Opinion On Illinois Becoming 3rd State

[postbacpremed87]

Illinois becomes third state to allow psychologists to prescribe medication (limited rights). What is your opinion? Do you think this will spread to other states?

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[MacDonaldTriad]

If these are states with high malpractice claim ceilings, I would think just a few avoidable bad outcomes from psychology prescribing would drive up the malpractice coverage rather severely. If not, and psychologists are doing meds as safely as we do meds, maybe we should let them do it.
The way I see it, psychologists are better at therapy and not as good with meds. We are better at meds and not so good (with exceptions of course) at therapy, or at least less trained. Patients put their faith more in one or the other camp. If they believe in medication as their solution and they are not getting better under a psychologist, they will come to us if they can.

 

[Frazier]

Illinois becomes third state to allow psychologists to prescribe medication (limited rights). What is your opinion? Do you think this will spread to other states?

Here's a recent excerpt of what I though about it in the "competitiveness" thread... figure it is relevant here to:

In regards to this recent Illinois bill, it looks like there are pretty tight reins on patient population (no one aged under 18, no one aged 65+, no one with a "serious mental condition") and also constraints on the meds which can be utilitzed. As always, things can quickly change from this point.

Encroachment is starting to take place at the specialty-level for many different areas of medicine (Psych, Gas, FM, Ophtho, EM, IM, Derm). Other specialties are more insulated against encroachment from midlevels (surgical specialties, RadOnc, Rads, Neuro, Path) -- but have their own problems ranging from hellish lifestyle, to poor job market, to high risk of low satisfaction.

The current solution for many of the specialties in the earlier group would be to pick a subspecialty and further differentiate yourself from the midlevels trying to claim equal SOP. For example, Ophtho can do VR surgery, IM can do Heme/Onc, Psych can do CA, etc. The solution for the specialties in the latter grouping is less clear cut.

A compromise was reached this spring, and the resulting measure requires psychologists to undergo extensive training and work under the supervision of a physician. They’ll only be permitted to prescribe a limited class of drugs and will be prohibited from writing prescriptions for minors, seniors or any patient with a serious mental condition.

“We have to make sure people across Illinois can be properly cared for by a medical professional they know and trust,” Quinn said in a statement. “If someone needs help and lives on a budget, they shouldn’t have to make multiple appointments or travel far and wide to get a prescription.”

Illinois joins New Mexico and Louisiana in granting the right to prescribe to psychologists.

Under the new law, psychologists could earn prescription rights after they have completed 2-1/2 years of additional, postdoctoral training, with course work requirements including graduate-level instruction in numerous areas such as neuroscience and psychopharmacology. In addition, training would require that psychologists treat a minimum of 100 patients under the supervision of a qualified medical practitioner, according to the legislation. Psychologists would be able to prescribe antidepressants, such as Prozac, but not stimulants, such as Ritalin, commonly used for attention deficit disorder. http://www.chicagotribune.com/news/...ist-prescription-bill-20140624,0,953771.story

In regards to your questions:

On whether it is a "good" or "bad" thing, it all depends on from whose perspective we are looking:

For psychologists = it is great to have an increase in SOP at their disposal if they choose to pursue it.

For patients = it will be a mixed bag. Some might indeed benefit from new accessibility to providers that can provide them with treatment that wasn't available in their community before. However there will also be some prescribing problems -- over prescribing, under prescribing, odd polypharm, or just wrong med choice.

How do I know? Because there are plenty of psychiatrists that make those same errors...and their physicians. In other words, pharm has been one of their main tools for a long time now and plenty of psychiatrists don't bat .1000 when it comes to making the correct choice.

I think it is very naive to think that psychologists will suddenly come out of this new training experiment magically more effective than those that went through 4+ years of residency training with prescribing and years under their belt with prescribing out in the real world.

For psychiatrists = it will be a mixed bag. Some docs might lose business if they were once considered the only option in town and now suddenly the more well-liked, popular psychologist becomes an option to get the meds filled. Other docs will benefit by employing a prescribing psychologist in their practice. As an employer, you have someone that is presumably well-versed in therapy and can also do basic meds...at a greatly discounted price...sounds like a good deal for the employing psychiatric practice. If you are a psychiatrist looking for an employed position youself, it might be a neutral development at best -- this will not help your cause.

