|Author: Christie Rose|
|PA Devotes Career to Psychiatric Care|
|William Hardy, MS, PA-C, works in the challenging field of mental health as a psychiatric Physician Assistant at Skyview Mental Health Facility in Rusk, Texas. Skyview is a part of the University of Texas Medical Branch of Galveston, Texas.
Hardy was an inquisitive high school student at Madisonville High School in Madisonville, Texas, where he was an active member of the school's Medical Explorers group. This group investigated health career options. A physician assistant, Mr. McFarland was the adult sponsor of the Medical Explorers and the man who introduced Hardy to the physician assistant profession. McFarland, an ex -Navy Corpsman was grandfathered into the Texas Department of Justice as a physician assistant. "You have to understand," says Hardy, "that this was 1974, a time when the profession of physician assistant was so new it practically sparkled. Few people had ever even heard of it."
Piqued by this early contact, Hardy's initial interest grew and he followed up with a B.S., PA at Howard University in Washington D.C. He joined the Physician Assistant Program in 1978. Hardy first put his medical skills to work at Dr. John Kenney's office where he worked as a PA in Dermatology during 1980-82. Late in 1982 Hardy got his first job in the corrections field with the U.S. Department of Justice in El Reno, Oklahoma where he was a general Physician Assistant. The Veteran's Administration Hospital in Oklahoma City recruited him in 1989. There he worked as a PA on an inpatient psychiatric ward. This was where Hardy first got interested in combining his physician assistant work with psychiatric care. In 1995 he transferred to the VA Medical Center in Kansas City, again working as a psychiatric PA, in order to be closer to his wife's parents. Then, in 1998 Hardy attended the University of Nebraska to take advantage of their MS-PA program.
As he worked in the medical field, Hardy did not forget his training. He continued to work as a PA while working toward his MS-PA at University of Nebraska College of Medicine.
The major focus of the Skyview Mental Health Facility where Hardy has worked since 1996, is to provide comprehensive quality mental health to inmates within the Texas Department of Criminal Justice system. There, Hardy evaluates and treats a wide variety of individuals who suffer from various types of mental or emotional problems. Skyview offers several levels of care including inpatient psychiatric care, outpatient psychiatric care, psychiatric crisis management, and acute, intermediate, and chronic psychiatric care.
When Hardy started his career at Skyview, he was the first physician assistant hired to work exclusively in the specialty field of psychiatry. He now finds that his job ranges from doing psychiatric evaluations, psychiatric diagnostic formulations, ordering and interpreting pertinent laboratory tests, prescribing psychoactive medications, developing individualized treatment programs, and follow-up psychiatric maintenance care. "After twenty years in this field," Hardy says, "I still find it an exciting and fascinating arena in which to practice."
Hardy's typical day-to-day responsibilities include evaluating and diagnosing patients with psychopathological signs and symptoms. The most frequent diagnoses he encounters are psychotic disorders, mood disorders, personality disorders, and anxiety disorders. "My greatest challenge," says Hardy, "is treating patients with antisocial and borderline personality disorders who are also chemically dependent and drug seeking." According to Hardy, these patients will often act out with extremely threatening or self-destructive behaviors. "They can be very manipulative," Hardy says. "It definitely keeps me on my toes."
As a psychiatric PA, Hardy does very little general medicine. For one thing, the psychiatric caseload is heavy enough to justify a full schedule of psychiatric patients. Also, the availability of general medical physicians and physician assistants at his facility frees him up for nearly full-time psychiatric care. He works four ten-hour days with a three-day weekend, and once or twice a month, he is on call. Although he has a supervising Psychiatrist who comes in bi-weekly to review and sign off on about 10% of his charts, Hardy works in a fairly autonomous atmosphere, which is to his liking.
He also teaches psychiatric diagnosis and evaluation for DSM-IV which is a diagnostic statistic manual in the training program for both graduate and undergraduate PAs at UTMB and the University of North Texas Health Science Center at Fort Worth.
Hardy finds his work as a psychiatric PA extremely rewarding. "It's gratifying to see psychiatric patients respond so dramatically to the appropriate treatment," Hardy says. "To assist a psychotic patient's return to sanity, or a depressed patient to regain a sense of joy, or a manic patient to regain mood stability, or to help a panic-stricken patient relax and resume normal daily function, is for me so very exciting." Another obvious perk that Hardy enjoys but doesn't focus on is that the pay scale for a psychiatric physician assistant is higher for this specialty simply because of the lack of experienced psychiatric PAs.
When Hardy worked with the University of Texas Medical Branch Correctional Managed Care Organization (UTMB), he played a lead role in developing and promoting physician assistants in the field of psychiatry. The first thing he did was to establish a preceptor training agreement with two physician assistant programs in order to provide clinical rotations in psychiatry for PA students.
