Illinois Becomes the Third State to Pass Prescriptive Authority

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edieb

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The Illinois House passed prescriptive authority for psychologists by a margin of 91 for and 21 against. The bill passed the Illinois Senate last year
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There were 94 yeas and 21 nay after a short public debate. It has passed the senate and house. This has happened in other States to have the Governor veto as in Hawaii.

There is another review on May 30, 2014.


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I believe it passed on the third reading with a huge majority and it goes tithe Governor for signature. I can't see the governor veto since it had an overwhelming majority of support 94/21.


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This is really exciting, keep us updated. I think it will be a 50-50 if it gets all the way through. The good news is that the RxP bill included some better training standards than the last one.
 
The Illinois bill provides for receiving the clinical psychopharmacology training during doctoral studies and having a 14 month supervised practicum/internship so a new graduate my have prescription privileges when they graduate. It also requires students to have bioscience or hard science undergraduate courses to gain admissions into the clinical psychopharmacology doctoral program.

Not sure how this will affect licensed psychologist who have completed the postdoctoral training. My guess is the postdoctoral training will make them eligible.

Illinois has a large population and probably 6000 or more licensed psychologist, so this is a monumental law for many psychologists in Illinois.

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OneNeuroDoctor said:
The Illinois bill provides for receiving the clinical psychopharmacology training during doctoral studies and having a 14 month supervised practicum/internship so a new graduate my have prescription privileges when they graduate. It also requires students to have bioscience or hard science undergraduate courses to gain admissions into the clinical psychopharmacology doctoral program.

Not sure how this will affect licensed psychologist who have completed the postdoctoral training. My guess is the postdoctoral training will make them eligible.

Illinois has a large population and probably 6000 or more licensed psychologist, so this is a monumental law for many psychologists in Illinois.

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So, take me for example, a clinical psych applicant for the '15-'16 academic year - UIC & Northwestern are two of my top picks, but I don't have any extensive premed/bioscience coursework. Do you know if I could take advantage of the all-in-one route of getting psychopharm training while in grad school? Maybe taking UG courses while in grad school (not ideal, but maybe a possible alternative route?) - I know this is all brand new, but I can't say that I'm not very excited by this news.
 
briarcliff said:
So, take me for example, a clinical psych applicant for the '15-'16 academic year - UIC & Northwestern are two of my top picks, but I don't have any extensive premed/bioscience coursework. Do you know if I could take advantage of the all-in-one route of getting psychopharm training while in grad school? Maybe taking UG courses while in grad school (not ideal, but maybe a possible alternative route?) - I know this is all brand new, but I can't say that I'm not very excited by this news.
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Apparently to get the Nursing Board and the Medical Board, and the American Medical and American Psychiatric Association approval they made many concessions. There is restrictions on age groups for prescribing and restrictions on medications allowed to prescribe.

For new doctoral students bioscience or hard science undergrads courses are required but it does not indicate how many courses. I guess they will have to figure this out if the Governor signs the bill.

In my undergraduate psychology program, we had to take 24 hours of science. I took biology I and II, physiology I and II and astronomy. I also had physiological psychology as required for my psychology credits.

My guess is that microbiology I and II general and organic chemistry may be required. There is a mention of 35 credit hours in the changes so this could be the new undergraduate requirement for biosciences.

There must be some 200 or more Universities in Illinois and some 30 doctoral level clinical psychology programs in Illinois so it will change many of their education requirements.

Probably all of the details won't be worked out until 2016. If you are graduating in two years and get into one of the Illinois clinical programs, this will give you some time to take the undergraduate bioscience courses.

I've heard of people obtaining a BS in psychology and then going back a year or later and take all of the premed courses and then get into med school.

It is much more practical to take additional psychopharmacology courses in grad school and then be able to prescribe early career rather than do a two year postdoctoral training program.


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What I am hearing:
- Training very similar to Physician's Assistant and accredited by that body
- Last minute changes to bill were not revealed to the IPA
- Current RxP training standards will not qualify for Illinois. Meaning many of the people that already received the postdoctoral psychopharm training will not be able to practice in Illinois
- Once licensed, the physician's cannot have collaborative agreement with more than 3 psychologists. No random MDs, the collaborative agreement has to be with someone that would ordinarily treat that client
 
DynamicDidactic said:
What I am hearing:
- Training very similar to Physician's Assistant and accredited by that body
- Last minute changes to bill were not revealed to the IPA
- Current RxP training standards will not qualify for Illinois. Meaning many of the people that already received the postdoctoral psychopharm training will not be able to practice in Illinois
- Once licensed, the physician's cannot have collaborative agreement with more than 3 psychologists. No random MDs, the collaborative agreement has to be with someone that would ordinarily treat that client
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A number of licensed psychologist have the ANP license so it sounds like they may follow this model except as physician assistant. My guess is the psychologist already licensed will be able to complete their training and if they already have the RxP training they will receive credit for this training and will only need to take the supervised preceptorship. The postdoctoral RxP training is basically equivalent to PA and NP training.



