Psychiatric Nurse Practitioner vs. Psychiatrist Guide: Role, Education, Scope of Practice, and Current Salary Comparison

If you are interested in a career in psychiatry, the roles of a Psychiatric Mental Health Nurse Practitioner (PMHNP) and of a Psychiatrist are two popular avenues for entering the workforce. Although they share the same industry sector, there are substantial differences between the two roles, including required education, scope of practice, salary expectations, working conditions, settings, advancement opportunities, and so on.

To help you make the right choices as early as possible in your career journey, we compiled a structured comparison of PHMNPs and Psychiatrists, highlighting the main differences across key areas. Finally, you will also find valuable and actionable guidelines for making the right decision in the Psychiatric Nurse Practitioner vs. Psychiatrist role debate.

Psychiatric Nurse Practitioner vs. Psychiatrist: Role Definitions and the Key Difference

Let us start by defining the two roles and highlighting the key aspect that differentiates them in the current healthcare industry.

What Is a Psychiatric Mental Health Nurse Practitioner (PMHNP-BC)?

A Psychiatric Mental Health Nurse Practitioner (PMHNP) is an Advanced Practice Registered Nurse (APRN) with graduate training in mental health. PMHNPs are licensed, board-certified nurses who assess, diagnose, and treat individuals or families with psychiatric disorders. 

PMHNPs take a holistic, nursing-centered approach to mental health care, with their abilities going beyond prescribing medications — they will address psychological and social factors alongside biological needs.

The PMHNP-BC designation indicates that the nurse has passed a national certification exam in psychiatric nursing, earning the Psychiatric–Mental Health Nurse Practitioner-Board Certified title.

What Is a Psychiatrist?

A Psychiatrist is a Medical Doctor (MD or DO) specialized in mental health care who is tasked to diagnose and treat mental illnesses using both psychotherapy and medical interventions. Psychiatrists can also prescribe medication, including controlled substances, in all states and may perform medical procedures or treatments that APRNs cannot, such as electroconvulsive therapy. 

They approach patient care from a medical model, focusing on biological aspects of mental illness while also considering psychological and social components. 

Psychiatrists work in both clinical settings and academic or research institutions, and they are often the professionals with authority to lead interdisciplinary mental health teams and to carry out specific legal responsibilities that are beyond an APRN’s scope, such as involuntary commitment.

The Key Difference Between Psychiatrists and Psychiatric Nurse Practitioners

The main difference between the two roles is that the practice of Psychiatric Nurse Practitioners involves a nursing-centered approach, while that of Psychiatrists involves a medical approach to the same mental health conditions. 

As a consequence, aspects such as the types of academic and clinical preparation, scopes of practice, work settings, and daily activities of Psychiatric Nurse Practitioners and Psychiatrists will differ accordingly.

Below, you will find the details of the Psychiatric Nurse Practitioner vs. Psychiatric comparison across seven central areas of interest — education, licensure and certification, roles and clinical responsibilities, practice authority and autonomy, treatment approaches, salaries, and job outlook.

Psychiatrist vs. Psychiatric Nurse Practitioner: Education Comparison

The first difference between the career paths of a Psychiatrist and a Psychiatric Nurse Practitioner is found in their education.

PMHNPs begin their careers as registered nurses and then pursue advanced graduate education in psychiatric nursing. Here are the typical steps to becoming a Psychiatric Nurse Practitioner:

• Obtain a Bachelor of Science in Nursing (BSN).
• Become a Registered Nurse (RN) by taking the NCLEX-RN.
• Enroll in a 2-year Master of Science in Nursing with the Psychiatric-Mental Health specialty (MSN PMHNP).
• After earning the degree, you must pass the national certification exam offered by the American Nurses Credentialing Center (ANCC) to obtain the PMHNP-BC credential.

In total, it typically takes around 6–8 years of post-secondary education and training (including undergraduate and graduate studies) to become a PMHNP, depending on the prior education and whether you choose full-time or part-time programs. You can learn more about the time spent in preparation in our nursing school length by program guide. Many programs require or prefer a couple of years of nursing experience before or during graduate study. Graduate PMHNP programs include extensive coursework in mental health assessment, psychopharmacology, and psychotherapy, along with clinical rotations in psychiatric settings.

If you want to advance your education and become a Psychiatric Mental Health Nurse Practitioner, enroll in Nightingale College’s MSN PMHNP Program — a 2-year hybrid learning option that blends online instruction with in-person seminars and preceptorship experiences in one of the many SOFE areas across the US, to deliver top-quality nursing education in the most accessible way possible. 

Learn more about the MSN PMHNP Program and enroll today!

If you are only starting your nursing education, consider completing the BSN Program necessary for RN licensure. Nightingale College’s bachelor’s program is a hybrid program that prepares you to take the NCLEX-RN in just 3 years. Once enrolled, you will also receive mentorship and NCLEX coaching, among other services and resources comprising the learner experience.

