PAs and team care can work in psychiatry, too

Depression and other mental illnesses are among the leading causes of disability worldwide, according to the World Health Organization. Consequently, the need and demand for mental health services is self-evident.

Couple that with physician shortages we face in psychiatry (and medicine in general), and we are courting a true health care system and societal emergency.

Even positive trends – like the destigmatization of mental illness and broadening availability of insurance coverage for mental health treatment – can exacerbate the challenges, potentially exposing more demand for services than we can currently supply. The bottom line: Psychiatric services are a widespread and growing need for patients, but the supply of physicians is clearly not in line with the demand.

One solution? As psychiatrists, we must consider setting aside territorial resistance and embrace the concept of team care alongside mid-level practitioners. Physician assistants (PAs) already are helping to fill the gap in provider services in many areas of medicine, and their use is growing and will likely continue to do so. They break down the barrier of access to health care for many. They also are cost-effective providers, and often receive favorable reimbursement by third-party payers for their services.

I personally practice in a general psychiatry outpatient practice that deals with adult psychiatric issues, mild to severe. PAs first came to my attention when I observed them practicing with my father-in-law, an allergist. He considered them trusted resources, and I believed that they could extend access in my practice and make an impact as well. Today, two physician assistants support me, enabling additional patient access than I am able to provide on my own.

Psychiatrists will recognize the medical model of training that physician assistants complete. They graduate from master’s level programs, which include a year of didactic education followed by clinical rotations similar to those we completed as medical students. With proper training and supervision on site, PAs can be particularly effective handling medication management decisions of mild to moderate complexity. The supervising physician should be available, and PAs are trained and expected to seek help and supervision when the acuity or severity exceeds their training or comfort level. I do not expect PAs to practice formal psychotherapy.

PAs are certified by the National Commission on Certification of Physician Assistants (NCCPA), and that group’s data show that many PAs are conducting psychiatric interviews and developing differential diagnoses and treatment plans.

The current reality is that family practice and ob.gyn. PAs are often prescribing antidepressants, hypnotics, and other psychotropic medications to their patients to fill the aforementioned supply-demand gap in psychiatry. The NCCPA now offers an additional credential – the Certificate of Added Qualifications (CAQ) in Psychiatry – for PAs who have experience, continuing medical education, and patient management skills focused in this specialty. Those requirements must be fulfilled before taking and passing the national Psychiatry Specialty Exam. I encourage our PAs to seek the CAQ in psychiatry, as patients recognize that those PAs have additional knowledge and experience.

The key to making physician/PA team care work starts with compatibility, something that begins during the interview process. Beyond that, best practices call for you, the physician and/or employer, to set clear expectations, provide protocols, and communicate frequently. This is the key to delivering quality, safe mental health care in a team care model.

In my practice, we use a collaborative approach to patient care. Both the PA and I will interact and visit with the patients on their first appointment. The PA might take a history, formulate a preliminary diagnosis and plan; then step outside the treatment room and review this with me. The PA might ask questions, and I might suggest alternative diagnoses or treatments to consider. When I meet the patient, I ask any additional questions I might have, as well as answer theirs. With the PA present, I explain our assessment, and plan and seek informed consent. This solidifies the physician/patient relationship.

This initial meeting creates a distinctive treatment alliance between the patient, me, and the PA. From there, we suggest whether the patients will have their follow-up appointment with me or the PA. However if the patient insists on following up with me, we will in most cases honor that. It is worth noting that PAs can add gender diversity to a solo psychiatry practice, and some patients might prefer a provider that makes them feel more comfortable based on their issues or particular background.

Like many psychiatrists in my area, my schedule stays busy. A prospective new patient who calls in to see me might have to wait for some time. However, we can offer the patients a choice to have a PA see them often much sooner. It is important to be clear with patients what their options are. Some patients might decline the team care model. However, I’ve been pleased to see how patients respond to PAs and their overall outcomes. Patients are often grateful for the opportunity to receive treatment more quickly and begin their path to wellness.

My quality assessment includes reviewing more charts than required by law and providing time for regular consults with the PAs regarding specific questions on any patient that is challenging. It is a team-based approach to mental health care, and it’s successful and rewarding.

As psychiatrists, we must recognize that our growing population, and the increased demand for services, play an active role in the solution. We have to appreciate the changing landscape of health care and welcome other qualified providers to our mission to serve. Integrating PAs into a practice can be an effective way to reach more people and deliver on the promise of health care availability to all.

Dr. Musgrove’s private practice is in Round Rock, Texas. He also has practiced in numerous residential treatment centers and correctional facilities.

