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T(r)IC(k)S #15

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Life's A Twitch! Celebrating 15 years.
1998 - 2018
Life's A Twitch! Celebrating 15 years.


You Say ‘M.’D., I Say ‘Ph.’D.:
The Diagnosis Game I

“What’s the difference between a Psychologist and a Psychiatrist??” “Which one do I need to go to for a diagnosis??” “Why would I go to one versus the other – who is better for what types of things??” Given the ‘state of the union’, misunderstanding and confusion in this area is more than understandable – the legislation is complicated, it is lacking in certain respects, and it is not universal. Within Canada each province has different laws (although the overall layout is similar), and Canadian laws have some differences from other countries (sometimes striking ones). Having recently begun the process of becoming registered as a Psychologist in the province of Ontario, I am perhaps in the best position I’ll ever be in (i.e. entrenched in learning this province’s laws) to address this topic. While of course you don’t all live in Ontario, the discussion provided here can nevertheless help you to understand the way things would work in your own province in a general way; at the very least it will help you to know which questions to ask.

To start with, it is important that I offer a disclaimer. Psychiatrists (or other Physicians) and Psychologists are both well trained and qualified professionals – this article should NOT be perceived as an attack on one profession versus another, or an attempt to show the superiority of one to the other. They are, though, different disciplines with different training and laws governing them. Given an individual’s needs and situation, a person may prefer going to one type of professional versus the other then. ALL I hope to accomplish in this 2-part article is to make you a more informed consumer by giving you enough information to make the choice that is best for you.

Having said that, my understanding about the training of Psychiatrists is of course that of an outsider, and to speak of it in more than brief terms is most appropriately left to someone with more intimate and extensive knowledge of it. Hence, despite an honest effort to be fair and accurate this article may be ‘lop-sided’ in that I simply know more about what Psychologists have to offer. Perhaps in the future a Physician counterpart will continue what I’ve started by offering a more thorough look at ‘their’ side, giving you the most complete picture possible.

Before getting into the differences between professions, I need to give you some context as to how ALL mental health disciplines are organized…

In Ontario, the Regulated Health Professions Act (RHPA) was launched in 1991. The purpose of this law (and other similar ones in other provinces, such as Alberta’s Health Professions Act) was to formally recognize ‘newer’ health care professions and to introduce legal standards for them to follow. There are obviously a lot of different types of health care fields these days (everything from massage therapy to midwifery), and so the general idea was to have fairly uniform principles across all professions. The RHPA was also designed to more formally recognize the skills and knowledge of these ‘newer’ professionals. This, optimally, could ‘free-up’ Physicians to concentrate on their own fields of expertise again. The concern was that, as the mental health field grew, Physicians needed to adopt more and more roles that were getting further and further from their traditional scope of practice and training. This meant that they were more and more submerged in patients, their waiting lists were getting longer and longer, and health care was becoming more and more expensive. Other ‘newer’ (and cheaper) professions with equal or more expertise in certain areas were limited in how much they could lighten the load for Physicians, because the laws didn’t yet allow these ‘new’ professionals to replace the Physician in providing those services.

Under the RHPA each health profession was given an Act, and was governed by its own regulatory college. There are currently 21 Colleges in total, including the College of Physicians and Surgeons (governing medical doctors like Psychiatrists, Neurologists, and Paediatricians) and the College of Psychologists of Ontario. Psychology has far more official jurisprudence – Standards, Code of Ethics, and Guidelines – than many of these colleges combined. The reason for this is that we are one of those ‘newer’ professions I was talking about above – we are still evolving as a discipline and are too young to have the benefit of centuries of common law and traditional apprenticeship practice to draw upon the way Physicians do. To compensate we have developed a system of moral values on paper. They at times bog us down, but they also ensure that our Respect for the Dignity of Persons, Responsible Caring, Integrity in Relationships, and Responsibility to Society is of the highest calibre despite our relative youth.

