All Our Psychiatric Services are Carried Out Only by a Psychiatrist 

Our psychiatric services such as medication management and Veteran related evaluations are all performed by a psychiatrist who is Board Certified by the American Board of Psychiatry and Neurology. With the exception of those in the medical field, there tends to be a general lack of awareness or understanding when it comes to the different types of prescribers who are allowed to carry out psychiatric services; the various types can be confusing. It is critical for  anyone receiving psychiatric treatment to understand the type of provider overseeing their treatment so that they can make a more fully informed decision regarding who they receive this type of care from.   

Below are brief descriptions of the most common types of psychiatric prescribers: 

 Psychiatrists: A psychiatrist is a medical doctor. All medical doctors are required to first complete 4 years of medical school that include coursework and training within the various areas of medicine and settings. Before they are allowed to graduate, they must pass the State Medical Board examination. After graduation, they start an intensive and rigorous training period called residency. Medical doctors who have chosen to specialize in a particular area of medicine will have longer residencies.

A psychiatrist is a medical doctor who has chosen to specialize in a particular area of medicine, psychiatry. The residency for psychiatrists is at minimum 4 years. In total it takes about 8 years (in some cases longer if they decide to pursue additional training) before a psychiatrist can start treating patients on their own. 

 Other Medical Doctors: A medical doctor who has not specialized in psychiatry, regardless of the field of medicine they are in such as primary care physicians (PCPs), cardiologists, neurologists, etc. are also allowed to treat psychiatric conditions and prescribe psychiatric medications.

 Physician’s  Assistants-Certified: A Physician’s assistant (PA-C) is what is sometimes referred to as a midlevel provider. They are required to complete the equivalent of a Master’s Degree within a physician assistant program also called PA school that typically take between 2 to 2 1/2 years on average to complete. During that time course work is required followed by a series of what are called clinical rotations. The clinical rotations are where PA students gain exposure and training within the various areas of medicine and practice and get hands on training and experience. They are called rotations because they are in essence a tour through the various and common types of medical practices such as primary care, cardiology, pediatrics, psychiatry, etc. Each clinical rotation focuses on the specific area of medicine. Within the PA’s clinical rotation, they will typically spend, on average about 1 to 2 months within each area of medicine before moving onto the next one. Prior to completing the PA program, they must pass the PA certification exam that is part of the requirements to becoming licensed to treat patients once they graduate. 

 A PA-C is allowed to work and treat patients as well as prescribe medications throughout most areas of medicine. They must be supervised by a medical doctor though the supervising doctor is not required to be within the same physical or virtual medical office or setting as the PA and may even be in a different part of the State than where the PA is treating patients.  

 Some PA-Cs may choose to specialize in psychiatric medicine through additional training and education to earn their Certification of Additional Qualifications (CAQ) in this area. However, this is not a requirement for PA-Cs to work in a psychiatric setting and/or to diagnose and treat patients with psychiatric conditions or prescribe psychiatric medications.

 In total it takes about 3 years to become a PA-C and to be allowed to start treating patients and prescribing medications.  

 Psychiatric Mental Health Nurse PractitionersThere are several different types of nursing certifications with either a Master’s or a Doctorate Degree in nursing. Registered nurses with a Bachelor’s Degree who want to earn their Master’s and specialize in a particular area may choose to specialize in psychiatric care, by completing the psychiatric mental health nurse practitioner (PMHNP) certification during their program. Course work and about 500 hours of clinical training and observation hours within the different areas of psychiatric treatment and assessment are required. Once all requirements are met, they must pass the PMHNP certification exam. 

 Once a nurse has graduated from the program and passed the PMHNP exam, they may work in a psychiatric setting where they are able to diagnose and prescribe psychiatric medications. They may also open their own psychiatric practice where they treat patients. Supervision by a medical doctor is required but the medical doctor does not have to be in the same practice or office setting and may even be in a different part of the State as the nurse-PMHNP.

 In total it takes about 1.5 to 2 years to complete the Master’s of Nursing Program with the PMHNP certification. Once completed, they are allowed to open their own private psychiatric practice. 

The original intention of nurse practitioner and PAs were to work along side the MD in the same office. What has occurred over time however is that nurse practitioners and PAs are practicing independently of an MD and opening up their own practice. In other cases, medical and mental health practices will hire several nurse practitioners and PA's to see patients with little to no involvement by the MD with the exception of periodic supervision meetings to meet the Medical Board requirements.  

Dr. Laura Cavicchi, LPC-S, Our Family Experts Counseling and Psychiatry


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