Is there a role for physician assistants in community mental health?

The authors briefly describe the history and development of the medical discipline of physician assistants (PAs). A careful review of the literature reveals the limited use of PAs in psychiatry, usually only for primary health care needs. A model for using PAs as psychiatric assistants is presented, including the training required and a description of the clinical and administrative functions. The advantages of such a model are multiple. These include: 1) more effective and efficient use of the psychiatrist; 2) reduced costs of service; 3) increased primary medical screening capability in the CMHC; and 4) increased presence of ethnic minorities on the professional staff of the CMHC. Disadvantages of the model relate to training and "turf" issues. In view of the shortage and dissatisfaction of psychiatrists in CMHC settings, and other challenges to the provision of quality mental health care in the community, this model should be considered as a logical and positive response to that challenge. If the model is valid, then training facilities must make a systematic effort to recruit, train, and place psychiatric physician assistants in community agencies.