Under the RHPA and similar provincial Acts certain titles are restricted through a certification process. In the case of psychology, it is prohibited for anyone in Ontario who is not registered with the College of Psychologists of Ontario to use the terms “Psychologist”, “Psychological Associate”, “psychology”, or “psychological” in describing their work. This prevents unqualified persons from misleading you into thinking that they are ‘the real deal’. Look for these terms, and also certain credentials which I’ll outline in Part II. That way you can be sure that you are seeing someone who is well-trained, bound to certain regulations, and can be disciplined by their profession if they break those rules.

Psychologists are one of only 5 groups of professionals in Ontario that are legally bestowed with the title of “Dr.”; as per section 33 item 1 of the RHPA, the only other groups with this right are Physicians and Surgeons, Optometrists, Chiropractors, and Dentists. If you are involved with a Psychologist who is NOT a doctor, this likely means that this person has a Masters degree rather than a Ph.D. and that you are in a province where a Ph.D. is not required to be a Psychologist (I’ll talk more about this below).

So let’s talk about the differences between Psychiatrists and Psychologists now. Psychiatrists obtain their professional degrees through medical school after obtaining an undergraduate university degree, while Psychologists obtain their professional degrees through graduate school after their undergraduate studies. Medical students are part of a general curriculum for the majority of their training; this means that everyone is learning the same information. It is in the final stages of their process where specialities are chosen; students interested in (for example) surgery, obstetrics, or family practices are streamed into appropriate rotations, internships, and residencies. This is the point when medical students who want to work in mental health move towards psychiatry.

Each province differs in the requirements necessary to be considered eligible for registration as a Psychologist. In Ontario, one needs to obtain a doctoral degree in the study of Psychology (usually called a Ph.D., but can by a Psy.D. or an Ed.D.). My own nine years of post-secondary schooling is an average time for achieving this. Next a one-year internship is required (which often requires at least 1500 hours of supervised clinical experience before you can apply). Finally, Psychologists must practice for between 1 and 2 years under supervision; during this time certain rules and restrictions are in place (not taking your own clients, for instance) and you are rigorously tested to prove your competence in the area you wish to work in.

In sum, you can consider yourself going at a good clip if you find yourself registered for autonomous practice as a Psychologist a mere 11 years following high school graduation. This is a comparable amount of time to becoming a Physician. The most important difference to note between the two is that while Psychologists can spend those 11 years intensively studying the mind and brain, Physicians don’t have that luxury – they also need to learn about how the rest of the body works, how it can fail, and how to fix it.

Other provinces have different requirements – my understanding is that Ontario, Manitoba and British Columbia are currently the only provinces where a Ph.D. degree is absolutely required to be a Psychologist. All other provinces require at least a Masters level of education (but often more work experience, so the time involved in becoming registered is still about the same), and vary in the examinations and hours of experience necessary. If a person in Ontario wants to practice psychology but has only a Masters degree, (s)he can register as a “Psychological Associate” and go through the same supervision and examination process as a Psychologist if (s)he first works for at least 4 years in the mental health field.

Ok, so that’s a Psychiatrist versus a Psychologist. Now, what about who can diagnose? There are 13 Controlled Acts in the RHPA across colleges. There are rules around which professionals can do which controlled acts. Communication of a Diagnosis is considered to be the most potentially harmful activity of all Controlled Acts, as it impacts a number of subsequent steps including treatment. Physicians, Psychologists, and (as of very recently) Psychological Associates are the only professionals who can legally diagnose a mental health condition (i.e. disorders like OCD, schizophrenia, or a learning disability). While a Physician can obviously diagnose other conditions too (i.e. everything from bronchitis to bone cancer), and while other professionals can diagnose conditions in their own areas of training (e.g. optometrists can make diagnoses involving visual problems), in the area of mental health one does NOT require a diagnosis from a Physician for it to be considered “official” in Canada.

Will conclude next time…

B. Duncan McKinlay, Ph.D., C.Psych. (supervised practice)

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Last updated on January 3, 2018

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