Psychologists prescribing medication

[235750]

Hi everyone,

I'm new to this section of SDN. I am starting medical school in a few months with an interest in psychiatry and I wanted to ask you future psychologists something

First, a little background. There are a number of states (Like Oregon and New Mexico) that now allow psychologists (PhDs and PsyDs) to persribe some types of medication to patients after a period of training. I'm sure most of you know about this. The requirements vary slightly. Oregon for example requires about an extra week (50 hours) of additional training. The area and types of medicine one can prescribe are restricted of course, but it appears that the rights to PhD/PsyD theraptists is expanding. At first the areas targeted were rural, but now one can prescribe meds in Albuquerque which is the largest city in NM I believe. The psychiatry forum is up in arms about this, as they feel (1) PhDs/PsyDs don't have the training necessary to prescribe meds safety,even after a week of training, and (2) because they don't want to lose one of their key abilities. Of course it's a matter of opinion which issue you think they are more concerned about

My question is: are you future psychologists planning on taking this extra class so you can prescribe meds when you graduate? Is this something you've been planning for? In other words, is one of the reasons you picked a doctorate level training in psychology (PhD/PsyD) because you were interested in the ability to perscribe medication?

May I add that I'm not trying to be abrasive in any way. I saw other threads on this topic and their were troll posts for the most part. I have family who are psychologists as well as psychiatrists and we all get along just fine.

Thanks for your input

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[cara susanna]

No. I love psychopharmacology, but frankly the idea terrifies me. I mean, just a personal feeling, I'm not against the idea of psychologists being able to prescribe.

 

[PsyDr]

OP,

that 50 hrs are semester hours, not clock hours. so 50 hrs= about 2 years.

 

[Psychology 76]

OP,

that 50 hrs are semester hours, not clock hours. so 50 hrs= about 2 years.

You beat me to it

Anyway, to answer your question I am NOT going for a doctorate in clinical psychology to prescribe medication. Personally, I want to take a neuropsych tract in my clinical route and ultimately become a clinical neuropsychologist. As far as psychologists prescribing, I don't think it would be a bad idea. With the two years of training I definitely think they would be capable of doing a good and safe job. Many psychologists already have a lot of knowledge in psychoactive drugs so the extra 2 years will be fine. However, I feel that a really good thing that can come out of psychologists have prescription rights is so hopefully psychologists can UNsubscribe medication. The population is over medicated as it is.

 

[psychwhy]

Frankly, I do not understand those commenting seem to fear the prospect of prescribing medication.

Drug companies set up displays at APA conventions because they know that psychologists, while not literally writing the prescription, are the ones "suggesting" to internists, pediatricians, gynecologists, etc., etc..

In all but the largest cities, there are vast spans of geography throughout the US where there are no psychiatrists or psychologists. If you were the only psychologist for 100 miles and there were no psychiatrists for 200 miles, is your patient really receiving appropriate standard of care? (The most effective treatment for depression combines medication and therapy.)

Finally, if you are a practicting clinical psychologist who doesn't know the difference between a tricyclic and an SSRI (which many of your patients will likely be taking), are YOU really providing quality care?

During my internship (in a forensic center), we were the ones who saw the inmates regularly and reported TO the consulting psychiatrist (who visited twice a month) about the efficacy of and any deleterious effects from psychotropics.

Like it or not, but you should already been fluent in the biological/psychopharmological treatment of mental illness.

Steve

 

[cara susanna]

It's more the non-brain-related side effects/interactions/etc that concern me.

 

[Pia Getty]

Just to clarify the gross misinterpretation of 50 hours:


http://www.oregonlive.com/politics/index.ssf/2009/05/oregon_house_passes_bill_allow.html

 

[terpskins10]

Hi everyone,



My question is: are you future psychologists planning on taking this extra class so you can prescribe meds when you graduate? Is this something you've been planning for? In other words, is one of the reasons you picked a doctorate level training in psychology (PhD/PsyD) because you were interested in the ability to perscribe medication?


Thanks for your input

If I reside in one of those states, I would consider taking the extra classes necessary, but I don't know for sure. However, if I were dead set on the idea of prescribing meds I would be applying to medical school instead. So I guess to answer the last part of your question: no.