Start your nursing career — enroll in Nightingale College’s BSN Program!

Psychiatrists undergo a longer medical path of education. First, an aspiring psychiatrist completes a bachelor’s degree, often with pre-medical coursework in biology or psychology.

Next comes medical school, lasting 4 years, where they earn an MD or DO degree and gain broad medical knowledge. After graduating from medical school, they must pass the United States Medical Licensing Examination (USMLE) for MDs or COMLEX for DOs to become a licensed physician. 

Then, graduates enter psychiatric residency programs, which typically last 4 years and provide in-depth specialized training in psychiatry, including diagnosing mental illness, psychotherapy techniques, and medication management. Some Psychiatrists may pursue additional fellowships (1-2 years) in subspecialties such as child psychiatry or forensic psychiatry.

In total, it takes roughly 12 years or more after high school to train a psychiatrist.

Upon completing residency, psychiatrists often become board-certified by passing an exam from the American Board of Psychiatry and Neurology (ABPN). While board certification is sometimes optional for practice, it is usually required by employers, as it demonstrates a Psychiatrist’s expertise.

Psychiatric Nurse Practitioner vs. Psychiatrist: Licensure and Certification Differences

Both PMHNPs and psychiatrists must be licensed in order to practice, but the licensing bodies and certifications differ.

As noted above, a PMHNP must hold an active RN license and then receive an advanced practice nursing license in the state where they will be practicing. Upon completing their graduate program, they must also achieve board certification by passing the ANCC’s PMHNP exam — thereby earning the PMHNP-BC credential.

Psychiatrists, on the other hand, must obtain a medical license by passing either the USMLE or the COMLEX (depending on whether they aim to be MDs or DOs), and then meet their state’s medical board requirements. Following residency, they will typically seek board certification in psychiatry via the ABPN, a process that involves sitting rigorous exams and fulfilling training requirements. Although voluntary, board certification is often seen as a requirement for employability and autonomy.

The key takeaway is that while Psychiatric Mental Health Nurse Practitioners are licensed as advanced practice nurses (APRNs) with a specialty certification in psychiatry-mental health, Psychiatrists are licensed as physicians with a specialty board certification in psychiatry.

Read about the differences between Family Nurse Practitioners and Physician Assistants.

Roles and Clinical Responsibilities of Psych NPs vs. Psychiatrists

In daily practice, Psychiatric NPs and Psychiatrists share many clinical duties, dealing primarily with treating mental health patients. Their scopes of practice showcase many similarities, both conducting psychiatric evaluations, making diagnoses according to DSM criteria, developing treatment plans, providing psychotherapy, and prescribing medications for various conditions, including depression, anxiety, and BPD.

Additionally, both roles share responsibility for educating patients, their families, and peers about mental health, and collaborate within teams to manage care. 

However, there are many essential differences in responsibilities and procedures, with many reserved only for Psychiatrists, given their medical training. The ability to perform some somatic therapies, such as the electroconvulsive therapy (ECT), or the legal authority to commit patients who are a danger to themselves or others to involuntary hospitalizations, are two critical points of divergence, with PMHNPs not being able to perform either. In such scenarios, Psychiatric NPs must work in tandem with a Psychiatrist or a Physician.

Additionally, Psychiatrists have full prescriptive authority in all states, whereas the scope of prescriptive authority, particularly for controlled substances, of PMHNPs is dependent on state law, sometimes requiring Physician oversight.

Nevertheless, both Psychiatrists and Psychiatric Nurse Practitioners deliver high-quality mental health care, with studies showing that patient outcomes were comparable for those treated by a PMHNP or a Psychiatrist for common mental health issues.

Practice Authority and Autonomy Differences Between Psychiatrists and Psychiatric Nurse Practitioners

The question of practice authority and workplace autonomy represents one central difference between Psychiatrists and Psychiatric Nurse Practitioners, with the latter being dependent on state laws and local jurisdictions.

Given their Physician credentials, Psychiatrists can practice autonomously in all states, evaluating, diagnosing, and treating patients without direct supervision. They are governed by state medical boards and generally have broad authority in clinical decision-making.

Comparatively, the autonomy of PMHNPs varies by state. In many states — often called “full practice” states — NPs can evaluate patients, order and interpret tests, make diagnoses, and prescribe medications independently under their nursing license. About half of the US states are now categorized as “full practice,” highlighting a trend toward granting Practitioners a level of autonomy similar to that of Physician-licensed professionals.

In states characterized as “reduced” or “restricted practice,” NPs, in general, must enter into collaborative agreements with Physicians or be supervised by them to perform certain aspects of care, particularly medication prescribing and the execution of treatment plans.

