r/PMHNP

Hey for anyone on here (NC based, though not sure if that really matters) who owns their own single provider practice. I just started and am trying to panel with insurance though I'm hitting a potential issue with IRS rules vs paneling rules (I think). IRS says I must use my own SSN/EIN for W9 but I'm being told that if I use that info to contract with insurance companies I cant bill under my practice type 2 NPI (thus I'd have to contract as me, causing ineligibility of S-Corp election in the future unless I go through the credentialing process again etc. ....not sure how much of this is accurate but looking for any protips or advice on this.

Hi all! My new job doesnt pay for resources so I have to pay for the membership myself. Which do you prefer? and do you have any other favorite resources? Thanks in advance!

Hello community!

I graduated this month and take my PMHNP boards September 15th. I spoke to a recruiter for a large hospital weeks ago and she enthusiastically said she’d move me along to “her leader”. Today I got the call that I’ll have a 30 minute zoom session tomorrow afternoon with the Director of Medical Services for the Outpatient program and I’m immediately nervous. I’m never nervous about an interview so I came here to seek advice. What questions were you asked at your first PMHNP job interview? What specifically do you feel they were looking for that landed you the job? I’m SO excited to be able to be more helpful to folks experiencing struggle and I truly need this opportunity! Advice? Eeeeeee! 😊🤞

“Recruiters”” trying to sign me up on headway in the first five minutes. Am I being paranoid?

I’m currently going through the process of applying for the VA VR&E program to hopefully go back to school and become a PMHNP. I’d ideally go through the VA’s 12mo PMHNP residency, and hopefully actually go to work for them.
In the VR&E process, everything I’ve read recommends having 2-3 informational interviews with current PMHNPs for the counselor working on my case.
So if you’re okay with doxing each other, I’d be super grateful to get some answers in my PMs!

What are your credentials (degree and certs)?

What are the physical and environmental demands of your day-to-day practice?

What is the current demand for psychiatric prescribers in outpatient and private practice settings?

What specific software, diagnostic equipment, or computer hardware do you rely on daily?

I know the answers, the counselors just like to hear it from current professionals instead of the veteran trying to go back to school.

Hello Everyone,

I am an aspiring PMHNP. I have a question regarding a medicaid-focused practice model. Would i have to advertise heavily to get medicaid patients? If I am not advertising how exactly do I build a strong enough panel to remain self employed if I work primarily with the medicaid demographic?

I am prepared to pay up to $2000 per semester for something close, but a total of $10,000 is just ridiculous, especially since I will have to stay in a hotel 1-2 nights per week. I am thinking that local preceptors might be more accepting if they know I will not be competing. If I do inpatient, I can even refer people to them.

I see a lot of telehealth, contract, and 1099 jobs posted at 100/hr but this seems low to me if I have to put away 30% for taxes, pay for insurance through the market, pay for my own malpractice and possibly collaborating physician. Am I missing something?? My coworker seems to think this is decent but I don't get it. And if your patients don't show you aren't making anything, so wouldn't the average be less than 100/hr for the year?

Hi everyone! I’m interested in pursuing formal DBT certification and would really appreciate advice from therapists who have already gone through the process.

I’m trying to understand:

• Where is the best place to take DBT training/courses?
• Which courses or trainings are actually necessary to become a fully certified DBT therapist?
• How long does the whole process usually take?
• Approximately how much does it cost, including training, supervision/consultation, and certification?

I’m especially interested in becoming properly trained in comprehensive DBT rather than just completing a short DBT workshop.

Any recommendations, personal experiences, or guidance would be greatly appreciated. Thank you!

Scheduled to start the program next month, but concerned with all the talk of market oversaturation, lack of meaningful jobs for new grads, and declining pay. Im from SoCal where there are lots of NPs. I knew fnp market was saturated but not pmhnp, at least not this bad. I heard others remained to be an RN even after getting their NP license.

Any new grads out there having issues finding work as a new grad? What options did you have? Did you take a massive paycut or how would you compare your rn pay vs np? Thoughts and advice appreciated.