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OneNeuroDoctor said:
A number of licensed psychologist have the ANP license so it sound like they may follow this model except as physician assistant.
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?

if they already have the RxP training they will receive credit for this training and will only need to take the supervised preceptorship.
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see my note about accreditation above and the hours are double what the original legislation proposed.

The postdoctoral RxP training is basically equivalent to PA and NP training.
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again, this appears inaccurate. The IL nurse's association stated the the training is not nearly equivalent and the new changes were put in place to make the training equivalent to PAs. Thus, the previous training requirement was not.
 
I guess we will find out the details soon. My guess is the details will be ironed out in the next year. Certainly there will be some grandfathering or credit given for psychologist who have completed the Postdoctoral RxP training. If not, then it will be another six or seven years before psychology graduate students will graduate and this will not help the current shortage of prescribers.

Supposedly NP standards are changing to doctoral degree requirement in the next five years.

I guess... Stay tuned as changes are a happening!!!


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I haven't read the legislation, so I could of course be wrong, but I'd actually be pretty surprised if there was any grandfathering in allowed for the postdoctoral education; it's not as if psychologists were already prescribing in the state, and then this legislation came along and upped the requirements. My knee-jerk guess would be that the postdoctoral programs will be developed around these guidelines, and that perhaps acceptable "booster courses" will also be available for folks who previously completed the psychopharm work but don't meet the training reqs.
 
OneNeuroDoctor said:
Certainly there will be some grandfathering
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definitely no grandfathering as there is no actual grandfather in the picture (as AA mentions)

this will not help the current shortage of prescribers.
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many believe that the bill was never, in reality, about addressing a prescriber shortage.

AcronymAllergy said:
My knee-jerk guess would be that the postdoctoral programs will be developed around these guidelines, and that perhaps acceptable "booster courses" will also be available for folks who previously completed the psychopharm work but don't meet the training reqs.
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that would be my assumption as well. Since Med Schools train PAs, to me it seems that Med Schools will be creating these programs and are going to benefit most from the bill. I think the bill makes it difficult for professional psychology programs to meet the training requirements. However, Chicago has the first clinical psychology program housed within a Med School. I imagine this program is going to expand a bit.
 
If this is true regarding the training in PA programs in medical schools; will already licensed psychologist have to take premed undergraduate courses and the MCAT for admissions? Will it be similar to re specialization programs?

What about the psychologist who have completed the postgraduate training Phase III and work as consultants for family practice physicians?

What about DOD prescribing psychologist working in Illinois?




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OneNeuroDoctor said:
If this is true regarding the training in PA programs in medical schools; will already licensed psychologist have to take premed undergraduate courses and the MCAT for admissions? Will it be similar to re specialization programs?

What about the psychologist who have completed the postgraduate training Phase III and work as consultants for family practice physicians?

What about DOD prescribing psychologist working in Illinois?

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Not sure about the undergrad classes, but I'd think they might roll them in to the postgrad programs if necessary. Perhaps the only grandfathering that would be done might be for already-licensed psychologists to be exempt from the undergrad requirements. I doubt there'd be an entrance exam, though, but who knows (do PA students actually take the MCAT? I wasn't aware that was the case).

For those who've already completed the existing postgrad training, as I mentioned above, I'm going to think they'll need to take additional classes to qualify. Same might go for already-prescribing psychologists, although maybe there'd be a stipulation that those with XX years' worth of experience are exempt. Not guaranteed, of course, but the DOD psychologists can still continue prescribing in for DOD patients regardless of what Illinois state law says.
 
AcronymAllergy said:
For those who've already completed the existing postgrad training, as I mentioned above, I'm going to think they'll need to take additional classes to qualify. Same might go for already-prescribing psychologists, although maybe there'd be a stipulation that those with XX years' worth of experience are exempt. Not guaranteed, of course, but the DOD psychologists can still continue prescribing in for DOD patients regardless of what Illinois state law says.
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I'm curious as to how this will work. For some of us who have already completed the training and/or work in academia, *we* are the ones teaching those classes (whether it be in an undergrad program, med program, grad program, etc).
 