Psychiatrist vs. Psychiatric Nurse Practitioner Work Settings and Job Outlook Differences

One immediate consequence of the varying level of autonomy of PMHNPs is that, as opposed to Psychiatrists, who can potentially run their own clinical practice anywhere, the former may need a Psychiatrist’s or Physician’s oversight for care decisions; thus, independent work is excluded in “restricted practice” states. 

Otherwise, both types of professionals will work in similar settings, although in different concentrations. Nearly half (48%) of all Psychiatrists work in physicians' offices, with another 27% finding employment in general medical and surgical hospitals. Other frequent work settings for Psychiatrists include outpatient mental health clinics, academic and research institutions, correctional facilities, and telepsychiatry platforms.

One study notes that 70% Psychiatric Mental Health Nurse Practitioners work in outpatient or community-based settings, with other growing roles including telehealth and integrated primary care. Psychiatric Mental Health Nurse Practitioners also find work in behavioral health clinics, hospitals, and private practice clinics (either autonomously in full-practice states or under supervision in others). Recent trends indicate that PMHNPs are increasingly employed in underserved areas where there are shortages of Psychiatrists.

Job outlook-wise, both roles are currently in high demand. However, the growth projections of Psychiatric Mental Health Nurse Practitioners are more robust. The Bureau of Labor Statistics (BLS) estimates a 40% increase in employment from 2024 to 2034 for Nurse Practitioners, amounting to a net of 128,400 new job openings, in excess of the current employment of 320,400 NPs. The job outlook for Psychiatric Mental Health NPs is similar to that of NPs in general, with job aggregator Zippia estimating a 40% growth rate, totaling 118,600 over the next decade (2025-2035).

The growth rate over the decade estimated by the BLS for Psychiatrists is 6%, which is slower than the growth rate for all healthcare diagnosing or treating practitioners (8%), but above that of all Physicians and surgeons (3%), as well as all surveyed occupations (3%). Over the decade, the net increase in jobs for Psychiatrists amounts to 1,700 in addition to the current working pool of 27,100. 

In other words, prospective PMHNPs can anticipate excellent job opportunities nationwide (especially in underserved rural or urban areas and in telehealth). Psychiatrists also remain in demand, particularly for complex cases and in leadership roles, but the increase in employment opportunities is expected to be lower.

Difference Between Psychiatrist and Psychiatric Nurse Practitioner Approaches to Treatment

The approach each role takes to patient care is another key, but subtle, difference between Psychiatrists and Psychiatric Nurse Practitioners.

PHMNPs are trained in and follow the nursing model of care, which adopts a holistic, patient-centered approach that integrates biological, psychological, social, and even spiritual aspects. In daily practice, this means that they may spend more time on counseling, patient education, and preventive strategies alongside clinical treatment.

The Nurse Practitioner model involves building strong therapeutic relationships, considering a patient’s environment and lifestyle in the plan of care, and utilizing interventions like psychotherapy and wellness promotion in addition to medications. 

Comparatively, Psychiatrists are trained in the medical model, which is centered on the biological aspects and underpinnings of mental health disorders and issues. As a consequence, they are more likely to emphasize pharmacological treatment as a central component, and may approach care with the perspective of diagnosing and treating an illness in a manner similar to other medical conditions. However, due to the nature of their specialty, Psychiatrists will still need to provide therapy and holistic care. 

The difference in the level of holistic integration involved in the practice of the two roles often comes down to variations in degree and emphasis: PMHNPs lean toward psychotherapy and holistic nursing interventions, while Psychiatrists lean toward medication management and medical interventions. This complementary difference often benefits mental health teams, as each provider brings a slightly different lens to patient care.

Psychiatric Nurse Practitioner vs. Psychiatrist Salary Comparison

Psychiatrists generally earn higher salaries than PMHNPs, reflecting their longer training and medical credentials.

According to recent data from the BLS, the median annual salary for Psychiatrists is $269,000. In comparison, Psychiatric Mental Health Nurse Practitioners have an estimated median salary of about $151,588 per year. Although top earners among MSN-trained APRNs, PMHNPs earn less on average due to their reduced autonomy and comparatively shorter training time.

The net difference between Psychiatrist and Psychiatric Nurse Practitioner estimated earnings amounts to $117,412. However, geographic and work setting variations in pay often outweigh the nationwide median salary differences between the two roles. Below, you can find a state-by-state comparison of the salaries of Psychiatrists and Psychiatric Mental Health Nurse Practitioners:

All presented data were sourced from the current Occupational Employment and Wage Statistics (OEWS) published by the Bureau of Labor Statistics. Estimates are subject to change. We will update the estimates presented above as soon as new datasets are available.

Read more about Psychiatric Mental Health Nurse Practitioner salaries by state.

Which Career Path Will You Choose?

