. There is a definitely a need for psych NPs. At my institution they do a lot of intake and also can help with inpatient care (if an attending physician isn't assigned a resident, they have a nurse practitioner to do H&Ps, write orders for meds, etc). Our inpatient teams also have social workers, occupational therapists, and art therapists who are specialists in psychiatric patients and are indispensible in helping psych patients. You could do a lot of good by being one of these. You can also consider psychology, which is the pathway to doing psychotherapy. MDs/DOs don't do much psychotherapy these days, that is handled by therapists and the road to being a psychologist is somewhat shorter.

If you are really committed to becoming a psychiatrist, IMHO you shouldn't be an assistant nurse or go to nursing school first because you will waste all that time and effort that you spend in RN school -- I would argue that you wouldn't use nursing skills very often as a psychiatrist. A better route would be to go the conventional route: undergrad majoring in whatever you want, e.g. biology, taking the premed courses you need there, then go to med school. You mentioned something about earning money before getting a BS and let me tell you, if you want to be an MD you should worry about that later. Most people take out loans to go to undergrad and almost everyone takes out loans to go to med school. Everyone ends up in a lot of debt but there is no other way to do it, you won't be able to "work your way through med school" or anything like that. I am not trying to be condescending, but I doubt the salary of an assistant nurse would even make a dent in that kind of debt anyway.

One point on timing, med school is 4 years and then you are an MD. But to be a psychiatrist requires a 4 year residency after that. No to mention the 4 years before med school you have to spend in undergrad (with vanishingly few exceptions, without a 4-year undergraduate degree including the required pre-med courses, I don't think you can get into any medical school in the country). So that is 12 years at least before you'll be a real psych MD able to operate indepently...

bpkurtz

 

[Thewonderer]

you can also become a licensed clinical social worker. LCSW can do psychotherapy with psych patients. You need to get a master's degree in social work.

 

[MD OR RN?]

Thanks for the suggestions BPKurts. Much appreciated. 12 years certaintly seems like a lot of time. Other avenues are probably better suited for me.

Originally posted by Thewonderer
you can also become a licensed clinical social worker. LCSW can do psychotherapy with psych patients. You need to get a master's degree in social work.

Only problem with this is the pay. With a MSW most of the employment ads ive seen offer something around 10-15 dollars an hour. That is outrageous. I'd rather have a NP masters and make much better money. It's too bad though because SW is intriguing. Thanks for the suggestion though.

 

[Thewonderer]

Originally posted by MD OR RN?
Only problem with this is the pay. With a MSW most of the employment ads ive seen offer something around 10-15 dollars an hour. That is outrageous. I'd rather have a NP masters and make much better money. It's too bad though because SW is intriguing. Thanks for the suggestion though.

Uhm....I wonder if these MSW do psychotherapy. Let's ask around a little bit and get back to you in terms of pay discrepancy.

 

[Thewonderer]

Originally posted by Thewonderer
Uhm....I wonder if these MSW do psychotherapy. Let's ask around a little bit and get back to you in terms of pay discrepancy.

So I asked the social worker I worked with. She states that Master's of Social Work is a 2-year program, during which you decide on one of many tracks (clinical, administration, etc. etc.) and study+intern each for half of the time in those 2 years.

The starting pay is around 30k. however, if you plan to do psychotherapy, the pay in the VA system is 40-60k. I would imagine that the salary is higher in the private sector. To her, it does seem that the insurance companies are more and more willing to let license clinical social workers perform psychotherapy since it is cheaper than hiring a clinical psychologists. In her (not-so?) biased opinion , she believes that the job market will be more wide open for LCSW than clinical psychologists (although clinical psychologists do get paid more now, but their ability to get reimbursements in the future from the insurance companies might become more limited than the LCSW's.).

