Psychiatry 2021: Team Psychiatry.

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Author: John J. Miller
Date: Mar. 2021
From: Psychiatric Times(Vol. 38, Issue 3)
Publisher: Intellisphere, LLC
Document Type: Article
Length: 1,513 words
Lexile Measure: 1490L

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Individuals with mental illness continue to struggle with access to treatment in the United States, including in metropolitan hubs. Despite the huge unmet need for additional psychiatrists in the United States, the number of graduating medical students choosing psychiatry as their specialty training sadly remains quite low. Thomas et al estimated that approximately 96% of the 3140 US counties had an unmet need for practicing psychiatrists, and this need was higher in rural areas and areas with low per capita income. (1) In 2013, 70% of US psychiatrists were over the age of 50, (2) suggesting this shortage will only increase as current practitioners retire in the years ahead. I live in Exeter, New Hampshire, a mere hour north of Boston, Massachusetts, where the waiting time for an initial outpatient psychiatric evaluation is anywhere from 2 to 6 months.

I was introduced to my first psychiatric mental health advanced practice registered nurse (PMH-APRN) when I joined a private psychiatric group practice in 1995 in Newburyport, Massachusetts. This was a multispecialty outpatient practice with a wide range of clinical specialties: therapists of various degrees, a neuropsychologist, 6 psychiatrists, and a psychiatric nurse practitioner (psych NP--the title used at that time). To be honest, I was clueless that this advanced nursing degree even existed. Having completed my psychiatry residency training 4 years earlier, and then working in the Worcester County area since that time, I had never crossed paths with a psych NP.

Initially I was skeptical and, frankly, put off by the fact this person was prescribing medications with relatively little formal training. With the overconfidence (or maybe insecurity) of my 12 years of training in biochemistry, medical school, internship, and psychiatry residency, it was hard for me to believe that the Commonwealth of Massachusetts would license a nurse with a few years of additional training to practice clinical psychiatry--and to prescribe medications no less! The 6 psychiatrists who had worked with this psych NP for years continually reassured me that the nurse was clinically solid and competent. Over time I came to the same conclusion. We became, and remain, colleagues. I now refer patients to her without any reservation.

Over the next 10 years I served as the supervising psychiatrist to 5 PMH-APRNs in various clinical settings in...

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