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now we scream about it, but what are we doing

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by 50960, Nov 5, 2004.

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  1. 50960

    50960 Guest

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    To make MDs and psychs work more together as a team for mental health. I do it in practice working in a primary care med office, with a great doc, but what else is the field doing?? Let's speak out it :) !! Keep active in the other forums too as many psych/MD issues come up there!!
  2. PsyDRxPnow

    PsyDRxPnow Clinical Psychology

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    I don?t think that they have much interest in working with psychologists as a team. They rather just prescribe their meds and let clinical psych do whatever it is that they do with the patients. I hope this changes soon for the sake of the patients.
  3. kaylie

    kaylie Junior Member

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    Part of my goal is to show empirical support for the necessity of psychology in primary care and then move policy along in that direction.
  4. edieb

    edieb Senior Member

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    I work in Louisiana as a graduate student (3rd year clinical Ph.D.) in a hosptial. We frequently do inpatient consults on patient (i.e., schizophrenia, dementia vs delirium, suicide, etc.). I am always shocked by how condescending the M.D.s are to the psych people. One salient example of this is during our yearly resident talk: When the senior student was describing the services we offer to the new residents, a bunch of residents made really evil comments such as "We know you all do relaxation training (laught)."

    If psychology is to compete in the marketplace, it really essential we gain RxP. In Louisiana, the grad students played a very important role in helping the APA gain them. You really should join your state psych association, division 55, and ask your state psych association what you can do to help the RxP movement. The LA Psych Association was more than happy to put us to work....
  5. PsyDRxPnow

    PsyDRxPnow Clinical Psychology

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    It must be very exciting being in Louisiana during this time of RxP revolution. Would you share with us some of the things that you and other graduate students have done to help RxP? :)
  6. edieb

    edieb Senior Member

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    They're making the RxP training pre-doctoral (an option). We mainly helped with calling and faxing the House of Reps. We also helped getting LaFact petitions signed. There is more info on all of this at:

    louisianapsychologist.org

    and the LSU Dept of Psych. web site has the proposed pre-doctoral RxP training course list....

  7. PsyDRxPnow

    PsyDRxPnow Clinical Psychology

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    That was a very interesting web site. Thanks for the info. Cant wait until Florida adapts a similar bill and provide more holistic treatment to its people.

    KEEP UP THE GOOD WORK LOUISIANA!!! :thumbup: :thumbup:
  8. PublicHealth

    PublicHealth Removed

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    It'll be a long, painful, and expensive journey. The American Psychiatric Association recently formed a Task Force to prevent psychologists from obtaining RxP, and a substantial porportion of clinical psychologists who are opposed to psychologists gaining RxP are fiercely lobbying from within the field. It has been and will continue to be a long battle. Last I heard, neither New Mexico nor Louisiana psychologists are prescribing. There are all kinds of provisional periods, restrictions, and red tape. Malpractice lawyers in these two states must be drooling.
  9. PsyDRxPnow

    PsyDRxPnow Clinical Psychology

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    Yea, it might be a long and painful process in obtaining RxP in Florida and other states but it will happen due to the great demand by the majority of the psychologist population. Although, the Psychiatric assoc is lobbying against it, the legislators well eventually foresee its good potential for those suffering from mental illness.

    Yes, I am aware of the task force by the American Psychiatric Association but I do not see them as more organized and as more powerful then the American Psychological Association. The RxP agenda has been in the process for the past 20 yrs., a few psychiatrists getting together to form a task force will not discourage the APA from pursuing RxP.

    Besides, No Pain No gain! :)
  10. PublicHealth

    PublicHealth Removed

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    Ah, to be young and optimistic! :p
  11. aphistis

    aphistis Moderator Emeritus

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    Not to be excessively cynical, but the legislators and other politicians won't see anything except what puts the most money into their re-election campaigns. ;)
  12. PsyDRxPnow

    PsyDRxPnow Clinical Psychology

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    To a certain degree, I agree with that. That is why it is important for psych students and professionals to join www.APA.org, www.apa.org/divisions/div55.html and their state psychological association.

    In addition, there is no reason not to be optimistic!
    :)
  13. Anasazi23

    Anasazi23 Your Digital Ruler Moderator Emeritus

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    How does being a psychologist, untrained and untested in formal medical preclinical or clinical science, provide MORE "holistic treatment" than a fully licensed physician psychiatrist who has passed medical school examinations, physical exam competence, all preclinical science coursework (up to 3 years worth), pass 3 levels of medical licensing exams covering core competence in all disciplines of medicine (including and definately not limited to neurology, nephrology, endocrinology, obstetrics and gynecology, oncology, and other relevant subspecialties), psychiatric and neurology board examinations, residency therapy training and additional hundreds of clinical credit hours, psychiatric oral boards, and has years experience treating medical patients under the supervision of licensed medical practitioners?

