Psychopharmacology/Advanced Practice Psychology

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Wow, I am shocked that psycholgoists make approx. $50K a year... This degree is really, really hard to get and there is little compensation! How do PsyD's pay their loans back?

Originally Posted by edieb

Wow, I am shocked that psycholgoists make approx. $50K a year... This degree is really, really hard to get and there is little compensation! How do PsyD's pay their loans back?

Those BLS numbers lump PhD and Master's level "psychologists" into one category and do not break out categories by specialization. Most psychologists make $75-100K/year. The ones who make less than that are Master's level folks or PhD/PsyDs who provide therapy all day long, don't specialize, and don't maximize the application of their degree. Neuropsychologists make anywhere between $85-500K/year, mean is $110K/year (see recent survey by Jerry Sweet et al., 2006). These are also neuropsychologists who consult with pharm companies, who easily clear more than $200K/year. Forensic neuropsych pays especially well, with most average hourly fees of $250-500. There is money to be made in psychology, especially in assessment and consulting. Unfortunately, most psychologists don't know how to find it.

PH pretty much took the words out of my mouth, but of course said it better than I. Be weary of any stats that include "school psychologists" and "counseling" psychologists, as they are diffuse categories and frequently paid less well than an average clinical psych PhD.

Originally Posted by PublicHealth

I think the WashU numbers are low. I'm quoting data from the U.S. Dept. of Labor. http://www.bls.gov/oco/ocos074.htm#earnings

The BLS numbers for physicians look at gross, taxable income. I think that the cost of malpractice insurance is not taken into account. (By the way, I understand that you psychologists have go through the same HMO headaches as physicians for doing therapy. Do you also have to deal with malpractice and the fear of litigation?)

Originally Posted by PublicHealth

Those BLS numbers lump PhD and Master's level "psychologists" into one category and do not break out categories by specialization. Most psychologists make $75-100K/year. The ones who make less than that are Master's level folks or PhD/PsyDs who provide therapy all day long, don't specialize, and don't maximize the application of their degree. Neuropsychologists make anywhere between $85-500K/year, mean is $110K/year (see recent survey by Jerry Sweet et al., 2006). These are also neuropsychologists who consult with pharm companies, who easily clear more than $200K/year. Forensic neuropsych pays especially well, with most average hourly fees of $250-500. There is money to be made in psychology, especially in assessment and consulting. Unfortunately, most psychologists don't know how to find it.

I agree. Why do you think this is the case?

Originally Posted by PsychevalIII

[/B]

I agree. Why do you think this is the case?

Socialization problem in doctoral training? Graduate students in clinical psychology have NO IDEA (for the most part) of what being a clinical psychologist is really like. If they knew, they would not be in a clinical psychology program. I know several people who are pursuing clinical psychology. They are seemingly content with their programs, but more interested in therapy than assessment (problem #1), and have limited to no interest in psychopharmacology (problem #2), and get no training in business (problem #3).

Psychologists do assessment better than anyone else. An alphabet soup of providers do psychotherapy and data suggest that MSW/MA-level therapists and PhD/PsyD-level therapists produce equivalent patient outcomes.

Professional evolution of clinical psychology hinges on the field's ability to establish itself as unique. What do psychologists do that no one else does or does as well? Assessment. What is another area of expertise that psychologists could take on to further establish the uniqueness of their profession? Psychopharmacology.

It's a survival issue. People in professional, non-academic clinical psychology need to wake up and realize this. When they do, they need to encourage clinical psychology programs to modify their curricula, reduce the number of years and dizzying list of academic requirements, centralize and streamline application processes to doctoral and internship programs, and develop efforts to pass RxP legislation and refine assessment curricula. Put simply, cut out the fatty, irrelvant stuff and retain or add the stuff that's empirically supported, in demand, and reimbursable.

What do you consider irrelevant?

