Psychopharmacology/Advanced Practice Psychology

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Yeah, so SDN was down for a couple days. Where is everyone!? I'm eager to read your comments regarding the above!

Originally Posted by ergo_sum

Only reason I posted here was that after you had gone on your little racist rant there, an IMG who stood up to you (even just a little) was yelled down. I was trying to show you that there can be different opinions about American Greatness, and you should not be so certain of your superiority.

Mister, you are not in charge of this thread, this is not your courtroom, and you ain't gonna tell me where I can post.

I cannot compete however with your productivity in terms of sheer word volume, and I do not intend to try.

It is easy to be nasty and racist. I see that no evidence to the contrary will sway you from your very-dearly-held-opinion. You could have a thousand eloquent, educated IMG's posting here, you could meet a thousand rude and ignorant american docs, and you would still hold on to your opinions. It is clear that I have failed in my mission here on this thread, and you will persist in spreading these malignant views.

Signing off.

Ergo_sum.

Wow, despite having taken several anthropology classes as an undergraduate, I must have missed the day when IMGs were noted to be a racial classification. Thanks for educating me on this very important issue.

You know, it's really petty to envoke the "race" card in a discussion about Foreign Medical Grads. An FMG could be of any race, so I find your comments to be a gross distortion of fact and quite pointless. You see, maybe my point about US trained physicians being superior is valid. We must complete 4 years of undergraduate training prior to 4 years of medical school, whereas most FMGs received 5-6 years of undergraduate/medical education and do not earn a prior BA/BS degree. While this does not make your medical education inferior, per se, it deprives you of non-medical education and life experience in other areas. In your case, you might have learned that FMGs are not a racial classification.

Originally Posted by PublicHealth

In keeping with the topic of this thread, here's a .pdf of Tennessee psychologists' "back and forth" with Tennessee psychiatrists regarding psychologist RxP. Tennessee's mental health system is a mess!

http://www.tpaonline.org/leg/rxp.pdf

TN bill: http://www.legislature.state.tn.us/b...ILL/SB0723.pdf

I have a feeling that Tennessee will gain prescriptive authority for psychologists this upcoming legislative cycle -- they successfully passed it through the Senate and were ONE VOTE shy of passing it through the House last cycle (http://www.tpaonline.org/leg/id155.htm). Hawaii looks promising too. Anyone else have any insight regarding legislation for psychologist RxP in these or other states?

I also think TN will gain prescriptive authority for psychologists in 2006. Is their model more similar to NM or LA?

Originally Posted by PsychEval

I also think TN will gain prescriptive authority for psychologists in 2006. Is their model more similar to NM or LA?

It appears to be more similar to Lousiana's model in that it requires a "collaborative practice agreement."

Are you from TN? Apparently, there's a 2-year nurse practitioner program at Vanderbilt for people with a bachelor's degree in a non-nursing field. The Tennessee Psychiatric and Medical Associations supposedly encouraged Tennessee psychologists interested in RxP to pursue this training in order to acquire prescriptive authority. However, the curriculum seems to lack in psychopharmacology training and basic and clinical sciences relevant to the practice of psychopharmacology: http://www.mc.vanderbilt.edu/nursing/msn/prespec.html

Interestingly, these groups acknowledged that RxP training programs for psychologists are more extensive than nurse practitioner training programs! Clearly, this a political and economic issue between clinical psychology and psychiatry.

Originally Posted by PublicHealth

Flutterbyu, how do you like MSPP? I took a human neuropsychology course at the Jamaica Plain VA during my undergraduate training and really enjoyed it. I recall some MSPP PsyD students being in the course. Are most students in your program considering the Master's in psychopharmacology? What is the status of the psychologist RxP bill in Massachusetts?

I love MSPP- it was my first choice and so far I have not been disappointed at all. The location is great- we have field practicums every year and Boston is just a prime location for great training. We actually have a few specialty tracks, health, forensic, and child, so I know for sure that most of the health people tend toward psychopharm, but I'm not sure about the rest. We actually have quite a large psychoanalytic base and many students develop interest in that area, along with an emphasis on projectives. Interests are definitely diverse, though so I wouldn't really say that most of our students go in any one direction. I have had contact with several people who have completed the psychopharm program and they are very happy with the outcome and their level of training. Now if we could only get MA on the RxP bandwagon, we would really have an excuse to tack on an extra 2 years of school! Last I heard, MA wasn't even petitioning or moving in that direction, but being a student, I haven't exactly had much free time to find out more. If you hear anything, let me know!

Originally Posted by Flutterbyu

I love MSPP- it was my first choice and so far I have not been disappointed at all. The location is great- we have field practicums every year and Boston is just a prime location for great training. We actually have a few specialty tracks, health, forensic, and child, so I know for sure that most of the health people tend toward psychopharm, but I'm not sure about the rest. We actually have quite a large psychoanalytic base and many students develop interest in that area, along with an emphasis on projectives. Interests are definitely diverse, though so I wouldn't really say that most of our students go in any one direction. I have had contact with several people who have completed the psychopharm program and they are very happy with the outcome and their level of training. Now if we could only get MA on the RxP bandwagon, we would really have an excuse to tack on an extra 2 years of school! Last I heard, MA wasn't even petitioning or moving in that direction, but being a student, I haven't exactly had much free time to find out more. If you hear anything, let me know!

