What Does A Psychiatrist Do?
A psychiatrist is a medical doctor who specializes in mental health. Psychiatrists diagnose psychiatric conditions, look for medical causes of psychological symptoms, prescribe and manage medication, and many also provide psychotherapy. A therapist is a licensed professional whose main work is psychotherapy. In California, therapists and psychologists do not prescribe medication.
Who is who?
Psychiatrist (MD or DO). A physician who completed medical school and then a residency in psychiatry. More on that training below.
Psychologist (PhD or PsyD). A doctoral-level clinician trained in psychotherapy and psychological testing. Psychologists do not prescribe in California; a small number of states allow specially trained psychologists to prescribe certain medications (1).
Licensed therapist (LMFT, LCSW, LPCC). In California, a graduate degree, 3,000 hours of supervised experience over at least two years, and licensing exams (2).
Psychiatric nurse practitioner (PMHNP). An advanced practice nurse with graduate training in psychiatric nursing, who evaluates patients and prescribes.
How psychiatrists are trained
After four years of medical school, psychiatrists complete a residency, usually four years. The first year includes general medicine and neurology. The years that follow move through inpatient psychiatric units, emergency rooms, outpatient clinics, and consultation services that see patients on the medical and surgical floors of the hospital.
That range matters. Over those years, a psychiatrist sees mania, psychosis, delirium, severe depression, and medical illnesses that first show up as a change in mood or behavior. Conditions that many clinicians encounter only rarely become familiar. That exposure is what allows a psychiatrist to recognize what is unusual, what is being missed, and when a psychological symptom has a medical cause, in addition to more common milder conditions.
Where psychiatrists work
After training, psychiatrists work in hospitals and on inpatient units, in emergency departments, on consultation services in general hospitals, in outpatient clinics and community mental health centers, in universities and teaching hospitals, and in private practice, increasingly by telehealth. Training does not end with residency: board-certified psychiatrists keep their certification current through ongoing education and regular assessment, to keep pace with new treatments, research and discoveries throughout their careers.
What a psychiatrist does in practice
A psychiatric evaluation looks at symptoms in the context of a whole life and a whole body: current symptoms, past episodes, every medication tried, family history, medical conditions, other prescriptions, sleep and hormones. From there, the work is to tell apart conditions that look alike, decide whether medication makes sense, which one, at what dose and for how long, and when to reduce or stop it.
What a therapist does
Therapy is the work of understanding patterns in thinking, emotions and relationships, building skills, and working through painful experiences, usually in weekly or biweekly sessions.
How I work with patients
In my practice in San Diego, and by telehealth across California, patients work with me in four ways.
-Medication alongside therapy elsewhere. Many patients see me for medication while they work with a therapist in another practice. With their permission, I collaborate with that therapist, so the two treatments pull in the same direction.
-Medication only. Some patients come for medication management and are not interested in therapy. That is their choice to make, and the care is just as careful.
-Psychotherapy. A small number of patients see me for therapy, usually people who have tried other approaches, or who are looking for someone they feel they can relate to.
-The Expert Second Opinion. Some patients have navigated the system for months, sometimes years, without getting the answers or the improvement they hoped for. For them, we set a personalized schedule, review the full history and everything that has been tried, and work to untangle what has stayed unclear. There is time to explain the results, answer questions and discuss the alternatives for treatment. Afterwards, most return to their usual provider with clear recommendations. Some decide to stay.
To learn more:
This post is general information, not medical advice. If you are in crisis, the 988 Suicide and Crisis Lifeline is available by call or text.
Sylvia Cartwright MD is a board-certified psychiatrist in independent practice in San Diego since 2013. She sees adults across California by telehealth.
Sources
1. American Psychological Association. News release on Hawaii and Vermont laws allowing specially trained psychologists to prescribe, July 2026. Nine states now authorize it: Colorado, Hawaii, Idaho, Illinois, Iowa, Louisiana, New Mexico, Utah and Vermont.
2. California Board of Behavioral Sciences. Applicant handbooks for LMFT, LPCC and LCSW licensure: 3,000 hours of supervised experience over at least 104 weeks.
Comments