Addressing Psychiatric Workforce Shortages: The Role of Advanced Practice Psychiatric Nurses and Physician Assistants

The Controversies in Psychiatric Services column aims to highlight differing viewpoints on topics relevant to psychiatric services that have generated a debate or a divide in opinion. For this column, the editorial team chose to focus on the role of advanced practice psychiatric nurses (APRNs) and physician assistants (PAs) in addressing psychiatric staffing shortages, asking authors to respond to the following statement:

Psychiatrist staffing shortages have been exacerbated by the COVID-19 pandemic, limiting access to mental health treatment. Increasing the role of advanced practice psychiatric nurses and physician assistants in the delivery of psychiatric services is the best approach to address these shortages.

Li and Gates argue that recruiting APRNs and PAs is a better and more cost-effective mental health workforce solution than physician-focused locum tenens or telehealth hiring. These authors further suggest that stronger training, supervisory, and organizational structures need to be developed to support an expanded APRN/PA workforce and to address concerns about limitations in the training background of its members. In contrast, Tepper and Farb see the scope argument as artificially confining thinking about how mental health service needs should be approached. They maintain that expanding the roles of APRNs and PAs will not address the field’s access issues and that narrowly focusing on this solution wastes energy that would be best directed toward broader structural changes. As mental health service demand rises and access remains limited, we hope that these two viewpoints provide objective, thought-provoking perspectives on how and whether APRN and PA role expansion can help address this crisis.