Physician assistants (PAs) in psychiatry/mental health help improve access to mental health services in a health system where physician shortages are a painful reality in many parts of the county.
According to a report published by Mental Health America: Parity or Disparity: The State of Mental Health in America 2015, more than 42 million adults suffer from a mental health problem, and more than six million children suffer from an emotional, behavioral, or developmental problem. Experts know that screening and early intervention can reduce the negative impact of mental illness, yet too few psychiatrics and large out-of-pocket expenses limit many people’s access to psychiatric care.
Similar to other areas of medicine, physician assistants in psychiatry ease the physician shortage and provide high-quality medical care at a fraction of the cost of psychiatrists. Their expertise rounds out the physician-led psychiatric team, ensuring comprehensive care is available to patients with mental health needs.
What Do Physician Assistants in Psychiatry/Mental Health Do?
Physician assistants specialized in psychiatric/mental health provide mental health services under the supervision of a psychiatrist. They are an important component of a mental health team, and their medical know-how allows them to treat patients on an inpatient or outpatient basis.
The patient assessment is an important component of a physician assistant’s job in psychiatry/mental health. Assessing patients through informal conversation, through a physical examination, and through a review of their medical, personal, and drug (including substance abuse) histories allows PAs to make a diagnosis and rule out any underlying medical conditions, such as hyperthyroidism, a brain tumor, or medicine toxicity.
They may order labs, make referrals to other medical providers, and prescribe psychiatric medications throughout the process. Most physician assistants in psychiatry can prescribe psychiatric medications, including controlled substances; therefore, they are experts in psychopharmacology, the study of indications, actions, risks, and side effects of psychiatric drugs used independently and in combination with other psychiatric drugs.
Following an initial assessment and diagnosis, PAs in psychiatry oversee their patients’ physical and mental health while receiving psychiatric care. These PAs perform frequent follow-ups to see how patients are responding to counseling, medication and other therapies; and often work with families to ensure patients are receiving adequate care and support.
Where Do Physician Assistants in Psychiatry/Mental Health Work?
Physician assistants – under physician supervision – meet the diverse medical needs of mental health patients in a number of mental health settings, including:
- Behavioral health facilities
- Psychiatric hospital units
- Private practice
- Psychiatric emergency departments
- County and state mental health facilities
- Psychiatric emergency units/emergency rooms
- Private health clinics
- Prisons and jails
The job duties and responsibilities of PAs in psychiatry/mental health vary depending on the setting in which they work.
For example, in hospitals and inpatient psychiatric units, physician assistants serve as affiliate members of the medical staff, evaluating and treating patients and responding to behavioral emergencies. Their work includes:
- Performing admission histories and psychiatric assessments
- Performing rounds
- Ordering and interpreting diagnostic studies
- Ordering medications
- Managing ongoing care through consultation with the psychiatrist
In psychiatric practices and other outpatient settings, the work of physician assistants includes performing the following duties:
- Conducting histories for new patients
- Conducting initial assessments
- Performing physicals
- Performing psychiatric evaluations and assessments
- Ordering and interpreting diagnostic studies
- Establishing and managing treatment plans
- Ordering referrals
- Prescribing medications
Physician assistants may also provide mental healthcare in jails and prisons, where they:
- Perform psychiatric diagnostic evaluations and intake assessments
- Manage medications
- Formulate psychiatric diagnoses
They may also work in practices focused on specific populations, such as pediatrics, geriatrics, and posttraumatic stress patients.
Education, Certification and Training Required for the Mental Health Specialty
Just like physician assistants in other medical specialties, PAs in psychiatry must complete a physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). These graduate-level programs require candidates to possess a bachelor’s degree from an accredited college or university, along with specific undergraduate courses in the behavioral and biological sciences. Most PA programs last about 26 months and culminate in a master’s degree.
Upon completing the PA program, graduates must take and pass the Physician Assistant National Certifying Examination (PANCE) through the National Commission on Certification of Physician Assistants (NCCPA) and apply for state licensure in the state in which they plan to practice.
Although all PA programs include clinical rotations in a wide array of medical subspecialties, including psychiatry, many students with an interest in this area of medicine often choose to complete an additional clinical rotation in a psychiatric health setting.
Another way many graduates earn valuable experience in psychiatry/mental health is by completing a physician assistant post-graduate fellowship. These programs, which are about 12 months in duration, allow graduates to rotate with psychiatry residents through various inpatient and outpatient services. Inpatient rotations often include the following units:
- Psychotic disorders unit
- Geriatric psychiatry unit
- Mood disorders unit
- Child psychiatry unit
- Dual diagnosis (substance abuse and mental health) unit
Outpatient units include adult outpatient clinics, child outpatient clinics, and tele-psychiatry and outreach clinics.
How Can Physician Assistants in Psychiatry Earn Professional Certification?
The NCCPA offers the certificate of added qualifications (CAQ) program, which provides physician assistants with the opportunity to earn additional credentials in their area of practice. Physician assistants in psychiatry/mental health may pursue the Psychiatry CAQ, which requires candidates to possess a current PA-C designation and state licensure.
Candidates seeking the Psychiatry CAQ must demonstrate they possess advanced knowledge and experience in psychiatry by possessing the following:
- At least 150 credits of Category I CME focused on psychiatry practice (50 of those credits must have been earned within the last two years)
- At least 2,000 hours of experience working as a PA in psychiatry
- Attestation from a supervising physician working in psychiatry that the PA has performed patient management techniques or understands how and when appropriate techniques should be applied in the following areas:
- Psychiatric interview, differential diagnosis, and treatment plan
- Psychiatric pharmacology
- Treatment implementation/intervention
- Crisis intervention/risk management
- Ethical and legal issues
- Mood disorders
- Psychotic disorders
- Substance-related disorders
- Anxiety disorders
- Personality disorders
- Delirium, dementia, and cognitive disorders
- Life cycle and adjustment disorders
- Childhood disorders that persist into adolescence and adulthood
- Somatoform and factitious disorders
- Eating disorders
- Sexual and gender identity disorders
- Dissociative disorders
- Impulse control disorders
- Sleep disorders
- Ethics and forensic issues
Once candidates have submitted proof that they meet all minimum requirements, they must take and pass the Psychiatry Specialty Exam, which consists of 120 multiple-choice questions related to psychiatry and targeted for physician assistants with experience in the practice of psychiatry.
Resources for Physician Assistants in Psychiatry
Professional associations provide physician assistants with a vast array of resources, information, and networking opportunities related to the practice of psychiatry:
- Association of Physician Assistants in Psychiatry
- American Psychiatric Association
- American Association of Community Psychiatrists
- American Association for Geriatric Psychiatry
- American Academy of Child and Adolescent Psychiatry
- Association of Medicine and Psychiatry