 

[MacDonaldTriad]

Where are all of those psychiatrists with the strong need to believe that this is the end of the world as we know it? If we let this happen, the next thing you know, Rush Limbaugh will lobby for Illegal alien amnesty and Al Gore will renounce global warming. Sometimes I think $599.00 of my $600.00 APA dues go to this issue.

 

[PikminOC]

Here's a recent excerpt of what I though about it in the "competitiveness" thread... figure it is relevant here to:

As an employer, you have someone that is presumably well-versed in therapy and can also do basic meds...at a greatly discounted price...sounds like a good deal for the employing psychiatric practice. If you are a psychiatrist looking for an employed position youself, it might be a neutral development at best -- this will not help your cause.

Who's to say it will be a greatly discounted price?

 

[PikminOC]

If these are states with high malpractice claim ceilings, I would think just a few avoidable bad outcomes from psychology prescribing would drive up the malpractice coverage rather severely. If not, and psychologists are doing meds as safely as we do meds, maybe we should let them do it.
The way I see it, psychologists are better at therapy and not as good with meds. We are better at meds and not so good (with exceptions of course) at therapy, or at least less trained. Patients put their faith more in one or the other camp. If they believe in medication as their solution and they are not getting better under a psychologist, they will come to us if they can.

Illinois has very high malpractice rates. However, the psychologists will be shielded by the collaborative agreement. The real doc will be in trouble if there's a problem just like PA/NP care.

 

[Frazier]

Who's to say it will be a greatly discounted price?

As an employer, you come up with the initial salary offer...given enough time and with a large enough net you can almost always find an employee eager enough to fill a position.

Heck, take the popular, cynical psychiatrist on this forum. Didn't he say he had (chose?) to accept a job offer that only paid 100k. I'd say that is greatly discounted already.

If I am an enterprising psychiatrist looking to build up my practice, when it comes to hiring staff (that can prescribe) I can either go with a psychiatrist, a nurse practitioner, or a prescribing psychologist.

If you are looking to get people to respond to a job listing for 100k, I'd bet that the latter two would be more likely to reply to the listing than the psychiatrist that can go easily elsewhere for 150k+.

Assuming that the prescribing psychologist is well-trained, I would prob rather have one of those than a nurse practicioner employed at my practice (when it comes to personal philosophy).

 

[vistaril]

As an employer, you come up with the initial salary offer...given enough time and with a large enough net you can almost always find an employee eager enough to fill a position.

Heck, take the popular, cynical psychiatrist on this forum. Didn't he say he had (chose?) to accept a job offer that only paid 100k. I'd say that is greatly discounted already.

I did but that unfortunately didn't work out. It turns out that the owner of the practice wasn't going to let me practice 'my way' exclusively....which I get it's his practice and money and all.

 

[Frazier]

I did but that unfortunately didn't work out. It turns out that the owner of the practice wasn't going to let me practice 'my way' exclusively....which I get it's his practice and money and all.

I'm sorry to hear they switched stuff around on you like that. Are you back to looking or have you already found an alternative?

 

[vistaril]

I'm sorry to hear they switched stuff around on you like that. Are you back to looking or have you already found an alternative?

Oh no I found an alternative. It will give me enough time to hopefully pursue what I really want to do(real estate).

 

[erg923]

Oh no I found an alternative. It will give me enough time to hopefully pursue what I really want to do(real estate).

Are you going to try to mindf**k people into buying/renting your properties? Or just take them to a gentleman's club?

 

[Frazier]

Oh no I found an alternative. It will give me enough time to hopefully pursue what I really want to do(real estate).

Well that's awesome if you are getting to pursue a dream (or something at least closer to a dream).

Are you thinking single family homes? Multi-unit facilities? Business properties?

 

[vistaril]

Well that's awesome if you are getting to pursue a dream (or something at least closer to a dream).

Are you thinking single family homes? Multi-unit facilities? Business properties?

Well I've already dabbled in single-family homes a little...so I'm just going to expand what I've done there. But eventually yeah....I want to grow out and do all of that.

 

[vistaril]

Are you going to try to mindf**k people into buying/renting your properties? Or just take them to a gentleman's club?

as to the first question sure....and the second sure too

 

[Frazier]

Well I've already dabbled in single-family homes a little...so I'm just going to expand what I've done there. But eventually yeah....I want to grow out and do all of that.

Excellent.

 

[PikminOC]

As an employer, you come up with the initial salary offer...given enough time and with a large enough net you can almost always find an employee eager enough to fill a position.