From the MSPP website: (http://www.mspp.edu/index.asp?action=29&what=2001)

"The Federal Government Accounting Office (GAO) in 2000 issued a report on the DOD program and concluded that the psychologist practitioners were working at a level of professional competence, which prompted the catalyst in a number of states for licensing prescribing psychologists. Larger states with strong medical societies, such as New York and Massachusetts, may pass prescription authority legislation later than some of the rural states where thirty miles outside major cities, professional health services are inadequate."

I think that's the primary reason why psychologist RxP in MA will take a while. Here is some history on the issue:

"The resistance of the medical profession, and particularly of psychiatry, to the development of professional psychology has been strong and consistent throughout the history of professional psychology in the United States. A century ago, the medical society of the state of Massachusetts tried to pass laws to limit the practice of psychotherapy to physicians only. William James, then president of APA, prevented that by appearing before the Massachusetts legislature and declaring that neither psychologist nor physicians knew much about psychotherapy, but the promise for future progress lay more in the providence of psychology than in medicine.”

“But William James could not be everywhere. The efforts of organized medicine to resist the expansion of psychological practice continued and, in fact, continue today. Medical societies have used their much greater financial and political strength to block or at least to delay almost every expansion in the scope of practice of psychologists: Let me name just a few. In the early days of psychological testing, laws were passed requiring that even the determination of an IQ, based entirely on the results of testing by a psychologist, had to be confirmed by a physician."

Source: http://www.division42.org/MembersAre...es/DeLeon.html

Scroll down a bit:

http://www.nevadapsychologists.org/m.../pd_ocean.html

Notable paragraphs:

"We are now embarked upon the implementation of this historical statute. A total of 17 medical psychologists are now authorized to prescribe here in Louisiana, and by Summer's end, no less than 25 MPs will likely be practicing in Louisiana, and it is my hope that by the end of the year the remainder of those who have completed their training thus far will be doing so as well. A new class of psychologists is underway and being trained, and the next wave of MPs, will follow in due time. I also hope to be able to report to you in the near future another groundbreaking first, the credentialing of an MP to prescribe as part of the medical staff of a hospital. We have also been working with the insurance industry and I believe that I will soon have the pleasure of announcing an important breakthrough in the reimbursement of services provided by MPs, one that may well extend to other states for qualifying psychologists."

"To date, we are successfully feeling our way through the logistics required to fully realize the potential of our law. Louisiana requires a state Controlled and Dangerous Substance Permit before application can be made for a DEA number. This process has gone very smoothly and, with our DEA numbers in hand, we are now authorized to prescribe any drug, Schedule II through V, that has a recognized use (including off-label) in the management of any psychiatric disorder listed under either DSM or ICD. MPs, however, are not permitted to prescribe narcotics, agents which are specifically defined in our law as any '...natural or synthetic opiate analgesic used for the treatment of pain.' We are required to use the abbreviation 'MP' following our academic degree (Ph.D. or PsyD.) on all prescriptions and all medical records we generate, and the Louisiana State Board of Examiners (LSBEP) provides the Louisiana State Pharmacy Board a roster of all MPs in the state. Each of our psychology license numbers have been modified by LSBEP and are now followed by 'MP' so that our designation can quickly and easily be determined. The board also requires copies of our state Controlled and Dangerous Substances permits, DEA numbers and Basic Life Support for Health Care Providers certificates."

continued...

"It has also been gratifying to see that nonpsychiatric physicians appear to accept and even welcome MPs as partners in the delivery of health care. Whereas organized medicine has been obliged to oppose psychology in this movement, partly in deference to their psychiatric colleagues and partly out of a sense that medicine's monopoly on health care is waning, rank and file MDs, in my experience, are concerned not with turf issues but rather with providing quality care to their patients. We are not a threat; we are their allies and are being increasingly accepted as such. Patients appear absolutely thrilled with the ability of MPs to prescribe their psychotropic medications. It has freed them of the onerous requirement of seeing two doctors each time a prescription is needed while the close coordination of care between their MP and MD helps ensure optimized outcomes. We have written over 1,000 prescriptions, representing nearly 25,000 treatment days, without incident, for all classes of psychotropic medications."

"As for myself, this implementation period has been interesting. I find that I am conservative in my prescribing habits, adhering to the age old admonition to 'start low and go slow' when treating patients psychopharmacologically. My first 'official' act as an MP actually was to obtain labs on a new patient I suspected of thyroid disease and refer the patient whose studies were indeed abnormal. Subsequently, I have prescribed for all classes of psychotropic medications across all relevant schedules. All in all, patients have a better than 50-60% chance of leaving my clinic without a prescription so far, as psychotherapeutic/behavioral management was indicated and sufficed. Those for whom medication is necessary report that they find it refreshing that the doctor who prescribes for them also takes the time to listen to them and to approach their care in a more holistic manner."

