Psychopharmacology/Advanced Practice Psychology

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I do still believe that many psychologists will turn into pill factories. Especially if they get paid more per hour to do medication titration as opposed to do therapy, ane that's a managed healthcare issue that would need to be addressed. NOt to mention, I think there will?is a strong pull from many clients to "just give me the meds" for a quick fix. I still think it has the potential to mess things up. But I do realize that that is an empirical question...I would be interested to know the answer though.

Originally Posted by Psyclops

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.

That's the "glass is half empty" view. RxPs will change the field, but ruin it? That's awfully pessimistic of you to say that. Not all change is bad. It may create two separate fields of clinical practice in psych: traditional clinical psych and medical clinical psych. Perhaps two different doctoral programs/tracks for interested students?

Originally Posted by PublicHealth

Well put. How was the bar?

Thanks! IMO, the Michigan Bar exam was worse than the USMLE I and II. I think I did well, however. I'll know if I passed in May!!!!!! How am I going to wait that long?!?! How's medical school coming along?

Zack

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.

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.

Similar comments were made when RxPs were granted to optometrists in the 1980s and 1990s. Same thing when dentists were given full RxPs back in the 1950s and 1960s. Did it ruin those professions? No, in fact, it enhanced them and allowed them to grow and expand. It did change them, but it did not ruin them. Clinical psychology is going to have to change in order to survive managed health care and the ever expanding realm of psychopharmacology.

Why would any "sane" health insurance company pay a psychologist money to tallk to a patient, for an extended period of time, when it could simply pay for a magic pill and a 15 minute med review coupled with some therapy? If psychologists don't fight to protect their profession, or rather, strive to enhance their scope of practice, mid-level professionals, like LPCs or MSWs will try to do it. Think about it for a minute: (1) fewer and fewer med students (DO and MD) enter psych residencies each year; (2) more and FMGs fill the psychiatry void and provide poor services to patients; (3) more and more PAs and NPs are being produced by schools each year; (4) more and more MA/LPCs and MSWs are being produced every year; and (5) clinical psychology has to compete with a diverse group of skilled professionals.

What that means is this:
- fewer competent psychiatrists available
- more internists, OB-GYNs, peds, and FPs are Rxing psychotropics
- more NPs and PAs are treating psychiatric conditions
- more MSWs and LPCs are providing traditional counseling

If psychologists don't try to enhance their scope of practice and redefine their profession, others will and you'll be left in the dark. You can seize the opportunity and take advantage of these factors now before it's too late. If you don't, you'll see NPs, PAs, and eventually MSWs and even LPCs filling the void.

I think that from a pragmatic point RxP for psychologists be the way things are going and it may be the thing to do to provide the appropriate care to patients. But l'd like to draw attention to your own arguments, you seem to think that the way things are going are not in everyones best interest. I'd also like to think that mental health is a little more complex than dental work and eye care. I don't mean to take away from thier professions by any means, but its like comparing apples and oranges from my point of view. Specifically, those tend to be very practice oriented, specific professions I think that clinical psychology requires the ability to deal with a broader scope of problems, many of which are chronic. It's not like "take two of these and call me never". It requires management and should be part of a multidisciplinary plan. Mental health or the lack of it is a far cry from many of the problems that are dealt with on a routine basis by many of those in the general health care profession. Ideally I would see for practice specialized prescribing psycholgiatrist, who had more braodly informed mental health training than a psychiatrist and more biology/chemistry than a psycholgist. But, I still think that the profession, unless it is extreemly careful, will fall into the same place that psychiatry has. Which isn't something that I would like to be a part of. Call it whatever you want.

Here is a link to a site detailing how RxP is being integrated into practice; I am sure you will see psychologists are very careful to mantain their primary identity and use prescribing as an adjunct


http://www.nmpa.com/displaycommon.cf...barticlenbr=13

Sounds like that guy's doing a great job. Maybe I'm cynical or jaded but I have a hard time believing that everyone pushing for the privileges is doing so for the right reasons, also that it won't seriously undermine the way the field currently conceptualizes disorders. Although I'm not suggesting that we ignore the mind body interface I certainly don't believe that all of our theoretical networs should be reduced to chemicals. Just because a drug can alter behavior doesn't mean that it will "cure" the ill. But I guess these should ultimately be empirical questions.

Originally Posted by Psyclops

I think that from a pragmatic point RxP for psychologists be the way things are going and it may be the thing to do to provide the appropriate care to patients. But l'd like to draw attention to your own arguments, you seem to think that the way things are going are not in everyones best interest. I'd also like to think that mental health is a little more complex than dental work and eye care. I don't mean to take away from thier professions by any means, but its like comparing apples and oranges from my point of view. Specifically, those tend to be very practice oriented, specific professions I think that clinical psychology requires the ability to deal with a broader scope of problems, many of which are chronic. It's not like "take two of these and call me never". It requires management and should be part of a multidisciplinary plan. Mental health or the lack of it is a far cry from many of the problems that are dealt with on a routine basis by many of those in the general health care profession. Ideally I would see for practice specialized prescribing psycholgiatrist, who had more braodly informed mental health training than a psychiatrist and more biology/chemistry than a psycholgist. But, I still think that the profession, unless it is extreemly careful, will fall into the same place that psychiatry has. Which isn't something that I would like to be a part of. Call it whatever you want.