 

[Therapist4Chnge]

I went in with a goal of consulting and running a small private practice. I am currently in an RxP program, though my goal then (and still now) is to inform my work in the primary care setting. If I end up in an area I can....it is another tool in the tool box, but I don't plan on doing much day to day clinical work.

 

[deleted75966]

I think prescribing for psychologists is an awful idea, personally.

 

[Psychmeout]

I think prescribing for psychologists is an awful idea, personally.

I agree with Jon Snow for two main reasons.....

(1) We need to have a solid foundation of what our profession is about. Personally, I am disappointed with how poorly psychology is understood among the public. Even within the profession, I have noticed that this confusion exists. If psychologist begin prescribing medication, the value of therapy, behavioral medicine, and assessment will decline significantly. Most practicing clinicians will opt to provide interventions that provide most bang for their buck and easy reimbursement, which of course would be prescribing medications.

(2) Although most 2-year training programs in psychopharmacology are probably decent right now, I can imagine the implementation of a host of expensive online training programs that offer very poor quality of education. Need I say how awful some of the professional schools in psychology have become.....

Just my two cents

 

[Therapist4Chnge]

Online teaching of any kind should be banned at the grad level, let alone for prescribing. It is just irresponsible.

 

[cara susanna]

I think prescribing for psychologists is an awful idea, personally.

Can I ask why? I'm not trying to jump on you, just curious to hear your reasons.

 

[235750]

Hi everyone,

I apologize for my misreading the bill. Of course you all are right, the MS degree required is a two year program, and the 50 hours was in reference to the required CME credits. I tried reading the actual bill, but apparently I did a poor job. That was a mighty big mistake on my part, so I again beg your pardon

I didn't mean for this to turn into a discussion if PsyDs/PhDs should be allowed to prescribe. I was only curious if people in my position (considering a career in psychiatry) were being lured into the PhD/pysd route as a compromise. And I would like to here from more applicants or current students on this issue

But since we're here, I think in the hopes of better relations between the psyds/Phds and MDs/DOs, I will try to answer this big question from the side of the psychiatrist:

I think prescribing for psychologists is an awful idea, personally.

Can I ask why?

First is a concern of competency in medicine and human biology. In order to be eligible for medical school one needs 50 semester hours of science classes including gen chem, organic chem, biochem, genetics, calc, etc. And of course physicians spend an additional 4 years studying general medicine and then another 4 years focused on psychiatry for a total of over 17,000 hours of clinical experience.

When I applied for PhD programs in psychology, there were no serious science requirements. So, the people starting the MS in psychopharmacology are not expected to have any general biology background. Looking at the course layout for one such MS degree, you can see that Human Anatomy, Physiology, and Pathophysiology are combined into one 3 hour course!

One of the guiding philosophies of physicians is that feel they need to understand the foundations of biology before they can move on and treat people. Some feel these programs are unsafe to patients and unfair to physicians who invested so much time and money for the privilege of prescribing medications.

This being said, like I mentioned earlier, I think the real threat that physicians feel is that the psychologists are going to pick the 'low fruit' as it were. Medicating the high risk populations, like the schizos and biopolar folks, will still be in the hands of the psychiatrists, but there is a fear that the easier cases will be 'taken' by you all. The psychologists trained to prescribe are limited in the types of meds they can give out so I personally think that the risk is minimal to pts.

And finally, some people see this as just another way for desperate drug companies to get more people hooked on meds.

On the other side, others (myself included) believe that PsyDs/PhDs with the additional post-doc training are akin to other mid-level providers and will not cause a breakdown in mental health system in the states they are allowed to practice. I haven't seen any studies that show one way or another that prescribing psychologists in NM or OR have been detrimental. Of course the burden of proof is on the psychologists who prescribe, but that being said there are PLENTY of articles to support the theory that the introduction of mid-level providers (PAs, NPs) can lead to a mroe efficient system. So again, I'm all for it, but hopefully after this post you can understand why some people are not as happy

 

[apumic]

Can I ask why? I'm not trying to jump on you, just curious to hear your reasons.

