Psychiatric PAs and PMHNPs: What is it going to take to make a difference?

James R. Kilgore, DEL, DMSc, PhD, PA-C, DFAAPA

President, Academy of Doctoral PAs

The United States is in a sustained mental health crisis. Rates of crises, suicide, and psychiatric emergencies are at historic highs, while 40% of Americans live in a Mental Health Professional Shortage Area. Workforce shortages span nearly every behavioral‑health profession, with severe maldistribution and rising burnout.

A question that frequently arises is what role the Physician Associate (PA) is to play in addressing these issues. Education, certifications, reimbursement and a clear lack of a training pathway present a significant problem for the PA.

As we are aware there is a rising mental health crisis with nearly 1 in 10 U.S. adults  experienced a mental‑health crisis in the past year. Suicides are at record levels based upon recent data. Emergency departments are overwhelmed with mental‑health‑related ED visits composing roughly 10% of all ER encounters. Bottom line is the demand is rising sharply, but people often cannot access timely, appropriate care pushing them into emergency departments or leaving crises unaddressed.

Shortages are projected across nearly every behavioral‑health profession, including psychiatrists (adult and child/adolescent), psychologists, mental health counselors, addiction counselors, social workers, marriage and family therapists, psychiatric PAs and psychiatric mental health nurse practitioners (PMHNP). Our training pipelines are insufficient. This is compounded by the scope‑of‑practice variation prevents states from fully leveraging the workforce they have.

A major issue for the Psychiatric PA is the educational and certification differences from the PMHNP. The educational pathways, certification structures, and professional identities differ. These distinctions play a role in the employment opportunities for the providers as viewed by healthcare leaders, policymakers, and patients navigating the modern behavioral health workforce.

PAs are educated as medical generalists. Our graduate programs are still focused on  master-level training and span approximately two to two-and-a-half years and mirror a condensed version of medical school. Similar to medical school, the students rotate through a wide range of specialties, including internal medicine, surgery, pediatrics, emergency medicine, and psychiatry. However, the psychiatric exposure varies widely by program and is not designed to produce a mental health specialist at graduation.

A PA becomes a “psychiatric PA” not through formal academic specialization, but through postgraduate experience, employer-based training, or optional fellowships. On the job training (OTJ) opportunities are becoming less and less common as the profession moves to primary employment in healthcare systems.

In contrast, PMHNPs complete a graduate nursing program, either a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP) that is entirely focused on psychiatric–mental health care. Their curriculum includes advanced psychopharmacology, psychotherapy modalities, psychiatric assessment, and required clinical rotations across the lifespan. A major difference is that from the moment the nurse enters their graduate program, they are preparing for a single specialty: psychiatric–mental health nursing. This creates a standardized national pipeline of clinicians with consistent psychiatric training.

Certification further distinguishes the two roles. Specifically the focus of a generalist credential vs. specialty board certification. For the PA, all PAs earn the PA‑C credential by passing the Physician Assistant National Certifying Examination (PANCE). This exam covers general medicine and does not include a psychiatric specialty track. While PAs may pursue a Certificate of Added Qualifications (CAQ) in Psychiatry, this credential is optional, not universally recognized, and does not function as a formal specialty certification. The PMHNPs obtain a national board certification through the American Nurses Credentialing Center (ANCC), earning the PMHNP‑BC credential. This certification is a recognized psychiatric specialty and is required for practice. The PMHNP programs include formal training in therapeutic modalities, giving them a broader foundation in psychotherapy than most PAs receive.

So what is the impact on the PA who desires to enter the Psychiatric workforce in 2026?

The U.S. has roughly 22,000–25,000 practicing PMHNPs (based on ANCC and BLS workforce data from 2024–2025). Psychiatric NPs represent about 4–5% of the total U.S. nurse practitioner workforce (which now exceeds 450,000). And the growth projections are strong with about 40% job growth over the decade per national projections. The PMHNPs benefit from a nationally standardized psychiatric curriculum, while psychiatric PAs vary widely in training depending on experience and employer. The PMHNP programs produce a large, consistent supply of psychiatric specialists; PA psychiatric options remain limited. The PMHNP certification is widely recognized by credentialing bodies and insurers; PA psychiatric specialization is less formally defined. And finally, PMHNPs increasingly practice independently in many states, while PAs generally require some form of physician collaboration.

So, what are the PA options that need to be addressed: 1)Formalized training through a focused program on Psychiatry is critical. Several Post-professional Doctoral Programs (PPDPs) do offer 12-to-24-month focused training in a Mental Health / Psychiatry concentration. 2) Certification for the PA needs to be addressed beyond the generalist board certification through NCCPA. The CAQ is specifically described as NOT a board certification by the NCCPA. But in reality, the CAQ does reflect a didactic focused examination that should be defined as a Psychiatric Board Certification. 3) The need for formal PA psychiatric fellowships, with sufficient payment for training, is also a critical need that needs to be addressed.

The concept of the generalist PA who can change from specialty to specialty today is not realistic with a changing healthcare delivery system. According to the National Commission on Certification of Physician Assistants (NCCPA), approximately 2,500 PAs are practicing in psychiatry. While this number slowly continues to rise PMHNPs far outnumber psychiatric PAs at roughly 10-to-1 nationally.

Conclusion

Psychiatric PAs and PMHNPs both play essential roles in expanding access to mental health care, yet they arrive at psychiatric practice through fundamentally different pathways. PAs are medically trained generalists who specialize through experience, while PMHNPs complete a dedicated psychiatric graduate program and earn a recognized specialty certification. These distinctions influence training, scope, autonomy, and workforce structure. As mental health needs continue to grow, understanding these differences helps organizations build balanced, effective psychiatric care teams that leverage the strengths of each profession. Providers of the future, who address the multi-faceted mental health shortage challenges, must also be willing to seek beyond their clinical training, advanced training in leadership.

References

Bruza-Augatis, M., Kozikowski, A., Hooker, R.S. et al. Physician assistants/associates in psychiatry: a workforce analysis. Hum Resour Health 22, 40 (2024). https://doi.org/10.1186/s12960-024-00911-2

National Commission on Certification of Physician Assistants. 2024 Statistical Profile of Board Certified PAs by Specialty. NCCPA; 2024. Accessed March 29, 2026. https://www.nccpa.net/wp-content/uploads/2025/08/2024-Statistical-Profile-of-Board-Certified-PAs-by-Specialty.pdf

Hooker RS, Curry K, Tracy C. Specialization of Physician Associates and Nurse Practitioners as Reflected in Workforce Projections. Cureus. 2024 Nov 7;16(11):e73216. doi: 10.7759/cureus.73216. PMID: 39650953; PMCID: PMC11624891.

Kilgore, James R.; Somers, James C.; Munsell, Debra S.; Allen, Everett; Colletti, Tom; Rogers, Blake; Banger, Maggie; and Delis, Nikoleta (2025) "Roadmap to Better Mental Health Care," Lynchburg Journal of Medical Science: Vol. 1: Iss. 1, Article 2. Available at: https://digitalshowcase.lynchburg.edu/jms/vol1/iss1/2

Kilgore, James R., Rolfs, Jenna, Munsell, Debroah. "Leading with a Doctorate: The Impact of Advanced Scholarship on Leadership Effectiveness," Lynchburg Journal of Medical Science: Vol. 1: Iss. 3, Article 2.DOI: https://doi.org/10.63932/3067-7106.1047Available at: https://digitalshowcase.lynchburg.edu/jms/vol1/iss3/2