Heck, take the popular, cynical psychiatrist on this forum. Didn't he say he had (chose?) to accept a job offer that only paid 100k. I'd say that is greatly discounted already.

If I am an enterprising psychiatrist looking to build up my practice, when it comes to hiring staff (that can prescribe) I can either go with a psychiatrist, a nurse practitioner, or a prescribing psychologist.

If you are looking to get people to respond to a job listing for 100k, I'd bet that the latter two would be more likely to reply to the listing than the psychiatrist that can go easily elsewhere for 150k+.

Assuming that the prescribing psychologist is well-trained, I would prob rather have one of those than a nurse practicioner employed at my practice (when it comes to personal philosophy).

It will take time to figure out who is good when it comes to midlevels. I prefer to get a good night's sleep and do not hire any. Illinois malpractice climate is such that I only take responsibility for myself.

 

[PikminOC]

Mom: Drug caused movement disorder in autistic teenager
Amount:
$1,532,000
Type:
Verdict-Plaintiff
State:
Illinois
Venue:
Cook County
Court:
Cook County Circuit Court
Injury Type(s):
other-tongue; other-dyskinesia; mental/psychological-behavioral disorder
Case Type:
Medical Malpractice - Failure to Monitor, Negligent Treatment, Prescription and Medication
Case Name:
Lorrie Angel, mother and next friend to Michael Angel, a minor v. Michael Segal, M.D., Howard Klapman, M.D., and Howard Klapman, M.D., Ltd., No. 09-L-003496
Date:
February 11, 2014
Parties
Plaintiff(s):
Lorrie Angel (Female),
Michael Angel (Male, 14 Years)
Plaintiff Attorney(s):
Francis P. Morrissey; Burke Wise Morrissey & Kaveny, LLC; Chicago, IL, for Michael Angel ■ Brian T. Monico; Burke Wise Morrissey & Kaveny, LLC; Chicago, IL, for Michael Angel
Plaintiff Expert(s):
Emma Cabusao; M.D.; Psychiatry; Wheaton, IL called by Francis P. Morrissey, Brian T. Monico http://verdictsearch.com/verdict/mom-drug-cause...

 

[vistaril]

It will take time to figure out who is good when it comes to midlevels. I prefer to get a good night's sleep and do not hire any. Illinois malpractice climate is such that I only take responsibility for myself.

well for starters, psychologists are most certainly not mid-levels. Their training is a bit different and they have expertise in areas we typically don't(just as we have expertise in areas they typically don't)

Also, it takes time to figure out who is good when it comes to psychiatrists as well.

 

[Baller MD]

Can't wait for one of the old timers to say "there are plenty of psychiatry patients around" when hearing this news, while they already have one foot out the door. You guys know who you are.

Damn, medicine is going down the ****ters quicker than I have imagined...

 

[vistaril]

Can't wait for one of the old timers to say "there are plenty of psychiatry patients around" when hearing this news,.

there are....the problem is that a ton of psych nps doing the same thing drives down the prices hospital systems, community mental health centers, etc have to pay us to treat them.

 

[Baller MD]

there are....the problem is that a ton of psych nps doing the same thing drives down the prices hospital systems, community mental health centers, etc have to pay us to treat them.

Exactly. Psych services are becoming a commodity and may very well be the next primary care/anesthesiology in terms of midlevel encroachment.

 

[nitemagi]

Essentially the trick to raising awareness of bad outcomes is to have a pathway of low resistance for filing of grievances. Few patients will go through the hurdles of filing a lawsuit unless the outcome is catastrophic (death), especially in those without means. Many would never think to file with the state board, either. If no one is researching outcomes then essentially bad outcomes will go under the radar much of the time, unless the press is involved or a secondary level of surveillance is employed. Lack of monitoring will then continue the myth of "safe," as you won't find many of the bad outcomes if you don't look for it.

Anyone want to take up the mantle and create an online monitoring database where ppl can file complaints?

I've gone back and forth on the RxP thread over on the psychology forum on this for a long time. I don't think RxP solves any of the issues it purports to. It creates new problems. No one else is really solving the major mental health crisis, either. The problems are multi-level, endemic, and system-wide. RxP fixes none of them, because frankly the solution isn't more medication being prescribed by undertrained non-medical providers. In fact I don't think the problem is needing more meds in general. It's about better training practitioners at all levels, use meds wisely and in less ppl, better therapy training overall, skills training in youth, etc.