    Pardon my cynicism, but a psychologist, with therapy skills and knowledge of how to plop down an MMPI and hit ctl+P for the clinical printout or being able to tell you how to put the pictures in order so they make a story is not as holistic mental health care than that provided by a psychiatrist - sorry.

    Psychologists are valuable additions to the health care team. No question. But be careful of the claims you make. Especially without any experience from the other side. What looks easy to you may not be so.
  14. PsyDRxPnow

    PsyDRxPnow Clinical Psychology

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    Interesting point that you make regarding the elaborate training of the ?physician psychiatrist? and minimizing of the training and duties of a clinical psychologist. I to can break down the extensive training for a clinical psychologists which includes, course work (3 years), thousands of practicum hours, internship (one year), dissertation (1 yr.), testing (qualification exam), Internship (1-2 yrs. Post doc), and state licensing. In addition to all of this ?minimal? work, that you have implied, add another masters degree in psychopharmacology for RxP plus hundreds of hours of clinical training and supervision. Also, keep in mind that most of the clinical psych. students already have earned a masters degree before entering the clinical psych program.

    Needless to say, that we to are highly qualified individuals not a group of people who want to get prescriptive authority with minimal education. As a psychiatrist, can you inform us on why the majority of psychiatrists only push meds? What else can they competently do besides drugs?

    I inform you that psychologists will be able to do and will do much more then just push meds to our patients. We will provide meds, psychotherapy, extensive competent assessments and evaluations, educate, and provide expert witness.

    I can understand the threat that psychiatrists feel due to RxP because of job insecurity but do not macerate by proclaiming that you are advocating for patients safety. You are just advocating for job security and ego maintenance.

    But have no fear you can join us!!!!! http://www.apa.org/divisions/div55/, www.apa.org :)
  15. PublicHealth

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    Great point, Anasazi. Clinical psychology has dug its own grave. Attempts to obtain RxP seem like a futile effort to secure some sort of job security for clinical psychologists, who have been pushed out of the behavioral healthcare field to the point where their clinical services are no longer considered relevant or reimbursable. Psychologists' efforts to obtain RxP seem like a scramble to gain an additional treatment modality and increase financial security.

    However, as Anasazi noted above, psychologist training simply does not prepare one to prescribe psychotropic medications. There is simply too much emphasis on psychological assessment, psychosocial therapies, and research in predoctoral training programs in clinical psychology to adequately prepare psychologists to prescribe medications. Most programs are stuck in the antiquated approach to producing scientist-practitioners without a standardized level of training in psychopharmacology. Most of the predoctoral clinical psychology students that I have met do not even know the basics of psychopharmacology. It's almost as if clinical psychologists are trained in a strictly psychosocial treatment model, while medical students/psychiatric residents are trained in the medical/psychopharmacologic treatment model.

    Postdoctoral programs in clinical psychopharmacology also fall short of providing psychologists with comprehensive training in the medicine and pharmacology relevant to safely and effectively prescribing and monitoring the effects of psychotropic medications.

    Psychiatrists can prescribe medications and conduct psychotherapy. They are often reimbursed MORE for their psychotherapeutic services than psychologists.
  16. PsyDRxPnow

    PsyDRxPnow Clinical Psychology

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    Public health, I am not sure where you stand on things. You sound much more like John Kerry, remember him? He is that wish washy dude that wanted to become the leader of this nation but failed miserably. I do not know where you stand on RxP. One day you are for it and the next day your not. In addition, I thought that I have read somewhere in this form or the psychiatry forum that you, at one point, graduated from graduate school in psych.

    Make up your mind, stop going with the flow, and join www.Apa.org, and http://www.apa.org/divisions/div55/ :laugh:
  17. Anasazi23

    Anasazi23 Your Digital Ruler Moderator Emeritus

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    It may very well be that PublicHealth, with his toils of dealing with medical school, has seen the massive amount of information and more importantly, the complexities of the biological patient in his training thus far. It is hard, whether graduating psychology school or not, to assert that the psychology grad work stands up to the same level of difficulty or workload or requirement of understanding. This is not to say that medical school is better or worse, just very different, and has a different sort of patient in mind. Like he mentions, the graduate psychology curriculum is not as rigorous - by a long shot - as that of medical school. The "coursework (3 years)" and thousands of "practicum hours" are largely irrelevant classes or therapy/testing hours. The RxP master's with "hundreds of hours" is no less than a joke. A psychiatry resident completes hundreds of hours of work in a couple of weeks, while taking call, attending classes, making presentations, often performing research, and undertaking countless more patient responsibilities.