I’m looking for a job with a company that provides telehealth and offers benefits (healthcare most importantly).
I recently interviewed with Talkiatry, which offers benefits at 30hrs/week and pay seemed decent. However, they don’t accept any medicaid, which is important to me.
Are there companies that exist that do telehealth, pay well, provide benefits, and take care of patients with commercial, Medicaid/Medicare, and cash pay?
Any recommendations are welcomed!
This is such a great community! Thank you in advance!

starting pmhnp school this month and im curious if pmhnp still wear scrubs? im sure its more common inpatient, but what about outpatient?

Back story: I have 7 years of RN experience, 5 of which are inpatient psych. The other two were medical/ICU. I continued to work fulltime (3 12hour shifts) while completing school and clinicals. I also went from RN to MSN (bypassing my BSN) as this is what made sense for my particular situation and goals. School: I went to a school where that offered RB to MSN. This meant I took one additional class, which was a 4-credit hour class, before starting my MSN classes. My school stated they would help with clinical placement...blah, blah, blah. Any guesses on if they actually helped?! the answer was, h*ll no, it was ALL ON ME! Anyway, I had difficulty finding a rotation for children. I utilized Facebook. I posted multiple times on my personal page as well as local Talk of the Town pages. Eventually, someone messaged (thankfully!) me and I was able to obtain hours with her facility!

Georgette's: I was given Georgette's LMR in a word document early on. I made this into flashcards and Googled certain topics to help me understand, not just memorize. Her LMR is about 80 ish pages of solid content. I also had access to her modules but, for me personally, the LMR was more focused on essentials than the modules. I felt I had enough prior background knowledge on mental health to focus more on the LMR.

NP Exam Coach: I also have the crash course as well as all of the modules for this course. I felt the material and layout was very, very similar to Georgette's. However, I felt this had a bit more explanation to help me understand certain topics rather than memorization of Georgette's. What I felt did not overlap, I made into flash cards and would go through X amount each day. He also has a YouTube channel with recorded games (questions and answers) as well as lectures. I would listen to the lectures at work or while I was driving.

PocketPrep: I purchased 3 months access of PocketPrep about 3 months before I wanted to test. You can Google PocketPrep discount codes (I think they're referral codes) to discount your 90 days. I believe the cost was between $20-$35 for the 90 day access. Pocketprep was hard, in my opinion. I felt the questions were very advanced compared to the material I understood from NP Exam Coach and Georgette. However, Pocketprep offered REALLY detailed rationales to help understand. This app is set up with questions in the 5 domains we are tested over. Even if I got an answer correct, I would still read the rationales. You would receive a score for each domain. You're also able to retake questions that you have previously missed. You can also choose to have questions from your weakest subject. Mine throughout was therapy and the theorists. Ugh I hated this topic. Pocketprep had so many questions. It took me about 25 days of studying to get 80% in all domains. I tried to do at least 50 questions a day.

My opinion: I felt the exam was not as hard as PocketPrep, but more in-depth than Georgette's. I felt I was able to know the information for Georgette's but apply rationale information from PocketPrep to help me navigate my exam.

I passed my exam a few weeks before I graduated school! it was 175 questions, all single answers. No SATA or drag and drop- at least on my exam. 150 questions are scored. You are not aware of which questions are scored vs pilot. I was given a dry erase board and marker I could use. I did not use my board - I honestly forgot about it during my test anxiety. My questions were all over the place. 1-2 on theorists- which I nailed correctly! I had about 8-10 on CIWA/COWS. One on a medical issue which I just picked an answer and moved on. You're able to "cross out" answers to help you focus on the answers you're between. You're able to skip and go back. I flagged about 23 to go back to. The test took me about 2 and a half hours.

Now: I am a PMHNP! I start my new job in two weeks! I made a word document with medications lists, dosing ranges, LAI options, DSM-IV criteria tests, labs, Georgette's info, the NP Exam Crash Course, and much more. When I'm stuck, I can use this resource to search for the specific topic and compare medications and side effects. It is over 300 pages long. My plan is to F9 and search topics until I become more confident.

I hope this post helps someone! Goodluck!