 

[MacDonaldTriad]

Can't wait for one of the old timers to say "there are plenty of psychiatry patients around" when hearing this news, while they already have one foot out the door. You guys know who you are.

Damn, medicine is going down the ****ters quicker than I have imagined...

Yes we do, and 30 years ago I was saying things just like you. Didn't happen though....

 

[Baller MD]

Yes we do, and 30 years ago I was saying things just like you. Didn't happen though....

Ummm, let's compare the scope of practice of nurses 30 years ago to those of NPs and DNPs today. Yeah, that's what I thought.

http://www.nytimes.com/2014/04/30/opinion/nurses-are-not-doctors.html?_r=0

I bet back in the day they can prescribe without physician supervision huh. It's so damn easy for you to say **** like that now that you've already collected millions, not giving a crap about the future generation of physicians.

 

[vistaril]

Exactly. Psych services are becoming a commodity and may very well be the next primary care/anesthesiology in terms of midlevel encroachment.

well if I made anesthesia dollars(even now) I'd be more than happy.

 

[Baller MD]

well if I made anesthesia dollars(even now) I'd be more than happy.

You won't. But you'll be making relatively less than what your predecessors are. Anesthesiologist's salaries have been going down. If psych really becomes the next primary care, you only have your kind of mentality to blame i.e. freely bending over backwards without any resistance.

 

[OldPsychDoc]

Can't wait for one of the old timers to say "there are plenty of psychiatry patients around" when hearing this news, while they already have one foot out the door. You guys know who you are.

Damn, medicine is going down the ****ters quicker than I have imagined...

Yup. Better get out while you can. Make sure the door doesn't hit you.
Thanks for sharing.

 

[Frazier]

Here's what the psychologists in Illinois think of this law:
From: Marlin Hoover <[email protected] /* */ >
Date: May 30, 2014 at 3:18:23 PM CDT
To: [email protected] /* */
Subject: [IPA-SERVE] My thoughts about our prescriptive authority bill.


