With over 300,000 opioid-related deaths reported since 2000 and two million patients battling addiction today, it’s evident that more qualified medical providers are needed to care for substance abuse patients. Psychiatrists and addiction specialists are struggling to meet the demands of this high need population. The good news amid this national health care epidemic is that more than 1,200 certified PAs practicing in psychiatry work hard to help fill these care gaps.
With medical education supplemented by post-graduate training by psychiatrists, PAs in psychiatry are prepared to review medication histories, engage with patients, perform psychiatric evaluations, manage treatment plans and prescribe psychotropic drugs. Like physicians, PAs pass a rigorous national certification exam and maintain recertification through substantive CME and exams throughout our careers. Thus, PAs are highly-qualified medical providers who can ease psychiatric shortages and permit psychiatrists to perform more consultations while providing high-quality, cost-effective mental health care.
In Virginia, I am a psychiatric PA working at two rural, “safety net” health care facilities where most of my patients are low-income, uninsured and dealing with co-occurring addictions (primarily heroin) and serious mental illnesses. I frequently work as the sole mental health provider at an inpatient facility and as part of a team of specialists at an outpatient center. I see patients during the acute phase of treatment when they undergo medication-assisted treatment, or MAT, for an initial 7-10 days of detoxification.
Medications are prescribed to control mild to severe withdrawal symptoms, and patients have access to drug counselors, social workers, and case managers to support their recovery. I also work with patients on an outpatient basis managing the co-occurring condition. Some patients opt for therapy only, even though medicinal options are available for suboxone or methadone to aid in their recovery.
In both settings, I perform full psychiatric evaluations, an expanded scope of practice afforded to me as a result of my Psychiatry Certificate of Added Qualifications (CAQ), an additional credential that documents my experience and advanced expertise in this critical specialty. The CAQ, offered through the National Commission on Certification of Physician Assistants, is awarded to those PAs who have at least 2,000 hours of clinical experience in psychiatry, earn 150 credits of CME in psychiatry, acquire an attestation from a collaborating psychiatrist and pass a national specialty exam. My CAQ has been crucial to establishing credibility in addiction management, advocating for PAs in the Virginia legislature and opening opportunities for PAs to work more effectively in psychiatric settings.
For instance, I authored the briefing for the legislative committee of Virginia’s physician medical society, which resulted in support for naming PAs as mental health providers. This outcome was key for PAs to be recognized by Medicaid and other insurance plans. It also empowers PAs to do other things, such as support involuntary admissions and screenings.
PAs are struggling nationwide to be recognized as mental health providers. Policymakers must remove barriers to care that prevent PAs from getting reimbursed or prescribing class two drugs. They must also reform state and federal laws that prohibit PAs from practicing to the full extent of our licenses, education, and abilities. Additionally, PAs can be instrumental in the use of telepsychiatry programs, which is the future of health care delivery. Telepsychiatry allows PAs to connect patients to providers with specialized expertise and ensures all patients, no matter where they live, are seen, diagnosed and managed for their addiction.
For most patients, addiction recovery lasts a lifetime. Certified PAs can facilitate the long-term recovery and care of those formerly addicted because we are certified at the highest levels and enable patients to have access to care with a psychiatrist leading the team. Since we are educated in the general medical model, we have the fluidity to specialize in areas of medicine that sorely need attention. We are continuing to trend towards specialization, with over 70 percent of PAs working in specialties outside of primary care. This is good news for patients who need access to care and providers who want to open more access to care.
There’s a lot of discussion about how prescribing practices need to change — and that’s a debate that needs to be litigated — but more conversation is needed on who can treat the millions of patients suffering from an opioid addiction. Efforts to curb opioid addiction must include PAs because combating addiction needs the might of a unified coalition. In this age of inter-professional health care teams, PAs are crucial to the fight.
James Cannon is a physician assistant.
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