I agree with you...it's true, most clinical/counseling doctoral student don't know the 'real' psych when they leave school... all the stuff taught in school is an ideal compared to the stuff that goes on in real life... and I tell you, psychologist in general have no sense of business... but for the most part are the expert, top of the class providers of psychological treatments, which far surpasses MSW and MA's... those folks want you to think that and constantly refer back to studies like the one conducted by consumer reports... (in which contains huge methodological flaws) suggesting no difference in outcome between doctoral psychologist and msw/ma's... that' is dead wrong in general and the insurance companies wants everybody to believe that too... one must look at the specificity of the treatment provided and the population being served... I believe that Barlow recently published a study indicating that psychological treatment produced better results, larger effect size when measuring efficacy of treatment for specific disorders (largely anxiety and depression)... on a first hand level, I've also observed this... I had a number of MSW/MA level staff claim to know how to conduct CBT and they only equated CBT to stress management... that was it... they didn't even know Beck's cognitive therapy and REBT... in fact, most of them didn't even know Beck and Ellis... some even thought that OCD was untreatable!!!

But I think that you are right, psychology won't survive if we only rely on providing psychological treatment... that specialty has been washed down by everyone... now including nurses... we have to specialize and apply our expertise in other arenas as well...

Originally Posted by doctorpsych

But I think that you are right, psychology won't survive if we only rely on providing psychological treatment... that specialty has been washed down by everyone... now including nurses... we have to specialize and apply our expertise in other arenas as well...

Do tell. What is your vision for the well-prepared, well-rounded psychologist of tomorrow?

well, for one, since this is a rxp thread... solidify rxp legislation and get this rolling in all states, increase growth of doctoral level psychologist in forensics and fight not to let any other non-doctoral trained clinician get into it, management/HR organizational development, continue growth of neuropsych, hang on tight and fight others who wants to provide and interpret psych testing, keep college mental health for psychologists only, change doctoral programs to train students on 'real world/market' knowledge, be more business savee...

One of the most important things that we as psychologist have just recently began to pay attention to... and perhaps too late, is to protect our craft... we as a profession tend to be very touchy feely and want to help everyone... well, we must wake up! this is the mentallity that get us screwed while we feel good for for ourselves temporarily, at the same time, we are not even aware that we are killing our unborn... the students who come out clinically well trained and face a hostile market with very little opportunities for unlicensed psychologists... (did you ever think why unlicensed social workers are able to provide clinical practice and be reimbursed by insurance while psychologist with much more experience and training can't...) most businesses, including medicine have been doing that for ever... we shouldn't just give our knowledge, ability and skills away to others who will only claim to be able to do the same for cheaper... I suspect that that is why there are so few doctoral level psychologist in charge of adminitrative duties in agencies... for example, most social workers claim to be able to do what psychologist can do but for cheaper but then wash down the value to psychotherapy... the health industry does not necessarily care if treatment is done appropriately or if patients are getting better, it's a business, the bottom line is to do what they are contracted to do (or perceived to be doing) but with the lowest amount of expendetures... psychologist must be seen as the goto specialist that will get the job done with quality rather then 'only if you are willing to pay out of pocket' specialist.

Originally Posted by PublicHealth

Graduate students in clinical psychology.........get no training in business (problem #3).

I'm banking on this fact. Part of my consulting business will address this deficiency. It isn't always training either....some people just don't CARE about that stuff, even if it can be a huge factor in their ability to make $. I've done some polling about issues related to the business aspect of clinical work, and many clinicians would much rather outsource these issues, especially if they take insurance and have to do all of the paperwork.

This is just based on my sampling, so make sure to do your own before making any decisions.

......for example, most social workers claim to be able to do what psychologist can do but for cheaper but then wash down the value to psychotherapy

This is a HUGE pet peeve of mine. I've run across quite a few LSWs, MHC, etc who go out of their way to tell people that they can handle everything a clinician can. They use different treatment models, have different training, etc. I don't mean to generalize this to everyone who has these degrees, but I sure have run into a number of people who share these views, so it isn't just an isolated sample.

-t

Psychiatr News August 18, 2006
Volume 41, Number 16, page 36
© 2006 American Psychiatric Association
Services


Letters to the Editor


Compromised Care
Ronald C. Thurston, M.D., Chair
California Psychiatric Political Action Committee

I am writing in response to the president's column in the May 5 issue titled "How Will Psychologists Practicing Medicine Affect Psychiatry?"

While I applaud Dr. Steven Sharfstein's acknowledgement that "prescriptive authority" is the practice of medicine, I have a different view and a different answer to his rhetorical question.