Not really. The problem with RxPs and psychologists is no different than it was for other health care professions. The issue is whether a properly trained psychologist (either during his/her doctoral program or after his/her doctoral program) can safely and effectively prescribe the appropriate psychotropic medication to the appropriate patient for the appropriate reason.

I used dentistry and optometry as an example to illustrate how this issue played out in other areas. Forget the "complexity" of the practice area; that is not relevant. Dentists Rx a wide range of meds for a wide range of conditions, including powerful narcotics for pain relief after root canals and oral surgery. Optometrists Rx a very limited range of diagnostic and therapeutic meds to treat a very limited range of ocular conditions. Nevertheless, both professions do so regularly, in all states, without any harm done to their patients. Why is this example helpful? It is because it shows that other professionals, who have not attended medical school, can effectively, competently, and safely prescribe appropriate meds to their patients.

Historically, if your dentist performed a root canal, you had to see your MD to get pain meds for post op pain. After dentists lobbied for and obtained fairly unlimited RxPs, they could Rx the meds themselves w/o MD/DO consultation. Dental schools began to incorporate pharmacology into their curricula. The same is true of optometrists who also began to study pharmacology in opt school.

Now, rather than earn a post doc MS in psychopharm, I think medical psychologists should earn a professional PsyD (not a PhD) degree which includes physical assessment, biochem, neuroanatomy, pharmacology, etc., classes like those taught in comparable health programs such as dentistry, optometry, pharmacy, and podiatry. I think the PhD (a research degree with a clinical component to it) is inappropriate for clinical medical practice. Who cares about stats, MANOVAs, ANOVAS, dissertations, etc., when your primary educational goal is to render clinical services to patients?

I really believe there needs to be reform to the training program of clinical psychologists in order for the profession to stay alive and compete with mid-levels and psychiatry. I also think a post PhD masters degree in psychopharm is overkill. IF (and only if) psychologists want RxPs, then push the APA to reform its curriculum and move from a scientist-practitioner-researcher emphasis (PhD) to a professional practitioner (PsyD) emphasis. Swap 2-3 stats classes, dissertation classes and requirements, and other "irrelevant" to clinical practice classes for pharmacology, neurobiology, biochem, physical assessment, etc. For those who want to research, get a PhD in experimental or developmental psych. For those who just want to do counseling, get a PhD/EdD in counseling psych. For those who want to do clinical psychology and have RxPs, get a professional degree and not a researcher's degree.

Originally Posted by Psyclops

I think that from a pragmatic point RxP for psychologists be the way things are going and it may be the thing to do to provide the appropriate care to patients. But l'd like to draw attention to your own arguments, you seem to think that the way things are going are not in everyones best interest. I'd also like to think that mental health is a little more complex than dental work and eye care. I don't mean to take away from thier professions by any means, but its like comparing apples and oranges from my point of view. Specifically, those tend to be very practice oriented, specific professions I think that clinical psychology requires the ability to deal with a broader scope of problems, many of which are chronic. It's not like "take two of these and call me never". It requires management and should be part of a multidisciplinary plan. Mental health or the lack of it is a far cry from many of the problems that are dealt with on a routine basis by many of those in the general health care profession. Ideally I would see for practice specialized prescribing psycholgiatrist, who had more braodly informed mental health training than a psychiatrist and more biology/chemistry than a psycholgist. But, I still think that the profession, unless it is extreemly careful, will fall into the same place that psychiatry has. Which isn't something that I would like to be a part of. Call it whatever you want.

I'm not trying to minimalize the efficacy of psychotherapy and other non-medical modalities of mental health treatment, nor am I trying to diminish the complexity of psychiatric conditions. However, managed health care has changed the future of psychotherapy. Research has shown that many common psychiatric conditions have an endogenous/biochemical etiology. Depression was once thought to be a purely psychological condition, but over the last 25 years, research has shown it's much more biochemical in origin than it is psychological. Once that little tidbit was discovered, the psychotropic meds began to proliferate.

Psychotherapy can be very effective in the treatment of some psychological conditions afflicting some patients. Medication is more effective for other conditions and certain types of patients. Medication is usually cheaper and fast-acting that talk therapy. To a managed care bureaucrat, it's much more effective to have the doctor (MD, DO, PHD) prescribe something and also give psychotherapy than to pay one doctor to Rx and another to talk.

I'm saying that managed care, increased awareness of neurotransmitters and neurobiology, increased understanding of psychopharmacology, decreased numbers of competent psychiatrists, and increased numbers of NPs, PAs, MSWs, and LPCs either has had (or is going to have) a deleterious effect on the practice of clinical psychology, and whether you like it or not, you will need to evolve or become extinct.

I think that those are some well thought out and compelling arguments. I think they are clearly presented and well formulated. In many ways I would conceed the argument to you on those points. However, and I'm not trying to be obstinate, but I do think that there are other issues that deserve some thought, which you may have done already. If so I'd be interested to hear them. I'm certain that psychologists could prescribe medications just fine. No argument there. I do think it's worth considering what would happen to the profession, and I'm not convinced that it would be good. This is how I see it, RxP ---> Higher Insurance ---> More Med checks to be profitable ----> only med checks.

