With an increasing number of patients requiring mental health services and a growing shortage of mental health providers, PAs can play a key role in expanding access to mental health care for underserved areas and populations. “Flexibility at the practice level is key to successful physician-PA team practice.”1 Their ability to play various roles is what makes PAs in psychiatry such important additions to the mental health care team.
Creating a specialty association has helped PAs in psychiatry to identify how they can work in different clinical settings and to describe the multiple tasks they can perform. Using data from its survey of PAs in psychiatry, the Association of Psychiatric Physician Assistants (APPA) has learned that PAs working in psychiatry are developing a unique practice niche-first as PAs, and second as crucial members of the mental health care team.
What do PAs in psychiatry look like, and what do they do? According to the AAPA's 2006 Census, 201 respondents reported working in psychiatry, representing 1% of survey respondents.2 These PAs work in a wide variety of practice settings, with more than half in private practice with a supervising psychiatrist.3 They arrive on the job well-educated and well-trained: 32% have a bachelor's degree with advanced training, 53% have a master's degree, 10% have a doctorate, and 29% have additional licensure as a mental health professional.3 On average, PAs in psychiatry have more than 10 years of experience and see 18 patients per day.
Don St. John, MA, PA-C, the president of APPA, commented in a February 20, 2007, telephone interview, “It is the diversity of tasks that PAs in psychiatry perform that I find one of the most interesting aspects of this group. Over time, I have seen a wide variety of roles develop.” PAs can conduct psychiatric evaluations, initiate treatment, perform individual and group psychotherapy, write admitting orders, make rounds on psychiatric patients in hospitals and nursing homes, evaluate and treat general medical conditions in psychiatric patients, and oversee alcohol detoxification.
The underserved often cannot afford mental health services or none are available nearby. An important financial barrier was removed for these underserved populations when, in March 2003, the Centers for Medicare & Medicaid Services included PAs as qualified mental health providers.4 Their services are covered and reimbursed by Medicare at 85% of the physician fee schedule.
The role of PAs in psychiatry, as it continues to evolve, has many faces and often blends psychiatric and medical care.
These examples, provided by AAPA, provide an interesting and diverse picture.1
- In the northern Midwest, a PA oversees the only inpatient psychiatric unit available to patients within 1,200 square miles. With her supervising physician, this PA provides outpatient psychiatric services and, under the supervision of a family physician, treats patients' medical problems.
- In a small urban center, nine psychiatrists and one PA work at a mental health clinic providing care to children, adolescents, and adults with a variety of needs. This PA also does medication management and mental health assessments for aging patients in a personal-care home.
- Nine PAs function as house officers after 4 PM and on weekends at a state psychiatric center in New England. Working with a staff psychiatrist and an internist, the PAs respond to behavioral emergencies and evaluate and treat the medical needs of inpatients.
- PAs at a large county jail provide mental health services, including performing psychiatric assessments and managing medications and comorbid medical problems. One PA has been co-principal investigator for psychiatric clinical trials, works on a psychoneuroendocrine research program, and teaches at a local PA program and medical school.
- A VA Medical Center created a new position for a PA to provide medical care to nursing home patients, and the role eventually expanded to include psychiatric care.1
PAs have the training and ability to provide mental health care and have been creative in defining their roles. According to Dr. Bruce Pfohl, a psychiatrist at the University of Iowa Hospitals, PAs “have become an integral part of our psychiatric outpatient clinic…. Many of our patients prefer to see a PA instead of a resident physician because the PA can provide better long-term continuity. Given the shortage of mental health providers…, carefully supervised PAs can play a valuable role in meeting this unmet need.”
2. American Academy of Physician Assistants. 2006 Physician Assistant Census Report. Table 3.7: number and percent distribution of clinically practicing respondents by specialty practiced for primary employer. Available at: http://www.aapa.org/research/06census-content.html#3.7.
Accessed March 1, 2007.
3. St. John D. Physician assistants in psychiatry. Paper presented at: Annual Meeting of the Iowa Psychiatric Association; April 22, 2006; Des Moines, Iowa.
4. Centers for Medicare & Medicaid Services. Program memorandum: intermediaries/carriers. Transmittal AB-03-037. March 28, 2003. Available at: http://www.cms.hhs.gov/transmittals/
downloads/ab03037.pdf. Accessed March 1, 2007.