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Psychopharmacology/Advanced Practice Psychology

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by 50960, 12.06.05.

  1. 50960

    50960 Guest

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    New sticky.
  2. Jon Snow

    Jon Snow Senior Member

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    What is "advanced practice?"
  3. PublicHealth

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    Great idea, psisci, but we should try to narrow down an adjective to describe psychologists who prescribe. "Prescribing psychologist," "medical psychologist," etc., there are too many titles out there!
  4. PublicHealth

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  5. ProZackMI

    ProZackMI Psychiatrist/Attorney

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    I've said it a few times in the past, but I'll reiterate it here: I truly believe that with the appropriate training, a doctorally prepared psychologist, with advanced psychopharm and med assessment training, should be more than qualified to prescribe psychotropics.

    At first, I was against this, but after doing some research, I don't think it's a bad thing and may actually help some patients who wouldn't otherwise have access to a competent mental health professional (other than an an MSW/MA).

    Another point, master's level NPs and bachelor's level PAs, as well as optometrists, prescribe meds all the time and have not been through med school, and research shows that they prescribe meds more safely than many MDs and DOs (especially the IMG/FMGs). Podiatrists, pharmacists, and dentists also have full or partial RxPs and do a safe and effective job, for the most part, in prescribing meds.

    With the appropriate training, why wouldn't PhD/PsyDs with additional pharm/med training be effective and safe prescribers? I think the data from NM and LA has shown that so far, so good in terms of prescribing psychologists in those states.

    I still maintain that clinical psychology should move from the scientist-practitioner model (Boulder?) to the PsyD (practitioner) or Vail model. A PsyD should be a four year, post BA/BS professional degree, like the JD, MD, PharmD, DDS, DVM, OD, etc. Lose the heavy stats courses, the research courses, and focus on anatomy/physiology, pharmacology, med/psych assessment, counseling/therapeutics, psychometrics, etc.). Incorporate the pharm into the doctoral program rather than mandate a post-doc MS in psychopharm.

    If a student wishes to do research, publish, and experimentation, go for a PhD rather than a PsyD.

    Just my two cents. I wish you guys the best of luck in fighting for RxPs.
  6. 50960

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    Rock on ProZack!!

    I say "medical psychologist" is the best.
  7. PublicHealth

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    Prozack,

    Can you copy and paste the above, edit a bit to make it sound more "official" (you're a lawyer so I have faith in you :D ), and then send it to legislators in your state (Michigan)? I'm sure psychologists lobbying for RxP would appreciate having an MD, JD speaking out in favor of RxP for psychologists. Rock on. :thumbup:
  8. Jon Snow

    Jon Snow Senior Member

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    Given what the Psy.D. system is currently, I strongly disagree.
  9. ProZackMI

    ProZackMI Psychiatrist/Attorney

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    If all goes well, I'll be a lawyer if (and that's a big IF) I pass the February 06 bar exam. Xanax has helped me through 200 evidence and civil procedure questions for the last week!

    I'll tell you one thing, once I move into law, I will advocate strongly for RxPs for med psychologists. However, strangely, I haven't heard much of a movement for that sort of thing here in MI. It seems most of the momentum is either on the East Coast or out West (WA, OR, HI, and CA). I think I read that MO or another similar state had a bill on the floor, but it was rejected? Anyone know more about that? I wonder if it's that the APA's lobby group isn't as strong as the optometrists and NPs?
  10. sasevan

    sasevan Senior Member

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    Hey ProZackMI,

    Great to have you here and in the psychiatry forum. As usual, you make some great points. I really hope that you maintain some presence in medicine/psychiatry evenwhile practicing law. Though I'm sure that in either endeavor you'll continue to be a great advocate.

    Peace.

    P.S. Best of luck on the Bar Exam :luck:

  11. ProZackMI

    ProZackMI Psychiatrist/Attorney

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    It would require change, no doubt. The current PsyD is a quasi-professional degree. It's a hybrid between a PhD and a....JD/MD/DDS, whatever. In other words, it has characteristics of a PhD, but also has characteristics of a professional degree. I work with a woman who received her PsyD from either Pace or Rutgers (I really can't remember) and she told me she had to write a dissertation/doctoral paper, take a ton of stats classes, etc. That made me wonder, does she have a watered down PhD or a some kind of hybrid degree? There is no doctoral project or dissertation for the JD or MD or other professional doctorates.

    So, you'd have to scap the current PsyD curriculum and make it more like other professional health care programs.