I'm not saying that you would but someone might argue that there is no need for psychologists. You could have psychiatrists prescribe, and LCSWs do therapy. Who needs the psychologist? Except that psychologists have developed and continue to develop the best assesmnet devices, and continue to advance the field through research and theory. I think that practicioners (PhD/PsyD/MD/LSCW/Etc.) need to pay much more attention to current research and to the extent that they would be better consumers of research I think that practitioners should learn as much about the ANOVA families as they can. Also, just to play devils advocate, MDS don't get different degrees depending on whether they plan to do research or practice, am I wrong? Shouldn't we shoot for an all encompasing degree for psychology? Just something to think about. Maybe it's not a psychologist's primary role to be a therapsit or practictioner?

I'd like to know your thoughts.

Originally Posted by Psyclops

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.

You raise some important questions, but you would be well-advised to read as much as possible about this issue before criticizing it. ProZack, psisci, and others have thought this issue through considerably and have read the relevant literature. We have also debated psychologist RxP in countless other threads. There is a great deal of misunderstanding surrounding the level of training and safeguards built into clinical psychopharmacology training for clinical psychologists.

This website provides a preliminary understanding of postdoctoral Master's degree training programs in psychopharmacology: http://www.rxpsychology.com/ Check out the links on the left side of the page.

Originally Posted by Psyclops

Shouldn't we shoot for an all encompasing degree for psychology? Just something to think about. Maybe it's not a psychologist's primary role to be a therapsit or practictioner?

I'd like to know your thoughts.

An all-encompassing degree already exists -- the Ph.D. in clinical psychology. Graduates of such programs are trained in teaching, research, psychological assessment, psychotherapy, consultation, and occassionally, administration. Specialization tracks in clinical neuropsychology and other areas (e.g., forensic, child, sports) also exist in some programs. The Ph.D. degree in clinical psychology was originally founded as an academic degree. The Psy.D. degree is currently considered a professional psychology degree for people who seek primarily clinical careers. These folks will likely be first in line for prescriptive authority, as Ph.D.'s tend to pursue primarily research-oriented careers. Whether or not RxP will change this, however, is an open question.

The understanding behind Ph.D. programs is that graduates will be scientist-practitioners. How else can you test interventions if you don't understand how they work? That said, I strongly believe that incorporating a specialization track in medical psychology at the predoctoral level would greatly enhance the visibility and marketability of clinical psychology as a healthcare AND research discipline, especially since integrated psychotherapeutic and psychopharmacotherapeutic care appears to be (in most cases) superior to either treatment alone.

ProZack,

Med school is going. So much damn studying, though -- my basal nucleus hurts -- no more ACh left.

PH, thanks for the history lesson. My comment about an all encompassing degree was half toungue in cheek. I feel like some that the PhD should be it in terms of doctorates. I don't think that argument needs to be rehashed here, but individuals could then decide what type of program they would like to attend, heavy research (i.e., UCLA, PENN) or more practice oriented (i.e., CUNY, BYU). As you have noted, practice should inform research, but it goes the other way as well. My experience has been that practicioners who have not been heavily steeped in a research environment rarely put much stock in it and don't recognize the value (personal observation). Like I mentioned above I don't doubt that psychologist will be able to effectively and safely prescribe medication. I do worry about the role for the PhD in the future. With the large amount of MA/S level providers I'm not certain it should be a psychologists role to be a primary provider of any care therapeutic or pharmachological. Maybe psychologists (i.e., clinical PhDs) should go back to their pre-WWII roles. I see the practice of therapy as just one of the many things that a phd would learn during their training, but certainly not the primary pursuit of the degree (some may choose to specialize etc.). I see RxP as another push towards the PhD becoming a purely professional degree, I think the Vail model was a blow to the field, and I think RxP might be as well. I'm not certain, and many of the arguments presented here are compelling, but these are my thoughts at this juncture.

Originally Posted by Psyclops

I think that those are some well thought out and compelling arguments. I think they are clearly presented and well formulated. In many ways I would conceed the argument to you on those points. However, and I'm not trying to be obstinate, but I do think that there are other issues that deserve some thought, which you may have done already. If so I'd be interested to hear them. I'm certain that psychologists could prescribe medications just fine. No argument there. I do think it's worth considering what would happen to the profession, and I'm not convinced that it would be good. This is how I see it, RxP ---> Higher Insurance ---> More Med checks to be profitable ----> only med checks.

I'm not saying that you would but someone might argue that there is no need for psychologists. You could have psychiatrists prescribe, and LCSWs do therapy. Who needs the psychologist? Except that psychologists have developed and continue to develop the best assesmnet devices, and continue to advance the field through research and theory. I think that practicioners (PhD/PsyD/MD/LSCW/Etc.) need to pay much more attention to current research and to the extent that they would be better consumers of research I think that practitioners should learn as much about the ANOVA families as they can. Also, just to play devils advocate, MDS don't get different degrees depending on whether they plan to do research or practice, am I wrong? Shouldn't we shoot for an all encompasing degree for psychology? Just something to think about. Maybe it's not a psychologist's primary role to be a therapsit or practictioner?

I'd like to know your thoughts.

