Psychiatric PA

[ldesczi]

I have always wanted to work in the mental health field and after some thought, I decided to apply to medical school to pursue psychiatry (since they can provide both psychotherapy and prescribe medicine) as opposed to clinical psychology. However, I haven't looked much into Psychiatric PAs until recently and was wondering if anyone in this thread can speak to what kind practice setting it looks like for a Psychiatric PA. Do most psychiatric PAs only do medicine management or can they have enough flexibility to also conduct psychotherapy?

Also, how involved is the supervising psychiatrist in a psychiatric PA's diagnosis and treatment plans? I'm worried if it involves micromanagement and just more red-tapes or not. Are there any websites/stats on job satisfcation and such on psychiatric PAs? My passion is working in the mental health field with authority to do both therapy and prescribing.

Besides, I have interest to (eventually) work in admin/director levels in healthcare settings....does pursuing PA close any such doors?

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[pamac]

I know of a very successful PA working in addiction medicine, which has elements in psychiatric care. The money seems to roll in mostly through the addition medicine aspect of their care. One advantage of a PA can be a good mastery of the medical comorbidities that often accompanies many with psyche issues that need treatment. An NP that is specialized in psyche can lack a bit of skill in managing the medical issues. In my market, the most valuable "midlevel" providers to physicians are rumored to be family nurse practitioners with a psychiatric nurse practitioner certification tacked on, as they are independent providers that don't need physician sign off, and still have a decent mastery of managing medical conditions. Psyche PAs here have to have specific relationships with the psychiatrists, and they don't derive any benefits of having a partner that flies solo as far as the regulations are concerned. My friend is a psych NP that partners with physicians to provide psyche care, and being independent is a plus. Additionally, psych NPs are specialized in the field, so you tend to see more of them in that realm. There's still nothing keeping a PA from working for a psychiatrist and prescribing, and the scope of practice for a Pa is determined by the supervising physician, so there are plenty of PAs in that field. Psychoanalysis and therapy with patients don't seem to be a large part of the psych care I personally see in my role as an RN when I work in that setting, but management of medication, as well as a patient's underlying medical conditions is. You should do some research and see what you want to be involved in. Talking out issues with patients might be more in line with psychologists and therapists, and tweaking meds and medical issues might be more the realm of the PA. Operating on your own with few strings attached is more what you see with mental health nurse practitioners. Operating at the pinnacle is where the psychiatrists are.

 

[pamac]

As far as administration is concerned, nursing is generally dominant in that area, especially since hospitals are the hub for care, and nurses form much of the professional face of most of that care since we essentially live with the patients for 12 hours at a time. There are exceptions, but there are so many management positions in nursing that it's not difficult to find a manager among the nurses that can easily step up into that role. I know several NPs that also are directors and high up in management.

 

[Zenman1]

I'm a Psych NP and sole prescriber for an Army brigade embedded health team. The PAs for the military mostly have a primary care focus, and if Army trained, get 3 weeks of observational experience in psych which is a bummer. I precept some of them, but haven't in the last few months. I also have 3-4 of them as patients. We have no PAs in our behavioral health dept. I do a little bit of therapy with each med visit, but have a bunch of social workers, both civilian and active duty, as well as several psychologists who do therapy sessions and a couple of neuropsychologists who do testing. I can do group therapy if I want and currently have one in the planning stages. My experience as a nurse has allowed me to pick up a lot of co irbid problems and/or refer patients when they do not feel their PA is taking appropriate. Today, I referred a patient to OT for help with assistive devices in order to help him get his boots on in the morning. Today I also had a return visit on a guy who was about to be chaptered out of the military for failure to pass a PT test. He really was not happy since he didn't feel he was getting appropriate care. I didn't want to step on anyone's toes so just called an Army ortho surgeon who agreed to see the fellow in his walkin clinic the next day. The guy tells me today he will probably need surgery on both his shoulder and knee. As a result, proceedings to kick him out have been cancelled. I can justify a lot of my "medical" consults especially if medical problems are causing emotional distress. Most PAs here avoid any psych problems except for occasional starting someone on meds if their psych appt is out a ways. We only have one fellow who seems to like psych and enjoys learning and consulting with us. I do know there are some psych residencies available for interested PAs. That might be an option for you to explore.