Deciding between becoming a PMHNP or a Psychiatrist involves considering several personal and practical factors. 

The education timeline is a significant difference. The difference in post-high school timelines between Psychiatrist and Psychiatric Nurse Practitioner students is about 12+ years for the former, compared to 6 to 8 years for the latter. Thus, you will spend twice as much time in school to become a Psychiatrist as to earn the education required from PMHNPs. Hence, if you are eager to begin practicing sooner and prefer a nursing-based approach to care, the PMHNP path offers a faster entry into the field.

The care model and level of autonomy are other elements to consider. If you are drawn to the depth of medical school training, the ability to perform a broader range of medical procedures, and the potential for a higher salary, the Psychiatrist route might be more fulfilling. Compared with other roles, if you are interested in holistic care and in supporting patients and their peers throughout the medical journey, becoming a Psychiatric Nurse Practitioner is the recommended route. You should be comfortable working within nursing regulations and, depending on the state, possibly under physician oversight. In contrast, Psychiatrists will have independent authority but also the ultimate responsibility for patient care.

Financial factors could play a role, with Psychiatrists generally earning more while also incurring higher education costs and delayed earnings due to the longer training. PMHNPs have lower educational costs and can start earning sooner, potentially with less student debt.

To conclude, you should reflect on your career goals, the populations you want to serve, and the effects of your chosen path on your lifestyle. Remember that, no matter your initial choice, you can later take steps to pursue a different nursing career path. One key, but often overlooked, advantage of Nurse Practitioners is that they can pursue doctoral degrees later, once they have gained valuable experience in the field. If you choose to pursue the Psychiatric Mental Health Nurse Practitioner, you can advance up the career ladder and study to become a Doctor of Nursing Practice (DNP) — a position that garners similar benefits to those that come with Physician training, but that does not change your focus on nursing practice. Nursing also offers multiple advancement opportunities that do not require further education but can improve your workplace autonomy, earning potential, and role in the healthcare industry.

If you want to become a Psychiatric Mental Health Nurse Practitioner in the most accessible way, consider enrolling in Nightingale College’s MSN PMHNP Program – a learning option that blends online instruction with in-person seminars and preceptorship experiences to deliver top-quality nursing education to a broad spectrum of learners from various walks of life.

Advance your education — enroll in the MSN PMHNP Program at Nightingale College!

Psych NP vs. Psychiatrist FAQs

What Is the Difference Between a Psychiatrist and a Psychiatric Nurse Practitioner?

A Psychiatrist is a medical doctor (either an MD or DO) who has completed medical school and a psychiatry residency. In contrast, a Psychiatric Nurse Practitioner is an Advanced Practice Registered Nurse with a graduate degree (generally an MSN, with a DNP being possible) in psychiatric nursing. Both are licensed to assess, diagnose, and treat mental health disorders, but psychiatrists have a broader medical scope. 

A Psychiatric NP focuses on mental health through a nursing lens, often collaborating with physicians, and may face practice limitations depending on state laws.

Is a Psychiatric Nurse Practitioner as Good as a Psychiatrist?

For the vast majority of common mental health concerns, seeing a PMHNP is as effective as seeing a Psychiatrist. Studies and healthcare outcomes have shown that NPs deliver care on par with physicians in terms of patient satisfaction and outcomes.

However, Psychiatrists may be preferable for very complex cases or situations requiring specific medical interventions beyond an NP’s scope. This is counterbalanced by the holistic care that patients can receive from Psych NPs throughout their healthcare journeys — a central element of the nursing model that may be less emphasized in the medical approach.

Can Psychiatric Nurse Practitioners Diagnose?

Yes, both Psychiatric Nurse Practitioners and Psychiatrists have the authority to diagnose within their scope of practice. PMHNPs learn to perform psychiatric assessments and use the DSM-5 criteria to diagnose conditions ranging from anxiety and depression to bipolar disorder, schizophrenia, and others. However, depending on the jurisdiction and the nature of a case, Psych NPs may be required to be overseen by a Psychiatrist or Physician when diagnosing and treating patients. In full practice states, PMHNPs can independently diagnose and treat patients. In some restricted practice states, an NP's diagnosis may need to be co-signed or confirmed by a psychiatrist or another physician.

Can a Nurse Practitioner Become a Psychiatrist?

While a Nurse Practitioner and a Psychiatrist are distinct professions, it is possible for an individual to become both, but this requires completing the complete education and training in psychiatry. In other words, a nurse practitioner cannot upgrade to a Psychiatrist based on nursing credentials. They would need to attend medical school and complete a psychiatry residency to earn the title of psychiatrist. However, Nurse Practitioners have other avenues to reach the doctoral level, particularly by earning a Doctor of Nursing Practice (DNP) degree, which enhances their authority and autonomy without requiring a change from the nursing to the medical route.