"While some of our new professional activities are unmistakably medical in character (i.e., vital signs/review of systems/labs, evaluation of drug-drug and disease-drug interactions, etc.), the 'medical' in medical psychology is an adjective that modifies rather than defines who and what we are - psychologists. The opportunity to provide a broader range of therapeutic options certainly has not seemed to diminish my sense of professional identity."

Guess it's all me....just avoiding studying

Canada is supposedly interested in psychologist RxP: http://www.cpa.ca/Pharmpsych/Medical_Post.pdf

That's enough for now...no more until I hear from some of you! This is an important issue that will affect psychiatry and psychology in a major way.

Originally Posted by PublicHealth

Scroll down a bit:

http://www.nevadapsychologists.org/m.../pd_ocean.html

Notable paragraphs:

"We are now embarked upon the implementation of this historical statute. A total of 17 medical psychologists are now authorized to prescribe here in Louisiana, and by Summer's end, no less than 25 MPs will likely be practicing in Louisiana, and it is my hope that by the end of the year the remainder of those who have completed their training thus far will be doing so as well. A new class of psychologists is underway and being trained, and the next wave of MPs, will follow in due time. I also hope to be able to report to you in the near future another groundbreaking first, the credentialing of an MP to prescribe as part of the medical staff of a hospital. We have also been working with the insurance industry and I believe that I will soon have the pleasure of announcing an important breakthrough in the reimbursement of services provided by MPs, one that may well extend to other states for qualifying psychologists."

"To date, we are successfully feeling our way through the logistics required to fully realize the potential of our law. Louisiana requires a state Controlled and Dangerous Substance Permit before application can be made for a DEA number. [B]This process has gone very smoothly and, with our DEA numbers in hand, we are now authorized to prescribe any drug, Schedule II through V, that has a recognized use (including off-label) in the management of any psychiatric disorder listed under either DSM or ICD MPs, however, are not permitted to prescribe narcotics, agents which are specifically defined in our law as any '...natural or synthetic opiate analgesic used for the treatment of pain.' We are required to use the abbreviation 'MP' following our academic degree (Ph.D. or PsyD.) on all prescriptions and all medical records we generate, and the Louisiana State Board of Examiners (LSBEP) provides the Louisiana State Pharmacy Board a roster of all MPs in the state. Each of our psychology license numbers have been modified by LSBEP and are now followed by 'MP' so that our designation can quickly and easily be determined. The board also requires copies of our state Controlled and Dangerous Substances permits, DEA numbers and Basic Life Support for Health Care Providers certificates."

In NM, psychologists are also attempting to obtain authority to prescribe off label to treat psychiatric disorders. The differences in the laws in NM and LA are interesting. LA has more options regarding meds, but creates what appears to be a mid level provider with prescriptive authority. NM has less options regarding meds, but creates an independent provider with prescriptive authority. Which model do people prefer and why?

Originally Posted by PsychEval

In NM, psychologists are also attempting to obtain authority to prescribe off label to treat psychiatric disorders. The differences in the laws in NM and LA are interesting. LA has more options regarding meds, but creates what appears to be a mid level provider with prescriptive authority. NM has less options regarding meds, but creates an independent provider with prescriptive authority. Which model do people prefer and why?

NM is pushing to see how far they can get this bill to let them be like psychiatrists before legislators think they've gone too far. Last I heard, they wanted to prescribe drugs for neurologic conditions such as epilepsy and Parkinson's Disease, as well as for side effects of psychotropics.

LA's model seems more conservative and more in line with what others states will do. The consultation model is safe and decreases liability risks, while ensuring patients access to comprehensive behavioral healthcare. Check out the link to TN's bill, which is strikingly similar, if not exactly the same, as LA.

Originally Posted by PsychEval

In NM, psychologists are also attempting to obtain authority to prescribe off label to treat psychiatric disorders. The differences in the laws in NM and LA are interesting. LA has more options regarding meds, but creates what appears to be a mid level provider with prescriptive authority. NM has less options regarding meds, but creates an independent provider with prescriptive authority. Which model do people prefer and why?

Summary of differences: http://pn.psychiatryonline.org/cgi/c...code=psychnews

Originally Posted by PublicHealth

NM is pushing to see how far they can get this bill to let them be like psychiatrists before legislators think they've gone too far. Last I heard, they wanted to prescribe drugs for neurologic conditions such as epilepsy and Parkinson's Disease, as well as for side effects of psychotropics.

LA's model seems more conservative and more in line with what others states will do. The consultation model is safe and decreases liability risks, while ensuring patients access to comprehensive behavioral healthcare. Check out the link to TN's bill, which is strikingly similar, if not exactly the same, as LA.

Psychologists don’t want to treat Epilepsy, but having Carbamazepine in one’s formulary would be beneficial for the obvious reasons.

Originally Posted by PsychEval

Psychologists don’t want to treat Epilepsy, but having Carbamazepine in one’s formulary would be beneficial for the obvious reasons.

"In addition, the new proposal would permit psychologists to prescribe drugs to manage the side effects of psychotropic drugs. These could cover drugs to treat any condition from high blood pressure and seizures to Parkinson's disease and impotence, according to a report prepared by the Psychiatric Medical Association of New Mexico and the New Mexico Medical Society in opposing the proposed legislation."