Therapist4Chnge said:
I'm curious as to how this will work. For some of us who have already completed the training and/or work in academia, *we* are the ones teaching those classes (whether it be in an undergrad program, med program, grad program, etc).
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I then wonder if they'll stipulate who is a "qualified" instructor. Probably also depends on what the extra classes actually include/entail.
 
Therapist4Chnge said:
I'm curious as to how this will work. For some of us who have already completed the training and/or work in academia, *we* are the ones teaching those classes (whether it be in an undergrad program, med program, grad program, etc).
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When everything is finalized, it would be my guess that those who do not have the undergraduate bioscience classes will be able to take these classes online. However, the postdoctoral clinical psychopharmacology program has equivalent bioscience courses as part of the curriculum and it maybe that these courses will fulfill the UG course requirements.

It does seem odd to have this requirement when completion of the postdoctoral program is more intense and APA recommended training.

Some of the Medical Psychologist in LA and NM are now teaching and supervising medical school students and resident, but they will be ineligible for ILL licensure.

Great deal of complaining on the message boards/ listserv about this law going on today.


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As I mentioned earlier, my understanding is that training programs will have to be accredited by this organization http://www.arc-pa.org/index.html

Thus, for anyone looking to get this training during graduate study they would have to be in a place that already has a clinical psychology program and a PA training program. I believe there is only one such potential place in Illinois that is APA accredited. And maybe only one other in the US (that is, a clinical psychology training program within a Med School). Yet another wrinkle, however, is this would butt heads with the APA's policy of generalist training. I am not sure if already established programs will be willing to take that chance.

For anyone looking to get the postdoctoral training, they would most likely be waiting a while for a Med School to launch such a program. But I doubt that it would be a very viable option for postdoctoral training since it would take 2 years of full time, in class training and a 14 month full time internship. Which is very similar to traditional PA training.
 
Midwestern University, Roslyn Franklin Med, UIC, Northwestern U, and Southern Illinois University all have PhD/PsyD in clinical Psychology and accredited PA programs.

I checked PA curriculum at Midwestern and they take a heavy load of courses and labs the first year and all clerkships the second year for 56 hour PA degree. They have a PA exam for admissions.


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Northwestern's Feinberg SOM clinical psychology program is looking a lot more appealing to me today than it did just a couple days ago.
 
Basically it appears that psychologist will have to complete a PA program for prescription privileges.
I guess they would complete the three-year PA program during their doctoral studies. Here is a copy of the regulations that the House passed yesterday:

Sec. 4.2. Prescribing psychologist license.
11 (a) A psychologist may apply to the Department for a
12prescribing psychologist license. The application shall be
13made on a form approved by the Department, include the payment
14of any required fees, and be accompanied by evidence
15satisfactory to the Department that the applicant:
16 (1) holds a current license to practice clinical
17 psychology in Illinois;
18 (2) has successfully completed the following minimum
19 educational and training requirements either during the
20 doctoral program required for licensure under this Section
21 or in an accredited undergraduate or master level program
22 prior to or subsequent to the doctoral program required
23 under this Section:
24 (A) specific minimum undergraduate biomedical
25 prerequisite coursework, including, but not limited Medical Terminology (class or proficiency);
2 Chemistry or Biochemistry with lab (2 semesters);
3 Human Physiology (one semester); Human Anatomy (one
4 semester); Anatomy and Physiology; Microbiology with
5 lab (one semester); and General Biology for science
6 majors or Cell and Molecular Biology (one semester);
7 (B) a minimum of 60 credit hours of didactic
8 coursework, including, but not limited to:
9 Pharmacology; Clinical Psychopharmacology; Clinical
10 Anatomy and Integrated Science; Patient Evaluation;
11 Advanced Physical Assessment; Research Methods;
12 Advanced Pathophysiology; Diagnostic Methods; Problem
13 Based Learning; and Clinical and Procedural Skills;
14 and
15 (C) a full-time practicum of 14 months supervised
16 clinical training of at least 36 credit hours,
17 including a research project; during the clinical
18 rotation phase, students complete rotations in
19 Emergency Medicine, Family Medicine, Geriatrics,
20 Internal Medicine, Obstetrics and Gynecology,
21 Pediatrics, Psychiatrics, Surgery, and one elective of
22 the students' choice; program approval standards
23 addressing faculty qualifications, regular competency
24 evaluation and length of clinical rotations, and
25 instructional settings, including hospitals, hospital
26 outpatient clinics, community mental health clinics,
1 and correctional facilities, in accordance with those
2 of the Accreditation Review Commission on Education
3 for the Physician Assistant shall be set by Department
4 by rule;
 
Wow, a class in research methods and a research project as a part of the 14 month internship? Really? Maybe that'll just transfer over from the psych grad program.