    My point to you is only this....do not continue to assume that as a 2nd year Psy.D. (?) student, you have any idea of the complexities of prescribing medication or comprehensively understanding patient medical sickness and health - psychopharm related or not. You ask what else psychiatrists can do besides prescribing meds? This is incredibly naive and demonstrates a complete lack of education regarding the knowledge base of psychiatrists. They are fully licensed physicians that practice in the subspecialty of psychiatry. And what they can and often do is beyond the scope of an internet forum post. At its most elementary, most I've worked with do a good deal of neurology and also medically manage their patients - oftentimes very complex cases. In this respect, you don't know what you don't know.
  18. PsyDRxPnow

    PsyDRxPnow Clinical Psychology

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    I do not know why you feel the urge to speak on behalf of Public Health. I would have preferred for him to address his ?wish washy? for himself. He is his own man, no?

    I guess you could not inform us of all the things that a psychiatrist can do besides push meds in this forum but you could have given us a glimpse of it but you declined to do so.

    You inform us that we as psych graduate students do not fully understand a psychiatrist?s scope of practice and I believe that you can also extend that same logic to psych medical students as well in regards to their knowledge or lack their of, to psych graduate students and their training.

    I believe that the primary reason that medical psych students go tough the comprehensive training of medical school is b/c they assume that you might go on to more medical oriented specialties (e.g. urology, intern med., emergency meds). Perhaps if they would have known that a med student was intending to go to psych specialty, they may have given you less and more focused training to ?psychiatry?. However, this might create consequences for that school (e.g. money) so they rather train you the same way they train other MD (urology, intern med., emergency meds, etc.). The masters in psychopharmacology might be ?a joke? to you because it specializes to psychopharmacology and does not deal with other medical aspects that may not be fully relevant to mental health.

    I have read an article recently in the ?New Physician? monthly magazines that my brother receives, (http://www.amsa.org/tnp/). The article related to Psychiatry as being a joke and medical students who are interested in pursuing it become quacks and are ridiculed by other ?real physicians?. Can you help us understand why your own colleagues with similar training as psychiatrists find psychiatrists to be a ?joke?? By the way, this is not my opinion of psychiatrists and I am only referring to the article.

    Peace
  19. edieb

    edieb Senior Member

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    Good point, psychiatry is (for the most part) a bottom-feeding profession. Psychiatry residencies must recruit medical students from other nations b/c no med students want to do it. These recruite are usually with cultures much disparate than our own (i.e., India). What a shame that in a profession where empathy is very important, most psychiatrists are not even familiar with their patients' culture.

    Let's assess the approximate aptitudes of psychiatrists versus psychologists in order to see which profession should be ascendant in the health care arena:

    Medical School acceptance rates are around 70 percent. Clinical psyh. acceptance rates are about 5 percent. Psychiatrists are many times the lowest achievers in their class (which I remind you admits around 70 percent). In addition, you cannot flunk out of medical school; however, clinical psychology students must pass all classes with > 80 percent; classes that are designed to be very difficult.

    It is absurd that psychiatry argue that psychologists cannot prescribe safely. Do we prohibit psychiatrists, many of whom receive <2 years of training in psychotherapy, from performing this complex treatment? Psychiatry's arguments are akin to their old arguments against psychology: If you let psychology do _____ (pick one: assessments, psychotherapy), people will die...
  20. lazure

    lazure Senior Member

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    Good point, psychiatry is (for the most part) a bottom-feeding profession. Psychiatry residencies must recruit medical students from other nations b/c no med students want to do it. These recruite are usually with cultures much disparate than our own (i.e., India). What a shame that in a profession where empathy is very important, most psychiatrists are not even familiar with their patients' culture.

    Let's assess the approximate aptitudes of psychiatrists versus psychologists in order to see which profession should be ascendant in the health care arena:

    Medical School acceptance rates are around 70 percent. Clinical psyh. acceptance rates are about 5 percent. Psychiatrists are many times the lowest achievers in their class (which I remind you admits around 70 percent). In addition, you cannot flunk out of medical school; however, clinical psychology students must pass all classes with > 80 percent; classes that are designed to be very difficult.



