What is a Psychiatrist

Overview of Psychiatry

The Surgeon General’s report, Mental Health: Culture, Race and Ethnicity, unequivocally states that “mental health is fundamental to overall health and productivity.  It is the basis for successful contributions to family, community, and society.  Throughout the lifespan, mental health is the wellspring of thinking and communication skills, learning, resilience, and self-esteem.”  The report goes on to say, “Mental health problems are real and disabling conditions that are experienced by one in five Americans.  Left untreated, mental health can result in disability and despair for families, schools, communities, and the workplace.”  It is, therefore, disturbing to find that “the mental health field is plagued by disparities in the availability of and access to its services.  These disparities are viewed readily through the lenses of racial and cultural diversity.”

One way to reduce these disparities is to increase the number of psychiatrists from different racial, ethnic, and cultural groups.  You can make a difference because you can provide the knowledge and understanding crucial to cultural competence in the treatment of the mentally ill.  There is untold richness in diversity, and you hold the key to that treasure.

VIDEO "FACES OF PSYCHIATRY: Profiles of psychiatrists highlighting different career paths."

What is a psychiatrist?

A psychiatrist is a physician who specializes in the diagnosis, treatment, and prevention of mental health and emotional problems.  Because of extensive medical training, the psychiatrist understands the body’s functions and the complex relationship between emotional illness and other medical illness.  The psychiatrist is thus the mental health professional and physician best qualified to distinguish between physical and psychological causes of both mental and physical distress.  Psychiatrists are physicians who specialize in the diagnosis and treatment of mental health.

Mental healthes, including addictions, are common.  Like other medical illnesses, mental health range from severe and life-threatening disorders to relatively mild and self-limiting conditions.  Approximately 2.8% of the adult population suffers from severe mental health, such as schizophrenia or bipolar disorder, or from the more common, yet disabling, anxiety and depressive disorders or from alcohol and other substance abuse.

How do psychiatrists tell what is wrong with their patients?
Because they are physicians, psychiatrists can order or perform a full range of medical and psychological tests that provide a complete picture of a patient’s physical and mental state.  Their education and years of clinical experience equip them to understand the complex relationship between emotional and other medical illnesses, evaluate the entire medical and psychological data, make a diagnosis, and develop a treatment plan.
 
What treatments do psychiatrists use?
Psychiatrists use a wide variety of treatments – including various forms of psychotherapy, medications, and hospitalization – according to the needs of each patient.

Psychotherapy is a systematic treatment method in which, during regularly scheduled meetings, the psychiatrist and patient discuss troubling problems and feelings.  The physician helps patients understand the basis of these problems and find solutions.  Depending on the extent of the problem, treatment may take just a few sessions over one or two weeks, or many sessions over several years.
Psychiatrists use many forms of psychotherapy.  There are psychotherapies that help patients change behaviors or thought patterns, psychotherapies that help patients explore the effect of past relationships and experiences on present behaviors, psychotherapies that treat troubled couples or families together, and more treatments that are tailored to help solve other problems in specific ways.

Psychoanalysis is an intensive form of individual psychotherapy which requires frequent sessions over several years.  The psychiatrist, who must have additional years of training in psychoanalysis, helps the patient to recall and examine events, memories, and feelings from the past, many of them long forgotten, as a means of helping the patient understand present feelings and behavior and make

Psychiatry is one of the oldest medical specialties, but is also one of the most exciting frontiers of medicine.  Recent advances in the neurosciences have led to new technologies in the diagnosis and treatment of many of these illnesses.  For example, the DSM-IV diagnostic manual, brain imaging, and new pharmaceuticals have significantly improved diagnosis and treatment for these illnesses.

The average psychiatrist spends approximately 48 hours each week at work.  Most psychiatrists spend 60% of their time with patients.  Two-thirds of these patients are seen as outpatients, with the rest being seen in a hospital setting or, increasingly, in partial hospitalization or day programs and community residential programs.  Psychiatric hospitalization is now more intense, more focused, and much shorter in duration than in previous years.  Additional professional activities include administration, teaching, consultation, and research.

