PAs in Psychiatry: A Win-Win for Patients and Practices

Erin Crown, MHS, PA-C, Psych-CAQ

NCCPA and nccPA HEALTH FOUNDATION

Meet Erin Crown, MHS, PA-C, Psych-CAQ, a board certified physician assistant/associate (PA). She became a psychiatric PA over a decade ago when the number of PAs practicing in psychiatry was less than 1% of the body of certified PAs. Erin is one of the approximately 3000 board certified PAs practicing in psychiatry in the US.¹

Crown shares, “My interest in psychiatry started during my undergraduate years, graduating with a degree in health science and a minor in psychology. I entered my master’s program in PA studies, with the understanding that I would graduate having been broadly educated in medicine as a PA and eligible to pursue a career in any area of medicine. It was during my clinical clerkship year when I completed my psychiatry rotation at a maximum-security men’s penitentiary—SCI-Rockview; I knew where I wanted to be.”

Crown recalls, "over the years, I have experienced amazing career-broadening opportunities in psychiatric practice.” From her early clinical experiences in caring for acutely ill patients on a psychiatric stabilization unit, to splitting her time between that unit and several rural outpatient psychiatry clinics, “I knew I had found my calling.” As a psychiatric PA, Crown’s role has expanded to include co-ownership and management of a private psychiatry practice, supported by her supervising physician, while developing professional and industry relationships encompassing clinical research, professional education for both lay and medical communities, and continued clinical practice.

Crown shares, “As I have traveled and interacted with a wide variety of medical and other professionals, I am often asked how a PA finds themselves practicing psychiatry?” It is through these conversations that I have realized that it may be valuable to introduce the PA profession and PAs in psychiatry to the Psychiatric Times audience.

PAs Practice Medicine

PAs are medical providers who practice in nearly every medical specialty and subspecialty. NCCPA’s 2023 Statistical Profile of Board Certified PAs by Specialty Annual Report reveals that most PA practice specialties have experienced growth over the last year and the past 5 years. The largest percentages of PAs work in family medicine (16.5%), emergency medicine (10.8%), orthopedic surgery (10.7%), dermatology (4.3%), and internal medicine-general (4.0%).¹ With health care provider shortages, there is a significant demand for PAs in all clinical disciplines.

PAs Provide Mental and Behavioral Health Services

As the US continues to face a mental health crisis, PAs are at the forefront of caring for patients with mental and behavioral health concerns. NCCPA Professional Profile data indicates that 2.4% of PAs (~3,000) identify as Psychiatric PAs and are providing care in office-based private practices (46.1%), mental health facilities (18.3%), and hospitals (15.7%).¹

Table. Clinical Services Provided by Board Certified PAs in Psychiatry

As illustrated in the Table, board certified PAs in psychiatry provide a range of clinical services and work collaboratively with a range of health professionals (Figure). 

Figure. PAs in Psychiatry Work With Other Health Professionals

Mental health care provided by PAs is not limited to Psychiatry, with 33.4% of all PAs reporting they encounter patients daily who need treatment for mental disorders.¹ Approximately 10.8 million patients are seen by PAs each week, across all practice disciplines and settings.² PAs are making a positive impact on patient care nationwide.

Why PAs

The PA profession emerged in the mid-1960s from a need to provide health care services for a growing patient population, especially in rural and underserved communities; a shortage of primary care physicians; and the emerging supply of highly skilled former medics and corpsmen returning from military service. The first PA program was established in 1965 by Eugene A. Stead, Jr, MD, at Duke University. Since then, over 300 PA programs across the country have educated more than 200,000 PAs, who increasingly meet current and emerging patient care needs in all specialties and practice settings. Having been founded by a physician, the PA educational model mirrors medical education for physicians.

Before enrolling in one of the 311 accredited PA programs in the United States, undergraduate students typically complete prerequisite courses in biology, chemistry, anatomy, and physiology, among other relevant subjects. Pre-PA students must earn a bachelor’s degree, often in a science-related field, and document preadmission clinical experiences. PA programs typically span 27 months of full-time classroom, laboratory, and clinical training experiences, culminating in the award of a master’s degree. The PA curriculum follows the medical school model, incorporating graduate-level courses in pathophysiology, medical sciences, pharmacology, interviewing and physical assessment, clinical laboratory sciences, simulation, and clinical skills development. All programs are required to provide student learning experiences in mental and behavioral health. Required clinical training experiences include rotations in internal medicine, emergency medicine, pediatrics, and other specialties. PAs complete their educational program with over 2000 hours of clinical rotations.

