My name is Michael Asbach and I am a Psychiatric PA. I have worked in psychiatry for 11 years and I’d like to take you through a typical day in my outpatient behavioral health clinic. Psychiatry is an exciting and innovative field of medicine but is a specialty PAs have historically not pursued. Within the US, access to mental healthcare remains inadequate. I hope that through this blog, I can help other PAs and NPs see the joys and fulfillment that come with a career in psychiatry.
I practice clinically at DENT Neurologic Institute, one of the largest outpatient neuroscience centers in the country. DENT has many different neurologic specialty clinics including MS, neuro-oncology, movement disorders, memory, and more. A behavioral health department within a neurology practice demonstrates how much our understanding of mental illness has evolved.
Psychiatry was born within the field of neurology, only to split into its specialty in the early 20th century due to the lack of a neuroscientific model of illness. With time, we have come full circle and our understanding of brain neuroscience has returned psychiatry to its rightful place as a biologically focused specialty. At DENT, most of our behavioral health patients have a co-morbid neurologic diagnosis. Chronic neurologic illnesses such as MS, migraine, and dementia are all associated with higher rates of mental health struggles. Within DENT Behavioral Health, each provider carries a panel of approximately 800-1200 patients.
In addition to my role as a psych PA in the DENT behavioral health department, I also lead the DENT Interventional Psychiatry clinic. Interventional Psychiatry is a relatively new sub-specialty focused on rapid-acting and procedurally focused interventions for mental illness. Within the interventional psychiatry clinic, we offer various innovative treatments including intravenous ketamine, intranasal esketamine, transcranial magnetic stimulation, long-acting antipsychotic injections, injectable long-acting addiction treatments, and soon, psychedelic compounds.
A normal day in the clinic typically includes around 15 behavioral health visits and 15-20 interventional psychiatry treatments.
The clinic can sometimes feel like a chaotic but beautifully choreographed dance. When everything runs smoothly, it is beautiful, efficient, and gratifying. But when something goes wrong, it is chaotic and messy, but still a lot of fun as a provider. Most interventional treatments require a provider to be on-site to oversee the therapy, but the treatments themselves are carried out by techs and other members of the team. When I first arrive, I will review the upcoming day and ensure that we are tracking all scheduled interventional treatments. If a new patient is scheduled, I will review their chart and ensure orders are placed with the correct dosing and treatment protocol. I will often huddle with our treatment team to discuss any potential issues or talk through possible pain points, either clinically or logistically.
Once the day is prepped, I will begin seeing my behavioral health patients. I usually conduct 3 visits per hour, primarily providing medication management with brief psychotherapy. During behavioral health visits, we focus on whether the medications are helping, hurting, and tolerable. We also review the importance of overall wellness as it relates to mental health. Exercise, diet, sleep, and stress management are all critical components of emotional well-being. Additionally, having social support from loved ones is a key factor for emotional resilience and we often work with patients to try to help build these social connections through family, friends, and community.
During my behavioral health clinic, I try to pop into the interventional treatment room at least once or twice an hour. I like to check in on patients receiving interventional therapies and check in with staff to make sure there are no developing issues. The interventional treatment team keeps me updated on any potential adverse reactions or tolerability concerns as patients are receiving treatment. If an issue occurs during an interventional treatment, the team will pull me from my office to assess and triage the problem. Thankfully, our interventional team has been together for several years and has become adept at handling anything that Murphy’s law throws at them.
I start my day at 6:45 am and finish up my clinic day around 4:00 pm. One of the best parts of my job is that we are an outpatient clinic and operate Monday through Friday, no holidays no weekends. As a student, I always expected that a healthcare career would involve times when work would include atypical hours. I consider myself lucky and blessed to have a job with predictable and traditional hours. The work-life balance of psychiatry is very important as I believe it helps combat career burnout that is so prevalent in the healthcare profession.
I love psychiatry. I love my career as a PA. I have found a job with a broad level of autonomy where we make a meaningful difference in patients’ lives daily. One of the best parts of the PA profession is the positional flexibility to move within different specialties. If you are a PA or NP with an interest in psychiatry, I strongly encourage you to consider this field. The need for passionate and empathetic providers remains high, and greater mental health access leads to better patient outcomes.
Michael Asbach
DMSc, PA-C, Psych-CAQ
Associate Director of Interventional Psychiatry
DENT Neurologic Institute