Depression and other mental illnesses are among the leading causes of disability worldwide, according to the World Health Organization. Consequently, the need and demand for mental health services is self-evident.

Couple that with physician shortages we face in psychiatry (and medicine in general), and we are courting a true health care system and societal emergency.

Even positive trends – like the destigmatization of mental illness and broadening availability of insurance coverage for mental health treatment – can exacerbate the challenges, potentially exposing more demand for services than we can currently supply. The bottom line: Psychiatric services are a widespread and growing need for patients, but the supply of physicians is clearly not in line with the demand.

One solution? As psychiatrists, we must consider setting aside territorial resistance and embrace the concept of team care alongside mid-level practitioners. Physician assistants (PAs) already are helping to fill the gap in provider services in many areas of medicine, and their use is growing and will likely continue to do so. They break down the barrier of access to health care for many. They also are cost-effective providers, and often receive favorable reimbursement by third-party payers for their services.

I personally practice in a general psychiatry outpatient practice that deals with adult psychiatric issues, mild to severe. PAs first came to my attention when I observed them practicing with my father-in-law, an allergist. He considered them trusted resources, and I believed that they could extend access in my practice and make an impact as well. Today, two physician assistants support me, enabling additional patient access than I am able to provide on my own.

Psychiatrists will recognize the medical model of training that physician assistants complete. They graduate from master’s level programs, which include a year of didactic education followed by clinical rotations similar to those we completed as medical students. With proper training and supervision on site, PAs can be particularly effective handling medication management decisions of mild to moderate complexity. The supervising physician should be available, and PAs are trained and expected to seek help and supervision when the acuity or severity exceeds their training or comfort level. I do not expect PAs to practice formal psychotherapy.

PAs are certified by the National Commission on Certification of Physician Assistants (NCCPA), and that group’s data show that many PAs are conducting psychiatric interviews and developing differential diagnoses and treatment plans.

The current reality is that family practice and ob.gyn. PAs are often prescribing antidepressants, hypnotics, and other psychotropic medications to their patients to fill the aforementioned supply-demand gap in psychiatry. The NCCPA now offers an additional credential – the Certificate of Added Qualifications (CAQ) in Psychiatry – for PAs who have experience, continuing medical education, and patient management skills focused in this specialty. Those requirements must be fulfilled before taking and passing the national Psychiatry Specialty Exam. I encourage our PAs to seek the CAQ in psychiatry, as patients recognize that those PAs have additional knowledge and experience.

The key to making physician/PA team care work starts with compatibility, something that begins during the interview process. Beyond that, best practices call for you, the physician and/or employer, to set clear expectations, provide protocols, and communicate frequently. This is the key to delivering quality, safe mental health care in a team care model.

In my practice, we use a collaborative approach to patient care. Both the PA and I will interact and visit with the patients on their first appointment. The PA might take a history, formulate a preliminary diagnosis and plan; then step outside the treatment room and review this with me. The PA might ask questions, and I might suggest alternative diagnoses or treatments to consider. When I meet the patient, I ask any additional questions I might have, as well as answer theirs. With the PA present, I explain our assessment, and plan and seek informed consent. This solidifies the physician/patient relationship.

This initial meeting creates a distinctive treatment alliance between the patient, me, and the PA. From there, we suggest whether the patients will have their follow-up appointment with me or the PA. However if the patient insists on following up with me, we will in most cases honor that. It is worth noting that PAs can add gender diversity to a solo psychiatry practice, and some patients might prefer a provider that makes them feel more comfortable based on their issues or particular background.

Like many psychiatrists in my area, my schedule stays busy. A prospective new patient who calls in to see me might have to wait for some time. However, we can offer the patients a choice to have a PA see them often much sooner. It is important to be clear with patients what their options are. Some patients might decline the team care model. However, I’ve been pleased to see how patients respond to PAs and their overall outcomes. Patients are often grateful for the opportunity to receive treatment more quickly and begin their path to wellness.

My quality assessment includes reviewing more charts than required by law and providing time for regular consults with the PAs regarding specific questions on any patient that is challenging. It is a team-based approach to mental health care, and it’s successful and rewarding.

As psychiatrists, we must recognize that our growing population, and the increased demand for services, play an active role in the solution. We have to appreciate the changing landscape of health care and welcome other qualified providers to our mission to serve. Integrating PAs into a practice can be an effective way to reach more people and deliver on the promise of health care availability to all.

Dr. Musgrove’s private practice is in Round Rock, Texas. He also has practiced in numerous residential treatment centers and correctional facilities.