While the bill is still being passed in Illinois, I want to add my perspective on what this bill may achieve. For those who do not know who I am, I’m a prescribing psychologist in New Mexico and past president of the Illinois Psychological Association and past chair of the RxP committee for Illinois. I did not negotiate this bill. I was “consulted” from time to time, and lobbied when asked and did a couple media interviews on behalf of the IPA and this legislation.
1. The bill is not all, nor nearly all that I hoped for. What I hoped for was not possible and what has been negotiated is the best that could be done at this time. It was not a choice between this compromised bill and “something better.” Rather, it creates the right to prescribe for some psychologists for some needy patients rather than no psychologists prescribing for any patients.
2. The bill will enable some (not all) psychologists with RxP training to prescribe from a limited formulary to subsets of the people of Illinois, many of whom are badly in need of services.
3. The bill establishes a precedent that it is possible that a very medicalized populous state can permit some RxP psychologists to prescribe safely. Other states can argue now that “it is permissible in Illinois and the history of safe prescribing in New Mexico, Louisiana, the military and the HIS as well as Illinois shows that the Illinois bill may be too stringent.
4. There is no record of additional states passing legislation within the last 10 years so this advances RxP. Compared to our fantasy about what “should be” it is inferior, but compared to the reality that NO state has passed RxP legislation in the last 10 years it is superior.
5. The current bar against prescribing for children and the elderly parallels the training in psychiatry where the “state of the art” is to get additional sub-specialty training in Child and Adolescent or Geropsychiatry beyond the generalist training. It simply doesn’t have the “tracks” for C & A or Gero (yet we hope).
6. The barring of the prescribing of benzodiazepines will keep RxP’s on the “best practice” course of utilizing psychotherapeutic (behavioral) techniques to treat anxiety disorders in conjunction with SSRI’s when appropriate and keep us from an easy and addictive reliance on BZ medications that is what medicine has fallen prey to. I spend a lot of time taking people off those BZ’s when they should have had non-Rx treatment in the first place. I refused BZ’s in every patient who asked me for them yesterday because they were not in the patient’s best long term interest.
7. Barring of stimulants appears related to a controversy regarding simulant use in children. This is unfortunate but child psychologists have been dealing with not being able to prescribe these for a long time, obtaining the needed Rx’s from pediatricians and child psychiatrists.
8. The bill bars RxP’s from prescribing for the most vulnerable patients. Inadvertently this will protect us as we continue the tradition of being “safe” prescribers which will provide evidence for the expansion of the scope of the practice. For instance: I would rather not prescribe for a pregnant woman; I never do it here without the consent of the OB/Gyne or FP and the woman and then only after truly informed consent. I would just as soon have the OB/Gyne or a psychiatrist take over at that point.
9. The bill PERMITS some RxP’s to treat some very important segments of the population who are otherwise free of “serious medical illnesses.” Think of one of the neediest groups, veterans of the last decade of military service who are in great need; university students; young adults and middle aged adults suffering the stresses and strains of life for whom depression and anxiety may be debilitating conditions as well as young “trying to launch” adults with serious mental illnesses who have not yet lived long enough to accumulate serious medical illnesses.
10. The bill PERMITS RxP’s to be principal investigators in RCT’s including psychopharmacological and psychological interventions. It is my opinion that only when RxP’s can “control” the research will the literature give a balanced view of the benefits and limits of Rx compared to psychological treatments. The literature, at this time, is so biased (in my view) in the direction of Rx treatments in general that it has led to an overreliance on Rx rather than psychological interventions. The bill permits psychologists to do research with the primary population of people who can be, by IRB usual standards, subjects (i.e. healthy, age of consent, adults without medical illnesses). This, if it happens, will be tremendous boost to the treatment of mental disorders.
11. The bill PERMITS psychologists to treat a segment of the population, thus freeing psychiatrists to focus on populations where their additional medical training may have the most value. It may bring closer collaboration between psychiatrists and psychologists to the benefit of both through the collaborative agreements and lead to sensible specialization based on training.
12. It is my opinion that without this bills passage, the movement for RxP was essentially “dead.” This bill establishes a precedent that will permit some RxP’s in any state that passes similar legislation to get started and then, based on experience, expand the scope of practice over time.
13. Harder work on the part of the Illinois Psychological Association would not have produced a better bill. This was a maximally energized, maximally funded, maximally ingenious campaign fought against the biggest obstacles in the nation (except maybe New York where it might be harder). This is simply the best that could be done.
14. If you, in your consideration of the bill, think the team “missed something” I suggest that it is maximally unlikely that the team, led by Beth Rom-Rymer did not also think of it, consider it, or try it. Try to avoid the tendency to “Monday morning quarterback” what was done. I am offering this unsolicited advice as a prescribing psychologist who would love to be able to gain prescriptive authority in Illinois in addition to New Mexico but who probably does not qualify under this bill. RxP’s with my training can practice in Louisiana, New Mexico, the military and the HIS. They ARE needed in those states and services. Or, they can get whatever additional training they need to prescribe in Illinois. Additionally, they may need to wait until there is an increase in the scope of practice and in the training regulations in Illinois.
Respectfully Submitted by Marlin Hoover.


On Fri, May 30, 2014 at 12:00 PM, Michael Tilus < [email protected] /* */ > wrote:
Thanks for the call Marlin. I've fielded 11 calls today, all from practitioners, who are essentially seeing the IL RxP bill as a 'total loss' to the national RxP objectives; indentured servanthood; and ultimately a 'political decision', for 'Beth', but a lhuge oss for practice and a massive step backwards.
Not sure if you are willing, but it may be useful to have your points thrown out in the Div 55 list serve as counter punches...
I'm personally chewing on your optimism.. as I personally feel extremely disillusioned with what I perceive was given up for what we got....
I'm not discussing my opinion openly with anyone... outside you... but with so much traffic, I think your voice might be received on the list.
My biased opinion of course...
M
--
They say it is "indentured servanthood". I take great offense to that comment.

I like how she describes it as a "maximally ingenious campaign".

Interesting description from a RxP. Something about that wording just reminds me of a cartoon character villan.

 

[Baller MD]

Yup. Better get out while you can. Make sure the door doesn't hit you.
Thanks for sharing.

I was never in it to begin with. I really was interested in psych but that may change seeing as how most seniors are gutless. It is a shame to see the field headed where it seems to be heading now with all its potential for doing good.

All I can say is that if I do end up going into psych, I'll fight for the profession and not be a pansy about it.

 

[Frazier]

Exactly. Psych services are becoming a commodity and may very well be the next primary care/anesthesiology in terms of midlevel encroachment.

Couple thoughts...

Medicine unfortunately is a commodity in general.