    Year 1 - combination of advanced psychology and basic medical sciences
    Year 2 - Same
    Year 3- clinical psych, clinical med assessment and pharm
    Year 4- more clinical psych, clerkships, simple research, pharm
    PsyD + licensure exams, including pharmacology
    2-3 year post doc residency in a medical/hospital setting

    The PsyD in my world would be structured like the MD, DDS, OD, DPM, PharmD, DVM. First two years are mostly clinical/basic sciences. Third year is clinical. Fourth year is clinical and practical.

    The PhD would be reserved for researchers only. IMO, a PhD isn't geared for practice. No offense to any PhD practitioners out there, but your doctorate is a research degree. Just my thoughts! :)
    Zack
  12. ProZackMI

    ProZackMI Psychiatrist/Attorney

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    Thanks! I plan on maintaining a connection with medicine even while practicing law, but most likely, I'll go back to internal med. One of my best friends owns a small, urgent care clinic in a pretty swanky neighbourhood not too far from my condo, so once I get established in law, and as long as there are no conflicts of interest, I would most likely augment my income by pulling weekend duties at the clinic. You know, a few ear infections, some allergic conjunctivitis, exacerbations of asthma/COPD, basic wound care, etc. Anything "severe" is referred to a local ER. I miss IM. To be honest, I'm getting burned out with psych.

    If I could do it over again, I would have gone to law school after undergrad. I would have gotten my JD, passed the Bar, and then worked for several years. Then I would have gone back for a PhD/PsyD. Psychiatry is mostly...script writing with minimal actual patient counseling/therapy. Even though I'm a physician, I don't believe that every pathology has a biogenic or genetic etiology. Most of my peers, however, are quick to Rx an SSRI or TCA for reactive depression! And patients now expect it. I had a patient today beg me for Paxil/Prozac due to bereavement. Her husband died a week ago and she wants meds. I tried to tell her that her depression is natural, not endogenous...and that with time, her condition will improve. Psychotherapy is the best course of action, if any, in her case, not pharmacological intervention. She was pissed I suggested such a thing and stormed out of my office.

    That's what psychiatry has become...at least based on my personal experiences.

    Sorry to vent!
    Zack
  13. sasevan

    sasevan Senior Member

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    Another good post :thumbup:
    I think that RxP will have initial success in the less urbanized (i.e., with less psychiatric presence) states as one of the main arguments for medical psychologists is to increase patient access to psychopharmacologists. Given that I think that RxP has the best chance in the South, Midwest, Southwest, and Northwest (HI also). I don't think it has a very good chance in the near future to pass in places like MA, NY, NJ, PA, FL, IL, TX, or CA. Although in the latter I believe there's a lawsuit arguing that psychiatry's opposition to RxP is a violation of psychology's right to establish/regulate its own scope without unfair interference from its business competitor (not really sure about this but its what I remember hearing from an RxP conference at APA about 2 years ago). If there is such a lawsuit and psychology were to win then likely RxP will sweep most states. Can you think of any legal angle on this?
  14. sasevan

    sasevan Senior Member

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    I totally agree with this model for the PsyD but alas I don't think psychology would undertake such a restructuring of its current program (especially limiting the PhD to academicians and the PsyD to practitioners). It would also likely medicalize all of clinical psychologists, perhaps to the point where there would be too little difference between psychologists and psychiatrists. I think that perhaps a concentration in med psych (akin to neuropsych, forensic psych, health psych) is much more feasible; maybe the middle ground between the current proposed model of a post-doc MS in psychopharm and your proposed restructuring.
  15. ProZackMI

    ProZackMI Psychiatrist/Attorney

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    You have to remember that, like it or not, the AMA has one of the strongest lobby groups around. They have more clout than the ABA! This political muscle, coupled with the public's understanding of psychology, will be the biggest obstacle to RxPs.

    First, the AMA and ApA don't want psychologists to follow the path of the NPs, PAs, optometrists, and a few other physician extenders/professions who have increased their scope of practice authority. MDs and DOs fear encroachment from all ends. Examples:

    - Optometrists have limited RxPs (called TPA/DPA) in almost all states. In OK, they have limited surgical privileges (I believe a type of laser surgery) and their lobby groups are pushing for similar privileges in other states, like NC. They are also fighting for hospital admit and D/C privis. Thus, ODs are encroaching on internal med/family practice and ophthamology.

    - Audiologists, who perform a similar role as optometrists, only for the ears, used to receive an MA/MS degree in aud. Now, they are arguing for the AuD (Dr. of Audiology) degree. Their argument: Hey, we are the optometrists of the ears, why should we be stuck with a lowly masters and they get a fancy clincial doctorate? Lo and behold, the AuD is born. Soon, after this degree replaces the MA/MS in audiology as the basic professional credential, audiologists will seek enhanced scopes of practices to mirror the ODs. This will encroach upon ENTs/Otos.

