Finding Your Path in Medicine: A Psychiatric PA’s Journey Through Uncertainty and Purpose

Feeling lost in your medical career? Learn how a psychiatric PA’s unconventional journey offers insight into purpose, resilience, and meaningful patient care.

When Your Career Path Doesn’t Feel Clear

At some point in medicine, many of us quietly ask the same question:

“Am I in the right place?”

It doesn’t always come during training. Sometimes it shows up years into practice—when the pace is relentless, the connection feels thin, or the work no longer aligns with what initially drew us to healthcare.

In this Mini Mindset episode, we explore that exact moment through the story of Jo Hughes, a psychiatric PA whose path into mental health was anything but linear. Her journey reflects something many clinicians experience but don’t often talk about: uncertainty, redirection, and ultimately, rediscovery of purpose.

A Nonlinear Path Into Psychiatry

Jo Hughes didn’t begin her career in psychiatry—or even on a traditional pre-med path. With a background in business and years in emergency medicine, her early career was shaped by fast-paced environments, high acuity, and the need for rapid decision-making.

But over time, something shifted.

Emergency medicine offered intensity and breadth—but not always continuity, reflection, or deeper understanding of the patient experience. Like many clinicians, she began to recognize that the most complex cases weren’t just medical—they were human.

This transition wasn’t driven by a single moment. It was shaped by:

• Personal experiences with illness in her family

• A growing awareness of the limitations of episodic care

• A deeper pull toward understanding the “why” behind patient presentations

Her story reflects a broader truth in healthcare:

Our paths are often shaped not by certainty—but by paying attention to what feels meaningful over time.

From “What’s Wrong?” to “What Happened?”

One of the most important shifts in psychiatric care—and in medicine as a whole—is moving from a problem-focused lens to a trauma-informed perspective.

Instead of asking:

• “What’s wrong with this patient?”

We begin to ask:

• “What has this patient experienced?”

This reframing is foundational in psychiatry, but it applies across all specialties.

Why this matters clinically:

• Many physical symptoms have psychological or trauma-related components

• Patient behaviors often reflect adaptive responses to past experiences

• Mislabeling patients can lead to missed diagnoses and fractured trust

Jo’s journey highlights how psychiatry allows for slowing down, listening differently, and building relational understanding—something often difficult to achieve in more acute care settings.

The Power of Saying “Yes” in Medicine

A recurring theme in this conversation is simple—but powerful:

Say yes to opportunities, even when the path isn’t fully clear.

Throughout her career, Jo leaned into experiences that weren’t always planned:

• Transitioning specialties

• Taking on leadership roles

• Starting new clinical ventures

Each step added depth—not just to her resume, but to her clinical perspective.

Clinical takeaway:

Exposure to diverse patient populations and care settings:

• Improves diagnostic reasoning

• Builds adaptability

• Strengthens empathy and communication

For clinicians feeling “stuck,” this is an important reminder:

👉 Growth in medicine often comes from movement, not certainty

Integrating Mental Health Across All Specialties

One of the most relevant takeaways from this episode—especially for today’s healthcare environment—is this:

Mental health is not confined to psychiatry.

Whether you practice in primary care, emergency medicine, orthopedics, or women’s health—you are already managing mental health every day.

Common clinical realities:

• Anxiety presenting as chest pain

• Depression affecting treatment adherence

• Trauma influencing pain, sleep, and behavior

• ADHD impacting academic, occupational, and relational functioning

Yet many clinicians still feel underprepared to address these components.

Practical application:

• Use brief screening tools (PHQ-9, GAD-7)

• Normalize mental health conversations in routine visits

• Recognize when to treat vs. refer

• Approach patients with curiosity, not assumption

This is where your broader message resonates deeply:

Every clinician practices mental health care—whether they realize it or not.

Balancing Medicine, Identity, and Life Outside the Clinic

Another important layer of Jo’s story is one that often goes unspoken in medicine: how we sustain our careers over time.

Behind every professional transition are real-life considerations:

• Family responsibilities

• Personal health

• Evolving priorities

Her journey underscores the importance of:

• Support systems

• Flexibility

• Self-awareness

For clinicians:

Burnout doesn’t always come from workload alone—it often stems from misalignment between values and daily work.