First, the campaign is for parity. The mislabeled prescription bills authorize state boards of psychology to define, license, and grow a practice of medicine for psychologists. Psychologists in California and elsewhere have also initiated legislation, regulation, and litigation to expand independent authority to manage medical care for people at the office, in hospitals, and in jails and prisons. The recent manifesto by Division V of the California Psychological Association specifically identifies medical, economic, and career parity with psychiatrists as the campaign goal (see <division55.org/Pages/RxPBenefitsAll.htm>).

Second, this is a public policy debate, not an argument with psychologists. Here is the issue: Shall there be a separate, second-class standard for the medical care of people with mental illness?

Third, economics will determine the consequence, not quality. If legislatures permit two standards of care, institutional buyers—governments and health-care plans—will go for the cheaper standard. Medical education will be priced out of the mental health care market.

Fourth, it's about the future. Medicalized psychologists will replace, not add to, the psychiatric workforce. Future mental health providers will take the less expensive, more lucrative career path. Future medical students will seek careers that value fundamental medical education. Mental, like dental, will be referred out of medical curricula and medical practices.

Answer: The ultimate mental health carveout—bad for psychiatry, disaster for people with mental illness.

Psychiatr News November 3, 2006
Volume 41, Number 21, page 31
© 2006 American Psychiatric Association
Services

Letters to the Editor


Equality or Economics?
Hugh Chavern, M.D., M.P.H.
Fort Worth, Tex.

I certainly agree with Dr. Ronald C. Thurston who stated in his letter in the August 18 issue that what psychologists are really looking for is parity. Thirty or so years ago I sat in on a western state's fourth-year medical school class conference, which was being addressed by the president of the American Psychological Association. During the question-and-answer period, I asked, "What does psychology want?," and the answer was a firm "Equality."

No true professional such as a trained psychologist should be willing to prescribe medications without a complete medical education and experience. Psychologists can usually find a licensed physician who will prescribe medications for their patients and perform physical examinations and be responsible for the medical care of hospitalized patients. But psychologists want independent admission determination and treatment plan approval, and they want to be a member of the medical staff via "prescriptive authority." This is parity in name only, but billable. It is economics.

What a crock that letter is......Being on the medical staff has nothing to do with RxP really. Ca does not have RxP, but I have been a full member of medical staffs for years.

The irony is that it comes from california, because the state is in crisis right now because of severe healthcare problems related to cost of care. Medical psychologists could help with this burden AND still provide quality services. It is already prohibitively expensive for many people to live in and around the major cities, and now add rising healthcare costs to an already burdened population, and the options are limited. They could stay where they are and suffer in silence. They could move to less populated areas to lower the cost, but now it becomes a problem with access to timely care. There are not enough professionals to service the rural community, and the waiting list continues to grow. The PCP workload is even more burdened, and something has to give...whether it is quality, time, population served, etc.

This is definitely a turf war, but the casualties are not medical professionals, but the patients they serve.

-t

The most important aspect of managing medications is the ability to un-prescribe. There is an interesting article coming out in the national psychologist about this in Jan.....

Originally Posted by psisci

The most important aspect of managing medications is the ability to un-prescribe. There is an interesting article coming out in the national psychologist about this in Jan.....

I couldn't agree more. Not only do Medical Psychs prescribe less often (the rate escapes my mind at the moment, I want to say 16-23%...but I could be wrong), compared to the psychiatrist rate of 66%, but they also are more likely to reduce the # of medications a person is taking.

-t

Psychiatrists have used the same argument for decades. They used this argument when psychologists wanted to do psychotherapy, and now psychologists are considered leaders in this area. I am really curious to see how medical psychology will change the face of behavioral healthcare. Will medical psychologists become leaders in the area of combined pharmaco- and psychotherapeutic treatment?

Anyone have an update on which states will likely get RxP for psychologists next year?

Originally Posted by psisci

The most important aspect of managing medications is the ability to un-prescribe. There is an interesting article coming out in the national psychologist about this in Jan.....

Did you write it? If so, can you summarize the main points here?

Originally Posted by PublicHealth

Psychiatrists have used the same argument for decades. They used this argument when psychologists wanted to do psychotherapy, and now psychologists are considered leaders in this area. I am really curious to see how medical psychology will change the face of behavioral healthcare. Will medical psychologists become leaders in the area of combined pharmaco- and psychotherapeutic treatment?

