Clinical Psychologist-Physician Assistant

[PublicHealth]

What are people's thoughts about having clinical psychologists complete PA school if they want to prescribe medications. Has anyone ever met or work with such an animal? One would think that this route would enable psychologists to work collaboratively with physicians -- psychiatric and otherwise -- in providing pharmacotherapeutic and psychotherapeutic care for their patients. Why bother having M.S. in Clinical Psychopharmacology programs that are woefully inadequate in terms of educating psychologists in basic physiology when there are existing routes such as PA and NP that would provide a solid foundation in basic medicine AND allow psychologists to prescribe psychotropic as well as other medications? Is it that psychologists want independent prescriptive authority?

Psychologists are using the argument that other non-physician providers (e.g., PAs, NPs, optometrists, podiatrists) have prescriptive authority. Why not just gain additional training in one of these non-physician professions?

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[PsyD123]

Just to add...I don't know about nurse practitioners, but PA's aren't able to prescribe meds in all states. My roommate is a PA in Ohio and does not have prescription rights.

 

[Anasazi23]

I worked with one in Pennsylvania. She was good....to a point. Even did "supervised" ect. Had a little trouble when a patient's heart stopped for a few seconds, but that's another thread. The practice generally gave her the more chronic, stable patients, while more difficult or comorbid patients were seen by the doctors for a few weeks/months, then transferred to her. There were a few medication errors I remember her making that were a semi-big deal...mostly because she didn't clear it with the doctor, and there wound up being a hidden contraindication or problem.

To be honest, I wonder if psychologists are reluctant to take classes, tests and be supervised by an entity outside of psychology itself. A sort of "home field advantage" in remediation when needed, etc. Even the board exam and classes for rxp are created by and taught by psychologists.

 

[50960]

No, do your research, as I have. PA programs do not allow us into their progs due to medic/emt bias, even if we have been attending in a psych hospital etc, workining with MD's on a team.
NP programs are specific to RN's only. The MS is equal in scope
and more progressive in content for psych...

 

[SeaviewMD]

No, do your research, as I have. PA programs do not allow us into their progs due to medic/emt bias, even if we have been attending in a psych hospital etc, workining with MD's on a team.
NP programs are specific to RN's only. The MS is equal in scope
and more progressive in content for psych...

PA students that have rotated through the wards where I work have come from variety of healthcare backgrounds; a glance at various program websites indicate prerequisite experience of "hands on" clinical care (several mentioned that even phlebotomy would suffice). The real issue here is that a PA program would require established psychologists interested in practicing medicine (which is the true agenda, after all) to interrupt their income-generating practices to return to school full-time.

While I agree that the MS appears to approach PA and NP training in scope, I consider the depth of the MS programs to be what is lacking.

 

[Allotheria]

PA students that have rotated through the wards where I work have come from variety of healthcare backgrounds; a glance at various program websites indicate prerequisite experience of "hands on" clinical care (several mentioned that even phlebotomy would suffice). The real issue here is that a PA program would require established psychologists interested in practicing medicine (which is the true agenda, after all) to interrupt their income-generating practices to return to school full-time.

While I agree that the MS appears to approach PA and NP training in scope, I consider the depth of the MS programs to be what is lacking.

I agree with the idea that the MS program is lacking in depth, but I would like to see a program geared toward psychologists but with Adequate training.

I don't agree that the real issue is loss of "income-generation" but an issue of psychologists wanting to be trained by individuals familiar with their background, educational style, scope of practice, etc. Money may indeed play an issue but I know plenty of psychologists who would love to pursue the MS as a post-doc/fellowship option.

 

[SeaviewMD]

I agree with the idea that the MS program is lacking in depth, but I would like to see a program geared toward psychologists but with Adequate training.

-So would patient advocacy groups such as NAMI along with organized medicine; both have expressed this view repeatedly when opposing RXP bills.

I don't agree that the real issue is loss of "income-generation" but an issue of psychologists wanting to be trained by individuals familiar with their background, educational style, scope of practice, etc. Money may indeed play an issue but I know plenty of psychologists who would love to pursue the MS as a post-doc/fellowship option.

-Unfortunately, I think money is the primary force that's driving the RXP initiatives and the MS programs developed to facilitate them. I suspect if clinical psychology hadn't been systematically devalued and marginalized by the insurance industry, there wouldn't be the desperate legislative push for RXP or the development of "distance learning" master's programs in psychopharm.