Taking time to reassess your path is not failure.

It’s clinical self-awareness applied inward.

Evidence-Based Perspective: Why This Matters

Research consistently shows that:

• Clinician burnout is linked to reduced empathy, increased errors, and lower patient satisfaction

• Integrated behavioral health improves outcomes across chronic conditions

• Trauma-informed care improves engagement and long-term treatment adherence

From a neurobiological standpoint:

• Chronic stress and trauma impact the HPA axis, emotional regulation, and physical health

• Mental and physical health are deeply interconnected—not separate systems

This reinforces a key takeaway:

👉 Understanding the patient’s story is not optional—it’s clinically essential

Key Takeaways for Clinicians

• Your path doesn’t have to be linear to be meaningful

• Pay attention to what feels misaligned—it often signals growth

• Mental health is present in every clinical setting

• Trauma-informed care improves both diagnosis and connection

• Saying “yes” to new opportunities can shape your clinical identity in unexpected ways

Final Reflection

If you’ve ever questioned your place in medicine—or felt pulled in a different direction—you’re not alone.

And more importantly:

👉 You’re not behind.

Careers in healthcare are not built in straight lines. They are shaped through experience, reflection, and the willingness to evolve.

🎧 Listen to the Full Episode

Want to hear the full conversation and deeper insights from this journey?

🎙️ Tune into this episode of Mindset Matters on:

• YouTube

• Spotify

• Apple Podcasts

Menopause & Mental Health: Is It Depression… or Hormones?

“I just don’t feel like myself.”

If you’ve practiced in any clinical setting long enough, you’ve heard this—often from patients in midlife who can’t quite name what’s changed, only that something feels off. Mood is lower, sleep is disrupted, focus is slipping, and the usual strategies aren’t working.

It’s easy to reach for familiar diagnoses: major depressive disorder, generalized anxiety, maybe even ADHD. But what if we’re missing a key driver?

What if this isn’t just depression—but a hormonal transition?

Why This Matters in Clinical Practice

Perimenopause and menopause are not niche topics—they are common, under-recognized clinical realities that cut across primary care, psychiatry, women’s health, and therapy settings.

Too often, midlife patients are labeled with depression or anxiety without fully exploring the biological transitions occurring beneath the surface. When we miss that layer, we risk:

• Partial or poor treatment response

• Frustration for both patient and clinician

• Mislabeling “treatment resistance” when the formulation is incomplete

The opportunity here is not just better diagnosis—it’s more precise, compassionate care.

What the Evidence Shows — The Role of the SWAN Study

One of the most important longitudinal studies informing this space is the Study of Women's Health Across the Nation (SWAN). This large, multi-site study has helped clarify what many clinicians are now seeing in practice:

• The risk of depressive symptoms increases during perimenopause, even in women with no prior psychiatric history

• Mood changes are not simply situational—they are often tied to hormonal fluctuation and neurobiological vulnerability

• This transition represents a distinct risk window, not just a continuation of prior mental health patterns

  
  

For clinicians, this reinforces a critical shift:When a midlife patient presents with new-onset mood symptoms, the question is not just “Is this depression?”—but also,“Is this a transition?”

The Overlap — When Hormones Mimic Mental Health Disorders

Perimenopause is a time of neuroendocrine instability, not simply decline. Fluctuating estrogen and progesterone levels influence key neurotransmitter systems, including serotonin, dopamine, and GABA.

Clinically, this can look like:

• New-onset anxiety or irritability

• Tearfulness or low mood

• Sleep disruption

• Cognitive changes (“brain fog”)

• Reduced stress tolerance

  
  

This period is often described as a “window of vulnerability”—where emotional regulation feels less stable and patients may feel like they’re on “shifting sands.”

Importantly, symptoms may mimic primary psychiatric disorders, making differentiation challenging without a broader lens.

The Diagnostic Challenge — Rethinking “Treatment Resistance”

A common scenario:A patient in her late 40s presents with anxiety and low mood. An SSRI is started. There’s some improvement—but not enough. Fatigue persists. Sleep is poor. Cognition feels off.

