Some thoughts about our mutual field
Can we move past the guild issue and come together to respect our given scopes of practice? I see psychiatry far ahead of the curve compared with APRNs in other specialties. The PMH-APRN is a highly educated nurse with a specific scope of practice that provides skilled psychiatric care (assessment, diagnosis, prescribing, psychotherapy) from a nursing perspective. Independent practice certainly does not imply that we do not collaborate with one another in a professional manner.
Mental Health Professional Shortage Areas
As of January 1, 2017, there are 4,627 Mental Health Professional Shortage Areas (MHPSA) in the United States and Territories (Table), which translates to only 44.2% of the need for psychiatric practitioners being met.15 To eliminate the designation of a MHSPA there must be a population to psychiatric provider ratio of at least 30,000 to 1 (20,000 to 1 if there are unusually high needs in the community). Currently 3,397 practitioners are needed to remove the designation across the United States. The state in most need of providers is Texas with 271 clinicians required to meet the need.
Considering that approximately 700 PMH-APRNs graduate each year16 and 1,317 psychiatry residents17 entered PGY-1 residency in 2016, it will be decades—or longer—before there are enough new providers to eliminate MHPSAs, particularly because the current workforce is aging (average age of the PMH-APRN is 55).
Because there are more than enough patients to go around, I encourage the APA to take a stand against the AMA and unite with the psychiatric APRNs to remove unnecessary barriers to practice and promote a unified and collegial workforce. This will transmit a strong message to the most underserved of our communities that psychiatrists and psychiatric nurse practitioners can emulate the therapeutic relationship by virtue of presenting a unified force. Imagine psychiatrists and psychiatric nurse practitioners going arm in arm to lobby county commissioners, state legislators, and Congressional Representatives and Senators. Together we could be a true force to be reckoned with.