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Psychiatric Nurse Practitioner vs. Psychiatrist: Which Career is Best for You?


Written By: Darby Faubion BSN, RN

Have you ever thought of pursuing a career as a mental health professional? In this article, we will discuss the similarities and differences between a psychiatric nurse practitioner and a psychiatrist. After reviewing the information, you will be able to compare psychiatric nurse practitioner vs psychiatrist roles and see if either of these is a career you are interested in pursuing.


Psychiatric Nurse Practitioner vs. Psychiatrist: Typical Job Duties


Some of the day to day responsibilities of a psychiatrist vs psychiatric nurse practitioner are quite similar. A psychiatric nurse practitioner or psychiatrist cares for patients who suffer from different emotional and mental health issues. Both psychiatrists and psychiatric nurse practitioners work closely with patients, diagnose mental health conditions, and prepare care plans for treating clients.

Both share the following typical job duties;

• Taking patient medical histories
• Conduct psychological assessments
• Identify risk factors that may impact a patient’s mental health
• Create care plans based on patient needs and desired outcomes
• Prescribe and assess the effectiveness of medications
• Educating patients and caregivers

Additionally, psychiatrists may:

• Be required to review or co-sign documents and orders completed by psychiatric nurse practitioners
• Work in administrative positions in a psychiatric care facility
• Perform research related to mental health conditions and treatments


Scope of Practice


In general, “scope of practice” refers to any activities that a healthcare provider can perform within their profession. This scope is based on education, training, and experience.

According to the American Psychiatric Nurses Association, the scope of practice of a PMHNP may include case management, education, consultation services, psychotherapy, psycho-pharmacotherapy, and administration. Psychiatric nurse practitioners have authority to write prescriptions for medications in all the United States.

*Please note the scope of practice laws that govern a psychiatric nurse practitioner’s responsibilities may vary by state.

The Scope of Practice for psychiatrists includes

• Performing psychological testing and evaluation of a client’s personality, mental status, intelligence, and neuropsychological functioning
• Counseling, psychotherapy, and implement psychopharmacological interventions
• Provide psychoeducational evaluation and therapy
• Utilization review of psychological consultations, plans of care, and services

*Any healthcare provider, despite degree level, should bear in mind that although scope of practice may allow a specific job to be done, the practitioner should know the limits of their own training and competence.


Skills & Personality Traits Required to be Successful


Psychiatrists and psychiatric nurse practitioners who want to positively impact patients realize it is essential to develop a broad range of professional and personal skills. The skills and personality traits required to be successful as either a psychiatric nurse practitioner or a psychiatrist are quite similar. Some crucial skills and personality traits required to be successful as a mental health care provider include the following.

• Professionalism: For many years, mental health issues were not openly discussed or treated. Although there is more awareness about the importance of mental health and wellness, it can still be difficult for some patients and their loved ones to openly discuss their concerns. As a psychiatrist or psychiatric nurse practitioner, it is vital to recognize the way patients feel and to respond with a caring and professional attitude.

• Excellent communication: Patients with mental health disturbances may feel it is difficult to express their thoughts and feelings, especially following a stressful event or during a session when they are asked to discuss troubling events or memories. As a psychiatric nurse practitioner or psychiatrist, learning to recognize when a patient is feeling overwhelmed and being willing to communicate calmly and without judgment can help ease the patient's anxiety.

• Problem Solving: Mental health professionals need to develop good problem-solving skills and implement them throughout the patient's treatment. Problem-solving involves identifying a patient's risk factors such as a family history of mental illness, substance abuse, trauma, or environmental factors. It also consists in using logic and reasoning and collaborating with other health care providers to make sure the patient is getting the help he/she needs.


Psychiatrist vs. Psychiatric Nurse Practitioner: What Education is Required to Become?


The education required to become a psychiatric nurse practitioner vs psychiatrist has some basic similarities, but also some broad differences.

Psychiatric Nurse Practitioner Education Requirements: A nurse practitioner is a registered nurse who has completed a master's in nursing program (MSN) or doctorate in nursing program (DNP). To become a psychiatric nurse practitioner, registered nurses must enroll in a master's in nursing (MSN) or Doctor of Nursing Practice (DNP)-level psychiatric mental health nurse practitioner (PMHNP) program.