    PsyDRxPnow and Edieb,

    both of you complain about lack of respect from other mental health professions, particularly physicians. Yet you do not hesitate to throw around blanket insults, thereby diminishing the significance of any valid arguments you may have made...sad...
  21. Anasazi23

    Anasazi23 Your Digital Ruler Moderator Emeritus

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    Like I alluded to earlier....if you want to know what a psychiatrist "can do," I refer you to any general medicine textbook (Cecil's would be a nice start). Again, psychiatrists are physicians that specialize in psychiatry. Therefore, they are privy to and treat many medical conditions (pick some) and especially those patients that exhibit psychiatric symptoms. You think we don't do anything but "push meds?" I invite you to any typical day in our residency program. You will be scared at what you don't understand. Psychiatric patients do not exist in a health vacuum. They are often indigent and sick. Today I worked up a woman who has extremely dangerous and erratic BG levels who was originally admitted in DKA. She has complex medical issues, including a PE, and anoxic sequelae that is affecting her psychiatrically. I'm dosing heparin and consulting with other doctors on her case. Wrong move is made, she throws another PE. We're having trouble keeping her compliant and in dealing with her labs. Are you comfortable with this?

    Not only does this make no sense, it further makes me wonder if you have any idea at all what medical school training entails.
    I said the 100 patients seen in the practicum was a joke. I still stand by that statement.

    I read the same articles. I'm curious as to why you didn't mention the other responding articles focusing on how psychiatry is an increasingly sought after career career and how more and more medical students are pursuing psychiatry as their specialties, how it is intellectually stimulating, etc. Medical students and medical attendings make fun of every other field (refer to "specialty one-liners" in the clinical rotations forum). This does not make them less important.
  22. PsyDRxPnow

    PsyDRxPnow Clinical Psychology

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    PsyDRxPnow and Edieb,

    both of you complain about lack of respect from other mental health professions, particularly physicians. Yet you do not hesitate to throw around blanket insults, thereby diminishing the significance of any valid arguments you may have made...sad...[/QUOTE]

    Excuse me, but your not bothering to be accurate and you?re the one that is offering a blanket of insult. I have never once referred to psychologists as being disrespected by ?other mental health professions, particularly physicians? nor have I insulted anyone at any time. I did however, point out to an article that may have demonstrated disappointment/stigma in psychiatry and the MDs that want to pursue it but I made it clear that its night my opinion of other mental health practitioners.

    Please do your research before the accusations.

    Have you joined www.apa.org and http://www.apa.org/divisions/div55/ today? :)
  23. Anasazi23

    Anasazi23 Your Digital Ruler Moderator Emeritus

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    I agree that language barriers often provide unfortunate disparities in the understanding of American culture. Do not assume, however, that psychiatrists from particular countries do not often specialize in treating other patients from their native countries who have emigrated. I see specialty culture clinics all the time and often refer to them - i.e. Russian, Asian, Hispanic, Indian, etc, etc. I also see my share of foreign-born psychologists. They are often as good or better than their American counterparts.

    My hospital has already over 400 applications for psychiatry residency. About one half of them are American graduates. So to say "no med students want to do it" is false.

    This is wrong on at least a few levels. Let me begin by saying that this is not an intent to insult psychology grad students. In general they are a bright group and I know from personal experience that it difficult to get in. That being said: Please everyone stop with this notion that psychology is harder than psychiatry coursewise. People are constantly comparing GPAs and other numbers and it makes no sense. Psychology bachelors degrees often require no biology, no physics, no organic chem, no calculus, no physiology, no general or physical chem, etc. These classes are harder than psychology classes. The GPAs, while similar for psych grad school, reflect a completely different curriculum. In general, a 3.8 obtained in a B.A. in psychology is not as difficult as a 3.8 GPA obtained in premed.

    You say clinical psychology students must pass all classes >80%. You know that this is completely false. You say nobody can flunk out of med school. I can name 10 people I know off the top of my head from my class alone.
    You say psych classes are designed to be difficult. Please don't think that med school makes things a breeze once you get in. It is probably the hardest set of curricula to pass aside from some complex Ph.D. level science degree curricula (physics, propulsion, etc). You know perfectly well that a large portion of psychology grad courses are psychological testing (projective, intellectual, etc), history of psychology, therapy modalities (existential, psychodynamic, insight oriented, brief, family, etc) These are not terribly difficult in general. Yes, statistics and research classes can be very difficult. I think it is something at which many, but not most, clinical psychologists excel.

    You know as well as I do that this is a completely different ballgame. Don't be so high-horsed in your attempts to gain prescription privilages. Psychologists are fighting a very similar scope-of-practice battle vs. social workers, as you should. I haven't seen arguments from psychologists saying that they should be allowed to perform therapy and testing, to "help poor psychiatric patients," which is the argument psychology is using in their scope-of-practice increase quest.