Probably because psychologists have basically NO training for it. (Two years is a joke -- heck, 3-4 would be too.) Consider the difference in medical training (and basic sciences underlying it):

Clinical Psychologist (requires minimal and often off-site/via phone supervision):

• Undergraduate: if a B.S., perhaps a neuropsych/physiopsych course and introductory biology; if a B.A., probably none..
• Graduate: psychological assessment coursework, 1 semester biological psychology, 1 semester psychopharmacology (only in some programs)
• Internship: NONE
• Postdoctoral: at FDU's program, which appears to exceed the basic req'ts, is a 5-semester course of study with 30 credits; many are primarily online

Physician's Assistant (requires direct MD/DO supervision in every case):

• Undergraduate: varies by program (pre-reqs), but generally includes General Bio I & II, General Chem I & II, Intro to Organic Chem, Anatomy & Physiology I & II, upperdivision Biology (2-4 semesters), Biochemistry, etc.
• Professional Experience (req'd for most programs): 2,000-8,000 hours of experience with patients, usually in a hospital or clinic setting
• Doctoral: 2 year med-school-like experience of combined didactic training and medical rotations with an emphasis on knowing the whole body so as to make appropriate diagnoses
• On-The-Job: ongoing training and supervision by a licensed physician for duration of career

Medical Doctor:

• Undergraduate: General Biology I & II, General Physics I & II, General Chem I & II, Organic Chem I & II as well as such strongly recommended courses as Biochemistry I & II, Cell Biology, Genetics, etc.; MCAT
• Pre-Med School Professional Experience: typically experience includes volunteer medical work (often abroad), etc.
• Med School: 4 years -- 2 didactic, 2 rotations
• Residency: 4-6 years (for Psychiatry)

I'd say there's a pretty significant difference in medical training between medical psychologists and PAs or MDs from the very beginning (i.e., undergraduate-level).

 

[appelsoranjes]

Probably because psychologists have basically NO training for it. (Two years is a joke -- heck, 3-4 would be too.) Consider the difference in medical training (and basic sciences underlying it):

Nurse Practioners can prescribe and practice, independently, in 12 states. They can do therapy, testing, and medication management. It takes 1 year post-BSN to become one.

That being said, I do think the training for psychologists to obtain prescription privledges needs to be much more substantial. It can/should be done in 2 years, but the intensity, requirements, and hours needs to be ratcheted up.

And yes, we will likely take the low-hanging fruit. Psychiatrists will always be in demand for polypharmacy and difficult cases.... given it takes 3-6 months for a client to get a psychiatrist in some states, having shrinks take the low hanging fruit isn't such a bad plan.

 

[deleted75966]

First is a concern of competency in medicine and human biology. In order to be eligible for medical school one needs 50 semester hours of science classes including gen chem, organic chem, biochem, genetics, calc, etc. And of course physicians spend an additional 4 years studying general medicine and then another 4 years focused on psychiatry for a total of over 17,000 hours of clinical experience.

This is partially my stance. As a psych undergrad, I actually had quite a bit of biology/science (but it wasn't required). I took bio, chem, physics, neuroscience, neuroanatomy, and so on. I think physicians should keep their scope of practice and we should stay out of it. Unfortunately, the world hasn't worked like that and we do have midlevels (PAs and nurses, optometrists) prescribing drugs. This is another avenue of objection I have. While I agree that psychologists could meet at least that standard, I don't want to be lumped in with "midlevels," which is how this often is conceptualized. I spent 4 years in undergrad, 5 in graduate school, 1 on internship, 2 on postdoc, and now continue to participate in CE programs, etc. . . I'm not a freakin' midlevel. Further, our expertise lies along a different and important path. I don't want to see that forsaken for this carrot of prescription drugs.

Just a note on psychiatrist training (it's 3 years of psychiatry residency, not 4, one is usually internal medicine).

Conversely, I think physicians overstep their scope constantly, especially in neuropsychology. They give our tests. They mis-interpret them. And then don't refer to us (I watch this happen weekly at my job). Or, they give our tests, use our billing codes, refer to us, and then we can't be reimbursed by the insurance companies. The arrogance to think they can just pick up neuropsych on the fly and do it competently is obnoxious. Abuses include having receptionists and nurses give neuropsych tests, among other things. In addition to not administering them correctly (I've watched this), the interpretation (I know I already mentioned this) is often horribly botched. This is true even with the behavioral neurologists, which they at least have a clue (compared with your usual general neurologist. . . who is a cranial nerve testing machine).

