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)