Psychiatric Physician Assistant: Mental Health Allies

List of Psychiatric Physician Assistant Postgraduate Programs (US)

1. Houston VA/Physician Assistant Residency in Mental Health/Psychiatry
2. University of Missouri Psychiatry Advanced Practice Provider Fellowship
3. Regions Hospital Psychiatry Advanced Practice Clinician Fellowship
4. Indiana University Health Psychiatry Postgraduate APP Training Program
5. Community-Focused Psychiatry Fellowship for Advanced Practice Providers
6. Pacific University Physician Assistant Postgraduate Behavioral Health Fellowship
7. Atrium Health Adult Specialty Care Fellowship in Behavioral Health

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What is a Psychiatric Physician Assistant?

A psychiatric physician assistant is someone that helps patients with a wide spectrum of mental illnesses from the most common (depression, anxiety, PTSD) to more severe issues such as bi-polar disorder, major depressive disorders and schizophrenia. Physician assistants, in general, are often the first healthcare providers to encounter someone seeking help for a mental health condition.

In one year, 62% of all physician assistants in the US (not solely psychiatric physician assistants) reported having treated a patient for a mental health issue every week. Meaning psychiatric concerns were more prevalent than any other medical specialty including family medicine, emergency medicine and internal medicine. But the fact that psychiatric physician assistants are often the first point of contact for people suffering from mental health issues means they can properly triage a psychiatric patient and help determine the best treatment for them.

Psychiatric physician assistants usually help treat the less severe forms of mental illnesses in a wide range for patients from children and adolescents to adults and seniors. But they are not often tasked with providing care for the most complex, chronic and serious mental health illnesses, which are typically treated by psychiatrists and other expert practitioners.

This primary care role means that psychiatric physician assistants play an important role in helping screen and diagnose someone with any type of mental health concern. Psychiatric physician assistants practice in a variety of different settings and you can encounter one anywhere you would seek mental health care services in either inpatient or outpatient settings, from local urgent care clinics, family practices, outpatient clinics and community health centers.

Most physician assistants do not normally seek out additional training (only 2% of recent PA graduates entered a postgraduate, residency, or fellowship program). This is because the nature of physician assistant’s job means they can get as much training on-the-job, as they would in a formal, didactic setting. But if you want to earn a certificate of completion or improve your patient management, diagnostic, and treatment skills, you could either complete a Certificate of Added Qualifications (CAQ) with the National Commission on Certification of Physician Assistants (NCCPA), or enroll in any one of the above-listed programs.

What Does a Psychiatric Physician Assistant Do?

A psychiatric physician assistant can be tasked with several important roles during the time a patient is in their care, whether as an inpatient or an outpatient, and depending on their particular type of mental or behavioral health problem. For example, in a hospital, or emergency psychiatric ward, a psychiatric physician assistant can be involved in everything from:

• Screening and admitting patients
• Performing mental health assessments
• Managing a patient’s medication or other therapies
• Ordering specific tests and other evaluations
• Performing physical examinations

But aside from these primary care roles, psychiatric physician assistants can also participate in treating specific issues, if they have the requisite experience or training and are supervised by a staff psychiatrist or other licensed clinician. Psychiatric physician assistants can also be crucial to helping treat behavioral issues that often accompany a patient with mental illness, such as substance abuse, self-harm, eating disorders, and dissociative disorders.

Treating people with co-occurring disorders, as they are called, is challenging. But it is a frequent occurrence among the most severe instances of mental illness, meaning psychiatric physician assistants may need to refer patients to a residential, inpatient program for sustained, long-term care, or help a patient within their clinical setting, be it at a hospital with an inpatient unit, or at a community-care clinic.

Again, the severity of a patient’s disorder also determines how a psychiatric physician assistant can help them. For example, some outpatients can benefit from seeing a psychiatric physician assistant to get medication for their depression or anxiety or even receive therapy or counseling in some instances. Psychiatric physician assistants can perform motivational interviewing, a counseling approach to help people understand the motivations for self-destructive behavior (addiction, compulsion, etc.), if they feel a patient will benefit.

Given there are so many different mental health conditions and levels of severity in each, psychiatric physician assistants are often split between various demographic groups that have their particular treatment concerns, such as:

• Psychotic behaviors and psychosis
• Geriatric psychiatry
• Child and adolescent psychiatry
• Co-occurring disorders

If you decide to perform a PA residency or postgraduate program, you might be able to focus on either of these groups, or something else related to mental health. The postgraduate program at the University of Missouri offers three distinct tracks within psychiatry to reflect the various population groups that mental illnesses can affect. At the University of Missouri, you can choose from:

• Child and Adolescent Psychiatry Fellowship
• Forensic Psychiatry Fellowship
• Psychiatry Advanced Practice Provider Fellowship

Each of these concentrations focuses on a specific group that requires specialized training. But they also reflect the many different sub-specialties you can explore being a psychiatric physician assistant.

How Do you Become a Psychiatric Physician Assistant?

One of the advantages of being a physician assistant is that you can explore as many different PA specialties as you want throughout your career and gain knowledge in each of them without having to formally earn a degree, certificate or diploma. Those options are available, but they are completely optional, and that applies to nearly every sub-specialty within medicine. You do not have to follow a specific path to become a psychiatric physician assistant, especially since many PA schools include psychiatry as a core rotation during the clinical portion of your program.

Unlike a physician assistant OBGYN, who often needs to seek out women’s health courses and electives because it is not a universal core rotation, you’ll receive the same amount of training in psychiatry and mental health, as any other medical specialties, such as family, emergency, or internal medicine. Your psychiatry rotation may last for up to two to four weeks, depending on your physician assistant program.