I really hope so. I think our extensive training (compared to pychiatry) in therapuetic interventions make clinicians uniquely qualified if we have proper psychopharm training. It is a promising future from what i've read of the initial studies of medical psychologists. I am admittedly biased (currently pursuing RxP training), but I did an extensive amount of research about the training, and I like what i've seen so far.

-t

Originally Posted by Therapist4Chnge

I really hope so. I think our extensive training (compared to pychiatry) in therapuetic interventions make clinicians uniquely qualified if we have proper psychopharm training. It is a promising future from what i've read of the initial studies of medical psychologists. I am admittedly biased (currently pursuing RxP training), but I did an extensive amount of research about the training, and I like what i've seen so far.

-t

Where are you pursuing RxP training? How is the training there? I think we need more information about the rigor of RxP training for psychologists. Medical folks, myself EXcluded, tend to think that this training is subpar. Are you planning to prescribe in LA or NM following graduation?

Originally Posted by PublicHealth

Where are you pursuing RxP training? How is the training there? I think we need more information about the rigor of RxP training for psychologists. Medical folks, myself EXcluded, tend to think that this training is subpar. Are you planning to prescribe in LA or NM following graduation?

Currently i'm doing the RxP at Nova Southeastern Uni. I think the classes have been excellent so far (fly-in program, typically 6 day intensive, and self study in between, with 2 required practicums over the 2-years). You need to do quite a bit of reading and studying in between classes, but I really think they do a good job in the classes. I like it because they are on-campus classes and you really get to work with the information. It is intense, but worth it.

I am in S. FL, so the practicum will be convenient (jackson memorial from what i've been told). I am at the beginning of the program, so I can't speak to it as a whole, but I've had friends who have completed it, and they are very happy with their training. I find it troubling that some other programs don't require a practicum, which i think is a disservice to the experience. My friends told me that the practicum REALLY crystalized the experience.

I would like to eventually live in CA (where there is a healthcare crisis), but LA is a definite option. I was planning on relocating to the northeast for awhile (for current opportunities), but would like to settle in a state that has prescription privledges.

I am a strong supporter of RxP programs (as long as they req. a practicum AND sufficient residency programs). As much as I want psychologists to be able to move into the prescribing position, I am very aware that proper training is needed. According to the initial studies, the medical psychologist has been very effective, and that is promising. I really thing we can fill an underserved area AND provide not only competent care but IMPROVED care because we have additional therapuetic training.

-t

Originally Posted by Therapist4Chnge

Currently i'm doing the RxP at Nova Southeastern Uni. I think the classes have been excellent so far (fly-in program, typically 6 day intensive, and self study in between, with 2 required practicums over the 2-years). You need to do quite a bit of reading and studying in between classes, but I really think they do a good job in the classes. I like it because they are on-campus classes and you really get to work with the information. It is intense, but worth it.

I am in S. FL, so the practicum will be convenient (jackson memorial from what i've been told). I am at the beginning of the program, so I can't speak to it as a whole, but I've had friends who have completed it, and they are very happy with their training. I find it troubling that some other programs don't require a practicum, which i think is a disservice to the experience. My friends told me that the practicum REALLY crystalized the experience.

I would like to eventually live in CA (where there is a healthcare crisis), but LA is a definite option. I was planning on relocating to the northeast for awhile (for current opportunities), but would like to settle in a state that has prescription privledges.

I am a strong supporter of RxP programs (as long as they req. a practicum AND sufficient residency programs). As much as I want psychologists to be able to move into the prescribing position, I am very aware that proper training is needed. According to the initial studies, the medical psychologist has been very effective, and that is promising. I really thing we can fill an underserved area AND provide not only competent care but IMPROVED care because we have additional therapuetic training.

-t

Thank you for sharing. So the practicum for the Nova RxP program is at Jackson Memorial? Is this a formal agreement with the Dept of Psychiatry or some other dept? I'm a bit surprised to hear that this practicum placement exists, given psychiatry's blatant disapproval of psychologist RxP. I'm curious to know how this arrangement works.

I cannot understand why psychologists seeking to prescribe do not have to complete a practicum prior to doing so. Isn't a supervised practicum worked into the RxP laws in NM and LA? Or is the LA law less strict?

That lawsuit in CA may open the door for RxP in CA prisons. I think they will know the outcome of that case within the next couple of months. What's the story on RxP in FL? Other states? It's hard to find information on-line, so please share any information that you may have, as I'm interested in this movement.

