Questions Regarding Psych-PA Role in Healthcare

[lrnprcll]

Hi-- I'm a college junior trying to explore all possible career options to work in mental health. Currently, I am a biology major with about a 3.65 GPA at a good school with a solid list of health care clinical experience and other ECs and passions. I really have a strong desire into working with mental health.

 

I just have a few questions:

Regarding the medical role....

 

Psychiatrists: I am fairly aware that psychiatrists primarily do medication management in relatively shorter sessions than psychologists/social workers/other people practicing psychotherapy. From what I gather, psychiatrists are practicing psychotherapy less and less due to other occupations (master level therapists, psychologists, etc.) being able to provide it at a lower rate and the fact that medical management is realistically more profitable than psychotherapy.

 

Questions about Psych-PAs: (Note: I read the forum and googled online, but there really does seem to be very limited information out there as the state of PAs in psychiatry). In general, do many PAs fulfill the psychiatry positions? Does the PA school model itself adequately prepare you to work with mental health patients? If I want to become a nurse practitioner, is that a more feasible route to enter the mid-level mental health field? For the PAs practicing in psych, what are their general duties (is it mostly medication management, medical management for underlying/other symptoms)? How does the psych PA role differ from the psychiatrist role?

 

I'm debating between psychiatrist, psych PA, or psych NP in order to enter the mental health field...as I'm also trying to figure out how these roles compare to typical roles in psychology, psychotherapists/mid-level therapists who primarily practice therapy.

 

Ideally, I would love to really get to know my patient at a deeper level and be a solid source of support for him/her. I am concerned about the psych/psychNP/psychPA route that it will literally be feeling like I am only putting a "band-aid" (the medication) over the people's problems, where I really would like the opportunity to challenge many of their views, help them figure out how to develop a healthy lifestyle, and help them deal with their problems. I'm not sure if a medical route is best-suited for this, or if I should look more into a more psychology-oriented path.

 

Thanks greatly for any advice. It would be highly appreciated.

[IAmAPAStudent]

Mostly NPs work in psychiatry, but there are some PAs in psych.

 

One of my coworkers at the VA (she's the head of addiction psych at the VA where I worked) tried to hire psychiatry PAs for almost a year, but she couldn't find any, and the people she hired were NPs.

 

From your description, I would recommend that you get a PhD in Psychology. PA/NP do not train you for therapy with patients. Psychology does. Especially with cognitive behavioral therapy, but also with other types of counseling therapy.

 

I have worked in mental health for years, and I have a MA in psychology. I am studying to become a PA, and I had to make a very similar choice as you.

 

The psychiatrists I worked with did a minimal amount of therapy and 100% of the time - treated with medications.

 

PAs/NPs will follow suit similarly.

 

This has been my experience, and I certainly can't speak for any "norm." But at the VA where I worked, that was the MO.

 

Only the psychologists and counselors did therapy with patients. The NPs/PAs did assessments, diagnosis, prescribing, and could set up therapy for the patient with one of the psychologists or substance abuse counselors (group and individual).

 

Best of luck to you in your choices! I hope you let us know what you decide.

[Contrarian]

^^^ What (S)He Said^^^...

 

Therapists do therapy... we promote "better living thru chemistry"...

 

Most of the Psychiatrists I work with do Therapy as a "hobby"... because as you stated... it really doesn't pay.

Most have a "job" somewhere to pay the bills but maintain a private office for therapy sessions a couple days a week.

 

ALL of the Psych NPS that I know and work with do ONLY medication management.

I do both medication management and medical management for acute/chronic issues in both inpatient and outpatient settings.

 

YMMV

 

Contrarian

[Jonathan Yoder]

I think both the previous posters are correct in saying that most PAs/psych NPs are primarily focused on med management.

 

If you really just want to work in mental health and do therapy you may want to consider how interested you would be in the non-mental health rotations that make up most of PA, nursing, or medical school.

 

That said I wanted to point out that psychiatric NP programs do provide training in psychotherapy. I can't comment on the depth or quality, but therapy is part of the curriculum. While they are not the norm some psychiatric advanced practice nurses are primarily engaged in therapy, you probably aren't going to make top dollar doing this, but if you enjoy the work the lower salary may be acceptable.

 

The downside to the nursing route for you is the need to become an RN and then complete NP training; this takes about three years total through most direct-entry programs.

 

Finally, if you opt for the PA route you could always do a residency in psychiatry afterward. There are at least three listed on the APPAP website currently: http://www.appap.org/

[NewtonsApple]

I wouldn't recommend getting a PhD in psychology, as therapy can be conducted by obtaining an MSW than a LSCW, or a clinical or counseling masters in psychology than obtaining an LPC. One of my professors has been both a LCSW and psych-PA for the past few decades. He has worked for Docs that allowed him to conduct therapy and prescribe, however, he contacted a lawyer to make sure he wasn't practicing psychiatry without a license.

[Avalon]

Hello,

 

I have a doctoral degree in clinical pyschology and recently retrained as a PA. I still work as a psychologist part-time, and as a PA full-time in family medicine. IMHO, PAs are not at all adequately trained to do psychotherapy. I spent five full years in graduate school learning psychological assessment and treatment, and another two years as a supervised post-doc before I was eligible for licensure. Psychotherapy is a complex and intricate enterprise; it does not distill down to simply "talking" with patients or, worse yet, giving them advice. My training in mental health in PA school was quite limited and came exclusively from a medical management model. I also spent 16 years as a psychology professor, and I am well acquainted with the literature on the equal efficacy of psychotherapy (and the lack of efficacy of many medications). Please feel free to PM me; I am happy to have a conversation with you about your options and my experience in these two different roles.