Physicians can be replaced in hospitals, albeit some specialties harder than others.

Hell, head over to the derm forum and check out the Derm PA thread...now that is some heavy propaganda.

RxP’s aren't technically midlevels...rather a different career track entirely (ie terminal academic degree) within the same sector (mental health) as psychiatrists (ie terminal professional degree).

 

[Baller MD]

Couple thoughts...

Medicine unfortunately is a commodity in general.

Physicians can be replaced in hospitals, albeit some specialties harder than others.

Hell, head over to the derm forum and check out the Derm PA thread...now that is some heavy propaganda.

RxP’s aren't technically midlevels...rather a different career track entirely (ie terminal academic degree) within the same sector (mental health) as psychiatrists (ie terminal professional degree).

I agree. But just because it's becoming a trend for most specialties (I don't see surgery having encroachment any time soon), doesn't mean you should freely allow it to happen and be so indifferent about it.

 

[Frazier]

I agree. But just because it's becoming a trend for most specialties (I don't see surgery having encroachment any time soon), doesn't mean you should freely allow it to happen and be so indifferent about it.

Yep, surg, radonc, rads, neuro, and path will be safe from encroachment for a long time, IMO. But, of course, they have their own problems too.

I guess the key, as I think you allude to -- is to avoid indifference...as in head in the sand.

Either you don't believe in increased SOP for nonphysicians, and you actively try to stop it... or you can accept that the way politics work in modern times (ie loudest voice with the most money wins) and use those aforementioned encroaching professionals to maximize your own benefit as a physician while continuing to provide your patients the best care possible.

As a physician you owe your patients something indeed; you owe other professions outside your own absolutely nothing, IMO.

Find a way to ethically profit from the political mess that is medicine and suddenly the insidious anger eating you from inside becomes a smile and satisfaction as you check your bank statement.

I'll strive to achieve the latter.

 

[smalltownpsych]

I agree. But just because it's becoming a trend for most specialties (I don't see surgery having encroachment any time soon), doesn't mean you should freely allow it to happen and be so indifferent about it.

Maybe they don't see it as such a bad thing and maybe there is room for psychiatrists and psychologists to work together coming from two different perspectives. Or maybe we fight each other while the mid-levels take over all of our business. Don't think for a minute that we aren't concerned about the proliferation of Master's level "therapists".

 

[MacDonaldTriad]

Ummm, let's compare the scope of practice of nurses 30 years ago to those of NPs and DNPs today. Yeah, that's what I thought.

http://www.nytimes.com/2014/04/30/opinion/nurses-are-not-doctors.html?_r=0

I bet back in the day they can prescribe without physician supervision huh. It's so damn easy for you to say **** like that now that you've already collected millions, not giving a crap about the future generation of physicians.

Not sharing your hysteria isn’t the same as not caring about future physicians. Sure there is more mid-level penetration now than when I finished medical school. My point is that the sky was supposedly falling in the 80s with the introduction of managed care. Everyone has been predicting the demise of medicine as a respected career and safe income choice for so long, it should have died a thousand times by now. In psychiatry specifically, we were complaining about MFCCs (now MFTs), LCSWs, psychologists, drug counselors as threatening our jobs. These alternative sources of mental health care are being sucked into being because we enjoy a vacuum. There was a demand, there is a demand, and there will be a demand.

I had a grandfather who was born in 1900. When I was a young child, he used to complain that he shouldn't have to pay into this new fangled social security because he didn’t believe he would ever see any of it since it was unstable and going to go away very soon. Of course he collected on it until he died just shy of 90. Now my brother is telling me the same thing.

 

[TexasPhysician]

I was never in it to begin with. I really was interested in psych but that may change seeing as how most seniors are gutless. It is a shame to see the field headed where it seems to be heading now with all its potential for doing good.

All I can say is that if I do end up going into psych, I'll fight for the profession and not be a pansy about it.

Let's please keep things civil here.

While I am not happy about this new law as well, I know of dozens of psychiatrists that fought hard against it passing. It failed multiple legislations before getting passed in this restrictive format. Physicians are lobbying against it still, and hopefully something will come of it.

 

[Atom bum]

Let's please keep things civil here.

While I am not happy about this new law as well, I know of dozens of psychiatrists that fought hard against it passing. It failed multiple legislations before getting passed in this restrictive format. Physicians are lobbying against it still, and hopefully something will come of it.