I think you make some very valid points also. I also understand where you're coming from. Not all change is for the better even though it ostensibly appears to be for the better. If I'm understanding you correctly, you're saying that your primary fear is the extinction, or possibly "corruption" of the clinical psych discipline. That is a valid concern. Once you move over to the medical side, there probably is no going back.

I'm not saying to change the entire curriculum so that it emulates an MD program. I'm saying, keep the clinical psychology curriculum the same as it is now, but add as much pharmacology, neuroanatomy, and assessment classes as necessary to render effective pharmacological tx to your patients. Also, eliminate the research components to the doctoral program. A PhD is a RESEARCH degree; it's not a practitioner's degree.

There is NO clinical degree in medical research. An MD does NOT prepare anyone to do any research, although there are plenty of folks out there who do research with only an MD. They learned how to do research on their own, post med school. Med school does not teach students how to do research. Most medical researchers go on to earn a separate biomedical PhD. Many earn a post MD master's degree instead of a PHD.

I really think there should be a research doctorate and a clinical doctorate. This is just my opinion, however. I'm a psychiatrist, so my knowledge of your area is based on association and observation, not personal experience.

Interesting.
http://www.division55.org/draftguidelines.htm

Originally Posted by sasevan

Interesting.
http://www.division55.org/draftguidelines.htm

Sas, what did you find interesting?

I appreciate your replies and our developing dialogue. My greatest concern is the loss of a multidimensional view, especially when it comes to practice. As it stands there are multiple levels of analyses for mental health problems, such as biological, cognitive, interpersonal, etc. Although I certainly don't ascribe to dualistic views of mind and body I resist an overly reductionist view that everything is most usefully studied or treated at the ceulular, neurochemical, etc. level. I certainly advocate everyone to be as aware as they can of all the other levels of problems. I think that even though it has not always ben the case, clinical psychologists should also study the biological bases of maladaptive behavior but not ultimately assume that that is the final frontier nor will it always be the most useful or practical level a which to atack MH problems. I conceed that it is very aluring, and it is very attractive to lay audiences. I merely want to maintain the interest and prominence of the multi dimensional approach to problems.

Naturally, theoretical ideals (or any ideals for that matter) need to be considered in light of what the pragmatic issues are. For example, the mental health system as it stands now is abysmal in my opinion. And the advent of more effective psychopharmaceuticals has not helped many of the problems in ways that have led to overall change for the better. What I mean is even with great advances there are unforseen side effects. For example (Don't stone me for what I'm about to say), with the advent of effective antipsychotics (i.e., phenothyiazines) in the 50's there was a push to close down large state run mental hospitals (not to argue about standard of care there) because there was no longer a need. Many chronic psychotic patients were released to be managed at the county level, only later did people realize that there were such strong side effects that teh sufferers wouldn't adhere to the regimens given them. Now counties all accross the country have to manage very difficult cases, that might best be served by larger more adequately equiped facilites. (I want to qualify this by saying I am just using it as an example, I'm not here to advocate locking away all of those who sufer from tragic debilitating diseases like psychosis).

I've somehow lost my train of thought, but I guess ultimately my concern is that like you said once you go bio you might not go back.

Originally Posted by PublicHealth

Sas, what did you find interesting?

hey PH,
nothing in particular; just a general observation.

Originally Posted by sasevan

hey PH,
nothing in particular; just a general observation.

I like the biopsychosocial approach that they're proposing. Whether or not that will actually happen, though, remains to be determined. Nevertheless, reports from medical psychologists in LA indicate that patients are increasingly being taken off psychotropics and are getting psychotherapy instead. These reports also suggest that patients are quite content with having both their medication and therapy needs met by one provider.

Originally Posted by PublicHealth

I like the biopsychosocial approach that they're proposing. Whether or not that will actually happen, though, remains to be determined. Nevertheless, reports from medical psychologists in LA indicate that patients are increasingly being taken off psychotropics and are getting psychotherapy instead. These reports also suggest that patients are quite content with having both their medication and therapy needs met by one provider.

Yeah, that's what I also like; integrated psychotx and pharmacotx.
I hope that psychiatry is influenced by this model and that more psych MD/DOs follow suit.
It's my hope that at least I end up practicing this way.

Originally Posted by sasevan

Yeah, that's what I also like; integrated psychotx and pharmacotx.
I hope that psychiatry is influenced by this model and that more psych MD/DOs follow suit.
It's my hope that at least I end up practicing this way.

Right, but when you have the option of making $150 for a 15-minute med check and $90 for an hour of psychotherapy, the med-check service usually prevails. It'll be interesting to see how these market trend affects medical/prescribing psychology.

Integrated treatment is usually more effective than either treatment alone. Psychiatry and psychology are well aware of this. Unfortunately, our fast-paced world and Big Pharma influence has made psychiatric drugs appear as cure-alls for everyday mood, anxiety, sleep, attention, stress, and social problems. Sure, there are people who need meds, but many do not. Pharma wants MORE people to take MORE drugs for as LONG as possible. There's a reason why "social anxiety disorder" is one of the most prevalent psychiatric "disorders."

Steven Sharfstein on the matter: http://pn.psychiatryonline.org/cgi/content/full/41/5/3

Originally Posted by PublicHealth

Right, but when you have the option of making $150 for a 15-minute med check and $90 for an hour of psychotherapy, the med-check service usually prevails. It'll be interesting to see how these market trend affects medical/prescribing psychology.

