Elise Haupt was hoping to land a physician assistant position in a community health care setting in the Twin Cities when she graduated from George Washington University last August.

An AmeriCorps veteran, Haupt wanted to combine her interests in social justice and public health. When she couldn't find a PA job, Haupt found another opportunity - a one-year fellowship in psychiatry for physician assistants and nurse practitioners at Regions Hospital (regionshospital.com) in her home town of St. Paul.

The fellowship's director, Tracy Keizer, went through the program in 2008. As president-elect of the Minnesota Academy of Physician Assistants (mnacadpa.org) she sees a need for more PAs in psychiatry.

Psychiatry wasn't her first choice, either, but when Keizer went through rotations as a PA student at Augsburg College in Minneapolis (augsburg.edu), she got to know patients with serious and persistent mental illness, such as schizophrenia and bipolar disorder. The biopsychosocial approach to working with hospitalized mental health patients piqued her interest.

"Working inpatient is a very exciting opportunity - working with patients at their sickest and to be able to see them get better in a rather quick fashion," Keizer said.

Physician assistants receive much the same didactic education as medical doctors, but in a master's degree timeframe. They work under the supervision of physicians and are licensed to diagnose and prescribe medications.

Keizer sees eight to 10 patients a day, making admissions and discharge decisions, writing treatment plans and collaborating with psychiatrists, nurses and social workers. Most psychiatry PAs she knows are working inpatient as well.

"It's relatively new that psychiatric recruiters are looking for physician assistants," Keizer said. Salaries range from $80,000 to $120,000 in the Twin Cities.

Haupt's fellowship has taken her on rotation with the Ramsey County Assertive Community Treatment team, an interdisciplinary group of mental health professionals who work intensely with local residents with severe mental illness to keep them from being hospitalized.

"We literally meet them where they're at," Haupt said, whether that be an apartment, transitional or group housing, or even McDonald's.

She also worked in an outpatient clinic at Regions and in neurology, addiction and child psychiatry rotations. Haupt hopes to remain at Regions or find work in a community mental health setting when her fellowship ends in January.

"I am trying to brainstorm and pull pieces together during this fellowship, and I think it will evolve throughout my career," she said. "There are not many primary care jobs around. It's still a tricky economy and a tricky market."