    - Physical Therapists (PTs) have recently upgraded to a 3-year post BA/BS professional doctorate called a DPT. With the enhanced degree, PTs wish to become primary care providers whereby there would be no need for an MD/DO Rx to receive PT tx. Eventually, down the line, PTs will most likely seek RxPs (analglesics, narcotics, etc.) and possibly even surgical privis. Thus, encroachment on PM&R and ortho!

    - PAs and NPs are already encroaching on FP/GP and IM. A few NP programs now grant the DNP (doc of nursing practice) degree! Dr. Nurse? Where do we draw the line, folks? :)

    - CRNAs --> anesthesiology

    - Midwives --> OB-GYN

    NOW...here come the clin. psychologists who are asking to be one of the "boys" and treated as true health care providers, not glorified social workers. Organized medicine doesn't want yet another competitor. The insurance companies, however, love it. Lawyers love it!

    Another obstacle you guys have is the older psychologists who feel this change is eroding the practice of clin psychology. Psychology, according to them, is NOT medicine. They argue, "if you want to Rx meds, go to medical school!" You guys are divided and not unified. Almost all ODs advocated for enhanced scope of practice powers, but you find psychologists divided into two or three factions: 1) those strongly for RxPs, 2) those strongly against RxPs, and 3) those who don't care. Until you guys unify, you will continue to lose the battle.

    Another obstacle, the public's perception. Many folks get confused between psychiatrists, psychologists and even MSWs. Both psychiatrists and psychologists are "doctors", but one is a "talking doctor" as one of my colleagues likes to say, and the other is a "pill pusher". If they both have the same "powers and privileges", what's the difference? If psychologists become more like psychiatrists, will the MSWs attempt to fill the void and become more like psychologists? Can you see MSWs trying to perform TATs, Rorschachs, MMPIs, WAIS, WISCs, WIATs, etc.?

    The public thinks a psychologist is a professor type or a touchy-feely therapist type. If you guys start Rx'ing one day, that will confuse the public.

    Lastly, the current doctoral education program for most clinical psychology programs is vastly under medicalized in terms of training and assessment. It would seem unfair to make you guys, who usually have more formal schooling than MDs, to obtain another degree in order to have RxPs. One solution here would be to make your professional doctorate more like the MD (see my previous few posts), or make an optional residency for post docs in med psych/psychopharm. Rather than the standard APA one year post doc internship, a prospective med psych would do a two-four year, paid, hospital-based residency, in med psych/psypharm, where you'd do physical exams, read labs, prescribe meds, and do normal psychological testing and counseling. This option would keep the status quo as well as allow many newly minted PhDs and PsyDs to acquire some serious medical skills/training.

    Whew...I'm long-winded.

    Enough for now! :)
    Zack
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  16. PsychEval

    PsychEval Senior Member

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    Prozack,

    I have attached an application in case you may be interested in being a Collaborative Practice Associate of the American Society for the Advancement of Pharmacotherapy. The purpose of the Collaborative Practice Committee is to establish liaisons with health care professionals who are currently licensed to prescribe medications, with the goal of increasing opportunities for interdiscipilinary collaboration, research, and education. Essentially, it is for prescribing providers who support prescriptive authority for psychologists. Additionally, I suspect many RxP training programs all over the country would be interested in having a psychiatrist teach some of the coursework.

    http://www.division55.org/pdf/CollaborativePracticeApplication.pdf
  17. Solideliquid

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    I'm an IMG, and it seems like you are willing to put down a population of hard working physicians to improve your cause, which is wrong.

    Care to show me this research? I mean if you are going to compare prescribing patterns of optometrists, and PAs to all phsycians that's bad research.
  18. PsychEval

    PsychEval Senior Member

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    Hi Solid,

    I’m a Ph.D., and it seems like you are willing to put down a population of hard working psychologists to improve your cause, which is a losing battle. BTW, I'm sure your well versed in research.
  19. ProZackMI

    ProZackMI Psychiatrist/Attorney

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    Cool...I printed a copy and will look it over. I wouldn't mind mentoring a prescribing psychologist one day, should this issue ever present itself in MI. Thank you!
    Zack
  20. PublicHealth

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    But what about folks who are already licensed psychologists? How would they go about obtaining prescriptive authority?
  21. ProZackMI

    ProZackMI Psychiatrist/Attorney

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    As a physician and soon to be attorney, I have a thorough understanding of medical malpractice issues. My emphasis in law school was health care law and medical negligence. While I don't have facts and figures to share at the top of my head, I will tell you that the legal research strongly indicates that FMGs constitute the bulk of medical defendants in certain areas. Interestingly, the majority of these "physicians" are psychiatrists, pediatricians, gynecologists, and neurologists. I'm not sure why, but that is what the legal research indicates.