    P.S. I remind you that it could be argued that it was physicians that contributed to the early roots of psychotherapy.
  24. Janusdog

    Janusdog Member

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    Holy mother of Hades, people!

    I've stayed out of this because I find the whole thing incredibly depressing. Do you all even know how much you are all, and I mean all, throwing around insults?

    RxPnow, you really need to step down. You are coming across as exceedingly arrogant, and you started this flamewar. You do not speak for me as a psychologist when you accuse psychiatrists of not being holistic and undereducated. Get a few years under your belt and you'll see that things are not that black and white; not by a long shot.

    And BTW, please keep your politics out of it. I don't want to see how you voted.

    edieb, no excuse for the 'bottomfeeding' comment, and I'm a bit concerned about your cultural attitudes.

    Anasazi, please do not talk about me like what I do takes no intelligence at all. I like to think I at least have a few brain cells left from all the partying and drinking I did during my excuse for a graduate education.

    Am I the mother here? :laugh: :rolleyes:
  25. aphistis

    aphistis Moderator Emeritus

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    First dose of intelligence in this entire thread. :thumbup:
  26. LM02

    LM02 Senior Member

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    I have to say that this is really disheartening. Does anyone find it ironic that the original post was about what we can do to work together?

    I am a current clinical psychology intern, and I work with psychiatry residents daily. I have to say that we have mutual respect, and a great exchange of information. I have learned a lot about the biological aspects of disorder presentation and psychiatric treatment, but I've also found that I do fill a unique role.

    Upon starting internship, I have had 5 years under my belt of psychotherapy training and practice in CBT, IPT, DBT, and behavioral marital therapy modalities. Moreover, I am intimately familiar with the underlying treatment rationales as well as the treatment/outcome literature supporting their use. Moreover, I have administered several hundred SCIDs and Hamiltons, and have been trained in the administration and interpretation of several psych tests such as the MMPI-2, WAIS, WISC, etc. Residents at the same program here do not even start their CBT training until their 3rd year of residency. And that is just fine - up until now their training has focused other aspects of psychiatry training that are critical to their professional development.

    I'm not just here to toot my own horn - but hope this illustrates where we can work together. I can't read patient labs, and I don't have a clue about the therapeutic level of most psychotropic meds. In fact, I appreciate getting the summary from the MD, and feel that I have a lot to learn from the residents. But I've found that I've had a lot to offer with regards to diagnostic and psychotherapeutic conceptualization, and I can certainly speak to the research literature. After all that is what clinical psychologists are trained to do - to be clinical scientists. Research is built into our approach.

    This is not to say that psychiatrists do not get therapy training - I'm just saying that our focus and training is different, and we can work synergistically if we can just get over these guild issues. I know that I've had a wonderful experience as a clinical psychologist working in a hospital setting, and hope that these kinds of exchanges do not turn people off from pursuing psychology or psychiatry.

    I've said my peace. :D
  27. lazure

    lazure Senior Member

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    Janusdog and LM02

    I'm so happy you are here :)

    LM02,
    tell me more about your internship experience .... I will be embarking on this trail either this September or the following September :)
  28. Janusdog

    Janusdog Member

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    Nice to be wanted!
    :D
  29. PsyDRxPnow

    PsyDRxPnow Clinical Psychology

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    Greetings all
    Sorry, it may have gotten a bit out of hand in this forum but I felt that I was only responding to the threats and the insults that I have received from the other members (e.g. psychiatrists in training).

    Perhaps I will see things differently post licensing but for now, I could only educate myself from graduate school, other psychologists? personal experiences, and literature. I do however have strong opinions on RxP and occasionally, I like to have a stimulating and challenging conversation.

    My apologies once again.

    Thank you mother :)
  30. euromd

    euromd Guest

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    This is the most enlightening thing that I have read on this thread. Keep up the good work :)
  31. 50960

    50960 Guest

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    I spend 3 wonderful days on the mendocino coast, and come back to see another ruthless argument about RxP??? Once again, what can we do to work together?

    :)
  32. Janusdog

    Janusdog Member

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    Well, maybe it's cuz you left. Quit leaving, and maybe we'll quit arguing. :D
  33. 50960

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    OK, I shall answer my own question from my experience. I see alot of psychologists out there, primarily in medical settings with what I call "PhD syndrome". This syndrome's primary s/s are the loss of 20 IQ points, extreme deferential-ness (a word?), profound shyness, and mild to moderate conformism...all of these emerge quit quickly in the presence of a physician.
    This type of behavior tells the physician you expect to be treated like a nurse, and they are usually more than happy to have a paternal-like attitude towards nurses (and other allied health providers).
    I have found that if I am assertive, knowledgeable, and independent in my behavior with a physician I will be treated as a peer....usually. Of course it takes more than assertivenes to be effective so that is why being properly trained to work in a medical arena is so important. If I see a pt with a VPA level of 50 who is bipolar, I can say to the MD "50 is too low it needs to be at least 80, as long at plt etc are OK", or I can say "Are you getting good control of mania with a level of 50??". Both are assertive and knowledgeable, but the second version always gets me a better response and interaction from the MD; we often go on to discuss throbocytopenia issues, mania control etc...
    I say we need to be trained well to work along side MDs, and we need to be able to speak their language. We also need to be confident in our ability in the presence of the MD; this is vital.