Originally Posted by PublicHealth

Thank you for sharing. So the practicum for the Nova RxP program is at Jackson Memorial? Is this a formal agreement with the Dept of Psychiatry or some other dept? I'm a bit surprised to hear that this practicum placement exists, given psychiatry's blatant disapproval of psychologist RxP. I'm curious to know how this arrangement works.

I cannot understand why psychologists seeking to prescribe do not have to complete a practicum prior to doing so. Isn't a supervised practicum worked into the RxP laws in NM and LA? Or is the LA law less strict?

That lawsuit in CA may open the door for RxP in CA prisons. I think they will know the outcome of that case within the next couple of months. What's the story on RxP in FL? Other states? It's hard to find information on-line, so please share any information that you may have, as I'm interested in this movement.

I'm not sure if anything is formalized. Friends of mine who completed the program a couple of years ago did their practicum there (IIRC). People who fly-in for the program have to find a supervisor and placement wherever they live, but from my understanding everyone has been able to find superivision in the past. For the S. Floridians, they said they already have supervisors available, etc.

You DEFINITELY need supervision hours before gaining licensure, but I believe all of the laws have that requirement after you complete your initial classes. You'd think that all programs would have some kind of practicum experience. I believe the practicum experiences really crystalizes your learning, and is necessary to really understand the work. I believe you need a minimum of a 1-2 years residency/supervision. IIRC, one state is 1, and the other is ~2. I think each state has hour requirements, and once you complete them, you can sit for the exam, apply for licensure, etc.

As for RxP in FL.....a couple years ago they had a bill, but it just fell short coming out of committee. It was tabled for the next go around while support is gathered. The FL Psych Assoc. is working hard trying to make this happen, and I think have a 3-4 year plan to get it done. Check out their website for more info: http://www.flapsych.com/ .

As for RxP in other states....if you are a member of APA, join Div. 55 (the RxP division). I've heard they have a listserv. I actually need to re-up with APA and get more involved with Div 55. I'm not sure where everyone is at right now, since i'm not on the listserv, but I know there are a number of states who have a good shot in the near future.

I really think CA will come around....whether it is through the prison lawsuit, or through their Psych Association. Healthcare is an issue out there, so i'm hoping we can help them and help ourselves by getting prescription privledges.

-t

any update from CA and other states?

Originally Posted by Livethedream

any update from CA and other states?