I hope this is allowed. It's a bit different from the usual post here, and I'm asking for advice, not advertising a job.

I'm a licensed psychologist who runs a rural, university-based, grant-funded clinic. I found out today that we got funding to hire a PMHNP, which I'm thrilled about. I'd rather hear from you than guess at what makes this a good place to work.

The team is me, a clinic manager (social worker), two LPCs, and practicum students. The PMHNP would be our only prescriber, which I know is a lot to ask, so making that feel supported rather than isolating is my main concern.

My rough vision is everyone working at the top of their license. Counselors do therapy, I do therapy plus assessment and testing, and clients come to the PMHNP with the intake and self-report measures already completed and a full workup in hand. To be clear, the psychiatric diagnosis would be theirs to make. Our job is to hand over good data, not a conclusion. But I genuinely don't know if that's what a PMHNP wants, or if I'm designing something that sounds nice to a psychologist and annoying to a prescriber.

Some specific things I'd love input on:

• What makes a solo-prescriber role feel supported instead of isolating? What would you want in place before you'd take a job like this?
• Comp structure. Straight salary, or some productivity component? What have you seen work for a rural non-profit setting? I am not sure if I am allowed with the rules to post our anticipated salary, but if so I am happy to do so. It seems above average for our region from what I have heard.
• Costs I should be budgeting for. I've got collaborating physician, licensure, and CE covered. I know credentialing takes months where they can't bill. What else am I missing?
• Where should I actually post this? I don't want to just throw it on Indeed and hope.
• What else should a psychologist who knows enough to be dangerous know, so I can be a little less dangerous? :)

Full transparency: it's grant-funded, and I'll be upfront with candidates about the term and what I think the odds of continuation look like. We are hoping for full-time, in-person, primarily seeing college-age students with a bit of an emphasis on substance use issues, and not a killer case load. I am not sure what a typical load looks like for a PMHNP, but for reference our therapists see 20 clients per week.

Thanks so much. I really appreciate any thoughts.

What do i expect going to my first psychiatry appointment? Im having alot of anxiety .

What questions will be asked ? My primary doctor wants me to see this guy and im so worried he will change the medicine thats different than what my doctor prescribe.

He is a PMHNP that works in the doctors office

I'm flairing this other rather than RANT, because I think it's something that we need to discuss. And yes, this is Lindsay Clancy-related.

Being vulnerable posting this at all. I’m not posting to the larger psychiatry sub because I feel like at least here, our mods will hold the line with brigading, and this is going to ruffle some feathers.

So after watching the Day 10 and 11 testimony (Jennfer Tufts’ cross-examination; direct testimony and cross-examination of PMHNPs Julie Paul and Rebecca Jolletta), I am left with this question: did the turf war between MDs and NPs kill 3 children?

While the clowns over on Noctor are gleefully saying things to the effect of doesn’t it make them happy that the PMHNPs involved with Lindsay Clancy’s case are being referred to as “Nurse,” I think a lot of us are missing something big.

It’s not that Rebecca Jolletta was the only clinician to suggest that bipolar disorder was the correct diagnosis; it’s that it got dismissed out of hand by pretty much everyone.

Look, it’s pretty clear that Lindsay Clancy was rejecting much of the help that she was offered. Rebecca Jolletta offered us a glimpse of that with her statement that when she suggested bipolar as a diagnosis to the Clancys, and Patrick said “My wife is not bipolar,” while Lindsay sat there silent. Lindsay was offered therapeutic doses of Seroquel, she had side effects. Problem is, most of the antipsychotic mood stabilizers have sedation as a major side effect in the first few weeks. She was offered olanzapine, rejected that too. I know lamotrigine eventually came into play (and correct me if I’m wrong, but I believe it was Jennifer Tufts who offered that), but too little, too late. It takes too long to safely titrate. I wish lithium had been offered by someone, but here we are.

Here’s the thing.

Dr. Jennifer Tufts was fresh out of residency. That is *not* a criticism. She had four years of practice under her belt, and she had experience as a resident managing postpartum disorders. However, all of us in the sub know how toxic the NP hate is in the residency sub, not to mention Noctor. I’ve seen that happens in real life as well, even among residents who don’t frequent Reddit, so I can only assume that the party line of “NPs have less training than PetSmart groomers,” is alive and well in real life.