As for criterion B above, I wonder how much that differs from the current psychopharm masters course list.
 
Yeah, the research component kind of annoys me.
 
The research requirement….:rolleyes:.

I will say that I'm glad they are looking to raise the standards, as some of the prior bills in other states were pretty weak on the education piece.

I wonder if NM & LA would accept the IL training (assuming it is signed into law by the governor) as sufficient? I'm looking to get licensed in one or more of the states, as it'd be helpful for my research work.
 
Yeah, that's basically the same as the existing options psychologists have (e.g., NP or PA). Tbh, I'm feeling more and more like RxP is a lost cause for the field and that the time and money spent lobbying for it could be better invested in tackling other issues.
 
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I will say that the Illinois approach of integrating it into existing training programs (rather than looking for a strictly postdoctoral method) is an interesting one. The downside is that it could eventually result in a significant blurring of professional duties given the increasing similarity of training material. Another downside is that it could (and I mean this as no affront to our PA colleagues), if proliferation occurs, eventually lead to psychologists being viewed more as mid-level medical providers rather than doctoral-level mental health experts who can also prescribe. This view would be accelerated if some of the more...profit-minded training conglomerates jump on the paradigm and begin jettisoning the in-depth mental health training in order to keep overall time-in-program numbers down.

Personally, I most prefer the approach of the program that edieb has previously posted about in NM--a formal (in-person) postdoctoral position that includes all necessary coursework and subsequent supervision. I'd rather Illinois had simply beefed up the coursework and/or supervision of that postdoctoral model than gone with this new integrated grad program amalgamation approach.
 
There are pluses and minus with either model, but the Illinois model allows for future doctoral students to finish the training during doctoral studies in Illinois and the training will have portability to other States. No need to stay in Illinois after you complete the program.

Illinois is a State with many Graduate Psychology programs and PA programs. This seems to be a more seamless process where psychologist won't be restricted to staying in Illinois and it is a model that could be generalized to other States.

Another factor that they have a large number of clinical psych doctoral and PA programs in Illinois.
It sounds like enrollment in PA programs has declined in the last ten years so the PA programs are trying to market and have more students in their PA programs. With some 6000 or more licensed psychologist in Illinois, many of the PA programs will now have increased enrollments. So it appears that Illinois decided to utilized the current PA programs in their State for training of clinical psychopharmacology for psychologist.

There seems to be mixed opinions about this bill. One psychologist indicated that undergraduate psychology training could benefit from this bill via changing core course to include more bioscience courses and psychology may now become more allied with biological sciences departments.
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At first glance, it would seem easier for a psychologist with a Ph.D. already to just go the NP route.
 
Neuropsych2be said:
At first glance, it would seem easier for a psychologist with a Ph.D. already to just go the NP route.
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Yes, this is the route that some psychologists have taken to gain prescription privileges. NP salaries are in the 90 thousand dollar range and PA are in the 60 thousand dollar range. PA enrollment has steadily declined but NP schools enrollment has increased the last ten years.

PA programs in Illinois will be packed in several years. Interesting as there are also a number of PA who returned to get the PsyD degree and they already have prescription privileges in Illinois.

My dissertation several years back indicate significant support for NP credentials by all psychologist except for psychologist who already were approved prescribers from postdoctoral training in DOD or NM/LA. However, my other hypothesis did not show significant differences between groups concerning completion of the psychopharmacology training during doctoral studies. Predoctoral clinical psychopharmacology training was agreed rather than disagreed by more psychologist, but it was not a significant difference. This law could add a year or two to the time completion of the doctoral program. There are similar combined program of PhD/JD so it can be accomplished. Most clinical psychology programs now have 4-5 courses in biological or physiological psychology, so it seems plausible that these courses will be completed in the PA program. Also, the internship could fulfill both programs so you do not need two internships. Many PA programs have two psychology courses so this would reduce the number of hours for the psychology student.

This law will require many changes in doctoral psychology curriculum. Academic psychologists have advocated for increased rigorous undergraduate psychology curriculum. Now it will be more common for the psychology major to have a minor in biology or physiology.

Hopefully, with this law, psychology will be more accepted and respected as a medical sub specialty and produce well rounded psychologists with prescription privileges.

My guess is the Medical Board PA programs are already set up for psychopharmacology training and there are many PA programs in Illinois. Normally in smaller States you may not have the PA option but probably have the NP option.

One difference between NP and PA licensure is recently NP will be a doctorate license in the next five year or by 2018 based on recent changes and PA licensure will remain a MS degree. This could be the reason NP program is not part of the new regulations. A number of PA gain admissions to MD or DO programs after completing their PA program.