 

[sasevan]

I agree with the opinions of the LCSW.
I'm currently doing my post-doc fellowship in clinical psychology and have decided to pursue psychiatry for both scope of practice and financial issues.
Last year my pre-doc internship class got a dose of the real world awaiting clinical psychologists (PhD/PsyD) getting into practice (trying to get into practice?) in the era of managed (mangled?) health care: we are limited in our scope of practice to testing and ind/grp therapies and barely getting paid for that while having an average of >100k debt in student loans. While we're seeking prescriptive authority (RxP) that will probably take many years (decades?) to happen, if ever. Testing is rarely approved and poorly reimbursed when it is. Ind/grp therapies can be done by master-level practitioners such as LCSW and nurse practitioners (NP). Additionally, NP have RxP to one extend or another in all 50 states, i.e., NP can do both psychotherapy and pharmacotherapy facilitating a more holistic care for their patients. LCSW, of course, have a lot of knowledge about community resources to meet the social and financial limitations of their clients.
Psychology is a great field but like most social sciences it is financially poorly compensated. According to the U.S. Dept of Labor psychologists on average [this is for ALL PhD/PsyD and not just starting ones) make 50k; compare that with NP 80k, LCSW 60k, or psychiatrists (MD/DO) 130k].
Of course, every one has different interests and financial responsibilities and there are PhD/PsyD who are very happy with their scope of practice and are very well compensated for what they do (the exceptions?). You may just be one of those individuals who would thrive in a clinical psychology practice. But if your interest lies more in psychotherapy then I say go the route of NP (this will also be great if you develop a future interest in pharmacotherapy).
Peace

 

[sasevan]

However, if you want the full scope of practice available to best treat your patients then I say go the route of psychiatry. Yes, 10-12 years is a long time but no matter what you do you will spend that time doing something. If your heart's desire is to be an MD/DO with all the resources that that will bring to the care of your patients then go for it. It will take sacrifices but whatever choice you make will also mean sacrificing something. What is your ultimate goal and how much do you want to prioritize that at this time?
Peace.

 

[Thewonderer]

Originally posted by sasevan
But if your interest lies more in psychotherapy then I say go the route of NP (this will also be great if you develop a future interest in pharmacotheapy).
Peace

I believe that to enter an NP program, you need to be an RN first (i.e. going through 4 years of undergrad nursing programs + work for 2 years). It is not reasonable for people to switch career to be an NP. Does PA do psychotherapy and psychopharm?

A friend of mine is getting sick of her job in the finance industry in NYC. She is well compensated but the company has made it clear to her that she is neither going to be promoted nor fired. She wants to enter a field that helps people but obviously she has financial and time constraints. I might suggest LCSW as a career to her.

 

[sasevan]

Hey,
The BSN (which includes the RN cert) can be done in 3 yrs and the MSN (which includes the NP cert) can be done in 2 yrs after that. If your friend has a BS/BA she may be able to cut down on the 5 yr full-time program. Also, she can do the program part-time and on-line: SUNY at Stony Brook has an MSN-NP on-line program.
PA can do pharmtx but I haven't heard of PAs usually specializing in psych practice. PA are most often in primary/general/family med practices. Also PA are cert through the med boards of their states, unlike nurses and other allied health professionals (DDS/DMD; PhD/PsyD, OD, DPM) which often means that PA are very much physician extenders; something to consider carefully if someone ever wants to be in independent private practice.
Finally, LCSW are very qualified to do psychotx but they can't do pharmtx, which is what managed care really reimburses. Additionally, a lot of LCSW that I know do not work in psychotx at all but rather in case mgr services where they are often overwhelmed with the volume of work and very poorly compensated for it.
Of course, every area of the country is a little diff. Check the phone listings under psychotx to see how many psychiatrists, psychologists, NP, PA, and LCSW are in private practice in your area. That might help in assessing the local limitations.
Peace

 

[J-Rad]

Just a point about NP's & Psychiatry: in the current nursing system, there are no psychiatric nurse practitioners (though, I believe, some are arguing for the creation of such). That isn't to say that NP's can't work in a psychiatric setting-I would imagine that they mostly work on the strictly medical side of things and do some drug management, in such a way that a family practitioner does psych drug mgt.-but psychiatric NP does not yet exist like pediatric NP, or family NP.
In the current system, there are psychiatric clinical nurse specialists, which, like an NP, is a 2 year masters level program after a BSN and work experience. They function much like a psychiatrist (though with similar constraints as NP's). In ~22 states they have prescription priveleges with the appropriate training.
The reason I am aware of this situation is I just completed an MSIII linical rotation in psych in which my primary supervisor was a psych CNS. In addition to the service we were on she has her own autonomous outpatient practice. And while she happened to be a miserable human being, I had a great deal of respect for her clinical abilities and extensive knowledge of psychopharmacology (which eclipsed any non-psychiatrist on staff)

 

[Kimya]

I am doing a MSW social work program now. What the LCSW (licensed clinical social worker) is mentioning is what I have found as well. More and more psychotherapy is being done by master's level clinicians. Even if you are trained to do it in MD/DO programs the reality is you are going to have a tough time finding an agency to reimburse you if that is your primary interest. Private practice is an option of course but then you have to consider overhead and what insurance will cover.