Source: http://pn.psychiatryonline.org/cgi/content/full/40/5/7

Originally Posted by PublicHealth

"In addition, the new proposal would permit psychologists to prescribe drugs to manage the side effects of psychotropic drugs. These could cover drugs to treat any condition from high blood pressure and seizures to Parkinson's disease and impotence, according to a report prepared by the Psychiatric Medical Association of New Mexico and the New Mexico Medical Society in opposing the proposed legislation."

Source: http://pn.psychiatryonline.org/cgi/content/full/40/5/7

Public Health

I would like to read the introduced bill (to expand the list of drugs) if you know of a link. I read and reference psychiatric news often, but like many of us, they have an agenda.



You don’t know psychiatry. I do.

Tom Cruise

Originally Posted by PsychEval

Public Health

I would like to read the introduced bill (to expand the list of drugs) if you know of a link. I read and reference psychiatric news often, but like many of us, they have an agenda.



You don’t know psychiatry. I do.

Tom Cruise

Am I the only one with google on my laptop?

http://hpc.state.nm.us/leg/2005/SB591-669%20.pdf

Originally Posted by PublicHealth

Am I the only one with google on my laptop?

http://hpc.state.nm.us/leg/2005/SB591-669%20.pdf

Wow, that was fast. Your good. Thanks.

Hopefully the bill will pass in 2006.

Originally Posted by PsychEval

Hopefully the bill will pass in 2006.

Are you in NM? If so, are you planning on pursuing RxP? If not, where are you, and what is the status of RxP legislation in your state?

Notes on psychologist RxP from the Psychopharmacology Section of the Canadian Psychological Association:

http://www.cpa.ca/Pharmpsych/Psynapse-Winter2005.pdf

http://www.cpa.ca/Pharmpsych/Litman1.pdf

http://www.cpa.ca/Pharmpsych/Litman2.pdf

http://www.cpa.ca/Pharmpsych/Bigelow.pdf

Latest from Division 55: http://www.division55.org/Readers/Current.htm

Originally Posted by PublicHealth

Notes on psychologist RxP from the Psychopharmacology Section of the Canadian Psychological Association:

http://www.cpa.ca/Pharmpsych/Psynapse-Winter2005.pdf

http://www.cpa.ca/Pharmpsych/Litman1.pdf

http://www.cpa.ca/Pharmpsych/Litman2.pdf

http://www.cpa.ca/Pharmpsych/Bigelow.pdf

Latest from Division 55: http://www.division55.org/Readers/Current.htm

All of these articles are very fascinating. I was amazed when I read the term “Psychologist Physician” in one of the links. I’m sure this is upsetting to many. I am familiar with the LA term of medical psychologist, but I never heard of the term psychologist physician. I have read throughout the student doctor network several strong positions on who is allowed to use the term physician in their title, who is allowed to wear a white coat (not to mention the length of the lab coat), the color of one's scrubs, and who has prescriptive authority. It seems like much of these neurotic issues relate to status, money, turf, and professional identity and have little to do with health care delivery.

Originally Posted by PsychEval

All of these articles are very fascinating. I was amazed when I read the term “Psychologist Physician” in one of the links. I’m sure this is upsetting to many. I am familiar with the LA term of medical psychologist, but I never heard of the term psychologist physician. I have read throughout the student doctor network several strong positions on who is allowed to use the term physician in their title, who is allowed to wear a white coat (not to mention the length of the lab coat), the color of one's scrubs, and who has prescriptive authority. It seems like much of these neurotic issues relate to status, money, turf, and professional identify and have little to do with health care delivery.

Yup! The term "physician" is used by many other non-allopathic/osteopathic doctors: Naturopathic physician, Chiropractic physician, Podiatric physician, Optometric physician, etc. I think the title "physician" is legally reserved in some states, however. For example, one can be "chiropractic physician" in some states but only "chiropractor" in others. Weird.

Makes sense considering that definitions of "physician" include: "a person skilled in the art of healing" and "one exerting a remedial or salutary influence." Here's what the etymologists have to say: "c.1225, fisicien, from O.Fr. fisicien "physician" (12c., Mod.Fr. physicien means "physicist"), from fisique "art of healing," from L. physica "natural science" (see physic); http://www.etymonline.com/index.php?term=physician

Interesting note on the history of therapy in clinical psychology and what it means for RxP:

"Fifty years ago psychologists fought among themselves over the issue of whether we should expand our practice into psychotherapy. Many argued that psychotherapy was properly the domain of psychiatry and we should properly restrict ourselves to limited forms of counseling and retain our strength and integrity as mental testers. There was a great concern that we would be fundamentally changed as a profession and loose our assessment tradition. We expanded our practice in spite of the opposition, we were changed, and we all survived it. Psychologists fought with each other over accreditation and over licensing. It was argued that accreditation and licensing would restrict our academic freedom and impose professional standardization. Some psychologists testified in legislatures again licensing. We achieved accreditation and licensing, we were changed again, largely for the better, and we survived it all. We’ll probably achieve prescription privileges for those who want it, we will be changed as a profession, and we will survive it."