 

[6SAnthony]

I am all for the division of labor and parts of the field of psychology has been lost in the attempts to become more "medical". The idea of getting a doctorate solely for the possibility of being able to, one day, maybe be able to prescribe is asinine. You go for a doctorate because it is the (supposedly) entry level degree in psychology and it gives you a range of abilities (eg, research, psychotherapy, and assessment). I am all for psychologists being able to provide a variety of services to their patients and being able to become more educated (either via online training or traditional classes), but I don't know how I feel about the prescribing ability. I think that it will expand the services that we are able to provide, but severely limit the role that psychology plays in the mental health field as a whole.

 

[spyspy]

I don't know anyone getting their PhD/PsyD for the main purpose of prescribing. It wouldn't be worth all the other, more central tasks in training.

Just curious though...how much training in psychotherapy do MDs get? Not trying to start a fight (we have plenty of threads for that ) but just making that point. If I were a psychiatrist, I wouldn't worry about the RxP thing. Focus on your studies and be the best psychiatrist you can be.

 

[cara susanna]

Interesting reasons, thanks. That's generally the reason I would not want to prescribe, myself: I took two intro-level bio courses and neurobio, as well as psychopharm and biopsych, and I know I'll take higher level courses like that in grad school as well, but that's still just the very tip of the iceberg. There's just so much more to it, IMO.

 

[235750]

Conversely, I think physicians overstep their scope constantly, especially in neuropsychology. They give our tests. They mis-interpret them. And then don't refer to us (I watch this happen weekly at my job

I couldn't agree more with you. I was an LPN at a psych ward for a while and I saw this too. It was one of the big reasons why I wanted to go the PhD route. And I know a few psychologists who feel that script privileges is good 'payback' for psychiatrists oversteeping their bounds.

Most of the time I see psychologists and psychiatrists getting along, but it seems they're at each others' necks when it comes to scope of practice issues. To be fair, I think both sides overstep their bounds sometimes, and I don't think it's helpful to back and forth pointing fingers.

I personally would LOVE a more integrated approach to training. I'd like to see a revamp of clinical psych/psychiatry education with graduates from both sides teaching classes in the other field. But, maybe that's just me

I spent 4 years in undergrad, 5 in graduate school, 1 on internship, 2 on postdoc, and now continue to participate in CE programs, etc. . . I'm not a freakin' midlevel.

Point well taken Sir. This is one of the main reasons I chose medical school. Clinical psychologists are well trained professionals and the trend of relegating them to mid-level providers is frightening, from the perspective that they (or rather, you) are better than that. Again, I have nothing against PhDs/Pysds prescribing, I just wouldn't want to spend all that time and schooling just to be seen as a psychiatrist's assistant.

That said, clinical psychologists could easily fill the spot and I think could play an important role in increasing access, speaking of which...

If you were the only psychologist for 100 miles and there were no psychiatrists for 200 miles, is your patient really receiving appropriate standard of care?

This isn't about geograhical isolation. If you look at where prescribing clinical pyschs. are registered, you'll find the majority are in large cities/towns like Albuquerque. There are plenty of psychiatrists in those areas, but it's unlikely that all patients would be able to get/afford an appointment with a physician. This is a problem partly to do with a physician shortage and physician greed (everyone wants a private practice it seems). These problems can be seen in all branches of medicine, and that's where a mid-level can really help.

The idea of getting a doctorate solely for the possibility of being able to, one day, maybe be able to prescribe is asinine.

I taught classes for RNs who eventually wanted to get an MSN and then move on and and get a DNP (Doctor of Nurse Practitioner), and then finally sit for an exam that would allow them to prescribe meds. I'm not saying that's right or wrong, it's just that people do go to great lengths for more privileges, especially the ability to give out meds

Just a note on psychiatrist training (it's 3 years of psychiatry residency, not 4, one is usually internal medicine).

I suppose if we want to be exact, it's about 4-6 months internal med and then ~3.5 years psychiatry for the programs I know of (Duke, OHSU), and previously in med school you've done around 6 months of rotations in psych, so it's pretty close to 4 yrs. Either way I think the 17k hours of clinical experience is the most relevant gauge. That said, I think spyspy is correct in that MD/DOs do not get a lot of psychotherapy training, which is why there should be more referrals to PhD/PsyDs and restructuring of the training as it stands

Thanks to all those students/clinicians for responding!

 

[Therapist4Chnge]

Further RxP discussion should be made in the RxP thread, and not posted in a new thread.

*Closing*