Its too bad this whole battle over RxP has developed between psychology and organized medicine the way it has. With the wholesale changes that have developed in the delivery of patient care in recent years (such as the proliferation of PAs and ARNPs serving as PCPs), I suspect that if a more collaborative model between psychology and medicine was proposed now to expand psychology's scope it wouldn't be met with same resistance. It appears there's far too much mutual distrust for this to occur at present, but a truly integrated and appropriate training program could have been devised- perhaps similar to that of a PA or ARNP- and perhaps offered as a post-doc or fellowship option for clinical psychologists. In its current state though, I don't think anyone with a background in medicine will ever view the MS psychopharm courses as anything more than a political tool that may be useful in providing an introduction or overview of certain biomedical principles.

 

[Allotheria]

-So would patient advocacy groups such as NAMI along with organized medicine; both have expressed this view repeatedly when opposing RXP bills.

-Unfortunately, I think money is the primary force that's driving the RXP initiatives and the MS programs developed to facilitate them. I suspect if clinical psychology hadn't been systematically devalued and marginalized by the insurance industry, there wouldn't be the desperate legislative push for RXP or the development of "distance learning" master's programs in psychopharm.

Its too bad this whole battle over RxP has developed between psychology and organized medicine the way it has. With the wholesale changes that have developed in the delivery of patient care in recent years (such as the proliferation of PAs and ARNPs serving as PCPs), I suspect that if a more collaborative model between psychology and medicine was proposed now to expand psychology's scope it wouldn't be met with same resistance. It appears there's far too much mutual distrust for this to occur at present, but a truly integrated and appropriate training program could have been devised- perhaps similar to that of a PA or ARNP- and perhaps offered as a post-doc or fellowship option for clinical psychologists. In its current state though, I don't think anyone with a background in medicine will ever view the MS psychopharm courses as anything more than a political tool that may be useful in providing an introduction or overview of certain biomedical principles.

I agree with the majority of this. Most of my posts have been dealing with this issue (see the MS Psychopharm thread). I wish that there was an integrative approach. I really don't see why psychologists cannot be competent providers if they have the proper training. With proper supervision why can't they perform much as PA's and ARNPs? I don't believe that the current MS degree provides psychologists an adequate level of training, but this can be rectified. I believe much like you, that if there was a collaborative model developed and integrated between psych and med adequate training could be provided. My main problem with the MS degree is that there are no real prerequisites for the program. I would like to see more of neuro or health psychologist background required for the degree, and have the MS set up as a post-doc or fellowship. I think what people don't realize about the degree is that it does not prepare the psychologist to be an independent provider. It only prepares them to be a mid-level practitioner because 20% of their clients have to be supervised/reviewed by an MD. I agree with this, because if they wanted to be physicians with stethoscopes they should have got an MD degree and that's why the art of referrals needs to be stressed in the MS program. They should just have a whole class devoted to that.

 

[Pharmohaulic]

No, do your research, as I have. PA programs do not allow us into their progs due to medic/emt bias, even if we have been attending in a psych hospital etc, workining with MD's on a team.
NP programs are specific to RN's only. The MS is equal in scope
and more progressive in content for psych...

So maybe they can have a joint program with some PA programs like a PsyD/ PA program where psychologist are able to bypass certain entry requirements since they have clinical experience, and their psych and neuroscience can be transfered to enable them to 'test out' of certain classes in the psychiatric rotation of the PA portion.

 

[Pharmohaulic]

So maybe they can have a joint program with some PA programs like a PsyD/ PA program where psychologist are able to bypass certain entry requirements since they have clinical experience, and their psych and neuroscience can be transfered to enable them to 'test out' of certain classes in the psychiatric rotation of the PA portion.

I could agree with this... The only only issue this brings up is that they would still need to be licensed under 2 seperate licensing boards... This makes it confusing because if for instance someone has a complaint (and not necessarily a complaint about a med error for those anti-RxP's so quick to jump the gun) which board do they contact?

If it was all under the psych board that the proposed MS postdoctoral degree would be, it would help to streamline the process

 

[Pharmohaulic]

No, do your research, as I have. PA programs do not allow us into their progs due to medic/emt bias, even if we have been attending in a psych hospital etc, workining with MD's on a team.
NP programs are specific to RN's only. The MS is equal in scope
and more progressive in content for psych...

Why cant psychology programs just collaborate with medical programs and just adopt the PA style of education into the post doctoral training?

 

[smalltownpsych]

Why cant psychology programs just collaborate with medical programs and just adopt the PA style of education into the post doctoral training?

Because the vast majority of psychologists don't want to be PAs.

 

[Pharmohaulic]

Because the vast majority of psychologists don't want to be PAs.

But if they incorporate the same style of training into a post back WITHIN the psychology department, then they would be training as a medical psychologist not a PA... it's like a nurse practitioner vs a PA, the training is similar but they are two separate entities