Finding care
Psychiatric nurse practitioner or psychiatrist? What the difference means for you.
The training is different and much of the outpatient care overlaps. Here is how the two roles compare in Washington, and when each may fit.
You search for a psychiatrist and the results include a mix of letters: MD, DO, ARNP, PMHNP-BC. It is fair to wonder who you would be seeing and whether the difference matters for you.
I am a psychiatric nurse practitioner, not a physician. Here is an honest account of what that means, what the two roles share, and when one may suit you better than the other.
What a psychiatrist is
A psychiatrist is a medical doctor (MD or DO) who completed medical school and then a four-year residency in psychiatry. The American Psychiatric Association describes about twelve years of education after high school for a general adult psychiatrist. Some go on to fellowships in areas such as child, geriatric, addiction, or forensic psychiatry. Read the APA overview.
What a psychiatric nurse practitioner is
A psychiatric-mental health nurse practitioner (PMHNP) is a registered nurse who went on to a graduate degree, a master’s or a doctorate, focused on psychiatric care. The program includes advanced pharmacology, physiology, health assessment, and supervised clinical training. Board certification requires that the program include at least 500 faculty-supervised clinical hours, followed by a national examination. See the ANCC certification requirements.
Many nurse practitioners also bring years of bedside nursing to the role. Mine were in intensive care and inpatient psychiatric units. That experience is valuable, and it is not the same thing as a medical residency. Physician training is longer and more extensive, and I think it is better to say so plainly.
What a nurse practitioner can do in Washington
The rules differ from state to state. Washington licenses nurse practitioners as independent practitioners. Its regulations describe an ARNP as prepared to assume primary responsibility for the care of patients: examining patients and establishing diagnoses, ordering and interpreting tests, prescribing medication when granted prescriptive authority, and referring to other clinicians. Read the Washington rule.
In practical terms, a psychiatric nurse practitioner in Washington can evaluate you, diagnose, prescribe, and follow your treatment without a supervising physician. The American Association of Nurse Practitioners explains how this compares with states that require a collaborative or supervisory agreement. See how states differ.
What the two roles have in common
For most adults seeking outpatient care for depression, anxiety, sleep problems, trauma, or bipolar disorder, the visit itself looks similar with either clinician. Both take a history, consider other explanations, discuss options, prescribe when medication is appropriate, and follow how you respond over time.
Both should also know the limits of what they can offer in a given setting and refer you when something else is needed.
When a physician psychiatrist may be the better fit
- Your psychiatric symptoms are closely tied to a complicated medical or neurological condition.
- You are considering a procedure such as electroconvulsive therapy, which is delivered by physician-led teams.
- You need hospital-level care, or a subspecialty such as child, geriatric, or forensic psychiatry.
- Several careful treatment attempts have not helped and you want a subspecialist’s opinion.
- You would simply feel more comfortable with a physician. That is a legitimate reason.
If any of these come up while we are working together, I will say so and help you find the right person.
What matters more than the letters
Within either profession, clinicians differ. A few questions tell you more than the credential alone:
- How long is the first evaluation, and what does it cover?
- Will I see the same person at each visit?
- How do you decide whether a medication is helping?
- What happens if I need something you do not provide?
- How do I reach you between appointments?
You can verify any Washington clinician’s license, whichever credential they hold, through the Department of Health. A free consultation is a reasonable place to ask these questions before you commit to anything.
Common questions
Is a psychiatric nurse practitioner a doctor?
No. A psychiatric nurse practitioner is an advanced practice nurse with graduate training in psychiatric care. A psychiatrist is a physician who completed medical school and a psychiatry residency.
Can a psychiatric nurse practitioner prescribe medication in Washington?
Yes. Washington nurse practitioners with prescriptive authority can prescribe independently. Whether any medication is appropriate depends on an individual evaluation, and no prescription is promised in advance.
Does a physician supervise your work?
No. Washington licenses nurse practitioners as independent practitioners. When a question would benefit from a physician’s or another specialist’s input, I refer or coordinate with your permission.