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

physician assistant specialty in psychiatry

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:

  1. 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.
  2. Maintaining patients’ physical health while they receive psychiatric care.
  3. Assigning a psychiatric diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM).
  4. Ordering labs or consultations with other providers (neurology is a common one).
  5. 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.
  6. Following up with patients to see how they respond, and adjusting their medications
  7. 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.

    physician assistant specialty that involves the brain

    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?

 

  • Krystle July 7, 2011, 8:23 am

    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.

    Reply
    • Paul July 7, 2011, 10:10 am

      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.

      Reply
  • Laurelin July 12, 2011, 9:17 am

    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?

    Reply
    • Paul July 13, 2011, 7:42 pm

      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.

      Reply
      • George January 29, 2012, 9:34 pm

        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.

        Reply
        • Paul January 29, 2012, 9:45 pm

          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.

          Reply
  • Roxana V August 9, 2011, 8:33 pm

    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

    Reply
    • Paul August 10, 2011, 10:51 am

      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

      Reply
  • Raquel September 15, 2011, 2:09 am

    Is PA school/training different if you want to get into this specialty?

    Reply
    • Paul September 15, 2011, 8:02 am

      No, generally it isn’t any different.

      Reply
  • KJ October 30, 2011, 1:43 pm

    What places currently offer additional training for PA’s in the field of psychiatry?

    Reply
    • KJ October 30, 2011, 5:58 pm

      I know there is a hospital in Iowa that offers a 1 year program but that is all I’ve been able to find.

      Reply
  • esther November 29, 2011, 8:57 am

    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?

    Reply
  • Paige January 12, 2012, 10:48 pm

    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

    Reply
    • Kyle January 26, 2012, 5:59 pm

      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.

      Reply
      • Ashley July 25, 2012, 12:49 am

        Hi Kyle!

        I am currently an undergraduate junior and considering a career as a PA in psychiatry. I was originally a BioChem major, but before I got into any BioChem classes, switched to Psychology (and learned I love psych so much more!)

        My question is, what pre-reqs should I focus on? I have taken many sciences but none too advanced. Every school seems to require slightly different pre-reqs for their programs.
        Also, how and when should I obtain my patient-contact experience? It’s difficult to fit-in the hours between working and attending school.

        Thanks!!

        Reply
        • Paul July 25, 2012, 10:54 am

          Your total focus now should be on your bachelors, specifically getting the best grades that you can until you graduate. Don’t worry too much about the prerequisites now – if you need to take some of them after your bachelors, that’s okay, or if you can take them as part of your major, even better. But get A’s!

          School prerequisites vary, but the most common, non-general-ed once are:
          General biology – one year
          General chemistry – one year
          Anatomy – one semester
          Physiology – one semester
          (Or a year of both as a combined class)
          Microbiology – one semester
          Some but not all schools require organic chemistry, one year.

          Once you’re done with your coursework, then you can pour yourself into getting a job in the health care field and obtaining health care experience with it. When you’re ready to do that, read our “Creative Ways to Get Health Care Experience” thread at the forum (www.mypatraining.com/forum),

          Reply
  • FranniePants March 17, 2012, 6:41 pm

    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!

    Reply
  • Jessica March 31, 2012, 12:19 pm

    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?

    Reply
    • Paul March 31, 2012, 12:41 pm

      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.

      Reply
  • Mary May 22, 2012, 11:24 am

    Great Article!

    As a PA working fulltime at Cherokee Mental Health Institute (inpatient) I can honestly say that this work can be some of the most interesting and rewarding you will find. Working in the mental health system can be really frustrating to be sure, but that’s where a good support network of other mental health professionals (social workers, nursing, therapists) comes in.

    Here at CMHI we work with some of the “most impaired” individuals in the State – everything from schizophrenia and bipolar to substance abuse and forensic issues.

    I would love to talk to anyone who is interested in finding out more about our residency program in psychiatry or just Psych PA questions in general. You can contact me by email or call the hospital phone number at our webiste!