The Master's degree program requires students to complete general advanced-practice classes and courses specifically geared toward the psychiatric mental health nurse practitioner program. Core concepts typically include:

• Individual and family psychotherapy
• Psychopharmacology
• Lifespan psychiatric-mental health nursing
• Advanced assessment of psychiatric-mental health conditions

Some of the advanced-practice courses that you may be required to take include:

• Advanced health assessment
• Health promotion and maintenance
• Advanced pathophysiology
• Pharmacology for advanced practice nurses

Psychiatrist Education Requirements: The educational path to becoming a psychiatrist is lengthy, but with the expected job outcome and salary outlook, it is believed to be a promising career choice. After completing a bachelor's degree level education, psychiatrist hopefuls must complete four years of medical school training to earn either a Doctor of Medicine (M.D.) or Osteopathic Medicine (D.O.) degree.

Medical school consists of two years of learning the foundation of all areas related to medicine. This includes taking courses such as anatomy and physiology, pathology, immunology, and biochemistry. Legalities and medical ethics are also covered.

After successful completion of medical school, graduates must pass the United States Medical Licensing Exam, which awards state license to practice medicine in the United States. Successful graduation means the graduate is a doctor, but they are not yet qualified to practice as a psychiatrist.

Medical doctors who wish to practice as a psychiatrist must complete a psychiatric residency program. This program allows the doctor to learn how to interact with patients and develop the skills needed to address patients' mental health needs.


Psychiatric Nurse Practitioner vs. Psychiatrist: How Long Does It Take to Become?


There is approximately a four to six-year difference between a psychiatric nurse practitioner and psychiatrist length of study.

To become a psychiatric nurse practitioner, it typically takes from six to eight years. Nurses must first complete an associate (ADN) or bachelor's (BSN) in nursing degree and then complete a master's degree. A bachelor's degree takes approximately four years to complete. A master's degree requires an additional two to four years of graduate work.

The timeline to become a psychiatric nurse practitioner is usually:

• Complete an accredited registered nurse program (two to four years)
• Complete a master’s degree in nursing (two to three years)
• Take and pass the Advanced-Practice Registered Nurse certification examination (typically less than one year, depending on how long you study for the exam)

If you are considering becoming a psychiatrist, you can expect to be a student for twelve to fourteen years total. An undergraduate program typically takes four years to complete. After achieving a bachelor’s degree, there are at least four years of medical school. Upon successful completion of medical school and passing the U.S. Medical Licensing Examination, a psychiatric residency program is required. The residency program is generally a four-year program.

Doctors who wish to pursue a subspecialty in psychiatry may participate in additional training, referred to as a fellowship. During the fellowship, the doctor will spend an additional one to two years of training during which they will focus on a specific concentration such as children and adolescents, forensics, addiction disorders, or geriatrics.


Psychiatrist vs. Psychiatric Nurse Practitioner: How Much Does It Cost to Become?


There are different factors that impact the cost of becoming a psychiatric nurse practitioner vs psychiatrist. Simply put, becoming a psychiatric nurse practitioner may cost $140,000 or more. To become a psychiatric nurse practitioner, one must first achieve a BSN degree. A bachelor's in nursing can cost between $70,000 and $105,000. After successfully obtaining a BSN degree, enrolling in a graduate program to pursue a Master's in Nursing degree (MSN) is necessary. Typically, the tuition cost for an MSN program averages about $425 per credit. A nurse practitioner program that requires 40 credit hours would, therefore, cost approximately $18,000.

The Association of American Medical Colleges (AAMC) reports that in 2014, eighty-four percent of medical school graduates had a school-related debt that averaged from $170,000 to over $200,000. The AAMC projects an approximate 3 percent increase annually.

Again, these numbers are approximate and may differ depending on factors such as your state of residence and whether you are required to pay out of state tuition fees.


Certification & Licensure Requirements


Both psychiatrists and psychiatric nurse practitioners are required to obtain licensure and certifications to practice.

Psychiatrist Certification & Licensure: To become a psychiatrist, you must take and pass the (USMLE) U.S. Medical Licensing Exam. After becoming a licensed physician, psychiatrist hopefuls can apply for and take the board certification exam through the American Board of Psychiatry and Neurology. Applicants must have completed a four-year residency with a minimum of three years spent in psychiatric focus to be eligible for board certification. As a psychiatrist, you can practice psychiatry anywhere in the United States, but the license must be renewed every ten years.