Integrated treatment is usually more effective than either treatment alone. Psychiatry and psychology are well aware of this.

It's going to be a challenge but I suppose that for the outpt part of my practice I'll want to do more than just 8 hr days of 15 min med checks.
What I envision is part-time inpt work (psych unit and C-L service) and part-time outpt (integrated therapy and pharm).
I believe (hope?) that if medical psychology actually adheres to the integrated model that many pts will begin to prefer that to the current model of psych MD/DOs providing pharm and either psych PhD/PsyDs or mid-level clinicians providing therapy.
If that's the case, perhaps then psychiatry will have to adopt the integrated model in order to be competitive in the outpt market.
In any case, I think that psychology's embrace of the bio in the biopsychosocial will ultimately improve it's assessment/treatment capacity, increase pt access to mh services, and challenge psychiatry to have a more integrated practice.

I have been doing psychopharm management for years now and this is exactly what I have seen. Pts are transferring.

Originally Posted by psisci

I have been doing psychopharm management for years now and this is exactly what I have seen. Pts are transferring.

Can you elaborate?

Also, how do you think RxP will change psychology?

I would predict that the advent of sidespread RxP for psychologist will be the death of psychiatry. I think that it will be more likely that psychiaty will fade away than integrate. My lay opinion is taht psychiatry has long been suffering from the inability to attract the best med students and oftentimes having many foreign trained MDs as practitioners in the field. (The only problem I see with that is taht many aspects of MH are very culturally based, and those MDs raised and trained abroad might have a difficult time accounting for those issues).

In terms of what choices will have to be made by practioners for med checks vs. therapy, as good intentioned as many of us might be, our hands might be forced by insurance premiums. Naturally, there will always be service providers of every ilk, but it would be interesting to know which way the field will generally trend.

Another thing that I have found iteresting is taht research has shown that there is a lower rate of relapse for those depressed patients treated with psychotherapy as opposed to phamaTx. It seems that the changes that are being effected might last longer. (they might take longer to come about as well).

Originally Posted by Psyclops

I would predict that the advent of sidespread RxP for psychologist will be the death of psychiatry. I think that it will be more likely that psychiaty will fade away than integrate. My lay opinion is taht psychiatry has long been suffering from the inability to attract the best med students and oftentimes having many foreign trained MDs as practitioners in the field. (The only problem I see with that is taht many aspects of MH are very culturally based, and those MDs raised and trained abroad might have a difficult time accounting for those issues).

In terms of what choices will have to be made by practioners for med checks vs. therapy, as good intentioned as many of us might be, our hands might be forced by insurance premiums. Naturally, there will always be service providers of every ilk, but it would be interesting to know which way the field will generally trend.

Another thing that I have found iteresting is taht research has shown that there is a lower rate of relapse for those depressed patients treated with psychotherapy as opposed to phamaTx. It seems that the changes that are being effected might last longer. (they might take longer to come about as well).

All good points. Regarding the 'death of psychiatry,' the same argument could have been made several decades ago when optometry began pursuing prescriptive authority. Did optometry's obtaining limited RxP in the US summon the death of ophthalmology? The "O" in the 'ROAD' specialties continues to be ophthalmology. What about nurse practitioners, who currently provide most outpatient pharmacotherapy in psychiatry? Last I checked, psychiatrists are still around and in high demand.

Regarding integrated treatment, it works better for some conditions than others. I recall reading a report which found that CBT was more efficacious than integrated pharmacotherapy and CBT for insomnia, as the patients in the integrated treatment arm began to rely on their meds and did not adhere to their CBT treatment program and homework.

It is an exciting and confusing time to be in mental health. The landscape is changing quickly and dramatically. Who knows what it'll look like ten, twenty, thirty years from now. That is, if we survive the pandemic.

Something I am curious about, and I readily admit my ignorance on the matter, is continuing education requirements. With such a rapidly evolving filed as mental health treatment is, it would make sense to me that practioners should be not only charged wiht but required to keep abreast of advancements. I think that one of the field's potential pitfals is the theoretical "orientation" of some of it's providers. I certainly don't think that anyone should blindly adhere to any particular slant based on mere principle. Additionally, it concerns me that many practioners, particularly mid-level practitioners, do not accord current reasearch trends enough weight, nor do I feel they make concerted efforts to kep up with the results (this is coming from my observations). What requirements are in place to ensure that those who hold a license are better able to practice than my grandmother (she had nothing to do with psych)? I think that if there is not substantial requirements there is little use for a licensensing process.

This is getting a bit off topic. Why don't you post a new thread on this. I agree with you about MA providers, but they can't really keep up with what they never learned to be begin with.

Originally Posted by ProZackMI

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.

First, PAs have masters degrees, not bachelors'. Second, of the groups that you mentioned, their prescribing rights are extremely limited. They aren't pushing the heavy stuff that gets MDs in trouble---hence why they might prescribe meds "safer." Eye drops from a optometrist are one thing, an ophthalmologist's doing surgery and giving pain meds are something else. Finally, dentists and podiatrists have gone to school for the same amount of time as physicians, meaning that they should be given full prescribing rights. Even then, they aren't prescribing with the same breath as an MD. I'm all for psychologists getting limited RxP rights, but we have to make sure that the move is done correctly like we have done with the PAs.