    I'm also basing my comments on research I did for a research paper I did in law school regarding scope of practice issues in various health care professions (e.g., optometry, NPs, PAs, podiatry, etc.). As an MD, I started off wanted to read that optometrists were killing people by inappropriately prescribing a medication, not understanding a drug contraindication, etc. I wanted to see that NPs and PAs did harm by having RxPs. I was wrong and surprised. What really shocked me is to learn that IMGs do more harm than non-physician prescribers.

    Also, based on my personal experience, working with many foreign medical grads who are psychiatrists, I often see inappropriate diagnoses, poor/dangerous medication choices, and frequent communication problems due to langauge barriers and poor communication skills and/or cultural differences. I have personally caught several egregious errors in prescribing and tx.

    I can look up the legal sources I mentioned above and give you hard facts and figures, but suffice it to say, more harm has been done my physicians prescribing (both US trained and non-US trained) than has been done by any PHD, OD, PharmD, DDS, NP, etc. The data suggests (but is not dispositive) that foreign medical grads (mostly from India and Asia) are the worst offenders in terms of medical malpractice issues related to prescribed medications. Yes, this seems like a sweeping generalization, but that is what the research has shown. Sorry if that bothers you.

    Of course, that does not mean ALL FMGs are poorly trained or dangerous. Some of the best physicians I know personally obtained their education abroad. It's a case-by-case basis, but unfortunately, the data suggests a pattern in terms of FMGs and medical negligence centered on prescribing.
  22. PublicHealth

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    I'm a "hard working physician" in training and support psychologists obtaining RxP 100%. This effort is not to "put down" physicians, but rather to increase access to desperately needed behavioral healthcare services in certain US states. US medical students tend not to be interested in psychiatry, leaving many residency spots occupied by FMGs, who often try to match into psychiatry not out of interest, but by default (it's easy to match). Even then, many states have few psychiatrists and GPs do most of the prescribing of psychotropics, with little to no follow-up. Add to that limited collaboration between behavioral healthcare providers (due mostly to discrepancies in the number of psychiatrists and psychologists in certain states) and 6-month long waiting lists to see a psychiatrist, and we've got a mental health crisis. Patients do not deserve to suffer. Psychologist RxP with appropriate training = :thumbup: in my book.
  23. PublicHealth

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    Well put. If possible, could you post a couple links or provide references to these articles. I'd like to take a look at them. Thank you!
  24. ProZackMI

    ProZackMI Psychiatrist/Attorney

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    1. I have no cause. I'm defending RxPs for "hard-working" and well-trained psychologists who are attempting to improve their professional standing and expand their scope of practice to better serve their patients. That is, after all, the subject of this topic. This discussion has nothing to do with FMGs. I merely mentioned that fact to show that the AMA's objections to properly trained professionals prescribing meds is inconsistent with the totality of the evidence. The bulk of the evidence in terms of overall safety of medications prescribed each year, in the US, shows that the majority of harm caused to patients by prescribing providers is NOT done by psychologists, optometrists, NPs, PAs, pharmacists, dentists, etc. The research shows, very clearly, that the majority of harm done to patients is done by MDs and DOs. Moreover, of this group (physicians as a whole), it is the FMGs who more frequently prescribe an inappropriate medication, over prescribe, don't look at the whole medical hx, don't understand pharmacology, etc. It is the FMGs who end up harming patients, more often, than the non-physician prescribers.


    Why is this? Several reasons. FMGs typically receive inferior training. They usually have 5-6 years of formal education (typically, a Bachelor's in Medicine is the degree earned without prior undergraduate training). They are often trained in medical schools with poor facilities, poorly trained faculty, and do not have access to medical technology or state-of-the-art treatment techniques and information. They come to the US and must pass the USMLE I and II and then complete a residency, where they actually learn to be physicians, but often, that process is like building a house on quicksand. Without a proper and strong foundation to start, any structure built thereafter will be subject to slowly sliding into the quagmire.