Psychiatric Nurse Practitioner Certification & Licensure: After completing an MSN or DNP program, registered nurses can obtain certification as a psychiatric mental health nurse practitioner. The American Nurses Credential Center (ANCC) offers graduates certification. To become certified as a PMHNP, the following must be met:

1. Completion of an MSN or DNP program
2. Hold a current, unencumbered license to practice as a registered nurse
3. Have completed courses in advanced health assessment, advanced pharmacology, and advanced pathophysiology
4. Have successfully completed studies in differential diagnose and disease management including clinical training in at least two areas of psychotherapy and prescribing medicine and health/promotion maintenance
5. A minimum of 500 hours of supervised clinical within the primary mental health nurse practitioner program (PMHNP)

Specialization Options


Although their roles may differ somewhat (esp. regarding management positions), both psychiatrists and PMHNPs can work in a variety of specialized areas. They may choose to work in general psychiatric practices or work in areas of focused care. A few examples of specialty areas psychiatrists and psychiatric nurse practitioners can choose to work in include

• Child and adolescent mental health: This subspecialty focuses on the assessment and treatment of mental health and behavioral disorders that affect children. PNPs who practice this specialty conduct psychotherapy, prescribe medications, and educate patients and caregivers. Some of the disorders that a PMHNP or psychiatrist may care for include autism spectrum disorders, learning disabilities, mood disorders, and attention-deficit hyperactivity disorder.

• Psychosomatic medicine (consultation-liaison psychiatry) focuses on how combined physical and mental illness may affect a person's overall mental health and well-being. Psychiatric nurse practitioners and psychiatrists who specialize in psychosomatic medicine may conduct medical evaluations and treat comorbid psychiatric and medical conditions, substance withdrawal, and somatoform disorders.

• Forensic psychiatry is a subspecialty that allows PMHNP and psychiatrists to combine their interest in the legal system with their love of psychiatry. With a job in forensic psychiatry, they may provide expert testimony in legal cases and offer their expert opinions about a person's criminal responsibility and competency to stand trial. They may also assist in child custody or juvenile justice cases.

• Geriatric psychiatry involves treating older adults. Some common disorders treated in this subspecialty include Alzheimer's disease, dementia, anxiety, depression, schizophrenia, or bipolar disorder.


Where Do They Typically Work?


While there are some differences in psychiatrist vs psychiatric nurse practitioner work settings, there are also some similarities.

Psychiatrists work in various settings such as:

• Clinics
• Private physician’s offices
• General hospitals
• Psychiatric hospitals
• Prisons
• Rehabilitation centers
• Nursing homes
• Emergency rooms
• Government and military settings
• Hospice

Psychiatric nurse practitioners may be found working in some of the following settings:

• In-patient psychiatric units
• In-patient psychiatric schools
• Emergency departments
• K-12 schools
• Residential treatment centers
• Correctional facilities


Work Hours


Like most healthcare professionals, psychiatrists and psychiatric nurse practitioners may work different shifts. The difference between psychiatric nurse practitioners and psychiatrists' work hours varies depending on the type of setting where they provide care. For example, those who work in a clinic or physician's office may work day shifts with no weekends or nights. On the other hand, emergency departments, correctional facilities, and residential treatment centers may have a psychiatrist who makes rounds during the day and a psychiatric nurse practitioner who works during evenings or nights.


Work-Related Stress


The work of a psychiatrist or psychiatric nurse practitioner can be both emotionally and mentally demanding. Mental health professionals are often exposed to patients with suicidal tendencies or chronic behavioral issues. Long-term exposure to these behaviors can cause a mental health professional to experience feelings of being emotionally detached from patients, which is counter-productive in providing psychiatric health care.

It is not uncommon for psychiatric nurse practitioners and psychiatrists to experience what many refer to as compassion fatigue. Compassion fatigue occurs in professionals whose jobs lead to prolonged exposure to the trauma or emotional upset that their clients are experiencing. It can leave one feeling detached and unwilling or unable to give to or provide care for others.


Job Satisfaction


According to Career Explorer, psychiatrists report their satisfaction with their career choice is approximately 3.8 out of 5 stars. PayScale.com also reports that based on 229 responses to a job satisfaction poll, psychiatric nurse practitioners rated their satisfaction with their job to be a 3.88 out of 5. These results indicate that psychiatric mental health providers are, overall, satisfied with their career choice.