EDIT: I meant to say that PAs and NPs are not prescribing the heavy stuff.

Originally Posted by deuist

First, PAs have masters degrees, not bachelors'. Second, of the groups that you mentioned, their prescribing rights are extremely limited. They are pushing the heavy stuff that gets MDs in trouble---hence why they might prescribe meds "safer." Eye drops from a optometrist are one thing, an ophthalmologist's doing surgery and giving pain meds are something else. Finally, dentists and podiatrists have gone to school for the same amount of time as physicians, meaning that they should be given full prescribing rights. Even then, they aren't prescribing with the same breath as an MD. I'm all for psychologists getting limited RxP rights, but we have to make sure that the move is done correctly like we have done with the PAs.

If you are going to go solely based on time in school, MDs don't necessarily go longer than PhDs. Just picking the nits.

Originally Posted by deuist

First, PAs have masters degrees, not bachelors'. Second, of the groups that you mentioned, their prescribing rights are extremely limited. They are pushing the heavy stuff that gets MDs in trouble---hence why they might prescribe meds "safer." Eye drops from a optometrist are one thing, an ophthalmologist's doing surgery and giving pain meds are something else. Finally, dentists and podiatrists have gone to school for the same amount of time as physicians, meaning that they should be given full prescribing rights. Even then, they aren't prescribing with the same breath as an MD. I'm all for psychologists getting limited RxP rights, but we have to make sure that the move is done correctly like we have done with the PAs.

Actually, an OD goes to school for the same amount of time as a DDS (Bachelor + 4 years minimum). As an OD, I can say that your fight for meds privs is going to be tough. No matter how you change your training you will encounter resistance. What strikes me is that a PA or Nurse Pract. can be independently prescribing meds and physical examination - while ODs, psychologists, and some other professional degree grads are scrutinized. the changes need to be incorporated at the professional school level. if optometry school and psych programs would include systemic diagnosis/treatment as more of a core element the arguement for prescriptive authority would be better. im not advocating that ODs be able to Rx anything, its just that their authority should include any med that could be used for any eye condition, example oral steriods, which are beyond prescriptive authority in some states. strangely, OD curriculum contains the same pharmacology and systemic/anatomical training as the DDS, yet we hold a much lower prescriptive authority. again, im not advocating that we be able to Rx all meds or perform major eye surgery, its just that any meds under the realm of eye care and VERY minor procedures are very much appropriate to an OD. i do not believe that a non-MD/DO should be able to independently examining nor prescribing for systemic disease (PAs and NPs). your struggle will be long and hard, but i wish you good luck.

Thanks, you too.

I'm interested in enrolling in a psychopharm program for the fall semester... I'm looking for some recommendations... please let me know some of the pro/cons of the programs that you are familiar with... I'm also asking for "hands-on" real experiences with them... I already know some of the information available on their sites... Thanks.

Also, do these programs require the student to be working in a clinical setting during their enrollment?

Originally Posted by doctorpsych

I'm interested in enrolling in a psychopharm program for the fall semester... I'm looking for some recommendations... please let me know some of the pro/cons of the programs that you are familiar with... I'm also asking for "hands-on" real experiences with them... I already know some of the information available on their sites... Thanks.

Also, do these programs require the student to be working in a clinical setting during their enrollment?

psisci may be better able to help you with this. Where in the country are you?

List of programs: http://www.division55.org/Pages/Post...lEducation.htm

Have you seen this?: http://www.division42.org/MembersAre...rescribing.php

Good luck!

Many of the psychologists that I know do not want prescribing priveleges - these are, of course, folks who have a full slate of fee-for-service patients and do not rely at all on managed care. They are making between $100K and $150K (net) and prescribing meds would increase their income, I guess, but it would also increase the paperwork, the liability, and the responsibility. So, I don't think that Rx priveleges are the holy grail for Ph.D.s and it is disturbing that M.D.s are freaking out about it. By the end of it, the Ph.D.s would have very similar training and most states require that they be supervised for a year or two. I just don't see how anyone can doubt that a Ph.D. level psychologist with the additional psychopharmacology training, over 4,000 training hours before they are licensed and then another close to 2,000 hours or more (in many states) of supervised Rx training before they can prescribe would be less qualified than a NP or PA. Seems a little ridiculous.

If you are good at what you do, you do not need to protect yourself from competition - you should welcome it and adapt. We all have to. If you are good, you are good.

Originally Posted by coloradocutter

Many of the psychologists that I know do not want prescribing priveleges - these are, of course, folks who have a full slate of fee-for-service patients and do not rely at all on managed care. They are making between $100K and $150K (net) and prescribing meds would increase their income, I guess, but it would also increase the paperwork, the liability, and the responsibility. So, I don't think that Rx priveleges are the holy grail for Ph.D.s and it is disturbing that M.D.s are freaking out about it. By the end of it, the Ph.D.s would have very similar training and most states require that they be supervised for a year or two. I just don't see how anyone can doubt that a Ph.D. level psychologist with the additional psychopharmacology training, over 4,000 training hours before they are licensed and then another close to 2,000 hours or more (in many states) of supervised Rx training before they can prescribe would be less qualified than a NP or PA. Seems a little ridiculous.