Source: http://www.uh.edu/~lrehm/pres2.html

Food for thought for budding Prescribing Psychologist...

http://www.mspp.net/pres0203.htm

Originally Posted by Harmony

Food for thought for budding Prescribing Psychologist...

http://www.mspp.net/pres0203.htm

Society for Psychoanalytic Psychology.....no comment.

Originally Posted by Harmony

Food for thought for budding Prescribing Psychologist...

http://www.mspp.net/pres0203.htm

Garden variety dissension within the ranks...same thing happened when psychologists sought psychotherapy privileges. Reality is that RxP, with proper training, is bound to happen for psychologists who want prescriptive authority. The first two dominoes have fallen...

PH-

I totally agree with you. The beautiful thing is the power of free market forces. As the number of prescribing psychologist will increase, variances in skills, education, training, capabilities will be automatically taken care of by actual outcomes and the legal system. It may result in shifting parardigms for both Psychologists and Psychiatrists.

The results may nullify the hypothesis that it requires solid biological background, medical training and years of supervision/training to prescribe psychotropic medications. On the other hand, it may totally support the hypothesis. Only time can tell. But whoever chose to prescribe need to understand the risks and rewards associated with venturing in a field that you are not fundamentally trained in. It will be a personal choice. It will be fascinating to see how this really unfolds!! There is always place on the top for those who excel in what they do. It will be difficult for those who just want to enjoy a free ride.

Originally Posted by Harmony

PH-

I totally agree with you. The beautiful thing is the power of free market forces. As the number of prescribing psychologist will increase, variances in skills, education, training, capabilities will be automatically taken care of by actual outcomes and the legal system. It may result in shifting parardigms for both Psychologists and Psychiatrists.

The results may nullify the hypothesis that it requires solid biological background, medical training and years of supervision/training to prescribe psychotropic medications. On the other hand, it may totally support the hypothesis. Only time can tell. But whoever chose to prescribe need to understand the risks and rewards associated with venturing in a field that you are not fundamentally trained in. It will be a personal choice. It will be fascinating to see how this really unfolds!! There is always place on the top for those who excel in what they do. It will be difficult for those who just want to enjoy a free ride.

Can you imagine the day when mid-levels will provide all primary healthcare and MDs/DOs will serve only manage hard-to-treat referrals? This is increasingly becoming the norm. Prescribing psychologists, if properly trained, will serve an important role in the primary care of psychiatric patients. Psychiatrists will remain the "experts" in psychopharmacology and will manage difficult cases. Think optometry and ophthalmology.

http://www.nmpsych.org/comparison_chart.htm

I came across this misleading information on the New Mexico Psychiatric Associations web site. I then began to wonder if anyone had ever put together a similar graph comparing different professions as related to their total years of training in psychotherapy. On this type of graph, psychologists would obviously be represented as having the most training, then masters level people, next drug & alcohol counselors with an associates degree, then psychiatrists at the bottom. Unfortunately, the New Mexico Psychiatric Association has not created such a graph.

Any news from Hawaii, Tennessee, Georgia, Illinois, Texas, California, or Florida?

Originally Posted by PsychEval

Any news from Hawaii, Tennessee, Georgia, Illinois, Texas, California, or Florida?

I suspect that the Psychological Associations from these and other states pursuing RxP are keeping quiet as the legislative session draws closer. This is strategic, as the goal is to catch Psychiatric Associations in these states off-guard and with limited time to prepare their arguments. Politics are ugly.

For example, the California Psychological Association formed a Division of Clinical Psychopharmacology that only members may access. Click on the link for Division of Clinical Psychopharmacology on the front page of the CPA website: http://www.calpsychlink.org/

Shhhhh....

Originally Posted by psisci

Shhhhh....

Check your PM

Originally Posted by PublicHealth

Can you imagine the day when mid-levels will provide all primary healthcare and MDs/DOs will serve only manage hard-to-treat referrals? This is increasingly becoming the norm. Prescribing psychologists, if properly trained, will serve an important role in the primary care of psychiatric patients. Psychiatrists will remain the "experts" in psychopharmacology and will manage difficult cases. Think optometry and ophthalmology.

What I think of when I see psychologists desperate to prescribe is how much they're cannibalizing their own profession.

If you want to prescribe, become an MD psychiatrist or a PA or even RN in many states. There's already a well-established set of training programs for this knowledge and there's nothing in the typical doctoral program that prepares a psychologist for prescribing.

What this leads to is the discovery that if psychologists can become prescribers, well, heck, clinical social workers and master's level therapists can do psychotherapy (which is exactly what's happened in the past decade). Since there's little to no research that shows having a doctorate results in better patient outcomes, it's only a matter of time before insurance companies realize how much cheaper they can get therapy services for. In fact, many already have.

So what do psychologists do? They turn to the lowest MD on the totem poll, the psychiatrist, and try and take away some of her business. It may be an inevitable result that psychologists gain prescription privileges, but those other professionals -- clinical social workers, master's level therapists, etc. -- aren't far behind. After all, what's good for the goose is good for the gander.

-John

Your ignorance is showing. Please do some research before you spout off. RNs do not prescribe anywhere, psychologists who do are required to get significant training post doctorally to do so. Get a clue.