National Psychologist article:
Victory near on California hospital privileges

By Richard E. Gill
Assistant Editor
A surprising decision by the California Department of Health Services
(DHS) to investigate a complaint that a Los Angeles hospital is violating
state law by not granting psychologists full attending authority, plus a
lawsuit that effectively ended in their favor have psychologists on the cusp
of receiving full hospital privileges denied them for nearly 30 years.
"We were not a high priority for DHS," said Bill Safarjan, Ph.D., past
president of the California Psychological Association (CPA) and current
member of the APA Committee for the Advancement of Professional Practice.
"But the DHS is there now investigating. This is a whole new wrinkle," added
an amazed Safarjan. "They're looking to see if the Metropolitan State
Hospital is violating the law as Psychology Shield has contended in a
complaint."
But it took the threat of legal action by Psychology Shield to force
the DHS to investigate whether or not the hospital was discriminating
against psychologists by not allowing them to admit and discharge patients,
order restraint or seclusion and suicide prevention, all the things
psychologists are trained to do, said Safarjan, who is on staff at a
state-run hospital.
Safarjan said he was stunned by the DHS decision because that same
organization, charged with enforcing health regulations in the state, has
for years broken the law by not enforcing mandates passed by the state
legislature. "Getting the bureaucracy to act is incredible," he said.
Another reason psychologists are hopeful is that in February 2005
Psychology Shield, working in collaboration with the CPA and the APA
Practice Organization, finally, under threat of suit, convinced the DHS to
implement regulations that gave psychologists full attending authority.
After all, Safarjan added, the state legislature had passed laws granting
psychologists full authority that were upheld by the California Supreme
Court, signed by the governor and ruled as enforceable by the state attorney
general's office.
Almost immediately, the Union of American Physicians and Dentists
(UAPD) filed suit against DHS to suspend the regulations claiming they were
"underground regulations" because they were not held to public scrutiny and
did not protect patients from inferior care. While the UAPD won the suit, in
reality it was a victory for psychologists, Safarjan said.
Although the judge agreed with the UAPD and ordered that the
regulations must undergo public comment, a procedure by which citizens can
voice their opinion on issues and ultimately decide their fate, he declined
to rule on the legality of the regulations. "Even in his decision, the judge
was not talking about whether or not the regulations were legal. He didn't
appear to have any problems with them."
Therefore, the UAPD won the battle, but according to Safarjan, it's
gradually losing the war.
Then a second ruling by the judge in April only served to reinforce
psychologists' belief that the long and difficult battle was about to end in
their favor. Claiming that it had won the earlier decision, the UAPD argued
that it was entitled to reimbursement of legal fees.
This time the judge strongly disagreed, stating that "The primary
motivation of this lawsuit was not to protect the public but to advance the
personal economic interests of the member psychiatrists by defeating the
regulations that arguably threatened to diminish the responsibility of
psychiatrists vis-à-vis clinical psychologists."
In effect, said Safarjan, the judge said, "Hey, you say you're doing
this to help the public, but that's absurd. You're doing this to help your
own economic interests and all the while preventing patients from receiving
badly needed psychological services."
The problem now is to get the DHS to present the regulations for public
comment. Safarjan said the DHS has delayed action for eight months and
Psychology Shield may have to file suit against the DHS and force the state
body to place the issue before the public.
"We keep communicating with them and they keep saying 'in a little bit.'
The process is expensive, and we need more funds if we are to succeed,"
Safarjan said. Over the past two years Safarjan has raised almost $350,000,
$200,000 of it coming from APA, to continue the fight. But the cupboard is
nearly empty and contributions are badly needed, he said. Psychology Shield,
Safarjan explained, is a non-profit organization formed when the CPA decided
not to pursue legal action for fear it could not afford the costs. The
four-member corporation is made up of Safarjan; Gilbert Newman, Ph.D.,
president of CPA; Sallie E. Hildebrandt, Ph.D., past president of CPA, and
Ann Carson, Ph.D., chair of the CPA Legislative Affairs Committee.
Safarjan said he is confident the public will endorse the regulations,
which will benefit both state-run and private hospitals and the patients
that psychologists serve. This has been a long, frustrating and expensive
battle, Safarjan said. The process started in 1978. It was immediately
successful because it took only two years to convince the state legislature
to pass a stronger law that granted psychologists independent authority to
admit and discharge hospitalized patients without discrimination. However,
the law was never enforced.
Later, CPA went through the legislative process and was responsible for
the legislature passing new laws in 1996 and 1998 that embolden the law that
it passed in 1980. Still, more years passed and nothing happened. Also, many
psychologists stopped advocating because of continuing delays, which caused
even more setbacks.
Safarjan blamed the limbo on the DHS that continually failed to
translate the law into regulations that hospitals could follow. The DHS
ignored the law and failed in its responsibility, he said.
"Quite frankly, the process has been slow. But we do have laws in place
that put us on par with psychiatry. It's David and Goliath. We're fighting
the American Medical Association that has earmarked California non-physician
providers and is trying to keep us down to the detriment of patient care.
"But we are going to win this one. Finally, everything is on our side."

http://www.division55.org/pdf/CAPsychiatAssnLetter.pdf

Getting desperate......

Why desperate? Are you that set on prescribing rights?

I meant CPA is getting desperate....

Originally Posted by psisci

I meant CPA is getting desperate....

I am waiting for "David" or "Goliath" to acknowledge that RxP is about money -- for both clinical psychology and psychiatry. Do psychologists and psychiatrists involved in this debate really believe that legislators are really so stupid to think that this issue is really about "increased access" and "patient safety?"

Psychiatrists' "patient safety" plea is tired and old. What solutions have they devised to alleviate the god-awful behavioral healthcare system in California? Other States?

I still do not understand why psychiatrists do not work together with psychologists to devise a RxP training program that would allow psychologists to prescribe a limited formulary of psychotropic medications. Protect the guild.

Originally Posted by PublicHealth

I still do not understand why psychiatrists do not work together with psychologists to devise a RxP training program that would allow psychologists to prescribe a limited formulary of psychotropic medications. Protect the guild.

That's because the bulk of psychiatry is spent dumping SSRI's on people who are too lazy to go through three months of behavioral therapy and change their lifestyle. If by limited formulary you mean Prozac, then shrinks will lose their major source of income to cheaper providers.

