Kathryn Werner, PA-C: From a Rocky Psych Rotation to Thriving Practice Owner — Clinical Pearls, OCD Care, and Building a Sustainable Career

Guest: Kathryn Werner, PA-C — Owner, White Pine Mental Health & Wellness; Senior Consultant at CPAC Team

Quick take

Kathryn Werner didn’t love her psych rotation. She almost went into surgery. A credentialing snag pushed her into an outpatient psychiatry role with a generous mentor—and that changed everything. Fifteen years later, she runs a tele-psychiatry practice, treats a large cohort of OCD patients, consults on practice start-ups, and speaks nationally on smart prescribing and de-prescribing.

This post gathers her most useful clinical pearls and career lessons for PAs interested in psychiatry (or already living it).

How she got here (and why the detour mattered)

• A rocky start: As a student, Kathryn’s psych rotation offered little patient contact. “Boring” was her word.

• The pivot: Hired by a psychiatrist to do intake physicals at a psych hospital (2007), she was blocked by credentialing. The win? Joining the psychiatrist’s outpatient clinic instead—where she was taught deliberately, starting with 1–2 patients/day, time to shadow, read, and study.

• Generalist roots, specialist vision: Stints in GI/hepatology research (as a sub-investigator on early HCV-curing regimens) and later in family/internal medicine sharpened her “whole-patient” lens before returning to psych full-time.

“When you see patients as frequently as we do in psych, you can catch medical issues earlier—BP trends, thyroid, anemia—then treat the right problem.”

Why primary care skills supercharge psychiatric care

• Better differentials: Fatigue + low mood? Don’t miss iron deficiency or thyroid disease.

• Right-sized workups: Vitals, brief focused exams, and targeted labs prevent both under- and over-referrals.

• Function first: Frequent, longer visits (her standard follow-up is 30 minutes) let you track outcomes and adjust care without rushing.

Pro tip: Normalize sensitive topics (sexual function, substance use, sleep). Patients expect you to ask—especially when they’re on meds where side effects matter.

Treating OCD: ask better questions, treat to target

Kathryn deliberately markets a niche in OCD and partners closely with therapists trained in ERP.

What she sees often

• Under-recognition (both providers and patients): “Relational OCD” can sound like “normal anxiety” until you ask how many hours/day are lost to rumination or checking.

• Sub-therapeutic trials: Patients discouraged after SSRI at “depression” doses (e.g., sertraline 100 mg). OCD often needs higher doses and longer trials, combined with ERP.

What helps

• Education with a simple model: intrusive thoughts → distress → compulsions/neutralizing → short-term relief → loop

• Normalize that everyone has intrusive thoughts. Pathology = time lost + impairment + compulsions/avoidance.

• Collaborate early with ERP therapists; set expectations about dose ceilings and duration before declaring non-response.

Smart polypharmacy: when to add, when to peel back

Kathryn will co-presents at Psych Congress (PA Institute) on a practical framework:

• Add when a clear, untreated target symptom remains after an adequate single-agent trial (right dose, right duration, right diagnosis).

• De-prescribe when side-effect burden, duplication, or unclear indication accumulates; taper methodically with patient-centered goals.

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Reality check: laws, logistics, and practicing across states

• State variability is real: Prescriptive authority (especially controlled substance), payer credentialing, and allowable codes differ widely.

• Example: She’s practiced in states where payers wouldn’t credential PAs as psych providers (even with a CAQ) or wouldn’t pay psych assessment codes for PAs.

• Clinic policy: Her current practice avoids controlled substances in one state due to cumbersome rules; she prioritizes access + safety over administrative burden.

“When PAs ask how to start in psych, my first question is: what state are you in? The plan depends on it.”

What she actually uses (and recommends to new psych PAs)

• DSM (full): Use the decision trees/flowcharts to parse tricky differentials (e.g., OCD vs anxiety vs psychotic spectrum).

• Stahl’s Prescriber’s Guide: Bread-and-butter pharmacology and dosing nuance.

• Interview guides: “The First Interview” style texts (any solid edition) to sharpen diagnostic interviewing.

• Free CME she likes:

  • MGH Psychiatry (esp. OCD-related topics)

  • Sheppard Pratt OCD CME (a 1-hour psychopharm talk she calls “practice-changing”)

Practice design = clinician well-being

• Visit length: 30-minute follow-ups reduce adrenaline-driven days and errors.

• Schedule control: Telemedicine + owner flexibility (e.g., blocking time for a midday yoga class) preserves longevity.

• Self-care that actually happens: Counselors for clinicians, chiropractic, massage, pizza night—Feel-Good Fridays.

• Micro-check-ins: “Habit stack” a 60-second self-scan every bathroom break—breathe, ask: What do I need in the next 3 hours? Food? Water? A reset?

Advocacy & the next 5–10 years

• More psych PAs in leadership and ownership

• Cleaner statutes on PA mental health services, prescriptive authority, and payer recognition

• Curricular emphasis on psychiatry across PA programs

• Team-forward conferences: The PA Institute at Psych Congress brings PAs, MDs, and (sometimes) NPs together—because care is collaborative.

Work with Kathryn / learn more

• Consulting & practice start-ups (any specialty): CPACteam.com

  • From “Can I even do this in my state?” to launch, growth, and operations

• Clinical practice: White Pine Mental Health & Wellness (telepsychiatry; OCD-informed care)

Shareable takeaways

• A generalist foundation makes you a sharper psychiatric clinician.

• OCD is common and fixable—if you ask the right questions and treat to target.

• Good care design (visit length, schedule, collaboration) is burnout prevention.

• Laws and payers vary; advocacy is part of the job.

Enjoy this conversation? Catch the full interview on Mindset Matters and pass it to a PA who’s curious about psychiatry or practice ownership.