Psychiatrists work in group or solo private practice.  They also practice in the public sector, such as Veterans Administration and state hospitals and community mental health centers that are unique to psychiatry.  Medical schools, HMOs, and general hospitals, as well as specialized psychiatric hospitals are also settings for psychiatric practice.

Today’s psychiatrist provides a wide range of biological, psychotherapeutic and psychosocial treatments which are tailored to the specific needs of the patient.  The psychiatrist also serves as the medical expert for the mind/brain/body interface.  Unfortunately, prejudice and discrimination against the mentally ill still exists.  Sometimes, this stigma is also directed against those who care for the mentally ill.  Occasionally, even our colleagues in medicine are unaware that mental health are real (i.e. genetically and biochemically based) and can be diagnosed and treated with the same accuracy and effectiveness as other medical illnesses.
 
How does one become a psychiatrist?
Medical students follow a standard curriculum, with only a few opportunities for choice.  In addition to chemistry, biochemistry, and physiology, students take courses in psychiatry, behavioral science and neuroscience in the first two years of medical school.  In the last two years, students are assigned to medical specialty “clerkships,” where they study and work with physicians in at least five different medical specialties.  Medical students taking a psychiatry clerkship take care of patients with mental health in the hospital and in outpatient settings.  They also have an opportunity to work with medical and surgical patients who may have psychiatric problems or who have difficulty coping with their illness.  Because modern psychiatry places special emphasis on the relationship between mind and body, students pay special attention to issues of stress and physical illness, prevention, and behavior change, in addition to learning to care for severely mentally ill patients.  Newly graduated physicians take written examinations for a state license to practice medicine.  After graduation, doctors spend the first year of residency training in a hospital taking care of patients with a wide range of medical illnesses.  The psychiatrist-in-training then spends at least three additional years in psychiatry residency learning the diagnosis and treatment of mental health, gaining valuable skills in various forms of psychotherapy, and in the use of psychiatric medications and other treatments.

The education and training requirements for psychiatry are set by the ACGME and the American Board of Psychiatry and Neurology. Physicians who pass the examination are granted board certification, a pre-requisite to subspecialty certification.
 
Can psychiatrists become “sub-specialists?”
Yes.  Many psychiatrists continue training beyond the initial four years.  They may study child and adolescent psychiatry, geriatric psychiatry, forensic (legal) psychiatry, administrative psychiatry, addiction psychiatry, emergency psychiatry, psychiatry in general medical settings (called “consultation/liaison psychiatry” or psychosomatic medicine), mental retardation psychiatry, community psychiatry and public health, military psychiatry, and psychiatric research.  Some choose additional training in psychoanalysis at psychoanalytic institutes.
 
Where do psychiatrists work?
Because of a continued shortage in the field, psychiatrists have many career opportunities.  They work in a variety of settings including general and psychiatric hospitals, university medical centers, community agencies, courts and prisons, nursing homes, industry, government, military settings, schools and universities, rehabilitation programs, emergency rooms, hospices, and many other places.  About half the 42,000 psychiatrists in the nation maintain private practice.

The hallmark of a psychiatrist’s career is diversity and flexibility.  Although some psychiatrists prefer working only in one setting, others work in several areas, combining, for instance, a private practice with hospital or community mental health center work.

Practitioners set their own work and time commitments according to their personal lifestyles and needs.

Also, because mental health affect all races, ethnic groups, and cultures, the specialty of psychiatry offers special opportunities for members of minority groups.
 
How much do psychiatrists earn?
Psychiatrists earn about the same as pediatricians and family physicians, depending on the type of practice, hours worked, geographic location, and whether the psychiatrist works in the public or private sector. According to the Bureau of Labor Statistics, mean annual wage for a psychiatrist is $163,660. 
 
Subspecialty/Fellowship Training
• Child and Adolescent Psychiatry
• Addiction Psychiatry
• Forensic Psychiatry
• Geriatric Psychiatry
• Psychosomatic Medicine