At the time, UTMB sponsored the founding luncheon meeting for psychiatric physician assistants which was held during the 26th annual AAPA (American Academy of Physician Assistants) Conference held in Salt Lake City, Utah in May of 1998. This kick-off effort was such a tremendous success it resulted in the 1998 AAPA House of Delegates giving their approval for the specialty recognition of "psychiatric physician assistants." This, in turn, paved the way for the establishment of the Association of Psychiatric Physician Assistants (APPA). During the meeting, the Articles of Incorporation and by-laws, authored by Hardy himself, were approved and endorsed.
Hardy's second goal was to establish the nation's first (and currently only) Psychiatric Physician Assistant Residency Training Program. This training program was approved by the Association of Postgraduate Physician Assistants Programs during their 1998 conference. The program provides residency-style on-the-job training to physician assistants who are interested in enhancing their knowledge and therapeutic skills in caring for the mentally ill. That means that on completion, successful students will be eligible to receive a Certificate of Completion from the UTMB Managed Care Health Service and a Master's Degree from the University of Nebraska Medical Center. Hardy has served as the coordinator and clinical instructor of this program since its inception.
In the future, Hardy plans to pursue writing, teaching, public speaking, and completing a doctoral level degree in religious counseling. He just completed his dissertation on religious counseling in a psychiatric setting and will soon earn his Ph.D. in this specialty field. Hardy also wants to obtain a Licensed Professional Counselor's Certification. But he is not sitting back and waiting for these accomplishments to come to pass of their own accord. He has done some teaching with his training of graduate and undergraduate PAs at UTMB and the University of North Texas Health Science Center at Forth Worth where he was named "Preceptor of the Year 2000." And, he has more than dabbled in the writing arena. He has also written a book. Mid-level Psychiatric Practitioner's Protocol was designed to provide some practical guidelines and scope of practice for psychiatric PAs and NPs. This book covers such concepts as evaluating and testing psychiatric mood, anxiety and impulse control disorders.
Hardy has also been active on the lecture circuit. He spoke at the AAPA Annual Conference in both 1999 and 2000. In 1999 he spoke on utilization of PAs in psychiatry and in 2000 he spoke on physical illnesses that mimic psychiatric illnesses. He has also spoken at the National Commission on Health Care. In 1998 he spoke on psychiatric PAs in a correctional setting. He followed that up in 1999 with a talk on professional training in a correctional setting. In 2000, Hardy spoke on recognizing psychiatric medical emergencies.
Hardy has been married for 21 years and has five children. His wife and 4 daughters accompanied Hardy on a Christian mission to Haiti in 1999. Having served in this capacity himself, bringing general medical care to the people of Guatemala and the Central Americas in 1987, Hardy was anxious to share the experience with his family. The Hardys primarily sponsored their own trip, taking with them $6,000 to $7,000 worth of medical supplies for the people of Haiti. The family lived in a local orphanage and visited nearby towns treating 60 or 70 people a day. As team leader, Hardy directed each case. "Most of what we saw was wound care, nutritional needs where vitamin supplements were given, skin problems, and standard-issue problems such colds and flu." Hardy's prior work experience with the dermatologist at the beginning of his career was a definite plus while serving in Haiti. "It was quite an experience," Hardy says. "We wanted to go back in 2000 but the political climate was pretty unstable." Instead, they sent supplies to their contacts in Haiti, sending what their experience had taught them was most needed to the areas where need was critical.
Hardy has also served as a medical specialty officer for the Army National Guard for the past 18 years. One weekend each month and two weeks in the summer in service to his country, continues to be a source of professional pride and camaraderie. He is currently in the process of being promoted from Captain to the rank of Major.
"I've had such a great life," Hardy says, "Physician Assistant was definitely the career for me. I wish I could find Mr. McFarland and tell him what a difference he made in my life."
William Hardy received his B.S. PA degree from Howard University in Washington D.C. in 1978. In 1998 he earned his MS-PA from the University of Nebraska. In late 1982 Hardy got his first job in the corrections field with the U.S. Department of Justice in El Reno, Oklahoma. In 1989 he began working as a psychiatric PA at the Veteran's Administration Hospital in Oklahoma City. Hardy authored the Articles of Incorporation and by-laws for the Association of Psychiatric Physician Assistants (APPA), a group he was instrumental in founding after the American Academy of Physician Assistants gave their blessing to the formation of specialty recognition of psychiatric physician assistants. Hardy teaches psychiatric diagnosis and evaluation for DSM-IV. He also a clinical instructor who helped establish a residency-style on-the-job training program for PAs interested in working with mentally ill patients. Hardy's book Mid-level Psychiatric Practitioner's Protocol is a hands-on practical guideline for psychiatric PAs. He has given several lectures for professionals in his field and is an active member of both the American Academy of Physician Assistants and the Association of Psychiatric Physician Assistants.
Christie Rose is a freelance from California. She is on the editorial staff of NEWS-Line for Physician Assistants.