As there seems to be some confusion in the community with differentiating between the disciplines of psychiatry and psychology, I have been asked to explain and contrast the practices and backgrounds of these two professions. To begin, the two have differing degree pathways, a psychiatrist is a physician (M.D. or D.O.) while a psychologist is a Doctor of Philosophy in Psychology (Ph.D) or a Doctor of Psychology (Psy.D.)
A psychiatrist attends medical school after their completion of undergraduate or graduate education. In medical school the first two years are largely academic work including biochemistry, cell biology, gross anatomy, pathology, etc., but there are also some clinical responsibilities. The final two years involve clerkships in the various medical disciplines (surgery, neurology, internal medicine, obstetrics and gynecology, pediatrics, etc.)
After the completion of medical school, a psychiatrist completes a residency in "psychiatry." The first year is generally an internship that includes internal medicine, neurology, family medicine, and emergency medicine, but may include other disciplines. A psychiatrist’s last three years of training are in psychiatry specific areas of medicine including but not limited to: inpatient and outpatient geriatric, adult, and child psychiatry, psychosomatic medicine, emergency psychiatry, forensics, addiction medicine, and psychotherapy. Generally during a residency program the physician will take "night call" for inpatient services, floor psychiatric consults, and emergency rooms at one or more local hospitals in addition to their daytime duties.
The amount of training in psychotherapy is greatly determined by the residency program attended. But this component is getting more focus per national guidelines of training after many years of decline as psychiatrists moved more towards medications and a "medical model" of psychiatric illness.
Within the highly trained and specialized psychologist arena, there are several varieties of programs, including but not limited to clinical psychology, counseling psychology, educational psychology, and organizational psychology. If you are seeking assistance with an emotional difficulty, you will most likely come in contact with a clinical or counseling psychologist.
A psychologist completes a traditional academic line of education with progression through bachelors, masters, and Ph.D (or Psy.D) programs. In the United States, a Psy.D is a non-dissertation, professional degree, while a Ph.D. is an academic degree requiring a significant research component and completion of a dissertation. Ph.D programs are highly selective with several hundred applicants for approximately six to eight positions yearly at any given university. Psy.D. programs are somewhat less competitive. Both degree pathways must obtain high levels of skill in individual, group, and family counseling modalities, and both receive experience in both the inpatient and outpatient setting. A psychologist generally will also obtain some training in the neurobiology basis of psychiatric disease.
A Ph.D. program will generally require more background in psychometric testing than a Psy.D. program. And both generally receive more background in testing than a physician. Further, both will likely receive more training in psychotherapy than a physician, but this varies greatly depending on the program of study of the psychologist and the psychiatrist.
In the community I often hear, "but which one prescribes drugs?" Well, that would be a physician- a psychiatrist. There are some psychologists that are obtaining prescription privileges in some states, however because of the complexities of pharmacology and organ systems, the need for a background in the major medical disciplines, and the medico-legal liability involved, this is likely to remain extremely limited or disappear altogether.
To fairly answer the prescription questio, both practitioners "prescribe" interventions. But on average, a psychiatrist will tend more towards medication with secondary attention to psychic and social interventions, whereas a psychologist will concentrate on more in-depth and explicit psycho-social prescriptions. The content of these non-pharmacologic interventions are varied with numerous schools of thought, and beyond the scope of this discussion.
Finally, the two disciplines work in concert with one another, often referring their patients between each other. A M.D. or D.O. will likely request a psychologist to do psychometric testing if it is more than rudimentary in nature. A psychologist may refer a patient to a psychiatrist for medical management of a disorder while the psychologist works with the psychosocial aspects. Both disciplines will generally do some psychotherapy, though depending on the psychiatrist, they may refer a patient to a psychologist if their practice does not allow for intensive psychotherapies due to the time intensive nature of the endeavor.
About the author: John Pybass, M.D., is an outpatient adult psychiatrist, who treats affective, personality, psychotic and dementia related disorders through psychopharmacology, psychotherapy, and family/social intervention. He can be reached at 843.514.4172 or by email at pybass@yahoo.com. His practice is on DI.