GIM-Psychiatry collaboration expands access to adult ADHD evaluations
The new program also supports team-based primary care through greater APP specialization
A new collaboration between the University of Wisconsin Departments of Medicine (UW DOM) and Psychiatry is training primary care advanced practice providers in how to evaluate adult patients for attention deficit-hyperactivity disorder (ADHD) in clinic, without the immediate need for specialty referral.
“This program really demonstrates how a relationship between primary care and specialty care can help remove barriers and provide better continuity for patients,” says Angela Morgan, PA, advanced practice provider (APP) supervisor for the DOM Division of General Internal Medicine (GIM).
“These types of programs, when well planned, can help our clinicians and APPs feel supported while giving patients access to appropriate care within their medical home,” adds Kathryn Miller, MD, division chief and Kenneth D. Skaar, MD, Chair of Primary Care, General Internal Medicine.
Identifying a care gap
The program began with identifying a care gap, as Dr. Miller explains: “More and more patients were coming to our clinicians with concerns about their attention and concentration. Since ADHD is not something most clinicians in GIM have expertise in diagnosing, patients were being referred to psychiatrists.”
But the sheer volume of adult patients seeking ADHD evaluations outpaced Psychiatry’s capacity to provide them.
“Patients were being redirected outside UW for these services and were waiting a long time to get them, if at all,” adds Morgan.
And for the primary care teams, those access gaps created added work and frustration as clinicians tried to help patients navigate limited options.
“When Psychiatry approached us to see if we wanted to help, we emphatically said yes.”
Collaborating on approach
From there—over roughly two years—GIM and Psychiatry worked to create a structured process that included specialized training, shared assessment tools, aligned documentation standards, and consultation pathways for more complex cases.
“Angie partnered with leadership in psychiatry, who agreed to provide training and ongoing support for our clinicians interested in doing this work,” Dr. Miller says. “Collaborative effort was the key to success.”
Charlotte Ladd, MD, was the faculty member in Psychiatry instrumental in developing the program with Morgan. While Dr. Ladd has since left UW, Morgan agrees that the program would not exist without her partnership.
Jonathan Williams, NP, nurse practitioner, Psychiatry, has taken over educating APPs on evaluating, treating and prescribing for patients with ADHD.
“It’s going well,” Williams says. “It feels good to collaborate with my GIM colleagues.”
By the end of 2025, GIM APPs completed over 300 evaluations. Team-based APPs embedded in larger primary care clinics completed over 260 of those evaluations, while consulting APPs supported smaller clinic cohorts. Evaluations are offered at all nine primary care clinic locations.
Combined evaluation referrals to Psychiatry from GIM and the Department of Family Medicine and Community Health (DFMCH), which also joined the collaboration, fell from 162 in calendar year 2024 to 48 in calendar year 2025—suggesting the program has helped reduced referral pressure on specialty partners.
Highlighting the role of APPs
For Morgan, the program highlights the way GIM fully integrates its APPs in a true team-based model of primary care.
Unlike systems that use APPs primarily for urgent access, GIM’s model integrates them more longitudinally. They support chronic disease management, routine follow-ups, new patient visits, and care transitions—often alternating visits with physicians so patients develop familiarity with both members of their care team.
“The APP is really embedded in the team as an equal partner with the physician,” Morgan says. “That’s by design.”
Moreover, ADHD evaluation is just one area division APPs can build specialization in.
“They can develop expertise in areas such as osteoarthritis management, wound care, women’s health procedures, dermatologic evaluations, migraine management, substance use disorder treatment, gender-affirming care, and HIV prophylaxis and treatment.”
By encouraging APP sub-specialization, the division can effectively expand in-house access to specialty care for patients at its primary care locations.
“Our model is designed to not only meet everyday patient needs but also evolve in partnership with our specialty colleagues when care gaps emerge,” Morgan concludes. “The ADHD training program is just one example of that model in action.”
Banner: David Castellanos, PA, physician assistant-primary care, General Internal Medicine, consulting with a colleague on a recent ADHD evaluation at the UW Health Junction Road Clinic.