I doubt is at 80% of anxiety/depression meds are prescribed by primary care providers.

If I remember correctly PH, you indicated you are at NYCOM (good choice). Geographically, I am a lot closer to Kirksville than you. If you look at the history of osteopathic medicine, was increased scope of practice only about money? I don’t think so. After being sick and tired of barriers to patient delivery, osteopathic physicians developed their own facilities and hospitals. This is what some are suggesting psychologists should do. Medical psychologist owned and operated private inpatient hospitals, partial hospitals, and intensive outpatient programs.




Take a look at the September issue.

http://nappp.org/backissues.php

Originally Posted by PsychevalIII

After being sick and tired of barriers to patient delivery, osteopathic physicians developed their own facilities and hospitals. This is what some are suggesting psychologists should do. Medical psychologist owned and operated private inpatient hospitals, partial hospitals, and intensive outpatient programs.

Right. And what happened to those hospitals? Competitive specialties notwithstanding, how many DOs REALLY want to train at osteopathic hospitals? The bottom line is that medical psychologists will have to become integrated with mainstream medicine. This is exactly what is happening in New Mexico and Louisiana. Medical psychologists are extending comprehensive behavioral healthcare services to those who need it. While this type of provider is unique in many ways, I do not think that medical psychology will go so far as to run their own hospitals. Outpatient clinics, maybe, but not hospitals. That said, I would be pleasantly surprised if they did. The combined psychotherapy/pharmacotherapy treatment model espoused by medical psychology is great, but getting reimbursed for such services is a whole other issue. What will prevent medical psychology from going the way of psychiatry?

Originally Posted by PublicHealth

The bottom line is that medical psychologists will have to become integrated with mainstream medicine. This is exactly what is happening in New Mexico and Louisiana. Medical psychologists are extending comprehensive behavioral healthcare services to those who need it.

I believe to truly become successful, medical psychologists must integrate into mainstream medicine. This will lend credibility, and also provide the best care to the patient (IMHO).

-t

The National Register is the last group that I would rely on. Why should psychologists allow them to decide what we are called, how we are trained, and by what criteria we should be certified? The NR has outlived its usefullness long ago. All they do is duplicate what your state licensing board alreday does. They are trying to now move into literally being the authority on psychology practice.

So which state(s) will likely pass RxP legislation this year? What is the forecast?

I know that Hawaii is expected to pass a RxP bill this year (it came very close last year). In addition, Missouri is supposed to be hot on the trails of passing an RxP bill. They have an awesome website dedicated to RxP:

http://www.mopsych.org/displaycommon...barticlenbr=56

Does anybody else know anything?

Money is needed to support RxP. Contact your respective state associations. This is your future!

Perhaps the lack of $ support is indicative of abivalent feelings or disagreement about the role of psychologists as prescribers of psychotropic medication.

I think it's important to remember that this argument is not merely about psychiatrists trying to keep the good psychologists down, many if not most of the detractors are psychologsits do not think that prescribing is or should be part of thier domain.

I am only a graduate student and have given $500 to Missouri RxP. When the bill was in session in Louisiana (where I am in grad school), all the graduate students (about 15 total in the clinical and neuro program) gave A LOT of money + were deeply involved in getting the bill passed. Lack of money is not a sign of ambivalence, but more a sign of apathy. Psychologists have lost a lot of their scope of practice because we have not been active enough in the political process. We always want to debate rather than be proactive -- much like psyclops is doing.

edie,

You confuse my stating of my opinion as a debate. Just like you I don't think there should be a debate.

Originally Posted by Psyclops

edie,

You confuse my stating of my opinion as a debate. Just like you I don't think there should be a debate.

Just fork over the money to support RxP. Money moves politics, not debate. Academic psychologists who oppose RxP are not sending in their money to prevent RxP. Supporters of RxP are.

I'm a medical student with growing debt and have submitted my share.

It's a new year... what's the status on RXP per State? anybody have any info? HI? others?

http://www.nappp.org/backissues.php
See page 13 (i.e., article by Jerry Morris, Psy.D.) of the January 2007 issue for a great, recent (1/07) article on RxP. I hope you give $$$ to the Missouri Psychological Assn for their RxP efforts; they are very close to passage this year but need more funds. Their RxP website is www.moplan.org. You can make a contribution through their site.