Commitment to High Standards

All US PA educational programs must demonstrate compliance with rigorous program standards as defined by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA).³ Accreditation of PA programs was initially under the auspices of the American Medical Association, but the ARC-PA was approved as an independent accrediting body in 2001. The ARC-PA is the US agency that protects the interests of the public and PA profession by defining the standards for PA education and evaluating PA educational programs within the territorial United States to ensure their compliance with those standards.⁴ The standards outline institutional responsibilities, curricula components, student clinical training experiences, as well as program and student evaluation components that must be documented to obtain ARC-PA accreditation. Although the master’s degree is currently the terminal degree for the PA profession, the ARC-PA does not accredit an academic degree awarded by the sponsoring institution of the PA program. The rigorous PA educational curriculum and evaluation processes demonstrate a commitment to high standards, as established by the profession's founders.

That commitment to high standards is further demonstrated through national PA certification. PAs are licensed to practice in all 50 states. All states and US territories require that PA graduates pass the Physician Assistant National Certifying Examination (PANCE), developed and administered by the National Commission on Certification of Physician Assistants (NCCPA), to obtain an initial license to practice medicine as a PA.

Established as a not-for-profit organization in 1974, NCCPA provides certification programs that reflect standards for clinical knowledge, clinical reasoning, and other medical skills and professional behaviors required upon entry into practice and throughout the careers of PAs. The exam specifications are based on the results of a profession-wide practice analysis, and exam questions are allocated to the range of medical content and task categories relevant to entry-level PA practice. Only individuals who graduate from an entry-level PA program accredited by the ARC-PA are eligible to apply to take the PANCE, which is administered throughout the year at more than 300 secure testing facilities in the US and abroad.⁵ The generalist nature of the PANCE ensures that graduates demonstrate a baseline fund of knowledge and skills necessary for entry into the profession.

PAs' continued competence in core medical knowledge is facilitated through recertification, which is achieved by successfully completing the Physician Assistant National Recertifying Examination (PANRE) every 10 years. Additionally, to maintain NCCPA board certification, PAs must document a minimum of 100 credits of continuing medical education (CME) every 2 years. PAs generally complete CME credits in their primary practice discipline. It is important to note that although only 17 states require current NCCPA certification for license renewal, 96% of PAs maintain NCCPA board certification, year-over-year, demonstrating their commitment to continued professional development and lifelong learning (NCCPA, unpublished data, January 2025). NCCPA’s certification maintenance and recertification processes ensure that PAs demonstrate continued learning and competence in core medical knowledge as well as their practice discipline(s).

Continued Learning

PAs can pursue additional voluntary education leading to doctoral and other advanced degrees in medical sciences (DMSc) and other disciplines. The PhD, MD, and DHSc are the most frequently acquired advanced degrees.⁶ Additionally, PAs may enroll in postgraduate clinical programs in their practice discipline. Early findings from NCCPA’s 2024 Statistical Profile of Board Certified PAs revealed that 5.7% of all PAs indicated that they completed a PA postgraduate training program (PA residency or fellowship) after graduating from their entry-level PA program. Furthermore, among those PAs who completed a postgraduate program, 3.1% did so in psychiatry.⁶

The NCCPA also offers an optional Certificate of Added Qualifications (CAQ) in 11 practice disciplines, including psychiatry. The CAQ is a voluntary credential that board certified PAs may earn to demonstrate advanced expertise in the selected clinical specialty. To earn a CAQ, PAs must maintain current NCCPA certification (PA-C), document completion of prescribed non-exam components, including CME credits in the relevant practice discipline, submit a clinical attestation, and successfully complete an objective assessment. Earning a CAQ demonstrates a PA's commitment to advanced learning and passion for health care in the selected practice discipline.

The PA profession is supported by 2 national membership organizations that advocate for the profession and PA patient-centered care, as well as provide continuing education opportunities and many additional services for PAs, PA faculty, and students. Founded in 1968, the American Academy of Physician Associates (AAPA) is the national professional society for PAs. It represents the PA profession across all medical and surgical specialties in all 50 states, the District of Columbia, US territories, and the uniformed services. AAPA advocates and educates on behalf of the profession and the patients PAs serve. AAPA works to ensure professional growth, personal excellence, and recognition of PAs. AAPA also enhances PAs’ ability to improve the quality, accessibility, and cost-effectiveness of patient-centered health care.⁷