    Reply
    • Chris February 26, 2013, 7:20 pm

      My son is a junior in college and wants to become a psychiatrist. I’m concerned that the cost for med school will be prohibitive. Other than run a hospital, can a PPA do most everything an MD do?
      His skill is in talking therapy but he wants to be able to write meds too. Is there any reason he can’t do both? He wants to treat the “whole” patient in private practice. Suggestions?

      Reply
      • Paul February 26, 2013, 10:35 pm

        Pretty much. Psychiatric PAs assess and treat mental health patients, including initiating involuntary confinement, prescribing, ordering tests, etc.

        He might have a hard time finding a psych job that allows him to do talk and medicinal therapy. As a PA, he can treat the whole patient, but he will not have 50 minute hours to do so. For the most part, psychiatry has abandoned talk therapy, leaving it to psychologists, marriage and family therapists, and social workers. In private practice he may be able to do a blend, but again, time is the limiting factor. Most psychiatrists do little more than medication management, and as a PA, he must work under a physician, who in this case will be a psychiatrist.

        Reply
  • Juli June 26, 2012, 8:49 am

    Hi Mary,

    I would love to know more about a residency program in psych PA. How did you get into the field? I am just thinking about applying to PA school by this October or the following, but this seems like a very interesting field that I would love to be a part of!

    Reply
    • Devon July 23, 2012, 9:24 pm

      Mary,

      I am very curious about the type of work you do as a psych pa. I have a few questions, such as how wide the field of work is? Could I work solely with adolescents dealing with ADHD, or patients dealing with Alzheimers?

      Reply
  • Jerry July 16, 2012, 3:19 pm

    Hello, I am a PA with 10 years experience. Five years family practice. 4 neurology and 1 in pain management. I have an opportunity to work in inpatient drug and alcohol abuse program. I was wondering if you could tell me more about what extra training would be needed to become a PA psychiatrist? Or if you know of other options to be more valuable asset to this organization. Thanks Jerry

    Reply
    • Paul July 16, 2012, 10:10 pm

      Hi, Jerry! With your experience, it shouldn’t be too hard. I might suggest you overhaul your resume to emphasize 1) psychiatric experiences you’ve had as a PA, if any, 2) your achievements in the area of communications, and 3) your neuro experience – a definite plus! Outpatient psychiatric clinics would be your target, since there are few private practice psychiatrists who use PA’s – it just cuts into their bottom line too much. If that works, then with a little experience, you could either continue that, or look to a county department of mental health. They have interesting caseloads, good resources, and fairly cushy benefits packages. If you have other questions, please feel free to contact me.

      Reply
  • Sherley July 26, 2012, 11:17 pm

    Hi Mary,
    I would def. like some more info on psych P.A. im looking to get into a pa program and i love psych. i wasnt sure there was a psych P.A.. Please help me!!!!

    Reply
  • Sherley July 26, 2012, 11:18 pm

    Hi Paul,
    I see you have alot of insight on psych P.A. please help me!!!

    Reply
  • Haley August 17, 2012, 10:59 pm

    Paul,
    Thank you so much for all of this info for aspiring psych pa’s. It’s hard to find reliable information since it is not a very well known position. Currently I have a ba in psychology and am working on the science prerequisites to apply to a pa program in april. I am also working at an inpatient psychiatric hospital. My hope is that my work here will serve as enough experience to be able to get into the program (I’m finding it is increasingly more competitive). I’m having a hard time finding information about the exact route to ppa once I’ve obtained my PA licensure. Any thoughts? Again, thank you so much for sharing your knowledge. I’ve found it extremely helpful!

    Reply
  • Jonathan January 30, 2013, 11:04 pm

    To Whom it May Concern:

    I have found myself using the CBT techniques I have been taught from my other degrees often during the application process of trying to become a PA. I have three years of full time paid experience as a psych tech/group facilitator, two undergrad internships in other hospitals, an AAS in Behavioral Health, a BS in Behavioral Health, a 3.73 for my BS, and so far am doing well in science prereq classes. I got an A in Bio I and II, and in A&P I and II. My problem is that I suffer from dyscalculia; without a calculator, I can neither multiply or divide, even on paper. I had to take both college Algebra and Statistics for Science (a four credit class) by them selves in order to get an an A and B+ respectively. I know I may need a tutor when I begin to take chemistry; should I use my grade in chemistry as a litmus test to know if I can handle the math involved in a PA program? I could take out loans and live with my parents in order to obtain an A in chemistry courses, but again, I feel this would be doing the same thing I did when I took Statistics for Science. To reiterate, is the math in PA school beyond my scope, or will my knowledge and experience outweigh my math problems?