I shuffled for a while between NP/psychologist/social worker. There are psychiatric NP programs and positions (UCSF has a specialization in psych NP for example), but they are not very well known at this time. I was concerned that the psychologist scope of practice was really not that different from MSW in my interests, considering the debt that one would incur. Since in the long term I am more interested in organizational planning and management instead of research and testing, the MSW seemed like a better fit. I could always go back and get a doctorate in SW if I wanted to do more research. Also, you can have your own private practice once you have a license to practice, which I like. I am in California and NP's here still need to be supervised by docs.

Some good info here on this thread...

 

[Thewonderer]

Originally posted by Kimya
I am doing a MSW social work program now. What the LCSW (licensed clinical social worker) is mentioning is what I have found as well. More and more psychotherapy is being done by master's level clinicians. Even if you are trained to do it in MD/DO programs the reality is you are going to have a tough time finding an agency to reimburse you if that is your primary interest. Private practice is an option of course but then you have to consider overhead and what insurance will cover.

I shuffled for a while between NP/psychologist/social worker. There are psychiatric NP programs and positions (UCSF has a specialization in psych NP for example), but they are not very well known at this time. I was concerned that the psychologist scope of practice was really not that different from MSW in my interests, considering the debt that one would incur. Since in the long term I am more interested in organizational planning and management instead of research and testing, the MSW seemed like a better fit. I could always go back and get a doctorate in SW if I wanted to do more research. Also, you can have your own private practice once you have a license to practice, which I like. I am in California and NP's here still need to be supervised by docs.

Some good info here on this thread...

Thanks for the feedback!

I rotated through the psych unit in a local community hospital during 2nd year and I did encounter a psych NP (or at least, that's what she told me, she is a NP but I could be wrong).

 

[MD OR RN?]

There is indeed Psych Mental Health NP here in Oregon. I do not jowever know the time it takes to obtain such a thing but I would think it would take the normal two years post-grad work.

 

[DrDre']

Also a psych NP at U of Iowa. Respected school and program. 5 semesters, I think.

 

[Doctor Bagel]

i saw a psychiatric np in oregon, and he did have prescribing ability. he operated totally independently of any physician and had his own practice. i think that's a pretty common thing here.

 

[peiyueng]

Originally posted by Kimya
I am doing a MSW social work program now. What the LCSW (licensed clinical social worker) is mentioning is what I have found as well. More and more psychotherapy is being done by master's level clinicians. Even if you are trained to do it in MD/DO programs the reality is you are going to have a tough time finding an agency to reimburse you if that is your primary interest. Private practice is an option of course but then you have to consider overhead and what insurance will cover.

I shuffled for a while between NP/psychologist/social worker. There are psychiatric NP programs and positions (UCSF has a specialization in psych NP for example), but they are not very well known at this time. I was concerned that the psychologist scope of practice was really not that different from MSW in my interests, considering the debt that one would incur. Since in the long term I am more interested in organizational planning and management instead of research and testing, the MSW seemed like a better fit. I could always go back and get a doctorate in SW if I wanted to do more research. Also, you can have your own private practice once you have a license to practice, which I like. I am in California and NP's here still need to be supervised by docs.

Some good info here on this thread...

Kimya:

I think I read your post correctly, but I just wanted to double check. Are you saying that LCSW can have a stand alone practice without anyone supervising them?

I am asking because I don't know how it works. If what you say is true, then I think it is fabulous.

See, my situation is that I have a D.O. degree, but I really would like to do psychotherapy. Psych residency is one way I could do this, but if indeed LCSW can have a stand alone practice, then it is a much quicker way and less strenuous way become a psychotherapist.

Another quesition I have is about terminology. I seem to remember that the term psychotherapy has specific legal meaning. Will you be able to call yourself a psychotherapist doing psychotherapy with an LCSW?

