Last post, we learned that psychiatry is among the highest paying physician assistant specialties, if not the highest paying specialty. A reader asked us just what being a psychiatric physician assistant is like, and this article aims to answer this question.
Psychiatry is the medical specialty of mental health, also known as behavioral health. In this physician assistant specialty, you will treat people with mental disorders. The list of disorders is long, and includes depression, anxiety, and insomnia, drug abuse/addition, post traumatic stress disorder (PTSD), bipolar disorder (formerly known as manic depression), schizophrenia, and many others.
Psychiatry used to rely on psychotherapy–talk therapy–but today it rarely does. Changes in the insurance industry forced most psychiatrists to abandon the weekly hours of “talking cure” as treatment, and to concentrate almost entirely on prescribing psychiatric medications. Today, psychotherapy is mostly done by psychologists, marriage and family therapists, and social workers.
What Psychiatric Physician Assistants Do
The days of Freud's psychotherapy "talking cure" are pretty much over.
As usual, in this physician assistant specialty you will do much the same work of your supervising physician, including:
- Assessing patients by carefully interviewing them, their family, and others who know them. Psychiatric interviews are informal conversations that invite patients to describe what is troubling them, their symptoms, their family history, allergies, medications, etc., so that a diagnosis can be made. A major responsibility of this physician assistant specialty is to make sure that the patient’s psychological problems are not due to an underlying (hidden) medical condition, such as a brain tumor, hypothyroidism, or toxicity from other medications.
- Maintaining patients’ physical health while they receive psychiatric care.
- Assigning a psychiatric diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM).
- Ordering labs or consultations with other providers (neurology is a common one).
- Prescribing psychiatric medications. Psychiatric PAs prescribe many psychiatric medications, and are therefore experts in psychopharmacology, the study of the indications, actions, and side effects of drugs that have psychological effects.
- Following up with patients to see how they respond, and adjusting their medications
- Helping to determine what kind of non-medication help they need (psychotherapy, hospitalization, conservatorship, etc.)
Where Physician Assistants in this Specialty Work
- County mental health facilities
- Managed care systems (Kaiser, for example)
- Hospitals: in-patient psychiatric units, psychiatric emergency units, and emergency rooms.
- Private health clinics, particularly those that serve large volumes of patients, and can therefore afford their own mental health provider
- Prisons and jails (one of the highest paying settings, for obvious reasons)
What is this Physician Assistant Specialty Like?
- Interesting – a true mixed bag. You never know what will come through your door. Not to be flip, but you’ll probably meet people who claim to be Jesus (a fairly common delusion. I met Jesus ~25 times during my three years working in a psychiatric emergency unit). You will probably meet people who think the CIA/FBI/KGB is talking to them through the radio (or some similar paranoid delusion). You will be entrusted with very private secrets of many people’s lives, and some of these stories are truly amazing.
- Casual. You won’t wear a lab coat. You will wear what is comfortable because it will put you and your patients at ease.
- Low tech. Just about the only true “procedure” you may do in this physician assistant specialty is administering “depot” medications (long-acting anti-psychotic drugs that are injected). These are often used to treat patients with schizophrenia who do not take their pills reliably.
Brain science has come a long way since Freud and his couch.
- Challenging.
- You will work with many people who are not mentally ill, but who are on drugs, and therefore appear mentally ill.
- Your bedside manner and your ability to size people up and think critically about the stories that they tell you will be your biggest and most important diagnostic tools.
- In this physician assistant specialty you will regularly come into contact with patients who are difficult in one way or another – demanding, frustrating, codependent/needy, manipulative, and sometimes violent. Many of your decisions be made to assure patient and practitioner safety. Many will be to soothe patients who are upset or distressed.
- You will learn much about the brain. Study up, and you could make some pretty amazing diagnoses. Just for fun, check these out: Capgras delusion, Munchausen syndrome, Dissociative fugue
- You won’t “cure” many patients. Most psychiatric medications only treat for symptoms, but that can make a huge impact. These drugs seldom fix the underlying problem (e.g. bipolar disorder). You will help many and you will cure some (depression and anxiety, for example, can be cured).
- Rewarding. Despite the challenges, this physician assistant specialty does change lives. Having persecutory delusions, panic attacks, or suicidal depression are horrible burdens for patients. When you can help alleviate these, your patients will be extremely grateful.
- And hey, did we mention the salary?
{ 19 comments… read them below or add one }
How does this specialty rank when you consider the number of hours they have to work for that salary. I once saw a chart that divided the specialties based on the per hour salary I believe. It is amazing how much more even the salaries become when you look at it that way.
That’s a great question. The survey that was done where those numbers came up were of PAs and NPs who worked at least 32 hours. Beyond that, it’s hard to tell. In my experience, mental health is 9-5er than most, but the actual # of hours per week varies by setting.
Great post, thanks so much (I was the one who asked for it:)! I wondered if you could speak to the availability of jobs in this field right now? I’ve tried to read up on it, but have encountered conflicting stories…some say there’s a high demand, others say there aren’t many jobs to be had. Thoughts?
Okay, I did a little research, and I see why you might have had trouble getting the straight scoop. It’s an area of specialty that accounts for only 1% of the PAs out there. Here’s a survey study done in 2009 that sheds a little light on the employment and use of psychiatric physician assistants
From what I can tell:
-There is a huge need for PAs in psychiatry, and a very small supply.