If you are good at what you do, you do not need to protect yourself from competition - you should welcome it and adapt. We all have to. If you are good, you are good.

Welcome abroad. We need some fresh perspectives around here. Your statement regarding training in psychopharmacology is right on. Psychiatry thinks that psychologists take a couple weekend courses over the internet and then prescribe psychotropics.

Greetings:

I've just logged on for the first time. Interesting thread and I look forward to learning. I am pediatric neuropsychologist and have a MS in clin psychopharm.I also teach psychopharm. If all goes well, I should have a DEA number by the end of the summer to provide services in Louisiana. In addition to learning from all of you, I would happy to answer questions as they arise.

Thanks for allowing me access to the forum!

JC

Originally Posted by PublicHealth

Welcome abroad. We need some fresh perspectives around here. Your statement regarding training in psychopharmacology is right on. Psychiatry thinks that psychologists take a couple weekend courses over the internet and then prescribe psychotropics.

Originally Posted by drjcc

Greetings:

I've just logged on for the first time. Interesting thread and I look forward to learning. I am pediatric neuropsychologist and have a MS in clin psychopharm.I also teach psychopharm. If all goes well, I should have a DEA number by the end of the summer to provide services in Louisiana. In addition to learning from all of you, I would happy to answer questions as they arise.

Thanks for allowing me access to the forum!

JC

Welcome. If you don't mind my asking, what is your background (graduate school, which MS psychopharm program, etc)?

Also, what are your thoughts regarding the rigor of the psychopharmacology training and the practicum? Where did you complete your practicum?

To be fair, I'm a second-year osteopathic medical student. I considered clinical psychology and was accepted to some programs, but decided on medicine instead. While I miss research, I look forward to psychiatric training.

Originally Posted by PublicHealth

Welcome. If you don't mind my asking, what is your background (graduate school, which MS psychopharm program, etc)?

Also, what are your thoughts regarding the rigor of the psychopharmacology training and the practicum? Where did you complete your practicum?

To be fair, I'm a second-year osteopathic medical student. I considered clinical psychology and was accepted to some programs, but decided on medicine instead. While I miss research, I look forward to psychiatric training.

No problem:

Before I did my doctoral work at the Illinois School of Professional Psychology, I was getting a doctorate in experimental psychopharmacology. I had to stop pursuant to some health problems. I did my clinical externships at Cook County Hosp, the Institute for Juvenile Research, the Illinois State Psychiatric Institute and my internship at the University of Notre Dame/St. Joseph Regional Med Center. I followed that with a 2 year npsych post-doc at a PIA facility just outside Chicago. (total . . . 7 years)

I did my M.S. in psychopharm at Nova. I work with a psychiatrist and a pediatric neurologist, both of whom carefully (and vigorously) proctored my work. My current total number of proctored hours is probably well over 1500 versus the 100 patient contact hours common. This is simply a byprodut of my location. I also teach psychopharm at Argosy University.

Personally, I think the training was great. The psychiatrist I work with has suggested that it was better training than most physicians ever get in both basic pharmacology and psychopharm. I don't really know if that's true, but he appears to have been very impressed. My position is that the training was sufficient to help me to feel confident to prescribe and to have a healthy respect for what I don't know.

Finally, my respect for what my psychiatrists colleagues know went up considerably after I finished the training (and I already had respectful relationships with these colleagues). If I could have my way, I would be very happy with collaborative authority versus completely independent. I think that this sort of relationship would be more productive for everyone involved. Then again, no one has asked me.

jc

Thanks for the info you posted...it was quite encouranging.. I'm seriously considering enrolling in a ms. psychopharm program... I live in the East Coast and the closest program to me is the FDU program in NJ... do you know anything about that program? Is there a highly recommended program in your opinion? Also I am a bit concerned that my life would completely be overwhelmed by going back to school and working full-time... how was your actual experience while being a student and working? how many hours did you spend on studying and school work/week? What are the job prospects of rxp? Are agencies actually looking for rxp psychologists in your area? thanks in advance!

Doctorpsych

Originally Posted by drjcc

No problem:

Before I did my doctoral work at the Illinois School of Professional Psychology, I was getting a doctorate in experimental psychopharmacology. I had to stop pursuant to some health problems. I did my clinical externships at Cook County Hosp, the Institute for Juvenile Research, the Illinois State Psychiatric Institute and my internship at the University of Notre Dame/St. Joseph Regional Med Center. I followed that with a 2 year npsych post-doc at a PIA facility just outside Chicago. (total . . . 7 years)

I did my M.S. in psychopharm at Nova. I work with a psychiatrist and a pediatric neurologist, both of whom carefully (and vigorously) proctored my work. My current total number of proctored hours is probably well over 1500 versus the 100 patient contact hours common. This is simply a byprodut of my location. I also teach psychopharm at Argosy University.

Personally, I think the training was great. The psychiatrist I work with has suggested that it was better training than most physicians ever get in both basic pharmacology and psychopharm. I don't really know if that's true, but he appears to have been very impressed. My position is that the training was sufficient to help me to feel confident to prescribe and to have a healthy respect for what I don't know.