 

[d2305]

I've never met a psych PA.

 

[AnnoyedByFreud]

PAs do not conduct psychotherapy (at least, not ethically), as they have no formal training in it. If you want to do psychiatry, then go to medical school or NP school. It's one of the few specialties in which PA school skimps on training (IMO). Even the psychiatry PA residencies I have looked into (2 or 3) don't really have impressive didactics, and it looks like just more medication management/assessment training.

 

[deleted6669]

PAs do not conduct psychotherapy (at least, not ethically), as they have no formal training in it. If you want to do psychiatry, then go to medical school or NP school. It's one of the few specialties in which PA school skimps on training (IMO). Even the psychiatry PA residencies I have looked into (2 or 3) don't really have impressive didactics, and it looks like just more medication management/assessment training.

really depends on the program. I had a great inpt psych rotation at a really busy state hospital where I did the medical side as well as sitting in on group every day, etc . If I had wanted extra psych electives I could have done them but did trauma and em instead. There is a small psych pa association (a few hundred members I think) who practice full scope psychiatry, many at VA, state, and federal facilities. apparently they are big enough now to host a conference:
http://www.psychpa.us/Psychiatry-Assistants-Association.html

 

[d2305]

There are some clinical psychologists that go to PA school so they can prescribe.

 

[ldesczi]

hmm very interesting, thanks for your inputs everyone!

 

[ldesczi]

There are some clinical psychologists that go to PA school so they can prescribe.

but then their prescription will have to be supervised by a psychiatrist then right? can they open up a "private practice"?!

 

[deleted6669]

but then their prescription will have to be supervised by a psychiatrist then right? can they open up a "private practice"?!

In most states a PA can own/operate a practice as long as they can demonstrate they meet the states min. requirements for association/collaboration with a physician. the way that generally works is this:
1. State requires X % of charts be reviewed within 1 month
2. PA hires doc (and backup doc if they are smart) to review said charts and be available for RARE consults and provides doc with malpractice policy + flat fee/month(generally a few thousand dollars/mo to review a stack of charts, say 2-3 hrs work/mo at most). most states don't require a doc to ever be on site. a few states require X hrs of doc time/week or per month on site.
3. PA opens legal practice, in this case as Dr. Smith PsyD, PA-C with a sign somewhere in the office which says John Smith is a PA working with Dr. Doe.

this would be quite the long path, at least 10 years of post-high school education not counting time to go back for PA school science prereqs , which the avg PsyD probably doesn't have. probably be faster to just go the md/do route and do a psych residency or do PsyD + direct entry psych NP program ( A PsyD/NP could work/prescribe without a physician at all due to how most state laws are written.

 

[ldesczi]

In most states a PA can own/operate a practice as long as they can demonstrate they meet the states min. requirements for association/collaboration with a physician. the way that generally works is this:
1. State requires X % of charts be reviewed within 1 month
2. PA hires doc (and backup doc if they are smart) to review said charts and be available for RARE consults and provides doc with malpractice policy + flat fee/month(generally a few thousand dollars/mo to review a stack of charts, say 2-3 hrs work/mo at most). most states don't require a doc to ever be on site. a few states require X hrs of doc time/week or per month on site.
3. PA opens legal practice, in this case as Dr. Smith PsyD, PA-C with a sign somewhere in the office which says John Smith is a PA working with Dr. Doe.

this would be quite the long path, at least 10 years of post-high school education not counting time to go back for PA school science prereqs , which the avg PsyD probably doesn't have. probably be faster to just go the md/do route and do a psych residency or do PsyD + direct entry psych NP program ( A PsyD/NP could work/prescribe without a physician at all due to how most state laws are written.

That's very helpful to know. I keep hearing that "physician supervision" is a very annoying part for the PA profession but if it's so minimal then PA route looks quite attractive in terms of both the number of years in training and the cost of attendance for PA vs. MD/DO route.