-There aren’t as many jobs in psychiatry as, say, Emergency Medicine, or primary care, but the ones that are out there are often hard to fill, and particularly so in rural areas and inner cities.
-These jobs tend to pay well, especially for new grads.
-The demand for psychiatric PAs is ever-increasing, thanks in part to a even bigger need for psychiatrists. Don’t have enough psychiatrists? Extend the ones you have. And who better to extend them than physician extenders (PAs). According to the article above, the huge demand is allowing PAs to expand what they do, and they seem to have gained the trust of the MDs they work with.
When I looked online for PPA jobs, I found oodles, but my guess is that it depends on where you’re looking and where you want to be. There are probably fewer in any given geographic area, but there also isn’t much competition. My guess? If you have any trouble finding a psychiatric PA job in your first choice location, you’ll have no trouble finding one if you’re willing to relocate, and odds are you won’t need to go far. Do a google search for “psychiatric physician assistant jobs,” and you’ll see. PS The army is also always looking for them, and Uncle Sam pays well.
Paul,
Your reply above is inline with what that psychologist was telling me. He can’t find anyone that suits his practice’s needs. I suspect this modality requires greater interpersonal skills and philosophic compatibility with your physician than say dermatology or orthopedics. In other words, the two of you must be more of a team, say like Holmes and Watson.
Nice talking with you tonight. You’ve done great work here.
Thanks, George. I think you’re right, although all PA work goes better and is more satisfying if you have a Homes and Watson-like teamwork approach. Nice talking to you too, buddy.
Hello,
Thank you for your informative article. I’m a Marriage Family Therapy intern in California and I have been considering psychiatric PA since its within my field of interest. I like it specially because it allows prescribing medications. I often get frustrated with psychiatrists who see my clients but just try to control the symptom with med rather than collaborating to find out and treat the root of the problems. I think with my background and having ability to prescribe meds I can have much better results. I just don’t know if there is any ethical-legal conflict. I would appreciate it if you could let me know if you know about this. My other question is that how do I chose the psychiatric specialty.
Thank you very much.
Roxana
Hi, Roxanna – by ethical-legal conflict, I assume you mean by filling both therapist and PA roles. I don’t see any, although you probably wouldn’t be doing both simultaneously. You could of course talk about psychosocial stressors and make psychotherapy-type interventions while working as a PA, along with any pharmacological therapies you provide. But I doubt you would ever be a patient’s PA and their regular therapist, though that would make some sense, wouldn’t it? So basically, I’d plan to draw on your therapy training to do a better job as a psych PA, rather than planning to do both at once. If you wanted to work as a therapist in one setting and a PA in another, I don’t think that would be a problem, so long as you are staying within your scope of practice. I hope that answers your question. -P
Is PA school/training different if you want to get into this specialty?
No, generally it isn’t any different.
What places currently offer additional training for PA’s in the field of psychiatry?
I know there is a hospital in Iowa that offers a 1 year program but that is all I’ve been able to find.
I’m a PA for over 20 years and would love to start working in psyche. But looking online in NY area (and moving isn’t an option) I haven’t come up with anything yet. Ideas?
Thank you so much for writing this article, it is utterly encouraging/informative to me. I am a sophomore at Ole Miss and I am very interested in becoming a psych PA.
I know that there is not a specific physician’s assistant major, but I was wondering what would be my best route for a major geared toward entering PA school after undergrad?
I began my freshmen year as a psych major then switched to pre-nursing.
Would I have a better chance at a good PA school if I became a nurse first?
Or should I get an undergrad in psych, along with taking my PA prerequisite courses?
Any help would be greatly appreciated!
Thank you
My understanding is that PA programs tend to not care so much what your undergrad major was, so much as how you well you did. Other important things: whether or not you completed the prerequisites, whether or not you have patient care experience, and what is your SOP like, how well rounded you are. Personally, I would stick with psychology…but then again I’m a psychology and anthropology major right now, so I’m biased.
Hi,
Thank you for this article. I’m currently a Pre-PA student, and trying to find a Psychiatric Postgraduate program to roll into after graduation. All I can find is Cherokee Mental Health Institute (Iowa) and Regions in St Paul MN. Are there more out there?
Thanks!
I’m not sure. Most PA training is on-the-job after graduation. But there are a few residencies. You should contact the Association of Physician Assistants in Psychiatry.
I have a bs in psychology. If go back to pa school, would that be all that is needed to be a psychiatric pa? Also, if you can’t find any ppa jobs, do you know if we’re qualified to work other pa positions as well?
Hi, Jessica! The only thing that’s required to become a PA in any specialty is a certificate or masters degree from an accredited PA program. If you want to become a psych PA, you will find a job as one. But the answer is yes, PAs are trained to be versatile, and can go in just about any direction with their certificate/degree. Graduate from an accredited PA program, and the doors are open to do whatever specialty you want. Of course, you may be competing against other PAs for certain jobs, but whatever specialty you want to work in, you’ll be able to. Some may be more competitive, so it depends how many jobs are available where you want to work, but usually not so much as to prevent you from taking a particular specialty at all. So as long as you aren’t banking on an unusually rare specialty, you should be fine.