    :D
  34. PublicHealth

    PublicHealth Removed

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    And how might this be done?

    Current predoctoral training programs in clinical psychology emphasize psychological assessment and psychotherapy. There is no basic medical training whatsoever. Neuropsychology courses do not even come close. Graduates of these programs are well-versed in psychological test administration, psychotherapy, and research. They do not, even in the least, "speak the language" of MDs. Most predoctoral training programs in clinical psychology are divorced from medical settings. Those that are affiliated with medical centers rarely allow students to work with MDs.

    In academic medical centers, interactions among MD psychiatrists and PhD psychologists are much more common in research than in clinical departments. Clinically, it is becoming increasingly rare to see psychiatrists and psychologists working side-by-side. Social workers are replacing psychologists in these positions. Most medical centers only employ a handful of psychologists for clinical purposes.

    Unfortunately, post-doctoral crash courses in psychopharmacology cannot even begin to cover what one needs to know to practice medicine and psychiatry. Clinical psychology needs to reconceptualize itself, define its role in healthcare, and restructure their predoctoral training programs accordingly. With the exception of a few programs (e.g., University of Florida: http://www.phhp.ufl.edu/chp/prospectivestudents/doctoral_program/index.html), clinical psychology training programs simply have not kept up with the times. It's really difficult to salvage one's career at the postdoctoral level.
  35. 50960

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    I agree with your points. I work in 3 locations, and all of them are directly with MDs; FT state hospital inpatient in which I share attending role with an MD (non-psych), second in primary care medical offices, and third I am on staff at a local hospital. Perhaps most psychologists do not work directly with MDs in most setting, but this is changing quickly. I agree with you that training of psychologists is not changing quickly enough to keep up with the clinical reality.

    :)
  36. PublicHealth

    PublicHealth Removed

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    Any ideas on how to improve upon the current training model?
  37. 50960

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    I think a new MPD (medical psychology doctorate ) would be a good start. The Psy.D. was an entry point for this idea, but we still have 70 year old PhD types teaching and creating policy for 20 year old students. Nothing against PhD types but we need to medicalize psychology in a bad way to keep it viable, and believe it or not this :cool: RxP is doing. Some programs are good, some are great, and some are OK, but this is a new venture. We would love help from psychiatry...
  38. sasevan

    sasevan Senior Member

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    Hi Psisci,

    I agree with you about the need to medicalize psychology. IMHO, it is a necessity in order to effectively and ethically assess and treat the biological dimension of many mental illnesses. Psychiatry has re-medicalize and now is our turn to medicalize. RxP is a critical component to that medicalization; without it, I suspect, psychologists will become little more than doctoral-level educated counselors.

    There will be some exceptions, such as those who sub-specialize in neuropsych or forensic psych evaluations, but for most psychologists conducting clinical psych interventions, the future, I fear, is not promising neither at the level of professional status nor of remuneration.
    Alas, the opposition to the medicalization of psychology is widespread, coming from psychiatry AND psychology-and I'm not just talking about the entrenched research establishment. Even the APA, despite its advocacy for RxP, has refused to revise doctoral training in such a way as to reflect a genuine commitment to psychology's evolution into a primarily healthcare discipline.

    Consequently, med minded psychs have to sort of fend for themselves by pursuing post-doc psychopharm training and/or continuing ed or by opting for nursing or med school. The net result of all of this, I suspect, is that the med of psych is necessary and inevitable but that it will be very slow and come after a monumental struggle with psychiatry and with much of psychology.

    Like you, I also wish psychiatry would assist and not hinder the medicalization of psychology but, IMHO, this is improbable. I do dream, though, of some collaboration between the two APAs and the AMA that would result in both a far longer training program for PhD/PsyD seeking RxP than current psychopharm programs but also a far shorter one than the current option of going to medical school/psychiatry residency.