Physician assistant programs in the US and physician assistant programs in Canada have different curriculum requirements, so whether you’ll receive training in psychiatry during your program depends on the program. During most psychiatry rotations in PA school, you’ll be introduced to various aspects of the neurological, physiological and behavioral causes of various mental illnesses and disorders, again, in several different population groups, from adolescents to geriatric patients. But you’ll cover more practical or clinical skills that are crucial in helping diagnose mental health issues, such as:

• History-taking to maintain a continuity of care for chronic mental health problems
• Mental and cognitive status examination skills
• Understanding the signs of early mental health issues to prescribe proper care

After finishing PA school, you can choose to enter a psychiatric physician assistant role right way. But you can also opt to delve deeper into more general specialties such as family or emergency medicine. You can also choose to focus on specialties related to psychiatry, such as behavioral health, addictions medicine or counseling, as well as public health specialties that address societal and economic factors that can affect a person’s mental health and well-being.

Psychiatric Physician Assistant: Should I Get a Postgraduate Certificate?

The two- or four-week rotation in psychiatry may not seem like enough to prepare you for a career as a psychiatric physician assistant, but, again, you will also not have to treat patients suffering from serious mental health issues, only those patients who are treatable in outpatient settings. Of course, if you do want to help treat patients with more severe mental health disorders, you can apply for a residency or postgraduate program to gain more experience, or achieve up to 2,000 hours of work experience in psychiatry to gain a certification.

The 2,000 hours minimum is a requirement of the NCCPA to gain a CAQ, but not the only one. You must also have completed up to 150 credits of continuing medical education courses specifically in psychiatry, which you can take at various institutions or during your PA school career. Your 2,000 hours must also be verified by a supervising clinician who can attest to your competency in several areas, including:

• Diagnostic skills
• Knowledge of psychiatric pharmacology
• Creating individualized treatment plans
• Conflict resolution and risk mitigation skills

Receiving a CAQ is more for improving your marketability when looking for a psychiatric physician assistant job. But it does not involve any direct training or knowledge building as you would get in an accredited postgraduate or PA residency program, which is what makes these programs so advantageous for you and your patients. Unfortunately, there are not many PA residency programs available for psychiatry, but they are not as competitive as medical school residencies.

The application process and requirements vary, but you often only have to have graduated from an accredited PA program and have passed the PANCE exam to gain your physician assistant license. You only typically have to fill out and submit an application – either directly to the school or through ERAS – but also have to submit materials such as a PA personal statement, two or three letters of recommendation, a PA school cover letter and PA school supplemental essays.

Additionally, these residency programs are similar to medical residencies in that they offer an annual salary, and other benefits (health and liability insurance, relocation support, etc.) so you can continue earning while learning and do not have to invest significant time (12 months, usually) or money. Some of these programs are also offered through online physician assistant programs and let you complete specific courses online.

What you Need to be a Psychiatric Physician Assistant

1. Get Your CAQ or Do a Psychiatric PA Residency

These steps are optional but getting either (you can also do both) will make you the best prepared and best qualified psychiatric physician assistant. You can spend a long time working in the field, independent of these requirements, but if you want to fast-track your career or start treating patients right away, then doing either of these things will make those happen. While the CAQ does not impart any knowledge and has no didactic elements, it forces you to self-direct your training by applying for psychiatric physician assistant jobs to help meet the minimum hour requirements. What’s more, doing a psychiatric physician assistant residency program will help meet those hour requirements, while also giving you more specialized training in the different aspects of being a psychiatric physician assistant, such as medication management, general mental health, and community-based mental health treatment.

2. Take Psychiatry-Related Electives in PA School

If you find that during your psychiatry PA school rotations you enjoy it and find it interesting, you should go beyond what’s required and take electives, internships or externships in psychiatry after you complete your rotation. This would also be a great opportunity to explore the different care facilities where you can work as a psychiatric physician assistant, from state-run psychiatric hospitals to private, residential inpatient facilities. You can also do additional rotations in underserved areas, such as rural or inner-city communities that do not often have access to either primary care or psychiatric care to get a better sense of the demands and challenges specific to each population or group.

3. Gain More Experience from Extracurriculars

You should, either before, during or after PA school, gain as much non-academic experience with mental or behavioral health patients in clinical and non-clinical settings. Familiarizing yourself early with the unique demands of being a psychiatric physician assistant will help ease the transition to official roles both during and after PA school. You do not have to be involved in direct patient experiences for your extracurriculars for PA school, but volunteering in an assisted care facility or supporting patients in a mental health center can give you an up-close perspective of the daily struggles people living with mental illnesses face thereby giving you more compassion and empathy when working with them.

4. Choose a Specific Sub-Specialty

We mentioned how there are several different sub-specialties within psychiatry that can appeal to you, or not, but if there is a specific sub-specialty or patient group (adolescents, or veterans, for example) who you want to work with specifically, you should explore postgraduate programs that offer these specializations. For example, the residency program offered by the VA in Houston has additional concentrations that focus specifically on the mental health issues faced by veterans, such as sleep medicine, pre- and post-deployment anxiety and treatment for PTSD. We already mentioned how the University of Missouri has a Child and Adolescent Psychiatry track, but many of these programs have several tracks and specialties you can take that help increase your treatment awareness of people from diverse patient groups.

Conclusion

Being a psychiatric physician assistant can be a demanding job. It’s made much more complicated by the fact that psychiatry is a multi-faceted medical specialty requiring various, treatment approaches and methods. Fortunately, as a psychiatric physician assistant you’ll be part of a healthcare team, so you won’t feel overwhelmed by the pressures of attending to people with any kind of disorder, from the everyday to the more severe.

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