What is a Psychiatrist?
Psychiatrists are medical doctors (MD or DO) uniquely trained to understand the medical, biological, sociological, and psychological aspects of mental health concerns, symptoms, and conditions.
Psychiatrists are trained in both psychotherapy (“talk therapy”) and advanced medication management across the full range of psychological symptoms and medical conditions that affect mental health and wellness. As physicians, psychiatrists can diagnose both psychiatric and many non-psychiatric medical conditions.
Psychiatrists have the extensive training for the whole-person perspective. After obtaining a medical doctorate from the same medical schools as other physicians and surgeons, psychiatrists complete a specialized four-year residency training in psychiatry. This allows psychiatrists to take into account the complex effects of medications (including non-psychiatric medications), medical conditions, nutrition, activities, and social circumstances on emotional and behavioral health.
Should I see a Psychiatrist first?
You do not have to have a complex condition or difficult-to-treat symptoms to see a psychiatrist.
Psychiatrists can address a broad range of concerns. They can provide support and stress management tools when there are changes in life circumstances or a stressful job, addressing grief, or healing from trauma and PTSD. Psychiatrists treat a wide variety of psychiatric conditions, including anxiety disorders and treatment resistant depression. As medical doctors with expertise in psychiatric medication, they can discuss the risks and benefits of psychiatric medication in pregnancy. Even if you have never spoken to a doctor or counselor about mood, anxiety, or other behavioral health concerns, you can make a visit with a psychiatrist your first.
Many psychiatrists in private practice offer talk therapy and medication treatment expertise as an option when needed. This allows you to work together in deciding what treatment is right for you. You don’t have to wonder if medication-only or therapy-only treatment is your only option. You don’t have to split your care between medication prescribers and therapists.
Common Myths and Misperceptions about Psychiatry
What is the difference between a psychiatrist and a psychologist?
Who can prescribe psychiatric medication?
Psychiatrists are the medical specialists with the most training and expertise in the advanced use of psychiatric medications. Psychiatrists have experience with using medication across the full spectrum of symptoms and conditions. Throughout the four-year psychiatry residency, they receive extensive education and hands-on training in:
When to use and not use psychiatric medications. There are situations where psychiatric medication would be unlikely to effectively reduce or treat a particular symptom or condition or would carry significant risks for an individual patient. Understanding when to prescribe medication is as important as understanding what to prescribe. Because psychiatrists are trained in the full spectrum of treatment options, they can explore the best treatment options and alternatives with you.
How psychiatric medications work and interact with one another, when to adjust doses, change to a new medication, or augment with a specific medication. Psychiatrists understand what combinations of medications may be safely used to optimize treatment, and which drug combinations must be avoided.
What medications work best for particular symptoms or conditions.
Accurate interpretation of pharmacogenetic testing (genetic testing that looks at psychiatric medication related factors). Psychiatrists understand what genetic testing can and cannot tell us about a particular medicine for a particular patient.
Potential medication interactions and side effects, and when and how to best treat side effects if they occur.
The effects of psychiatric medication on non-psychiatric medical conditions, and the effects of medical conditions on the effectiveness of psychiatric medications.
Use of specialty-level medications that require advanced expertise and experience to use safely and effectively.
Many non-psychiatrists also prescribe psychiatric medications.
Because of the shortage of psychiatrists, individuals with a wide variety of training have chosen to step in to help address the growth need for behavioral health services. These professionals include family medicine doctors, internists, obstetrician/gynecologists (Ob/Gyn), oncologists, and any doctor from any medical specialty that prescribes medications to patients. It also includes nurse practitioners (APRN) including family nurse practitioners (FNP) and psychiatric mental health nurse practitioners (PMH-NP).
There are benefits but also down sides to getting care for psychiatry-related concerns from other professionals. It can be hard to find a psychiatrist accepting patients, which can lead to delays in getting treatment. For the right treatment, understanding the causes and accurate diagnosis are very important. Understanding the full range of treatment options, including the expertise of specialty-level medication management, can optimize your treatment. Like any medication, psychiatric medications carry their own benefits and risks. Some medications require specialist-level expertise and experience to manage safely and minimize risk.