I would appreciate any enlightenment on this subject.

Sicnerely, Chin.

 

[Kimya]

Hi,

Yes, you can have an unsupervised private practice with a LCSW. However, it does take a little bit of time to get there- you need a MSW along with a certain number of supervised hours after that to qualify. It might be more time efficient and less repetitive for you to do the psych residency instead...Here is the information for California's requirements as an example.

http://naswca.org/onlinece/10steps.doc

I am pretty sure you can call yourself a psychotherapist also, although not 100% about this- have not heard otherwise and have seen job postings for psychotherapist, LSCW or psychologist etc...

Good luck in your endeavors.

Sincerely,
Kimya

 

[Thewonderer]

Originally posted by Kimya
Hi,

Yes, you can have an unsupervised private practice with a LCSW. However, it does take a little bit of time to get there- you need a MSW along with a certain number of supervised hours after that to qualify. It might be more time efficient and less repetitive for you to do the psych residency instead...Here is the information for California's requirements as an example.

I agree with Kimya. It is probably easier and less of a hassle for the future if you finish psych residency. If you have a real interest in psychotherapy (most med students do not get a lot of exposure to it during psych rotation), then just be sure to choose a psych program that is strong in psycotherapy training. Plus, you get so much elective times in your 3rd and 4th year of psych residency training that if you want to devote it to psychotherapy training and be a psychotherapist, I doubt anyone can stop you.

another important thing to keep in mind is that insurance companies "preferrentionally" give patients to LCSW for psychotherapy over clinical psychologists for a reason: LCSW charges less. I imagine that having an MD means that you can charge for the higher reimbursement rate for your psychotherapy sessions. And if you don't want the extra money so you can compete with other LCSW, I don't see anyone stopping you from giving the insurance companies discount on your services.

 

[osorry1]

To clarify some of the earlier posts, there is such a things as a Psych NP. Not only do MANY graduate nursing schools provide this specialty, there is a national certification exam for Adult and Family Psych NPs (Family NPs see children and adults).

Psych NPs work in both inpatient and outpatient settings, and depending on the state in which they live, have independent or collaborative practice (list a Psychiatrist with whom they consult for difficult cases). prescription writing priviledges are available to NPs in 49 states. (Georgia doesn't yet allow prescriptive priviledges).

There are also several schools where you can obtain a combined RN/NP degree in 2-3 years full-time.

Please look at the posts in the Nursing section of this board for more information.

There is a great shortage of psychaitric providers and when I graduated I had my choice of jobs offering salaries at and above the national average for NPs. NPs also qualify for loan repayment through NHSC and Nursing Education Loan Repayment.

See www.advancefornp.com for further stats.

Hope this helps.

 

[MD OR RN?]

That is very cool, osorry1. Are you currently a Psych NP?

If so...
Do you know how much Psych NP programs study psychosocial aspects and what percentage is based on the psycho pharmaceutical area?

 

[osorry1]

Yes,

I currently work as a Psych NP with both inpatient and outpatient clients. Most Psych NPs work for a time in outpatient settings once out of school to get added medication management experience.

The percentage of time spent with psychotherapy and med education varies somewhat at each school. Schools assume no prior psychotherapy knowledge and therefore focus on assessment, diagnosis and therapy skills in training, with hours of clinical experience required before graduation (the Psych NP certification specifies 500 hours, most schools provide more).

In addition, education on medication types, management and treatment are an additional focus, with almost as many hours set aside for this experience as well.

To further extend the Psych NP knowledge, pathophysiology, assessment and pharmacological and non-pharm management of medical problems are also taught. Most schools provide about 100 hours of experience working in a medical setting seeing and diagnosing medical patients, to allow the Psych NP to be able to distinguish medical from psych problems and to be able to approrpriately refer patients with medical problems to the right providers.

In this way, a Psych NP can complete screening H&Ps for patients (frequently new admits to psych hospitals), can see and treat patients for psych problems and can assess and refer patients to medical providers should a medical problem present.

Hope this gives you a better idea of the Psych NP position.
Here is a site with additional information:

http://www.valueoptions.com/prs/docs/psyc_nurse_prac.htm

Also please look at the nursing site in this forum fpr more info.