Is it possible that Dr. Tufts, Dr. Goodman, and whoever was at Women and Infants (they’re not being sued, I presume due to jurisdictional reasons, since it would have to be a separate case brought in RI) dismissed the possibility of bioplar disorder because it was diagnosed by a PMHNP?

I think we have to consider that possibility.

Rebecca Jolletta had the benefit of hindsight with what had already happened with meds prescribed by Dr. Tufts, and it's a lot easier to spot once you have a pattern (Zoloft, Prozac).

But then LC went back to Dr. Tufts. We should always consider when a patient switches providers, did the provider actually do something wrong, or was the provider telling the patient something that they didn't want to hear?

From her testimony, Dr. Tufts said "well, it *might* be bipolar disorder" to the Clancys, when discussing the medication trials at South Shore Perinatal Behavioral Health (Paul and Jolletta's practice). She also then proceeded to vehemently deny that bipolar disorder was a possibility when on the stand. I know she's got a malpractice trial coming (as does Rebecca Jolletta), so her whole defense is that she didn't miss bipolar, but come on. Maybe the outcome might have been a little different if she hadn't gone on to dismiss that possibility.

I don't think in this case we'll ever truly know, and this is not a diatribe on the Clancys. They will have to live with what happened for the rest of their lives.

The NPs involved:

Julie Paul Credentials: BSN in 1992, worked as an L&D nurse, CNM in 2006; added PMHNP in 2018.

Rebecca Jolletta: MA in Counseling Psychology in 2013; MSN Through MHG Institute for Health Professions in 2019 (RN in 2017). MGH is a direct-entry program.

Yes, both have done the PSI Perinatal Mental Health training and are PMH-C credentialed.

My little cousin was a groomer at PetSmart for like a decade, I promise you she did not have more training than either of these women.

If someone has a better timeline, it wasn't as if I was taking notes during the trial. Obviously, we'll learn more someday when those malpractice suits are either settled or go to trial, and we'll hear from the forensic experts later in the trial.

I would like to use the evidence we, as licensed providers, have from the media (assuming the reported information is factual) to formulate potential differentials based on hindsight. If participating, please keep the discussion evidence-based. I am not disputing the fact that whatever was occurring contributed to a episode with a devastating outcome.

A psychotic episode can be triggered by many things and is not specific to bipolar disorder. Potential contributors can include severe sleep deprivation, hormonal fluctuations, polypharmacy/medication effects, substance use, medical illness, delirium, and numerous other factors.

She was also described as experiencing delirium while hospitalized after surgery. For context, in January 2023, her UDS was negative for substances and her ethanol level was negative.

Please fact-check me if I have anything incorrect or if the available evidence does not support a particular hypothesis.

Share your thoughts! I think we really need stronger information to outline PRIOR concerning behaviors indicative of bipolar disorder.

Supporting bipolar disorder:

- clear adverse response to SSRIs, SARI (Trazodone), and NASSA (Mirtazapine)

- decreased need for sleep (longest was two days?)

- increased exercise activity (running long distances shortly after childbirth), though it is unclear if this was "unusual" for her or if her family found it to be uncharacteristic + many of these statements were made retrospectively

- racing thoughts, anxiety, agitation, irritability, dysphoric depression with eventual SI

- possible obsessional thoughts surrounding the youngest child's nap/feeding schedules/her daughter's stomach ache morphing into liver disease (Patrick's testimony), her diary entries

- a gradual, but significant impairment in daily function

- eventual psychosis s/t unclear etiology

Argument against bipolar disorder:

-no known prior manic episodes

- not sure if there had been any prior MDE or postpartum mood episodes, though I did read she might have taken SSRIs in college (couldn't find data to support this)

- no prior hospitalizations or suicide attempts that we are aware of

- no family history or biological predisposition that has been publicly established

- no grandiosity, hyperverbal speech, unclear if there was an increase in goals/impulsivity/risk taking

What are your differentials and why