Originally Posted by psisci

Your ignorance is showing. Please do some research before you spout off. RNs do not prescribe anywhere, psychologists who do are required to get significant training post doctorally to do so. Get a clue.

Our mod rocks!

I noticed that a common misunderstanding among medical folks is that psychologists will be prescribing straight out of PhD/PsyD programs. Many have characterized postdoctoral training in clinical psychopharmacology as an "on-line weekend workshop" and the like, when the requirements to prescribe include a 2-3 year postdoctoral training period consisting of extensive didactic preparation in basic sciences, psychopharmacology, and general physical and laboratory assessent, a supervised clinical practicum, a passing score on a national exam (Psychopharmacology Examination for Psychologists), and a 2-year conditional prescribing period during which a medical doctor supervises psychologist prescribing. Even then, prescribing/medical psychologists must consult with a patient's primary care physician prior to writing a prescription. This is extensive training with appropriate safeguards that will foster an increased sense of collaboration among healthcare professionals.

To the ignorant among us, consider yourself informed (and stop hijacking our forum!)

Thanks PH for the compliment, and for explaining the reality of the situation. This guy is a practicing psychologist with degrees from NOVA Southeastern, and seems to have alot of experience etc... I will give him the benefit of the doubt, and welcome him to join us here. FYI, his other posts were quite good I thought.
I find it funny that people who have very little medical and psychopharm training have such strong opinions about something they don't even know enough about to know what the don't know. The more I study the more I realize how hard and complex this can be, and I have been an avid student for over 5 years post-doctorally including a post-doc in medical psych.

i'm sorry, but i just had to point out that ProZackMI made the same points that docjohng did, but didn't get ripped a new one....is it just b/c he supports your position while docjohng doesn't?

i.e. post #5 (I didn't notice anyone calling him ignorant)

Another point, master's level NPs and bachelor's level PAs, as well as optometrists, prescribe meds all the time and have not been through med school, and research shows that they prescribe meds more safely than many MDs and DOs (especially the IMG/FMGs). Podiatrists, pharmacists, and dentists also have full or partial RxPs and do a safe and effective job, for the most part, in prescribing meds.

post#15

Another obstacle, the public's perception. Many folks get confused between psychiatrists, psychologists and even MSWs. Both psychiatrists and psychologists are "doctors", but one is a "talking doctor" as one of my colleagues likes to say, and the other is a "pill pusher". If they both have the same "powers and privileges", what's the difference? If psychologists become more like psychiatrists, will the MSWs attempt to fill the void and become more like psychologists? Can you see MSWs trying to perform TATs, Rorschachs, MMPIs, WAIS, WISCs, WIATs, etc.?

and I didn't notice docjohng ever saying it wouldn't take a lot of training to get RxP...but words were quickly put in his mouth

i just wanted to mention this b/c i'm a newbie here and was surprised by this hostility to an opposing opinion that was reasonably well stated and the exclusive labeling of "our forum" which I guess implies no new opinions are welcome

Originally Posted by vesper9

i'm sorry, but i just had to point out that ProZackMI made the same points that docjohng did, but didn't get ripped a new one....is it just b/c he supports your position while docjohng doesn't?

i.e. post #5 (I didn't notice anyone calling him ignorant)


post#15


and I didn't notice docjohng ever saying it wouldn't take a lot of training to get RxP...but words were quickly put in his mouth

i just wanted to mention this b/c i'm a newbie here and was surprised by this hostility to an opposing opinion that was reasonably well stated and the exclusive labeling of "our forum" which I guess implies no new opinions are welcome

Explain how ProZack's comments are confluent with docjohng's. I don't follow. ProZack's first statement above supports psychologist prescribing, as other nonphysician providers prescribe medications. His second point refers to the role social workers may have if psychologists transition to a more medical model that includes RxP. I see no connection.

The "our forum" statement was facetious. Last I checked, we openly welcome informed debate regarding RxP for psychologists (that's the purpose of this forum). All too often, medical folks turn to the "if you want to prescribe psychotropics, go to medical school" conclusion without fully understanding the issue at hand.

I don't think anyone minds heated opinions here as long as you are not presenting arguments that lack any sort of thought or research. His statement was ignorant because RNs do not prescribe anywhere, he said they did, psychologists do not get medical training and are not trained to prescribe in current PsyD, PhD programs, he implied that was the terminal training for psychologists that do prescribe. This is misinformation, and that bugs me. I feel if you are going to make emphatic, opinionated arguments you had better show you have some clue what you are talking about. I am a medical psychologist, I know the training, I know the field, and I work daily with medical professionals, but you don't see me going on a urology forum telling my opinion on the best way to perform a vasectomy just because I have an opinion on the matter??? Being a doctor and professional requires a certain degree of humbleness, confidence, and trust that other professionals can do their part. Being a student is all about learning that, and I like to reiterate that when I can.

happy friday...for you newbies fridays are when I like to stir it up!!

