The Evolving Role of PCPs, NPs, and PAs in Psychiatric Medication Management

I’ve been taught that 60% of all psychiatric meds are prescribed by primary care physicians (PCPs).

New data shows that the PCP share has decreased to 44% over the last 15 years. Nurse practitioners (NPs) and physician assistants (PAs) are now responsible for 13% of prescriptions for psychiatric meds.

The PCP share has contracted as the number of NPs and PAs has grown.

Psychiatrists’ share has stayed roughly the same at about a third. There just aren’t enough of us and that fact is unlikely to change any time soon.

Providers in rural communities tend to prescribe psychiatric medications more often than non-rural peers because fewer non-medical treatment alternatives exist in those settings.

For example, if excellent cognitive-behavioral therapy (CBT) clinicians were available everywhere, and if patients didn’t have to wait months for the first visit, then total prescription rates would likely drop.

Early diagnosis and timely access to evidence-based therapy would likely prevent many cases of mild to moderate mental health problems from progressing to diagnoses that require medications.

An even better solution would be to prevent chronic toxic childhood stress and to boost resilience in youth. About 50% of all mental illnesses emerge before age 18.

Psychiatrists get a bad rap.

Patients and caregivers worry that we just want to push pills. Most of us wish effective non-medical treatments were more easily accessible so we could prescribe less often.

We need desperately need disruptive innovation in mental health care for things to get better soon.

In the meantime, we have an obligation to help our non-psychiatrist colleagues prescribe the right psychotropic medications at the right times and at the right doses.

Just know that we wish things were different. And many of us are looking to introduce much-needed disruption.

Photo Credit: Jack Bell Photography