At this point, it’s tempting to ask:Is this treatment-resistant depression?

But another question may be more helpful:What are we missing?

Hormonal fluctuations can drive symptoms that don’t fully respond to standard psychiatric treatment alone. Without addressing sleep disruption, vasomotor symptoms, or hormonal contributions, medications may only partially help.

Reframing “treatment resistance” as “incomplete formulation” shifts us back into curiosity—and better care.

Clinical Clues You Shouldn’t Miss

When evaluating midlife patients, these clues can help differentiate hormonal contributions from primary psychiatric conditions:

• Vasomotor symptoms: hot flashes, night sweats

• Sleep fragmentation (often unexplained or new onset)

• Menstrual cycle changes or irregularity

• Midlife onset of symptoms without prior psychiatric history

• History of hormone-sensitive conditions:

  • Premenstrual dysphoric disorder (PMDD)

  • Postpartum depression

• Cognitive complaints (brain fog, memory lapses)

• Trauma history, which may amplify vulnerability during this transition

  
  

These are not just “extra questions”—they are diagnostic anchors.

Practical Treatment Considerations

Once we recognize the pattern, treatment becomes more targeted.

Medication Strategies

• SNRIs may be more effective than SSRIs when vasomotor symptoms are present, as they can address both mood and physical symptoms

• Be cautious with medications that have significant drug-drug interactions (e.g., paroxetine in certain contexts)

  
  

Hormonal Interventions

• Hormone Replacement Therapy (HRT) can be a critical component for some patients

• Collaboration with OB-GYN or women’s health providers is essential

  
  

Sleep as a Priority Target

Sleep disruption is often the central driver of worsening mood and cognition. Addressing it directly—through behavioral strategies or medication when appropriate—can significantly improve outcomes.

Behavioral & Lifestyle Interventions

• Cognitive Behavioral Therapy (CBT)

• Mindfulness and stress reduction

• Regular exercise

• Sleep hygiene optimization

These are not adjuncts—they are foundational supports during this transition.

Collaborative Care

Perimenopause is a multisystem experience, not a siloed condition. The most effective care often involves:

• Psychiatry or primary care

• OB-GYN or hormone specialists

• Therapists

When we collaborate, patients benefit.

The Bigger Picture — A Reproductive Mental Health Timeline

Perimenopause is not an isolated event—it’s part of a broader pattern of hormone-sensitive mental health shifts across a woman’s lifespan.

We already recognize:

• PMDD (cyclical hormone-related mood changes)

• Postpartum depression (rapid hormonal withdrawal)

Perimenopause follows a similar principle—but with less predictability and more fluctuation.

Framing mental health through this reproductive timeline helps normalize patient experiences and improves diagnostic clarity.

Trauma-Informed & Patient-Centered Care

At its core, this work requires a shift in how we approach patients.

Instead of asking:“What’s wrong with you?”

We ask:

• “What’s been changing in your body?”

• “What patterns are you noticing?”

• “What has or hasn’t been working lately?”

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Many patients have spent months—or years—being told their symptoms are “just stress” or “just part of aging.” Validation matters.

So does humility.

We don’t always have immediate answers. But when we stay curious, we create space for more accurate understanding and stronger therapeutic alliance.

Key Clinical Takeaways

• Not all midlife mood symptoms represent primary psychiatric disorders

• Hormonal fluctuations can significantly impact mood, sleep, and cognition

• Always assess for vasomotor symptoms and sleep disruption

• Reconsider “treatment resistance” as possible incomplete formulation

• Treat the symptom pattern, not just the diagnostic label

• Brain fog is common—and often temporary and reversible

✨Continuing Education & Resources for Clinicians

As awareness grows around menopause and mental health, so does the need for high-quality, clinically relevant education.

The American Academy of Physician Associates (AAPA) offers a dedicated psychiatry learning pathway through its CME platform, including content focused on women’s mental health across the lifespan.

