Psychiatric Providers

Joseph Andrews, M.D.
Psychiatric Providers is a topic covered in the Johns Hopkins Psychiatry Guide.

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DEFINITION

Some of mental health care does not require use of medications or procedures; hence, it can be practiced without a medical degree. As a result, multiple professions have independently converged upon its provision. This creates a confusing landscape for both physician and patient alike. Various professionals from distinct training backgrounds exist within the sphere of mental health care. The purpose of this module is to explain the origin, education, training, licensing and credentialing of these providers. Furthermore, we will describe unique strengths of these providers, the types of treatment they provide, and when it is appropriate to refer to each.

Psychiatrist (M.D., D.O., M.B.B.S., or M.B.Ch.B.)

  • A psychiatrist is a medical doctor who specializes in the evaluation and management of mental health conditions. Like all other physicians, psychiatrists attended medical school and earned a professional degree in the practice of medicine.
  • Medical education may occur domestically in the form of U.S. allopathic (M.D.) or osteopathic (D.O.) medical schools. Many physicians in the U.S., however, earned their medical degree abroad, either in their home country or at an offshore Caribbean medical school.
  • Among foreign medical degrees, the most common is the M.B.B.S. or M.B.Ch.B. These are abbreviations for Medicinae Baccalaureus, Baccalaureus Chirurgiae – “Bachelor of Medicine, Bachelor of Surgery” in Latin. This degree is awarded in numerous countries, including India – the country that produces the most foreign medical graduates practicing in the U.S.
  • To practice medicine in the U.S., psychiatrists – as with all other physicians – must pass a licensing examination (USMLE) and complete post-doctoral training, such as residency.
  • In the U.S., the American Board of Psychiatry and Neurology (ABPN) certifies psychiatrists. To obtain certification, psychiatrists must complete a psychiatric residency accredited by the Accreditation Council for Graduate Medical Education (ACGME), pass a board exam, and complete continuing medical education (CME) requirements.
  • Clinical psychologist
    • 1. Ph.D.: The Ph.D. is an academic degree, conferred upon one who is recognized as a leader in their field’s advancement. Ph.D. programs in psychology are about six years and primarily aim to train future researchers and educators.
    • Ph.D. programs often have specific training pathways for those who wish to enter clinical care.
    • Programs are research focused and require a dissertation.
    • 2. Psy.D.: The Psy.D. (doctor of psychology) is a professional degree- it was created in the same tradition as other professional degrees, such as the M.D. (medical doctor - physicians), J.D. (juris doctor - lawyers), and M.Div. (Master of Divinity - pastor). Psy.D.s often perform research, but they are primarily trained as clinicians.
    • Psy.D. programs were first piloted in 1968 and officially sanctioned in 1972. Today, half of all clinical psychologists have a Psy.D.
    • Doctoral psychology programs in the U.S.—whether Ph.D. or Psy.D.—are all accredited by the American Psychological Association Committee on Accreditation (APA-CoA). Accredited programs must consist of at least three academic years plus a clinical internship year.
    • Licensing of psychologists is granted by state licensing boards.
    • In general, states require: a doctoral degree in psychology (Ph.D. or Psy.D.), a standardized exam, and post-doctoral supervision.
    • State psychology licensing boards belong to the Association of State and Provincial Psychology Boards (ASPPB), which is responsible for the profession’s standardized test - the Examination for Professional Practice in Psychology (EPPP).
    • The last component required for licensing—supervision—must be obtained after graduating. It may be done in a formal program, such as an internship or residency, or through workplace experience.
  • Certified Nurse Practitioner (CNP)