Does it matter who prescribes my medicine?
Primary Care Prescribing for Psychiatric Conditions
For some conditions, your primary doctor or nurse practitioner may feel comfortable managing medication. Sometimes a patient is referred immediately for consultation with a psychiatrist to ensure a thorough evaluation and expert recommendation. Sometimes, primary care will leave it up to you to decide.
For some patients, receiving treatment in a primary care office may be preferred, though for many psychiatric conditions there are barriers to receiving optimal care in such settings. Behavioral healthcare in a primary care clinic is limited by the time constraints of a busy outpatient office. A quick visit may not meet all a patient's needs, and in some cases, primary care clinics may not have the necessary resources to provide specialized services.
Primary care training has a different focus than psychiatry. For primary care doctors, their four years of medical school are followed by three years of family practice or internal medicine residency. In Kentucky and Tennessee, nurse practitioners, after first becoming RN, receive a two-year training plus 500 clinical hours to become licensed as APRNs. Because training for primary care specialties has to be very broad yet fit into the time allotted for training, primary care doctors and APRN have not had the same advanced training in psychiatric evaluation and expertise in the use of psychiatric medication that a psychiatrist receives.
After completing medical school, psychiatrists undergo four years of specialized residency training that focuses on evaluation, diagnosis, and treatment of psychiatric symptoms, concerns, and conditions. This training includes understanding the bio-psycho-social and medical conditions that affect mental health symptoms and treatment. The vast majority of primary care doctors and APRN cannot provide you with psychotherapy, and most have not had any formal training in brief psychological interventions.
Non-Physician Prescribing in Mental Health Centers and Clinics
Sometimes, psychiatrists are not available, or have very limited availability even at centers that focus on mental health. Many community behavioral health centers and outpatient behavioral health clinics that are part of large systems do not regularly have an outpatient psychiatrist on site.
Often, behavioral health clinics rely on nurse practitioners to provide medication services. Usually, they choose psychiatric mental health nurse practitioners (PMH-NP) which have a behavioral health focus to their APRN training. Some primary care clinics also provide access to psychiatric mental health nurse practitioners on site or online for behavioral health needs. While PMH-NP can provide many behavioral health services, an important question for patients to ask is:
If I have or develop a complex medical or psychiatric condition outside the PMH-NP’s experience, or have a treatment-resistant condition, does the nurse practitioner have access to consult with a psychiatrist? Or do they provide access or referrals to a psychiatrist?
Unfortunately, it has become popular for sites to advertise having psychiatrists, but then patient appointments are not scheduled with a physician specializing in psychiatry. The name and professional credentials of the person you see for a medical service should always be clearly communicated to you. This may appear on a name badge, in a patient portal or clinic’s website, or shared verbally when you make your appointment. You can also ask prior to making an appointment who your appointment would be scheduled with.
Psychiatrists (first column on the left) have the most education and training in psychiatric medications and receive formal observed psychotherapy training. They are required to complete 12 years of education and training in contrast to as little as 6 years for some medication prescribers. Psychiatrists spend at least 4 years in a psychiatry specialty residency (dark yellow bar in the first column) and have over 22,000 hours of direct patient care before they can practice on their own. Psychiatric mental health nurse practitioners (PMH-NP) receive two years of training in mental health care (light yellow bar) and complete 500 required clinical observation hours in behavioral healthcare.
There can be some variability in training, for example there are combined, accelerated undergraduate to MD programs or three-year Primary Care tracts available at some medical schools. Many PA programs also require extensive hands-on clinical experience before beginning a PA program, which can add additional years required to completing training. Some nurse partitioners obtain a doctoral nursing degree or DNP. However, a DNP is considered a nursing degree and is usually research focused. A doctorate in nursing or DNP is not the same as a physician’s medical (MD or DO) degree. Under Kentucky law and in many other states, it is illegal for APRN to use the “Dr.” designation in a clinical setting to prevent misleading patients about medical credentials.