Psychiatric Nurse Practitioner vs. Psychiatrist: Job Outlook


The outlook for jobs in the psychiatric field is promising. The Bureau of Labor Statistics reports a positive outlook for employment for psychiatrists and psychiatric nurse practitioners. There were over twenty-five thousand psychiatrists practicing in the United States in 2018. The BLS suggests that psychiatrists can expect to see a growth in job opportunities of approximately 16.8 percent from 2018 to 2028. Because nurse practitioners now fill the role of what many call a physician extender, a psychiatric nurse practitioner can expect to experience an excellent job outlook, as well.


Starting Salary


Even at entry-level, the psychiatric nurse practitioner vs psychiatrist salary differs by almost $60 hourly and over $120,000 annually. Psychiatric nurse practitioners and psychiatrists who have any experience working with mental health patients may start out with higher salaries. Additional factors that may affect the beginning salary include the type of healthcare setting, what shift you work, and what state where you live.

Occupation Hourly Monthly Annual
PMHNP $34.73 $6,020 $72,240
Psychiatrist $93.50 $16,210 $194,486


Average Hourly Pay


On average, psychiatric mental health nurse practitioners (PMHNP) earn around $48.00 per hour. Psychiatrists, on the other hand, make almost $100 per hour. Some facilities may pay higher or lower wages, depending on the shift you work and whether you work on holidays.

OccupationHourly Pay
PMHNP$47.71
Psychiatrist$99.27
(Source: payscale.com)


Psychiatric Nurse Practitioner vs. Psychiatrist: Average Annual Salary


According to PayScale, the average annual salary for psychiatric mental health nurse practitioners is just less than $100,000. Psychiatrists earn an average of $206,000 each year. While these average yearly salaries are generous, both psychiatric nurse practitioners and psychiatrists can look forward to increased earning potential as they achieve more experience.

OccupationAnnual Salary
PMHNP$99,238
Psychiatrist$206,479
(Source: payscale.com)


Salary by Level of Experience


Years of experience in any given field are among the key factors that lead to increased salary opportunities. Psychiatric mental health nurse practitioners and psychiatrists are no exception.

PMHNPs who are just entering the workforce can expect to make about $35 per hour or $72,240 annually. With as little as one year and up to four years' experience, that yearly salary may increase by $10,000. Every five years after that, it is not uncommon for psychiatric nurse practitioners to see an increase in income of ten thousand to fifteen thousand dollars.

Psychiatrists entering the mental health industry typically earn a yearly salary of over $194,000. In as little ten years, a psychiatrist can see a salary increase of over twenty-five thousand dollars.

It's important to note that there are several factors, other than years of experience that may influence a psychiatric nurse practitioner or psychiatrist's salary. Geographical location is a common factor that influences wages across many fields. The higher the cost of living, the more generous a salary may be. Additionally, some employers may offer shift differential pay, paid vacation time, or incentive bonuses for working holidays or weekends.

Occupation Level of Experience Hourly Monthly Annual
PMHNP Starting (Entry-Level) $34.73 $6,020 $72,240
1-4 Years of Experience $39.58 $6,860 $82,330
5-9 Years of Experience $46.85 $8,120 $97,450
10-19 Years of Experience $54.19 $9,390 $112,720
20 Years or More Experience $64.91 $11,250 $135,010
Psychiatrist Starting (Entry-Level) $93.50 $16,210 $194,486
1-4 Years of Experience $94.52 $16,380 $196,595
5-9 Years of Experience $97.71 $16,940 $203,244
10-19 Years of Experience $106.57 $18,470 $221,660
20 Years or More Experience $113.49 $19,670 $236,064


The Bottom Line


Although there is a difference between a psychiatric nurse practitioner and a psychiatrist, both are integral members of the mental healthcare industry. When comparing psychiatrist vs psychiatric nurse practitioner career options, essential factors to consider are how long you want to go to school, your long-term career goals, and how much freedom you want to practice independently. Because of increased awareness of mental health and wellness issues, a career as either a PMHNP or a psychiatrist is promising.


Darby Faubion BSN, RN
Darby Faubion is a nurse and Allied Health educator with over twenty years' experience. She has assisted in developing curriculum for nursing programs and has instructed students at both community college and university levels.