The PA Education Association (PAEA) is the only national organization representing PA educational programs in the United States. PAEA provides development services for faculty at its member programs, as well as support services for PA applicants, student assessment tools, and a range of additional services for its stakeholders. Founded in 1972 as the Association of Physician Assistant Programs, the PAEA adopted its current name in 2022.⁸

PAs are a Win-Win

Since its founding in 1965, the PA profession and PAs like Crown have expanded access to health care and education in many disciplines. With 123 million Americans living in mental health profession shortage areas,⁹ the growing number of PAs in psychiatry represents another such example of those efforts. From 2019-2023, the number of PAs practicing in psychiatry had the greatest percentage change of any PA practice area.¹

Additional indicators underscore the growth of PAs as partners in mental and behavioral health care. By 2030, the Health Resources and Services Administration has forecasted an 86% increase in the number of PAs in the field of psychiatry.¹⁰ As opportunities emerge, the PA profession will be ready: More than 12,000 new graduates join the workforce annually, which represents a 40% increase over the last 5 years,⁶ and more than 30 new programs are in the accreditation pipeline (NCCPA, unpublished data, January 2025).

PAs are aided in their endeavors by (1) the national systems and structures that support rigorous program accreditation and certification as well as education and practice development; (2) their education in the medical model and commitment to continuous professional development, which supports their ability to emphasize whole-person care and their readiness, including prescriptive authority, to care for comorbid physical and mental health conditions; and (3) the profession’s commitment to adapting to meet patient, practice, and system needs.

To help support the PA profession’s mental and behavioral health initiatives, the nccPA Health Foundation leads the PArtners in Mental Health Initiative,¹¹ an intraprofessional, collaborative effort dedicated to advancing the role of all board certified PAs and strengthening partnerships to address mental health and substance use disorder needs. Led by a steering committee that includes representatives from the national PA organizations, individual PA champions, and interprofessional partners, this effort leverages a collective impact strategy that amplifies the profession’s commitment to enhancing educational approaches, strengthening the practice environment, and raising awareness of mental health needs and the contributions of board certified PAs.

PAs across disciplines are prepared and ready to respond to the increasing demand for mental and behavioral health services, bridging gaps in access to psychiatric care and providing a win-win for patients and practices.

Dr Morton-Rias is the president/CEO of the NCCPA and the nccPA Health Foundation.

References

1. 2023 Statistical Profile of Board Certified PAs by Specialty: An Annual Report of the National Commission on Certification of PAs. National Commission on Certification of Physician Assistants. Accessed June 23, 2025. https://www.nccpa.net/wp-content/uploads/2024/07/2023-Statistical-Profile-of-Board-Certified-PAs-by-Specialty-Annual-Report.pdf 

2. 2023 Statistical Profile of Board Certified Physician Assistants, Annual Report. National Commission on Certification of Physician Assistants. Accessed June 23, 2025. https://www.nccpa.net/wp-content/uploads/2024/05/2023-Statistical-Profile-of-Board-Certified-PAs5_3_24.pdf

3. Accreditation Standards for PA Education, 5th Edition. Accreditation Review Commission on Education for the Physician Assistant. September 2019. Accessed June 23, 2025. https://www.arc-pa.org/wp-content/uploads/2024/07/Standards-5th-Ed-July-2024.pdf

4. Accreditation review commission on education for the physician assistant. Accreditation Review Commission on Education for the Physician Assistant. Accessed June 23, 2025. https://www.arc-pa.org/about/

5. About NCCPA. National Commission on Certification for Physician Assistants. Accessed June 23, 2025. https://www.nccpa.net/about-nccpa/#who-we-are

6. 2024 Statistical Profile of Board Certified PAs, Annual Report. National Commission on Certification of Physician Assistants. Accessed June 23, 2025. https://www.nccpa.net/wp-content/uploads/2025/05/2024-Statistical-Profile-of-Board-Certified-PAs.pdf

7. About AAPA. American Academy of Physician Associates. Accessed June 23, 2025. https://www.aapa.org/about/

8. About us. PA Education Association. Accessed June 23, 2025. https://paeaonline.org/our-work/about-us

9. Health workforce shortage areas. Health Resources and Services Administration. Accessed June 23, 2025. https://data.hrsa.gov/topics/health-workforce/shortage-areas

10. Behavioral Health Workforce Projections, 2017-2030. Health Resources and Services Administration Health Workforce. Accessed June 23, 2025. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/bh-workforce-projections-fact-sheet.pdf

11. Collective Impact. nccPA Health Foundation. Accessed June 23, 2025. https://nccpahealthfoundation.net/our-causes/mental-health/#collective-impact