 

[Mad Jack]

PAs do not conduct psychotherapy (at least, not ethically), as they have no formal training in it. If you want to do psychiatry, then go to medical school or NP school. It's one of the few specialties in which PA school skimps on training (IMO). Even the psychiatry PA residencies I have looked into (2 or 3) don't really have impressive didactics, and it looks like just more medication management/assessment training.

You don't have to do psychotherapy to do psych. A lot of psychiatrists that employ PAs just use them for med management. Psych NPs are still the preferred provider to hire though.

 

[deleted6669]

That's very helpful to know. I keep hearing that "physician supervision" is a very annoying part for the PA profession but if it's so minimal then PA route looks quite attractive in terms of both the number of years in training and the cost of attendance for PA vs. MD/DO route.

What I described is the rare instance (5%) where PAs hire docs. most of the time (95%) it is the other way around. those can be the annoying situations if you work in a group with 1 or 2 docs who don't want to work with PAs. they can make your life suck big time.

 

[Makati2008]

That's very helpful to know. I keep hearing that "physician supervision" is a very annoying part for the PA profession but if it's so minimal then PA route looks quite attractive in terms of both the number of years in training and the cost of attendance for PA vs. MD/DO route.

Look at EMED post. I was in a group where a doc or two made my life utter hell. Went rural got better but still occurred.

 

[deleted6669]

Look at EMED post. I was in a group where a doc or two made my life utter hell. Went rural got better but still occurred.

Best option out there for an experienced PA is to work solo and/or rural. at one of my jobs I have not seen my collaborating physician of record in over 5 years...he sees my charts and once in a blue moon drops me an email question or a phone call about a patient.

 

[W19]

Don't psych physicians prescribe a lot narc such as benzo? I think a psych PA/NP would be somewhat limited in state where they can't prescribe narcs... That was the main reason I did not go to PA school because I want practice psych in a state that NP/PA can't prescribe controlled substances...

 

[deleted6669]

Don't psych physicians prescribe a lot narc such as benzo? I think a psych PA/NP would be somewhat limited in state where they can't prescribe narcs... That was the main reason I did not go to PA school because I want practice psych in a state that NP/PA can't prescribe controlled substances...

At this point I think that basically means florida...most everywhere else PAs can write almost anything (DEA sch 3-5), and in many/most (?30-40 or so) they can write for anything their SP can (DEA sch 2-5).

 

[W19]

At this point I think that basically means florida...most everywhere else PAs can write almost anything (DEA sch 3-5), and in many/most (?30-40 or so) they can write for anything their SP can (DEA sch 2-5).

It is FL and even NP can't prescribe controlled substances...

 

[AnnoyedByFreud]

You don't have to do psychotherapy to do psych. A lot of psychiatrists that employ PAs just use them for med management. Psych NPs are still the preferred provider to hire though.

Right, but I would hate to have my psych practice be literally just assessing symptoms and prescribing meds. I think psychotherapy is extremely important, but then again, in my current setting visits are 30-45 minutes long. We have the luxury of time to work in some therapy.

 

[Mad Jack]

Right, but I would hate to have my psych practice be literally just assessing symptoms and prescribing meds. I think psychotherapy is extremely important, but then again, in my current setting visits are 30-45 minutes long. We have the luxury of time to work in some therapy.

The PAs that I've heard of working in psych usually just do med checks, while the psychiatrist handles the psychotherapy and complex cases. So it's not like the practice doesn't do psychotherapy and the like, just that the PA doesn't. Sounds like a pretty awful job to me, personally, but if a PA is looking to make bank, it's actually pretty lucrative.

 

[AnnoyedByFreud]

Makes sense. In my setting it is just psychiatrists and psych NPs (no PAs). So the “prescribers” all see the same level of complexity, and we all do therapy. When it comes to picking up new evals, the only consideration is language (the psych NP speaks Spanish so he takes the Spanish-speaking cases). I see therapy as a very important part of my role, and I could never imagine working in psychiatry without a good knowledge of therapy. It could be because my program is pretty therapy heavy, especially for an NP program.