Depression and other mental illnesses are among the leading causes of disability worldwide, according to the World Health Organization. Consequently, the need and demand for mental health services is self-evident.

Couple that with physician shortages we face in psychiatry (and medicine in general), and we are courting a true health care system and societal emergency.

Even positive trends – like the destigmatization of mental illness and broadening availability of insurance coverage for mental health treatment – can exacerbate the challenges, potentially exposing more demand for services than we can currently supply. The bottom line: Psychiatric services are a widespread and growing need for patients, but the supply of physicians is clearly not in line with the demand.

One solution? As psychiatrists, we must consider setting aside territorial resistance and embrace the concept of team care alongside mid-level practitioners. Physician assistants (PAs) already are helping to fill the gap in provider services in many areas of medicine, and their use is growing and will likely continue to do so. They break down the barrier of access to health care for many. They also are cost-effective providers, and often receive favorable reimbursement by third-party payers for their services.

I personally practice in a general psychiatry outpatient practice that deals with adult psychiatric issues, mild to severe. PAs first came to my attention when I observed them practicing with my father-in-law, an allergist. He considered them trusted resources, and I believed that they could extend access in my practice and make an impact as well. Today, two physician assistants support me, enabling additional patient access than I am able to provide on my own.

Psychiatrists will recognize the medical model of training that physician assistants complete. They graduate from master’s level programs, which include a year of didactic education followed by clinical rotations similar to those we completed as medical students. With proper training and supervision on site, PAs can be particularly effective handling medication management decisions of mild to moderate complexity. The supervising physician should be available, and PAs are trained and expected to seek help and supervision when the acuity or severity exceeds their training or comfort level. I do not expect PAs to practice formal psychotherapy.

PAs are certified by the National Commission on Certification of Physician Assistants (NCCPA), and that group’s data show that many PAs are conducting psychiatric interviews and developing differential diagnoses and treatment plans.

The current reality is that family practice and ob.gyn. PAs are often prescribing antidepressants, hypnotics, and other psychotropic medications to their patients to fill the aforementioned supply-demand gap in psychiatry. The NCCPA now offers an additional credential – the Certificate of Added Qualifications (CAQ) in Psychiatry – for PAs who have experience, continuing medical education, and patient management skills focused in this specialty. Those requirements must be fulfilled before taking and passing the national Psychiatry Specialty Exam. I encourage our PAs to seek the CAQ in psychiatry, as patients recognize that those PAs have additional knowledge and experience.

The key to making physician/PA team care work starts with compatibility, something that begins during the interview process. Beyond that, best practices call for you, the physician and/or employer, to set clear expectations, provide protocols, and communicate frequently. This is the key to delivering quality, safe mental health care in a team care model.

In my practice, we use a collaborative approach to patient care. Both the PA and I will interact and visit with the patients on their first appointment. The PA might take a history, formulate a preliminary diagnosis and plan; then step outside the treatment room and review this with me. The PA might ask questions, and I might suggest alternative diagnoses or treatments to consider. When I meet the patient, I ask any additional questions I might have, as well as answer theirs. With the PA present, I explain our assessment, and plan and seek informed consent. This solidifies the physician/patient relationship.

This initial meeting creates a distinctive treatment alliance between the patient, me, and the PA. From there, we suggest whether the patients will have their follow-up appointment with me or the PA. However if the patient insists on following up with me, we will in most cases honor that. It is worth noting that PAs can add gender diversity to a solo psychiatry practice, and some patients might prefer a provider that makes them feel more comfortable based on their issues or particular background.

Like many psychiatrists in my area, my schedule stays busy. A prospective new patient who calls in to see me might have to wait for some time. However, we can offer the patients a choice to have a PA see them often much sooner. It is important to be clear with patients what their options are. Some patients might decline the team care model. However, I’ve been pleased to see how patients respond to PAs and their overall outcomes. Patients are often grateful for the opportunity to receive treatment more quickly and begin their path to wellness.

My quality assessment includes reviewing more charts than required by law and providing time for regular consults with the PAs regarding specific questions on any patient that is challenging. It is a team-based approach to mental health care, and it’s successful and rewarding.

As psychiatrists, we must recognize that our growing population, and the increased demand for services, play an active role in the solution. We have to appreciate the changing landscape of health care and welcome other qualified providers to our mission to serve. Integrating PAs into a practice can be an effective way to reach more people and deliver on the promise of health care availability to all.

Dr. Musgrove’s private practice is in Round Rock, Texas. He also has practiced in numerous residential treatment centers and correctional facilities.