Originally Posted by psisci

I don't think anyone minds heated opinions here as long as you are not presenting arguments that lack any sort of thought or research. His statement was ignorant because RNs do not prescribe anywhere, he said they did, psychologists do not get medical training and are not trained to prescribe in current PsyD, PhD programs, he implied that was the terminal training for psychologists that do prescribe. This is misinformation, and that bugs me. I feel if you are going to make emphatic, opinionated arguments you had better show you have some clue what you are talking about. I am a medical psychologist, I know the training, I know the field, and I work daily with medical professionals, but you don't see me going on a urology forum telling my opinion on the best way to perform a vasectomy just because I have an opinion on the matter??? Being a doctor and professional requires a certain degree of humbleness, confidence, and trust that other professionals can do their part. Being a student is all about learning that, and I like to reiterate that when I can.

happy friday...for you newbies fridays are when I like to stir it up!!

Cheers, bro!

Why? Why would we want to gain Rx privileges? We certainly would like to be the ultimate in MH tratment, but I don't think that we need to prescribe to do that. Being an expert in the field doesn't necesitate that we be able prescribe. Medication titration was not what drew me to the field and I gurantee that none of you were drawn to the field because you figured you could better dfferentiate between 20 and 40gms of Paxil for a Patient. Be true to yourselves, Rx privelges are not what will defeine our profession. Treat you rclients wholey and refer them when needed. But only after it is felt that they need pharmacholgical intervention.

Originally Posted by docjohng

What I think of when I see psychologists desperate to prescribe is how much they're cannibalizing their own profession.

If you want to prescribe, become an MD psychiatrist or a PA or even RN in many states. There's already a well-established set of training programs for this knowledge and there's nothing in the typical doctoral program that prepares a psychologist for prescribing.

What this leads to is the discovery that if psychologists can become prescribers, well, heck, clinical social workers and master's level therapists can do psychotherapy (which is exactly what's happened in the past decade). Since there's little to no research that shows having a doctorate results in better patient outcomes, it's only a matter of time before insurance companies realize how much cheaper they can get therapy services for. In fact, many already have.

So what do psychologists do? They turn to the lowest MD on the totem poll, the psychiatrist, and try and take away some of her business. It may be an inevitable result that psychologists gain prescription privileges, but those other professionals -- clinical social workers, master's level therapists, etc. -- aren't far behind. After all, what's good for the goose is good for the gander.

-John

Did I just read this right? A psychiatrist is the "lowest" MD on the totem pole? Wow...I feel so...low. Elitism can be found even among the physician fraternity. I really find this comment to be uninformed, rude, and downright nasty. Let me guess, are you a surgeon or neurologist?

Zack, the lowest MD on the totem pole and loving it!

Originally Posted by PublicHealth

Our mod rocks!

I noticed that a common misunderstanding among medical folks is that psychologists will be prescribing straight out of PhD/PsyD programs. Many have characterized postdoctoral training in clinical psychopharmacology as an "on-line weekend workshop" and the like, when the requirements to prescribe include a 2-3 year postdoctoral training period consisting of extensive didactic preparation in basic sciences, psychopharmacology, and general physical and laboratory assessent, a supervised clinical practicum, a passing score on a national exam (Psychopharmacology Examination for Psychologists), and a 2-year conditional prescribing period during which a medical doctor supervises psychologist prescribing. Even then, prescribing/medical psychologists must consult with a patient's primary care physician prior to writing a prescription. This is extensive training with appropriate safeguards that will foster an increased sense of collaboration among healthcare professionals.

To the ignorant among us, consider yourself informed (and stop hijacking our forum!)

People who oppose something will do their very best to minimize it, and those who advocate for something will do their very best to puff it up. I remember reading something in a magazine a few years ago comparing chiropractic education to medical education and the author was a chiropractor. Guess who had more "clinical" hours and didactic hours of anatomy, physiology, pathology, and neurology? Yep, the chiros, not the MDs/DOs. I laughed and laughed and laughed, but then became angry. Such puffery is not only false, but it's misleading to the public who might be naive enough to actually believe such puffery.

The same holds true for many MDs who denigrate and trivialize the advanced training PhD/PsyD psychs with RxPs actually have. If I understand correctly, it's actually a postdoctoral master's degree, right? An MS is a two year graduate degree, so it's actually MORE training in pharmacology than most MD/DO programs, and definitely more training than ANY OD or DDS program. Research shows that optometrists, PAs, NPs, and dentists do a damn good job in prescribing the appropriate med for the appropriate condition, so why wouldn't properly trained psychologists be able to do this? If a master's level nurse or bachelor's level PA can do it, so should a properly trained doctorally-prepared psychologist.

End of story.

No sorry Zack, not the end of story. I don't think that it's a question of whether or not PhDs would be competent, I agree with you that they would. I do think that the question is whether or not it should be a requisite part of a PhD's training to prescribe medication. Personally, I think if someone would like to be an expert in mental health they should become a psychologist. If someone would like to treat mental health they should become a psychiatrist or therapist. I think prescription privileges would ruin the field.

Huh??

BTW, prescription privilges are now allowed in Hawaii. RxP is not part of or required by any PsyD/PhD program in the USA. Are you undergrad? Reveal yourself, because you are not making sense.