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Criterion B and C is basically the PA program of 60 hours or more. For doctoral psychology students a number of courses in the Psychology curriculum will count towards the PA coursework reducing the PA hours to closer to 30 credit hours. Psychology required courses of physiological psychology, psychopharmacology, statistic, research, thesis or research project, and one or two other psychology courses, and practicum/internship.

In reviewing some of the PA programs that are in religious based universities, they require some theology courses.

When you combine the PA curriculum with the doctoral level curriculum it will most likely be an additional year of classes.

Currently, some PhD Clinical Psychology programs are set up where graduates receive a MS in Theology and a PhD in Clinical Psychology so this is most likely how it will be in Illinois, except you will get an MS in PA and a PhD in Clinical Psychology.

Most PA course curriculums are set where students take a course credit load of 15 credit hours per semester the first year Fall, Spring, Summer to have 45 credits, and second year is supervised practicum and research project. However, some variation between programs as some PA programs are 50 credit programs while others are closer to 80 credit hours.

Criterion A is basically undergrads premed major curriculum. My undergrad curriculum was 20-24 hour science courses but only required College Algebra. I would have had to take Chemistry 1 and 2, Anatomy, and microbiology 1and 2. I would have to take 20 more science hours. PA programs require a B or higher grad
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Given the size of Illinois in terms of population and the fact that this state in in the middle of the Midwest heartland, I suspect that this will have a significant impact on the prescription privileges movement. States like Louisiana and New Mexico are smaller and I suspect that one of the reasons the prescription privileges movement has not moved forward rapidly is that these states are perceived as "outliers."
 
Neuropsych2be said:
Given the size of Illinois in terms of population and the fact that this state in in the middle of the Midwest heartland, I suspect that this will have a significant impact on the prescription privileges movement. States like Louisiana and New Mexico are smaller and I suspect that one of the reasons the prescription privileges movement has not moved forward rapidly is that these states are perceived as "outliers."
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I had the same thought initially but am concerned that too few psychologists will go through the hoops. Also, I work with a lot of kids who have no child psychiatrist available. Up to six month wait and need to drive 2 to 3 hours top get there. We are going to contract with a company providing telemedicine for pediatric cases but found out yesterday that they are overwhelmed already. Family docs will prescribe ADHD meds but if it get's more complicated than that, they are looking for help and so are the parents. What do I do when little Johnny has bipolar disorder and sometimes seems like the exorcist and the mom wants help? As we all know, talk therapy won't help much with this. The mothers of these kids have already received more than enough parenting tips from well-meaning relatives so I avoid giving out more of the same. They do appreciate that I understand and don't blame them, but that is about all I can offer.
 
smalltownpsych said:
I had the same thought initially but am concerned that too few psychologists will go through the hoops. Also, I work with a lot of kids who have no child psychiatrist available. Up to six month wait and need to drive 2 to 3 hours top get there. We are going to contract with a company providing telemedicine for pediatric cases but found out yesterday that they are overwhelmed already. Family docs will prescribe ADHD meds but if it get's more complicated than that, they are looking for help and so are the parents. What do I do when little Johnny has bipolar disorder and sometimes seems like the exorcist and the mom wants help? As we all know, talk therapy won't help much with this. The mothers of these kids have already received more than enough parenting tips from well-meaning relatives so I avoid giving out more of the same. They do appreciate that I understand and don't blame them, but that is about all I can offer.
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I'd actually be surprised if, going forward, this doesn't end up being a fairly darn popular training model in IL. The main problem I foresee is that programs which already offer less-than-stellar training may add this PA-like component as a huge draw for students, and thereby start churning out folks who are much more akin to mid-level providers than prescribing psychologists (e.g., PAs with some extra not-so-great psych training).
 
AcronymAllergy said:
I'd actually be surprised if, going forward, this doesn't end up being a fairly darn popular training model in IL. The main problem I foresee is that programs which already offer less-than-stellar training may add this PA-like component as a huge draw for students, and thereby start churning out folks who are much more akin to mid-level providers than prescribing psychologists (e.g., PAs with some extra not-so-great psych training).
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Ugh! In other words, becoming a psychologist and the skill set necessary for that gets discounted in favor of med management.
 
Population in Illinois is 13 million and Louisiana is 4.5 million and New Mexico is 3 million. There are some 7000 psychologist in Illinois. Both NM and LA only have 200 to 300 psychologist who are prescribing psychologist. Some Psychologist are licensed in both Illinois and NM but they will not be eligible to prescribe in Illinois unless that go through the PA training. When Katrina hit LA, a substantial number of psychologist relocated to Texas and now they are licensed in Texas and LA.


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