    • Those with a bachelors of science in nursing (BSN) obtain a master’s or doctorate degree to become advanced practice registered nurses (APRN).
    • The CNP is one of four different APRN roles; nurse midwife, nurse anesthetist, and clinical nurse specialist are the other three.
    • A psychiatric nurse practitioner, also known as a Psychiatric Mental Health-Advanced Practice Registered Nurse (PMH-APRN), either: (1) completed a nurse practitioner degree (master’s or doctoral) with special focus on mental health; or (2) is an established CNP that subsequently completed a post-graduate certification in mental health.
    • Like other clinicians, licensure of a nurse practitioner is granted by state boards, and each board has its own requirements; however, they generally follow the Consensus Model for APRN Regulation.
    • Psychiatric NPs must also pass the 4-hour Psychiatric-Mental Health Nurse Practitioner board certification examination, which is administered by the American Nurse Credentialing Center (ANCC)
  • Physician Assistant (PA)
    • Physician assistants (PAs), like nurse practitioners, are considered “mid-level” providers in that they have many but not all privileges to practice medicine. ·
    • PA programs are master’s level and typically are two years.
    • Programs are accredited by the Accreditation Review Commission on Education for the Physician Assistant, Inc. (ARC-PA).
    • Certification of PAs is done through the National Commission on Credentialing Physician Assistants (NCCPA). To become certified a PA must: (1) graduate from an ARC-PA accredited program; and (2) pass the standardized exam for PAs, the Physician Assistant National Certifying Exam (PANCE)—a five hour, 300 multiple choice test.
    • PAs may obtain formal specialty recognition by applying for a Certificate of Added Qualification (CAQ) after one year of practice.
    • There are also now eight accredited post-graduate residency programs. Five of them are in surgical specialties. None of them are in psychiatry.
  • Licensed Certified Social Worker Clinical (LCSW-C)
    • The baccalaureate in social work (BSW) is a bachelor’s of arts (B.A.) with a major in social work.
    • The master’s degree program is two years and offers advanced study in social work in addition to the opportunity to identify a concentration. Graduates of master’s programs may become a Licensed Graduate Social Worker (LGSW).
    • Master’s programs are accredited by the Council on Social Work Education (CSEW).
    • In Maryland, the degree, a background check, and three references are required to obtain the LGSW. Other states have similar requirements. An LGSW may then progress to a Licensed Certified Social Worker (LCSW) following 3000 supervised hours of social work experience, as well as passing the Association of Social Work Boards (ASWB) licensing examination.
    • The “Clinical” distinction (LCSW-C) is granted when further criteria are met: (1) half of those 3000 supervised hours must be face-to-face client contact; and (2) they must receive “supervision in the assessment, formulation of a diagnostic impression, and treatment of mental disorders and other conditions and the provision of psychotherapy.”
  • Licensed Professional Clinical Counselor (LPCC), Licensed Mental Health Counselor (LMHC), and Licensed Clinical Professional Counselor (LCPC)
    • Counseling degrees are master’s level.
    • Educational programs in counseling are approved by the Council for Accreditation of Counseling and Related Educational Programs (CACREP).
    • Graduates are eligible to take a certification examination administered by the National Board for Certified Counselors (NBCC).
    • Licensure to practice mental health counseling is granted by state boards.
    • A New York State license in Mental Health Counseling, for example, is granted to those who meet the following criteria: (1) graduate from a CACREP accredited master’s program or a “substantial equivalent”; (2) obtain 3000 hours of post-graduate supervised work experience; and (3) pass the National Clinical Mental Health Counselor Examination (NCMHCE), administered by the NBCC.