Originally Posted by ProZackMI

People who oppose something will do their very best to minimize it, and those who advocate for something will do their very best to puff it up. I remember reading something in a magazine a few years ago comparing chiropractic education to medical education and the author was a chiropractor. Guess who had more "clinical" hours and didactic hours of anatomy, physiology, pathology, and neurology? Yep, the chiros, not the MDs/DOs. I laughed and laughed and laughed, but then became angry. Such puffery is not only false, but it's misleading to the public who might be naive enough to actually believe such puffery.

The same holds true for many MDs who denigrate and trivialize the advanced training PhD/PsyD psychs with RxPs actually have. If I understand correctly, it's actually a postdoctoral master's degree, right? An MS is a two year graduate degree, so it's actually MORE training in pharmacology than most MD/DO programs, and definitely more training than ANY OD or DDS program. Research shows that optometrists, PAs, NPs, and dentists do a damn good job in prescribing the appropriate med for the appropriate condition, so why wouldn't properly trained psychologists be able to do this? If a master's level nurse or bachelor's level PA can do it, so should a properly trained doctorally-prepared psychologist.

End of story.

Well put. How was the bar?

I am aware that they are allowed in Hawaii, New Mexico, the military, and if I'm not mistaken Louisianna? My concern is that RxP would take the field of clinical psychology down a path that would be detrimental and ultimately "ruin" (for lack of a better word) it. Correct me if I'm wrong but currently practitioners in the field enjoy the relative freedom of not having to pay enormous insurance costs, and are rarely if ever sued for malpractice. These are good things. Some have suggested that the field could benefit if there were some more suing going on, it would hasten the development of standards of care, etc. Personally I think it would be the most beneficial for everyone if the changes in the field came from within, an internally motivated impetus for developing things like standards of care, more effective treatment, cencorship of quacks, etc. But, if we take on the burden of RxP we will hasten in the era of legal (not legislative, i mean the attorneys) involvement. I think that would tear the field appart. I think the lawsuit filed in california (talked about on this site) is a bad idea and sets a bad precident. Beware of what happens when lawyers become involved. I also think that RxP will place demands on the practicioners to only prescribe. Forget about the detailed assessments, and therapeutic interventions. I've seen it with psychiatrists (again my personal observation, I know it doesn't hold in every case) and I would hate to be part of a profession that opperates like I've seen psychiatry work. You know, Thirty five 15min medchecks in an afternoon, and a couple of intake interviews that give someone a useless DSM code.

On another note, I am not an undergrad, nor do I think they have corner on the market of not making sense. Sorry if my last post was confusing.

Originally Posted by Psyclops

I am aware that they are allowed in Hawaii, New Mexico, the military, and if I'm not mistaken Louisianna? My concern is that RxP would take the field of clinical psychology down a path that would be detrimental and ultimately "ruin" (for lack of a better word) it. Correct me if I'm wrong but currently practitioners in the field enjoy the relative freedom of not having to pay enormous insurance costs, and are rarely if ever sued for malpractice. These are good things. Some have suggested that the field could benefit if there were some more suing going on, it would hasten the development of standards of care, etc. Personally I think it would be the most beneficial for everyone if the changes in the field came from within, an internally motivated impetus for developing things like standards of care, more effective treatment, cencorship of quacks, etc. But, if we take on the burden of RxP we will hasten in the era of legal (not legislative, i mean the attorneys) involvement. I think that would tear the field appart. I think the lawsuit filed in california (talked about on this site) is a bad idea and sets a bad precident. Beware of what happens when lawyers become involved. I also think that RxP will place demands on the practicioners to only prescribe. Forget about the detailed assessments, and therapeutic interventions. I've seen it with psychiatrists (again my personal observation, I know it doesn't hold in every case) and I would hate to be part of a profession that opperates like I've seen psychiatry work. You know, Thirty five 15min medchecks in an afternoon, and a couple of intake interviews that give someone a useless DSM code.

It's an access problem that is not being addressed adequately by psychiatry. Whether psychologists can prescribe a limited formulary of psychotropic medications is an empirical question.

Prescribing practices of psychologists will be different: http://www.division55.org/pdf/draftguidelines.pdf

Specialization in clinical psychology (e.g., neuropsychology, sports psychology, child psychology, child neuropsychology, forensic psychology) did not "tear the field apart." Not every psychologist will pursue RxP. The small number who do will be specialists in combined psychotherapy and psychopharmacotherapy.

Malpractice rates of other nonphysician providers (e.g., PAs, NPs, optometrists) have not changed once RxP was added to their scope of practice. Midlevels in some states are even allowed to prescribe independently with minimal physician supervision. The psychologist RxP bills explicitly state that prescribing of psychotropic medication MUST occur in collaboration with a patient's primary care physician. If anything, this will enhance collaborative care and increase access to optimal treatment.

If you're a clinical psychology student or advocate, keep in mind the words of the mighty Buddha:

“Decay is inherent in all compounded things.”

-- The Buddha, on his deathbed

Not that it is of great import to anyone, but I would support RxP as a specialization, I think that would be the right way to do it. I suppose then it brings up, what type of training, who would get the privileges, etc. I know that's an on going dialogue and most likely covered above, but I can understand why many would be concerned with who would get the privileges. PhD? PsyD???? MA/S?????????? Would RxP be given full autonomy? I'm not as familair witht the specifics. But I'll check out the link.