    Maybe something along the line of a 10 year program that would lead to a combined PhD/PsyD-MD/DO degree. :love:

    Just a dream...or is it a plan?...LOL

    Peace. :)
  39. Anasazi23

    Anasazi23 Your Digital Ruler Moderator Emeritus

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    But to what end? What is it exactly that a med-psychologist would want to do? Treat medical illness? Just "know" about medical diseases so they can better empathize with patients? I don't quite understand what the ultimate goal is here for these so-called medical psychologists. Are you hoping RxP will allow you to treat someone's thyroid dysfunction, prescribe an SSRI, while giving therapy and doing testing? Then you're damn right, the AMA and American Psychiatric Association will fight this to the death because it's simply inappropriate.

    Another poster above was giving examples of how he judiciously points out to the attending psychiatrist that a VPA level might be low for his manic patient. This is exactly what makes psychologists' pharmacological and medical knowldege appear too elementary and offers resistance from psychiatrists. There are so many other factors, besides platelets, etc, that go into these decisions to dose VPA or most other psych meds. A residency in psychiatry teaches you to "not treat the level" and depening on other meds they might be on and what enzyme metabolic systems are active, a subtherapeutic level of VPA may be appropriate if the patient is controlled (the patient was described as being manic). Frankly, most at-work attending psychiatrists may not feel they have the time to round with psychologists and essentially teach a very simplified psychiatry residency curriculum, while inappropriately giving compartmentalized factoids and tidbits that, out of context to medical training, can actually be harmful.

    If psychologists want to work with psychiatrists, presumably to be more knowledgable about disease processes, websites like webmd.com or emedicine give basic overviews. As for psychiatry helping the RxP process...remember that psychologists rejected a modified bill in New Mexico created by psychiatrists in a last ditch effort to have some influence over the process. The bill asked the legislators to not allow psychologists to prescribe to children since even psychiatrists must undergo a 2-year fellowship to do the same. The psychologists rejected it, demanding complete autonomy.

    That will probably be the last time psychiatry attempts to positively influence these types of bills with psychology.
  40. Janusdog

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    "Medical" psychology exists already. I consider myself to be a 'medical psychologist.' I'm a health psychologist, and others I know are into rehab psychology. I got my health psychology training as a graduate student, and did a postdoctoral fellowship in pediatric psychology. Peds is different from 'child and adolescent mental health'. I work alongside physicians and they respect me. I do not cower or feel myself lesser, and I can tell you that anyone who might think that of me going in rapidly changes their mind. When I do an intake and realize that someone has been a heavy drinker plus has the beginning signs of dementia, I can tell the referring physician that "I am concerned about the possibility of Korsakoff's, please evaluate." That is where that evaluation belongs, with the referring physican, and me giving some directional ideas.

    After radiation or brain surgery, I tell families, teachers, physicians what the consequences were cognitively for this child.

    I know headaches, I know imaging, I know several drug reactions, I know cleft palate, I know pain control, I know dementia, I know delirium. I know diabetes. I know all kinds of other stuff too. That's good enough and medical enough for me. I don't have to prescribe to feel important, I do what physicians can't and don't want to do, and that makes me a valuable team member.

    It bothers me when people start saying that graduate programs aren't doing enough. Vote with money! Why spend money on an archaic model? Do you expect to sit back and have this stuff poured in your head? Do you feel entitled? Take responsibility for your own education -- go to a health psychology program, do a health psychology postdoc, get your ABPP in health psychology. A medical psychologist is an integral member of the team who doesn't tell anyone else their business, and doesn't need to be told theirs.

    Anasazi, we do more than empathize with patients or 'slap down' an MMPI. I appreciate your frustration and share some of it. Some day you will likely need to have someone help manage a patient with chronic, functional back pain, and perhaps a somatization disorder with an Axis II diagnosis. You will most likely not have time for it, and probably not the inclination to deal with it. Say you hospitalize that person and this individual starts causing a ruckus on the unit and staff gets seriously pissed off and skirts the edge of neglecting this person. That's where I can help you and your staff. I design a behavior plan to minimize reinforcements for acting out. Staff gets happy, patient gets less happy, maybe, but gets therapeutic benefits.

    If someone isn't getting respect then one needs to take a look at oneself. Appropriating someone else's job is a poor way for psychology to compensate for feelings of general irrelevance and angst.

    Rowf. :rolleyes:
  41. 50960

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    Well put janusdog!! I agree.