One recommended course:

• “A Woman’s Mental Health Journey Through Life’s Transitions” — a clinically grounded session that explores perimenstrual, peripartum, and perimenopausal mental health considerations with practical application.

👉 Access the course here:https://cme.aapa.org/courses/innetwork-cme-a-womans-mental-health-journey-through-lifes-transitions

👉 Explore the full psychiatry learning pathway:https://cme.aapa.org/learn/learning-path/innetwork-cme-psychiatry

These resources are available through your AAPA CME Learning Center account and are a valuable way to deepen your understanding of reproductive psychiatry and integrated care models.

✨Final Thoughts

Menopause and perimenopause are gaining long-overdue attention—and for good reason. As clinicians, we are in a position to bridge the gap between mental health and hormonal health.

That starts with awareness. It continues with curiosity. And it’s sustained through collaboration.

Because when we expand our lens—from diagnosis to transition, physiology, and lived experience—we don’t just improve treatment. We improve trust, outcomes, and the way patients experience care.

🎧 Want to go deeper? Listen to the full Mini Mindset episode on menopause and mental health on your favorite podcast platform, including YouTube and Podbean, Spotify, Apple Podcast.

Exploring Psychiatry with Ava Smith: A Journey from Emergency Care to Academia

In this week's episode, we had the pleasure of speaking with Ava Smith, a seasoned PA in psychiatry, to explore her remarkable journey, experiences, and insights within the field.

Connecting Through a Shared Passion

Ava Smith and the hosts connected through the PAs in Psychiatry group on Facebook and further bonded during a Peloton challenge. From the outset, Ava's diverse background in emergency psychiatry and academia stood out. Her transition from emergency to outpatient psychiatry was driven by her desire to build long-term relationships with patients and witness the impact of her treatments over time.

A Personal Journey into Psychiatry

Ava's path to becoming a PA stemmed from her early interest in medicine, inspired by her family's medical background. It wasn't until she stumbled upon the PA role in her thirties that she found her true calling. Her personal experience with her mother's mental illness fueled her ambition to provide quality psychiatric care. Ava's story is a testament to how personal experiences often shape career trajectories in mental health.

Challenges and Achievements in the Field

Throughout her career, Ava encountered various challenges, one being the limited recognition of PAs in psychiatric roles. Her advice to aspiring PAs is to network boldly, ask questions, and actively seek learning opportunities, even when jobs don't specifically list the PA profession.

Ava's role at Texas A&M College of Medicine involves outpatient work and instructing future medical professionals. She mentors PA students and psychiatry residents, emphasizing the importance of effective communication and patient interaction skills. Her areas of interest include bipolar disorders, mood disorders, anxiety, and trauma-related disorders.

Navigating State Regulations in Psychiatry

Ava discusses the regulatory challenges faced by PAs, particularly in states like Texas, where PAs aren't authorized to prescribe controlled substances to minors. Despite these hurdles, Ava is optimistic about legislative changes and continues to advocate for expanded PA prescribing authority.

Maintaining Balance: A Passion for Puzzles and Peloton

Amidst her busy schedule, Ava relishes in solving jigsaw puzzles and enjoys the community and motivation offered by Peloton classes. Her journey with Peloton echoes the importance of finding motivating exercise routines that fit one's personality and lifestyle.

Resources and Inspirations

For continuous learning and inspiration, Ava recommends podcasts such as Dr. David Puder’s "Psychiatry and Psychotherapy," "The Carlat Podcast," and "The Curbsiders Teach." These resources offer valuable insights into psychopharmacology, patient care, and medical education.

A Call to Future PAs

The episode concluded with a call to action for aspiring PAs to advocate for themselves and actively seek experiences in psychiatry. Ava's journey is a powerful reminder of the impact PAs can have in mental health and the importance of pioneering roles within the profession.

Tune In and Stay Connected

Thank you for joining us on this insightful episode of The PA Mindset Matters podcast. Stay tuned for more stories and professional insights by following our podcast on platforms like Spotify, Apple Podcasts, and Podbean. Watch us on YouTube and connect with us on Instagram and LinkedIn. Until next time, continue to explore the dynamic world of psychiatry with us!