Yeah, something will come of it, the law well pass then increase in scope soon after till parity exists. Of course the same thing will start happening in every state as well. Eventually they will have same scope of practice all over. Precedence exists now.
What will it mean?I don't know.

 

[Frazier]

Yeah, something will come of it, the law well pass then increase in scope soon after till parity exists. Of course the same thing will start happening in every state as well. Eventually they will have same scope of practice all over. Precedence exists now.
What will it mean?I don't know.

I don't know all the intricacies... what precedent is set by this bill that wasn't set 10 years ago by New Mexico and Louisiana (other than being recent)?

 

[vistaril]

I was never in it to begin with. I really was interested in psych but that may change seeing as how most seniors are gutless. It is a shame to see the field headed where it seems to be heading now with all its potential for doing good.

All I can say is that if I do end up going into psych, I'll fight for the profession and not be a pansy about it.

dude, you come across as something of an alpha....this isn't the field for you. Leave psych(at least for the men in psych) to us betas......

 

[smalltownpsych]

I don't know all the intricacies... what precedent is set by this bill that wasn't set 10 years ago by New Mexico and Louisiana (other than being recent)?

I imagine he means the precedent of a more populous state. I read somewhere that New Jersey is close to passing this, as well.

 

[greenlion]

Medical training should be under one entity- ACGME- and standardized. In New Mexico the "medical training" of prescribing psychologists is 450 hours coursework (over the weekends, part-time) and an 80 hour practicum. If you think this sounds too insane look it up for yourself. And who formulated it? The American Psychological Association of course. Therein lies the problem: self-interest.

Honestly this is below "midlevel". A PMHNP (Psych NP for psychologists who don't know) is more qualified than this.

But I think the Illinois decision is ultimately a good thing. It recognizes the limitations of prescribing psychologists.

 

[F0nzie]

My point is that the sky was supposedly falling in the 80s with the introduction of managed care. Everyone has been predicting the demise of medicine as a respected career and safe income choice for so long, it should have died a thousand times by now. In psychiatry specifically, we were complaining about MFCCs (now MFTs), LCSWs, psychologists, drug counselors as threatening our jobs.

With all due respect...Didnt they? The therapy market is completely saturated... I have not had a single patient that wanted to come in strictly for therapy because they felt they needed an expert with an MD trained in Psychiatry.

I am all for greater access to care. However, in my opinion, this will just further erode Psychiatry's financial competitiveness as a medical specialty. We are already hanging out at the bottom justifying our lower incomes by tweaking numbers and talking about our sweet lifestyles. Don't get me wrong Psychiatry is a great specialty and we are currently in a sweet spot.

But as this movement of double encroachment continues to expand, I do not think we will necessarily be regarded as the experts in pharmacologic management as we currently see ourselves. In the same way a patient would not consider a psychiatrist for better therapy despite the fact we dominated psychotherapy prior to the 1970s and we continue to receive the training.

Regarding who gets the best training: Psychiatrists vs. Psychologists. I did not go to an Ivy league residency but we received top notch training from attending who graduated from Yale who's father was also a psychoanalyst. The psychologists at my program didn't get nearly the amount of therapy training that we did. The only difference I see is that these psychologists go out and do therapy and we don't so they are "better".

 

[vistaril]

With all due respect...Didnt they? The therapy market is completely saturated... I have not had a single patient that wanted to come in strictly for therapy because they felt they needed an expert with an MD trained in Psychiatry.

I am all for greater access to care. However, in my opinion, this will just further erode Psychiatry's financial competitiveness as a medical specialty. We are already hanging out at the bottom justifying our lower incomes by tweaking numbers ".

In all honesty, I don't think most of the posters in here tweak our numbers(maybe in a few cases).....I think most of the distortions come in when imagining what other specialties actually make.

 

[TexasPhysician]

Yeah, something will come of it, the law well pass then increase in scope soon after till parity exists. Of course the same thing will start happening in every state as well. Eventually they will have same scope of practice all over. Precedence exists now.
What will it mean?I don't know.

If true, no field is safe but maybe surgery. Parity would make them family docs, ob/gyns, IM, derm, etc. No way would psychologists stick with psych when they could make derm money.