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DEFINITION

Some of mental health care does not require use of medications or procedures; hence, it can be practiced without a medical degree. As a result, multiple professions have independently converged upon its provision. This creates a confusing landscape for both physician and patient alike. Various professionals from distinct training backgrounds exist within the sphere of mental health care. The purpose of this module is to explain the origin, education, training, licensing and credentialing of these providers. Furthermore, we will describe unique strengths of these providers, the types of treatment they provide, and when it is appropriate to refer to each.

Psychiatrist (M.D., D.O., M.B.B.S., or M.B.Ch.B.)

  • A psychiatrist is a medical doctor who specializes in the evaluation and management of mental health conditions. Like all other physicians, psychiatrists attended medical school and earned a professional degree in the practice of medicine.
  • Medical education may occur domestically in the form of U.S. allopathic (M.D.) or osteopathic (D.O.) medical schools. Many physicians in the U.S., however, earned their medical degree abroad, either in their home country or at an offshore Caribbean medical school.
  • Among foreign medical degrees, the most common is the M.B.B.S. or M.B.Ch.B. These are abbreviations for Medicinae Baccalaureus, Baccalaureus Chirurgiae – “Bachelor of Medicine, Bachelor of Surgery” in Latin. This degree is awarded in numerous countries, including India – the country that produces the most foreign medical graduates practicing in the U.S.
  • To practice medicine in the U.S., psychiatrists – as with all other physicians – must pass a licensing examination (USMLE) and complete post-doctoral training, such as residency.
  • In the U.S., the American Board of Psychiatry and Neurology (ABPN) certifies psychiatrists. To obtain certification, psychiatrists must complete a psychiatric residency accredited by the Accreditation Council for Graduate Medical Education (ACGME), pass a board exam, and complete continuing medical education (CME) requirements.
  • Clinical psychologist
    • 1. Ph.D.: The Ph.D. is an academic degree, conferred upon one who is recognized as a leader in their field’s advancement. Ph.D. programs in psychology are about six years and primarily aim to train future researchers and educators.
    • Ph.D. programs often have specific training pathways for those who wish to enter clinical care.
    • Programs are research focused and require a dissertation.
    • 2. Psy.D.: The Psy.D. (doctor of psychology) is a professional degree- it was created in the same tradition as other professional degrees, such as the M.D. (medical doctor - physicians), J.D. (juris doctor - lawyers), and M.Div. (Master of Divinity - pastor). Psy.D.s often perform research, but they are primarily trained as clinicians.
    • Psy.D. programs were first piloted in 1968 and officially sanctioned in 1972. Today, half of all clinical psychologists have a Psy.D.
    • Doctoral psychology programs in the U.S.—whether Ph.D. or Psy.D.—are all accredited by the American Psychological Association Committee on Accreditation (APA-CoA). Accredited programs must consist of at least three academic years plus a clinical internship year.
    • Licensing of psychologists is granted by state licensing boards.
    • In general, states require: a doctoral degree in psychology (Ph.D. or Psy.D.), a standardized exam, and post-doctoral supervision.
    • State psychology licensing boards belong to the Association of State and Provincial Psychology Boards (ASPPB), which is responsible for the profession’s standardized test - the Examination for Professional Practice in Psychology (EPPP).
    • The last component required for licensing—supervision—must be obtained after graduating. It may be done in a formal program, such as an internship or residency, or through workplace experience.
  • Certified Nurse Practitioner (CNP)
    • Those with a bachelors of science in nursing (BSN) obtain a master’s or doctorate degree to become advanced practice registered nurses (APRN).
    • The CNP is one of four different APRN roles; nurse midwife, nurse anesthetist, and clinical nurse specialist are the other three.
    • A psychiatric nurse practitioner, also known as a Psychiatric Mental Health-Advanced Practice Registered Nurse (PMH-APRN), either: (1) completed a nurse practitioner degree (master’s or doctoral) with special focus on mental health; or (2) is an established CNP that subsequently completed a post-graduate certification in mental health.
    • Like other clinicians, licensure of a nurse practitioner is granted by state boards, and each board has its own requirements; however, they generally follow the Consensus Model for APRN Regulation.
    • Psychiatric NPs must also pass the 4-hour Psychiatric-Mental Health Nurse Practitioner board certification examination, which is administered by the American Nurse Credentialing Center (ANCC)
  • Physician Assistant (PA)
    • Physician assistants (PAs), like nurse practitioners, are considered “mid-level” providers in that they have many but not all privileges to practice medicine. ·
    • PA programs are master’s level and typically are two years.
    • Programs are accredited by the Accreditation Review Commission on Education for the Physician Assistant, Inc. (ARC-PA).
    • Certification of PAs is done through the National Commission on Credentialing Physician Assistants (NCCPA). To become certified a PA must: (1) graduate from an ARC-PA accredited program; and (2) pass the standardized exam for PAs, the Physician Assistant National Certifying Exam (PANCE)—a five hour, 300 multiple choice test.
    • PAs may obtain formal specialty recognition by applying for a Certificate of Added Qualification (CAQ) after one year of practice.
    • There are also now eight accredited post-graduate residency programs. Five of them are in surgical specialties. None of them are in psychiatry.
  • Licensed Certified Social Worker Clinical (LCSW-C)
    • The baccalaureate in social work (BSW) is a bachelor’s of arts (B.A.) with a major in social work.
    • The master’s degree program is two years and offers advanced study in social work in addition to the opportunity to identify a concentration. Graduates of master’s programs may become a Licensed Graduate Social Worker (LGSW).
    • Master’s programs are accredited by the Council on Social Work Education (CSEW).
    • In Maryland, the degree, a background check, and three references are required to obtain the LGSW. Other states have similar requirements. An LGSW may then progress to a Licensed Certified Social Worker (LCSW) following 3000 supervised hours of social work experience, as well as passing the Association of Social Work Boards (ASWB) licensing examination.
    • The “Clinical” distinction (LCSW-C) is granted when further criteria are met: (1) half of those 3000 supervised hours must be face-to-face client contact; and (2) they must receive “supervision in the assessment, formulation of a diagnostic impression, and treatment of mental disorders and other conditions and the provision of psychotherapy.”
  • Licensed Professional Clinical Counselor (LPCC), Licensed Mental Health Counselor (LMHC), and Licensed Clinical Professional Counselor (LCPC)
    • Counseling degrees are master’s level.
    • Educational programs in counseling are approved by the Council for Accreditation of Counseling and Related Educational Programs (CACREP).
    • Graduates are eligible to take a certification examination administered by the National Board for Certified Counselors (NBCC).
    • Licensure to practice mental health counseling is granted by state boards.
    • A New York State license in Mental Health Counseling, for example, is granted to those who meet the following criteria: (1) graduate from a CACREP accredited master’s program or a “substantial equivalent”; (2) obtain 3000 hours of post-graduate supervised work experience; and (3) pass the National Clinical Mental Health Counselor Examination (NCMHCE), administered by the NBCC.

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Last updated: August 7, 2022