Originally Posted by edieb

http://www.nappp.org/backissues.php
See page 13 (i.e., article by Jerry Morris, Psy.D.) of the January 2007 issue for a great, recent (1/07) article on RxP. I hope you give $$$ to the Missouri Psychological Assn for their RxP efforts; they are very close to passage this year but need more funds. Their RxP website is www.moplan.org. You can make a contribution through their site.

I contributed to the Walker case as well as to HI... I'm looking into Missouri...

Sorry, I wasn't referring specifically to you or anybody else when I talked about contributing; I was talking about everybody as a whole. I gave only to Missouri and The Walker Case this year.

Originally Posted by edieb

Sorry, I wasn't referring specifically to you or anybody else when I talked about contributing; I was talking about everybody as a whole. I gave only to Missouri and The Walker Case this year.

no problem, didn't take it personally, this is important and all psychologist out there who is concerned about the downward slope of our field should support the rxp movement, even if you are not going to get the training, or even if you are in academia... rxp will be a benefit to psychology as a whole...

...Elaine LeVine, one of New Mexico’s pioneer prescribing
psychologists: “The year 2006 was very exciting for prescribing,
medical psychology in New Mexico. First, we were successful in
streamlining the regulations written to implement our Prescribing
Psychologists’ Act. As many of you are aware, the original
regulations were written by joint committees of psychologists and
physicians. Unfortunately, some on the committees were not aware of
the exigencies of completing supervised training in RxP; others were
more interested in assuring ultimate guarantees of safety than the
law could realistically implement. The new regulations, which passed
in August of 2006, closely parallel the Prescribing Psychologists’
Law itself. It is now more realistic to set up practicums and less
cumbersome to go through the training steps and apply for licensure.
There are now seven prescribing, medical psychologists in New Mexico.
About ten others are very close to completing all requirements.
Here are some of the major ways in which the prescribing, medical
psychologists are meeting the needs of New Mexico citizens:
“* These psychologists have averaged over 2,000
prescriptions with no significant untoward effects; * These
psychologists have reduced medication for a number of patients by
identifying more appropriate medications, and by implementing
behavioral and psychotherapeutic techniques; * Several of the
prescribing, medical psychologists work with children, and a primary
accomplishment has been to unprescribe multiple medications given to
children and to utilize less intrusive means of assisting them; *
These prescribing, medical psychologists report success in
diminishing the use of many pain medications by chronic pain
patients; * Because of their advanced training in pathophysiology,
each of these prescribing, medical psychologists can document cases
in which they have helped primary care physicians to diagnose
underlying medical conditions that presented as psychological
symptoms; * These prescribing, medical psychologists are located in
rural areas throughout New Mexico. One is working in a health clinic
in Truth or Consequences; one is working in Roswell. Several are
serving Medicaid and elderly patients in Las Cruces. One works with
Medicaid patients from Bernalillo and surrounding areas; * These
prescribing, medical psychologists are interfacing with physicians in
primary care in a number of critical ways. One of the prescribing,
medical psychologists is working as the Medical Behavioral specialist
at a Family Practice Residency Training Program. Another is working
along side of a psychiatrist at a rural health clinic providing
psychotropic evaluation and treatment to a seriously emotionally
disturbed population; * The Prescribing Psychologists’ Act has been
effective in encouraging other psychologists to move to New Mexico.
Presently, two of the seven prescribing, medical psychologists
completed their training outside of our State and are moving to New
Mexico in order to practice from this biopsychosocial model of care;
* Even as part of the training, these psychologists are extending
care to needed populations. The psychologists-in-training in
psychopharmacology are completing their internship experiences in the
community health centers of northern New Mexico. They are providing
critically needed psychological services while obtaining experience
and knowledge. As part of their clinical training in
psychopharmacology, other psychologists are providing pro bono care
in school-based clinics, shelters for battered women, and residential
treatment homes for the elderly.
“With over 50 psychologists who have completed academic
training in psychopharmacology in New Mexico, and other trained
prescribing psychologists moving to New Mexico, the Prescribing
Psychologists’ Act is offering a safe and effective way to provide
more available care to many underserved citizens of the State.” Will
West Virginia be next? Aloha,

Pat DeLeon, former APA President – West Virginia Psychological
Association – January, 2007