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?