    - Jon

    Reply
    • Paul February 4, 2013, 5:02 pm

      Most of the math in PA school is pretty basic. But it’s the basic stuff that really is important. Medication dosage calculations, ratios/proportions, and the like.

      The math in general chemistry is harder than most you will encounter than PA school. But again, that little bit is crucial. I would strongly encourage you to speak with a counselor at your school’s disability resource center if you have not already.

      Reply
  • Brandon Short April 12, 2013, 7:01 pm

    Paul,
    Great article. I just wanted to mention that we also work in private practice as well as the locations you listed(with a supervising doctor). I also round in the hospital and in the nursing homes. Ive been a Psychiatric PA-C for several years and am glad our profession is talking about it.
    Brandon Short PA-C
    Fort Myers, Fl.

    Reply
    • Paul April 13, 2013, 9:12 am

      Thanks, Brandon! We get lots of questions about psychiatry as a PA specialty. It’s nice to hear word direct from the horse’s mouth.

      Reply
    • Kyle Cooper March 28, 2014, 10:31 am

      Brandon Short,

      Hey,,,I’ve been a PA for close to 20 years now, retired Army, did Ortho Fellowship, now working ER and Urgent care and Psychiatry part time. I am considering going Psychiatry full time,,,if you are willing to answer some questions, I would love to talk to you!

      Kyle

      Reply
  • houston April 13, 2013, 5:09 pm

    I LOVE THIS SITE! THE INFO IS so right. I will finish up my degree in 2014 in psy and I am planning on going on to a PA school. The school I am attending will start a PA program in 2015 which they are allowing me to take the pre course at a local community so I can have those classes out of the way to get into PA school. My adivsor told to finish my psy degree and start working in the area of psy I want and then complete my PA school. She told that will give me a little edge during PA school.

    Reply
  • Gina May 19, 2013, 8:29 am

    Paul,

    I love this website and thank you for setting it up. Is there anyway you can elaborate a little more on how one could get into this field. Greatly appreciate it!

    Reply
  • Audrey October 11, 2013, 2:29 am

    I really love this site……..I want to be a child a nd adolescent psychiatrist but I’m currently offering physician assistant in the university so how do I achieve it with this physician assistantship.

    Reply
    • Paul October 14, 2013, 11:03 pm

      A child/adolescent psychiatrist is a physician, so to become one, you would need to go to medical school. If that’s your goal, I don’t recommend that you become a PA, since it won’t offer you much benefit in getting into medical school – you’ll need to start over from scratch.

      If you want to become a physician assistant who specializes in child/adolescent psychiatry, you do so by getting your license and accepting a job in that area – simple as that.

      Reply
  • Coralee Koning, MS PA-c March 23, 2014, 5:06 pm

    Hi Paul

    I hope you are still answering questions….We are in desperate need of Psych PA’s in our rural Oregon areas (yes, Bend is considered rural). Do you know how I can post for jobs for Psych PA’s? I hear the pay is around $200K….wow!

    Reply
    • Paul March 24, 2014, 1:26 pm

      There are many PA job boards. Probably the biggest is indeed.com’s PA job board. You should also contact the AAPA (AAPA.org) and your states PA organization.

      Reply
    • phil April 3, 2014, 1:31 am

      PAs beware. increasingly finding it difficult for pas to get credentialed under behavioral health with many insurances. Nurse pracs, unfortunately have the edge on this one. Intense lobbying needs to be done with regards to compromise of additional training.

      Reply
      • Paul April 6, 2014, 2:11 pm

        This has not been my experience, but I’m sure that it varies legally by state. I guess the lesson here is to do your research.

        Reply

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