    :)
  42. edieb

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    Hi, I just wanted to let you know that the term "medical psychologist" already exists: In LA, the prescribing psychologists are termed "medical psychologists," instead of "clinical psychologists." This is written up at www.louisianapsychologist.org


    Because the LPA does not have to get the RxP rules approved by the Louisiana Psychiatric Assoc., we are within 2 months of prescribing. The New Mexico Psychiatric Assoc. is going to try to have the law over there overturned this fall on the grounds that the medical and psychological board cannot come to an agreement. It doesn't sound like the psychiatrists are very coopereative....
  43. sasevan

    sasevan Senior Member

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    I don't propose that PsyD-DO do assessing/treating of any disease/disorder other than psychiatric ones but I dream of this alternative as a third way between psychology's proposed post-doc psychopharm programs option and psychiatry's proposed med school/psych residency option.
    I envision something along the line of:

    2 yrs med school
    2 yr med clerkship
    1 yr psych theory/assessment (intellectual, objective, projective, neuropsych, forensic, full battery)
    1 yr psych practicum/treatment (individual, group, couple, family, psychodynamic, CBT, interpersonal, DBT)
    4 yrs residency (3 yrs pharmacotherapy/1 yr psychotherapy).
    ------------
    10 yrs total leading to a psychologist-physician degree :love:

  44. Here, here. I am a PsyD who has decided after a few years in practice to return to school and earn an MD. I should say that I have never supported prescription privileges for psychologists. My feelings are well summarized by Janusdog. (My wife is a psychologist whose job sounds very much like yours, Janusdog. She also agrees.)

    I have seen a great deal of mutual respect between physicians and psychologists in my former career. I have also seen a stark lack of it. But the answer isn't some form of professional imperialism. Is psychiatry lacking in many ways? Sure. Has psychology been squeezed out of affordability by the lesser trained LCSW and MA's? Sure. Perhaps what the profession of psychology should do is spend more time educating the healthcare system on the immense contribution to health, wellness and outcomes the research says it makes.

    I must politely disagree with sasevan's dream. It sounds essentially like an MD/PhD in psychiatry: 4 years medical school (2years academic, 2years on the wards), 4 year residency and two additional years in specialized training in psychotherapy and psychometrics. You may be shocked to know such programs exist, or can be arranged due to flexibility in construction of the PhD.
  45. sasevan

    sasevan Senior Member

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    Hi Pterion,

    Same here. I'm a PsyD in pre-med intending to become an MD or DO.
    Where are you in the process? Will you be pursuing psychiatry or another specialty?
  46. Anasazi23

    Anasazi23 Your Digital Ruler Moderator Emeritus

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    I agree with most of the above points. And I can tell you from experience that I've been called at 3am for many consults describing the above troublesome patient, and in no way would turn down a psychologist's help in dealing with said patient. For these and many other reasons, I find psychologists, despite the lack of them in the hospital, to be valuable members of the treatment team.

    My question, however, remains. Louisiana(?) now enables 'medical psychologists' to do these and prescribe. To what end does this training entail? Medical treatments? It is naive to think that prescribing psychologists will not become too big for their britches and start prescribing inappropriate medications out of their training scope.
  47. Anasazi23

    Anasazi23 Your Digital Ruler Moderator Emeritus

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    Hi Sasavan,
    Interesting but impractical in the end. What this leaves out is the training that makes a psychiatrist just that - a physician with specialization in the specialty of psychiatry...the med school practicums, while invaluable, aren't enough. Experience as the responsible physician over medicine and surgical patients, ICU, CCU, ER, and neurology patients is essential for full understanding of the myriad masquerading syndromes you'll encounter as a psychiatrist. The model you propose gives no neurological or internal medicine training at the doctoral level which is standard in all psychiary residencies.

    The MD/DO/Ph.D. is another possibility, but a Ph.D. in psychology would be strongly frowned upon, as this is almost universally assumed to be in a hard scientific discipline . You could conceivably do 8 years total (4 med school + 4 residency), and get a year of continuing ed in assessment totaling 9 years. Otherwise, you could (and some do) simply get assesment training as a psychitary attending at conferences in their free time, therefore totaling the same 8 years, excluding fellowship. Depending on the residency program, you get therapy training in multiple modalities througout the 4 years of residency...some more than others.
  48. Janusdog

    Janusdog Member

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    That's an argument that applies to anyone. I personally have a problem with primary care docs prescribing SSRIs and Depakote on a regular basis. I work with one that was considering managing someone on Risperdal. I consider that out of the scope of practice for a family practice doc.
  49. I am in the throes of the first semester of first year. My wife and I planned for almost four years before I applied. As for the specialty: all I can commit to at this point is that I will definitely NOT be going into psychiatry.

    I knew where I wanted to go, so I only applied to state schools. The PsyD was well received by both. Keep me updated on your progress, I am sure you will do well.
  50. Janusdog

    Janusdog Member

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    Why not? Just curious.

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