 

[Armadillos]

I'm sure the entry of other professions into psychiatry isn't going to help salaries, but I would be fairly surprised if it hurt them to the point where the ratio of psychiatry's average salary compared to other medical specialties became worse than it is currently seeing as many other specialties are getting a lot more salary cynicism from the general public compared to psych, so would be much more surprising to see psych salaries take a big hit compared to others. (Although the others would still obviously make more than psych)

From a more philosophical standpoint I kind of like the idea of opening up various aspects of medicine to others because I think it puts more pressure on physicians as a whole to actually strive to be the best as opposed to just meeting some minimum standard of practice that allows us to continue to indefinitely reap the benefits of our monopoly.

 

[softballtennis]

My opinion is if a NP can prescribe without a doctor hovering around then a psychologist who has done 4 years of undergrad , 5 years to get there PHD and then continue on to do a course in pharmacology is more than ready to prescribe. I don't think it's a very good idea for NP's or psychologists to prescribe but times are changing. I would see a regular doctor anyday over a NP sorry I just don't trust someone with that little experience . I live in Illinois btw.

 

[TexasPhysician]

My opinion is if a NP can prescribe without a doctor hovering around then a psychologist who has done 4 years of undergrad , 5 years to get there PHD and then continue on to do a course in pharmacology is more than ready to prescribe. I don't think it's a very good idea for NP's or psychologists to prescribe but times are changing. I would see a regular doctor anyday over a NP sorry I just don't trust someone with that little experience . I live in Illinois btw.

"A" course in pharmacology? Wow.

 

[Baller MD]

I'm sure the entry of other professions into psychiatry isn't going to help salaries, but I would be fairly surprised if it hurt them to the point where the ratio of psychiatry's average salary compared to other medical specialties became worse than it is currently seeing as many other specialties are getting a lot more salary cynicism from the general public compared to psych, so would be much more surprising to see psych salaries take a big hit compared to others. (Although the others would still obviously make more than psych)

From a more philosophical standpoint I kind of like the idea of opening up various aspects of medicine to others because I think it puts more pressure on physicians as a whole to actually strive to be the best as opposed to just meeting some minimum standard of practice that allows us to continue to indefinitely reap the benefits of our monopoly.

Striving for your best doesn't mean anything in the eyes of policy makers and hospital administrators. If they can get away with having someone marginally care for a patient in order to save money, they will.

 

[MacDonaldTriad]

With all due respect...Didnt they? The therapy market is completely saturated... I have not had a single patient that wanted to come in strictly for therapy because they felt they needed an expert with an MD trained in Psychiatry.

.

Regarding who gets the best training: Psychiatrists vs. Psychologists. I did not go to an Ivy league residency but we received top notch training from attending who graduated from Yale who's father was also a psychoanalyst. The psychologists at my program didn't get nearly the amount of therapy training that we did. The only difference I see is that these psychologists go out and do therapy and we don't so they are "better".

I’m not so sure psychiatrists were pushed out of doing therapy or if we walked out. There are still MD’s with PhDs in psychoanalysis doing full time therapy for cash on the barrelhead. There are also psychologists doing this. The rest of the “therapists” are collecting pay rates from insurance that psychiatrists are not interested in. You might argue that if the other therapists didn’t exist, then insurance would have to pay more, but I doubt they would.
As far as quality of therapy training MD vs PhD, for psychiatrists, the minimum is a little better than a beefed up introduction. We can go on and further specialize in a particular brand, but trying to teach half a dozen approached in two maybe three years of part time effort just can’t be the same as PhD’s training in this. I’m not saying there aren’t any fine MD therapists, I’m just saying there are a lot of MDs who don’t do therapy and they aren’t good at it because they don’t do it.

 

[Armadillos]

Striving for your best doesn't mean anything in the eyes of policy makers and hospital administrators. If they can get away with having someone marginally care for a patient in order to save money, they will.

I meant as a profession, in general more competition drives better outcomes throughout society (even in highly regulated industries).

 

[smalltownpsych]

I just received an email saying that our tele-psychiatrists for children 12 and under is going to be up and running and to start referring kids there. Right now we have an PMHNP for 13 and up and soon to be tele-doc for the kids. This is the solution for the community. The medical doctors would rather have me do the job than the mid-levels because they recognize my expertise in diagnosing and treating mental illness. The primary care docs don't want to deal with psychiatric care. If we had enough psychiatrists, it wouldn't be a problem. From what I hear, the shortage is not just in rural areas like my own, so what is the solution, if not psychologists?

***edit*** FYI just wanted to add that I used to be more anti-RxP, but the needs of my patients and the community are pushing me in the other direction.