“You’re going to make a great psychiatrist someday.”
I hear that occasionally from patients and even fellow providers. However, as a certified physician assistant (PA-C) who specializes in the field of psychiatry, I’ve already attained a career goal of which I am proud: that of an active, respected and contributing member of the behavioral health team.
I’m one of two PAs working at an outpatient clinic affiliated with a hospital system in rural West Texas. Included on our team is our supervising psychiatrist, a nurse practitioner, a psychologist and our nursing staff. While small, our program’s experience serves as an example of how PAs, even in under-served rural areas, can help build stronger and more effective behavioral healthcare teams.
However, I also believe that as a first step we must address some of the myths about PAs that are pervasive in many parts of our profession. Answering questions about PAs in mental health, sharing examples of successful programs, and highlighting what we can do as PAs to help psychiatrists and primary care physicians are important and necessary steps to expand access to quality behavioral health services.
PAs provide services
As PAs, we want our colleagues, employers and patients to better understand the full scope of our capabilities. My responsibilities as one of a few mental health providers in a community are broad. There is no “average” patient. My panel includes patients from ages six to 90, and with diagnoses including, bipolar disorder, depression, ADHD, dementia, anxiety and many others. I see patients from our local community as well as those from surrounding towns who may drive two to three hours to their appointments.
Recently, a patient in her 70s, with multiple psychotic episodes and no family support, came to our clinic. During one of her episodes she had driven her car into a tree. I saw her for follow-up after discharge from the hospital, and I have tried to keep her out of the hospital. But, as often happens in mental health, we get pulled into other areas as well. During our initial visit, the patient admitted she had no access to water. Rather than ignore that issue, I did some research, and we sent out a plumber to fix her home repair issues. It was a small step that did take time, but it also made a substantial difference for this patient.
One of the key benefits PAs offer in mental health settings is that we are educated in the medical model and maintain certification by completing substantial continuing medical education and passing rigorous assessments throughout our careers. This gives us the background to support psychiatrists when patients have psycho-social-medical needs. Patients’ health needs do not end when they have a mental illness. They still need care for colds, flu, chronic conditions, etc. There are also interactions between anti-psychotic and opioid antagonist medications and prescriptions for common illnesses that must be factored into the care plan. Additionally, other medical conditions may present as a mental illness in some populations. For example, a urinary tract infection may cause older patients to exhibit psychosis.
Improve medication management
One of the most pervasive myths about PAs is that they can’t prescribe certain classifications of medications. Over the past few years, states have addressed that issue by expanding PAs prescribing authority. In most states, we can prescribe controlled substances authorized by the supervising physician. We are required to have a federal DEA number.
Although PAs are not authorized to write triplicate prescriptions, we can prescribe many controlled substances, including those for anxiety and ones used during detox to treat opioid addiction, which is especially important as providers all over the country are tackling the opioid crisis. For a busy medical clinic seeking to treat the growing issues of opioid addiction, the ability to provide needed drug therapy for more patients is extremely beneficial.
PAs also monitor patients for polypharmacy or those who may “doctor shop” for prescriptions. We can help by checking national databases to ensure that patients have not been getting addictive medication from multiple providers and pharmacies.
Maximizing the benefits a PA can bring to a mental health program begins with addressing myths and continues with hiring, onboarding and mentoring.
As a first step, I would encourage an organization to identify gaps in care and outcomes. Perhaps a clinic is getting low results on patient satisfaction, or there is a problem with wait times to see a psychiatrist. Look at those issues, and build a team around a PA who can take responsibility for addressing them.
I would also encourage organizations to seek out PAs with a psychiatric background, either through experience or the NCCPA’s Certificate of Added Qualification (CAQ) in psychiatry, as well as those interested in the field. On the job training from a psychiatrist committed to supporting professional development will lead to PAs that fit organizational culture and contribute to a powerful team. Additionally, for organizations looking to recruit PAs, consider student loan repayment as a lucrative incentive.
Once a PA is hired, ensure they are fully integrated into the staff so they can share insights, concerns and recommendations. Invite them to participate in key hospital management meetings. Likewise, just as with nurse practitioners, when looking to fill management spots, consider PAs for the depth and breadth of the experience they can bring.
Kristi Kincheloe, MPAS, MS, LSSP, PA-C. is a psychiatric physician assistant at Shannon Medical Center in San Angelo, Texas.