Finally, my respect for what my psychiatrists colleagues know went up considerably after I finished the training (and I already had respectful relationships with these colleagues). If I could have my way, I would be very happy with collaborative authority versus completely independent. I think that this sort of relationship would be more productive for everyone involved. Then again, no one has asked me.

jc

FD is a great program. Doug Hoffman is a particularly good teacher.

I found the NSU program to be rigorous, but manageable. In order to pass the tests . . studying was like grad school. Discipline is required. However, this is much more about memorization and less about conceptualization.

The dominos will fall & everyone knows it. After the 4th state, I predict they will fall very quickly.

I don't really know about the market for psychologists around here. Where are you from?

jc

Originally Posted by doctorpsych

Thanks for the info you posted...it was quite encouranging.. I'm seriously considering enrolling in a ms. psychopharm program... I live in the East Coast and the closest program to me is the FDU program in NJ... do you know anything about that program? Is there a highly recommended program in your opinion? Also I am a bit concerned that my life would completely be overwhelmed by going back to school and working full-time... how was your actual experience while being a student and working? how many hours did you spend on studying and school work/week? What are the job prospects of rxp? Are agencies actually looking for rxp psychologists in your area? thanks in advance!

Doctorpsych

Originally Posted by drjcc

FD is a great program. Doug Hoffman is a particularly good teacher.

I found the NSU program to be rigorous, but manageable. In order to pass the tests . . studying was like grad school. Discipline is required. However, this is much more about memorization and less about conceptualization.

The dominos will fall & everyone knows it. After the 4th state, I predict they will fall very quickly.

I don't really know about the market for psychologists around here. Where are you from?

jc

jc,

Thank you for sharing your background -- very impressive with the 1500 practicum hours!

You mentioned that the dominos will fall. HI came close this year. What about other states that are supposed to "go" such as TN, MI, and GA? Are they gearing up (read: saving up) for next year?

You mentioned that you're going to be providing services in LA. Are you currently living there or are you moving there from another state? Do you think many other RxP-trained psychologists will be relocating in order to provide RxP services? What is the status regarding reimbursement for RxP services in LA and NM?

It would take alot more than RxP to get me to move to LA.

Originally Posted by Psyclops

It would take alot more than RxP to get me to move to LA.

By the time you complete your PhD, I'm sure you'll have some more options (states) available to you.

Originally Posted by PublicHealth

By the time you complete your PhD, I'm sure you'll have some more options (states) available to you.

I'm sure, I wouldn't want them though. I'm personally not intereted in pursuing them.

Welcome. I am also a psychologist with Rxp training, but live in Ca, so I "consult" . Look forward to talking with you!!

Originally Posted by psisci

Welcome. I am also a psychologist with Rxp training, but live in Ca, so I "consult" . Look forward to talking with you!!

Good to know that we can have a civil discussion about this issue.

Psisci, any update on the lawsuit in CA? Some on the Div 55 listserv have criticized this route to pursuing RxP. What are your thoughts about it?

I think it is lame and underhanded really, but it may work in the PC world we live in. I do know that the CMA is quite worried about RxP in Ca this year. My real position, although I am in favor of RxP is that psychologists need some medical training in this day and age. The more I learn about meds, clinical medicine etc, the more I know how much I don't know, most docs may not know and is really not knowable yet. Alot of patients just see a psychologist and if that person does not even know enough to know when to refer it is bad health care. The PhD/PsyD models need to change.

We can have a civil discussion on this as long as we keep it off the psychiatry forum. They are feeling badgered by this topic, and I can sorta see why although I personally wouldn't feel that way.

Originally Posted by psisci

I think it is lame and underhanded really, but it may work in the PC world we live in. I do know that the CMA is quite worried about RxP in Ca this year. My real position, although I am in favor of RxP is that psychologists need some medical training in this day and age. The more I learn about meds, clinical medicine etc, the more I know how much I don't know, most docs may not know and is really not knowable yet. Alot of patients just see a psychologist and if that person does not even know enough to know when to refer it is bad health care. The PhD/PsyD models need to change.

I agree wholeheartedly. Hence, my decision to go to medical school. I always found it kind of odd that clinical psychology programs were not in medical schools or at least closely affiliated with them. Why is it that clinical psychology training is largely in "liberal arts and sciences graduate programs" and then some clinical psychologists go on to work at hospitals? I understand that clinical psychology as a discipline arose out of the academic model, but for the folks who want to practice in medical settings, well, they need to train in medical settings. To my knowledge, one clinical psychology program provides this type of program, where the entire curriculum is aligned closely with a medical school: http://www.utsouthwestern.edu/utsw/h...ogy/index.html

Note that this program is designed to take four years of full-time work. Not some variable range of 5-8 years that is typical of many clinical psychology programs and just plain stupid and a waste of time. There are also collaborations among departments of psychology, psychiatry, neurology, PM&R, etc. If you ask me, I think this kind of program is what clinical psychology training should be in 2006. Its emphasis on health/medical psychology, neuropsychology, and related fields is consistent with the APA's interest in expanding the role of psychology in primary care settings, pursuing RxP, etc. Incorporating a track in "medical/prescribing psychology" into this program would be much more easily done than incorporating such a track in some liberal arts-based clinical psychology program.