    I have a co-worker (psychiatrist) from India, who told me that his son, who is in the 8th grade, has better science facilities at his middle school than my friend did at medical school (in Bangalore, India). In school, he never was exposed to sophisticated medical technology like we have in the US. His pharmacology professor (just one) had a medical degree from India, not a PhD or PharmD. The cardiology dept. consisted of two physicians who never performed a CABG or PTCA. They had no idea how to read an Echo. Their EKG machines were 20 years old. They had no clue how to read a Thallium or Persantine. They never knew how to do or read a cath. No clue about LVEF, ischemic cardiomyopathy, etc. He had to learn this in his residency. When I look at my patient's med hx, I actually understand what I am reading; he does often does not. The sad part is, many of the PhDs I work with know more medicine and pharmacology than many of the FMGs! Who would you rather have prescribing powerful psychoactive meds to you or your kids? A FMG who has no clue but can pass through a relatively easy residency, or a PhD with proper training?

    To make matters worse, a large amount of FMGs lack the communication skills necessary to be effective medical practitioners. Not all, but many FMGs have no problem reading English, but have a hard time speaking it clearly and effectively. Many have a hard time understanding Americans, especially minorities and children who often use colloquialisms and slang or who speak more quickly than others. Frequently, I see patients request a new doctor because they cannot understand theirs, or worse, their doctor doesn't understand them or doesn't appear to listen to them.

    2. I was not comparing prescribing patterns of optometrists to all physicians. I was pointing out that when optometrists do prescribe, they so safely and effectively, unlike many FMGs. I was making a statement that if optometrists and nurse practitioners can do it safely, it's reasonable to conclude that properly trained psychologists should be able to do so safely and effectively.
  25. PublicHealth

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    To those who have not seen this, here is a flyer for the upcoming Mid-Winter Conference of the American Society for the Advancement of Pharmacotherapy (Division 55 of the American Psychological Association):

    http://www.division55.org/2006MidwinterBrochure.pdf

    Is anyone planning on going? I am not, but would love to hear about the meeting from someone who does attend.

    Did anyone attend the American Psychological Association meeting this year? Were there any talks on RxP? If so, what did they cover?
  26. Solideliquid

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    Dear Psych,

    You have me wrong on both counts! I am not opposed to psychologists prescribing meds as long as there is a well thought out education route.

    On the second count, no I am not versed in research as I am a fresh medical graduate and there hasn't been time for me to swim in those waters. LOL
  27. PublicHealth

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    Funny how quickly your tone and opinion changed once a lawyer reamed your ass. Go ProZack! :thumbup:
  28. ergo_sum

    ergo_sum psychiatrist

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    What a load of self serving B.S. When I came to the U.S. I was shocked at the level of medicine I saw. Where I was trained, we were taught to think and we were expected to be knowledgable, hard working and caring. Here's what I saw in the U.S., an initial impression that has only been stregnthened in the years since:

    American doctors are trained to throw a pill automatically at every complaint. They do not know how to think.

    American doctors aim to please the customer, not treat the patient, as a physician should.

    American doctors know how to play office poltiics and suck up to those in power - they do not care about the patients, or about what is right.

    American doctors haven't got a clue about collegiality. They consistently attack one another and eat their young alive.

    US doctors resemble robots, IMO. Money grubbing ones, that is.

    Medicine here is far inferior to that practiced in other countries. Sure, the rooms are nicer, the instruments might be newer, and at the cutting edge of certain sub specialties, the US is undoubtedly number one. But you do not know how to be a caring, thoughtful, logical, empathic physician, a person who has dedicated their life to the health and well being of others. You know how to be slick and make money.

    I have treated many patients that had been treated by American doctors, including some working at several famous Boston hospitals (MGH, Mclean). It seems at times that every single person who walks through their doors is diagnosed with Bipolar and loaded up with lamotrigine, lithium, seroquel and a bunch of other junk. This overdiagnosis of Bipolar and this rabid polypharamcy originate from the so-called "best" academic centers, and are rampant in all levels of practice.

    I find your posts ridiculous and I think you are a hate mongerer. You have built up an entire thought system just to justify your own xenophobia, Mr. lawyer-doctor.
  29. 50960

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    Be nice.... This is getting off topic.
  30. PublicHealth

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  31. PublicHealth

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  32. ProZackMI

    ProZackMI Psychiatrist/Attorney

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    I am in the process of leaving medicine, at least in part, because I tend to agree with you. There are still many medical students (and for that matter, law students) out there who start off with altruism in mind and intend to serve others by alleviating their pain and suffering, but for some reason, usually during school or in residency, the altruism is traded in for hedonsim, or at the very least, materialism. I remember hearing med students talk about how much they were going to earn after residency, etc. To some degree, I bought into it myself. Medicine has always been a big money maker in the US. Not so in Europe and other countries where physicians are often treated as "inferiors" by other professions. In many countries, like Russia, physicians are thought to be mere "body mechanics" and make much less than other professionals.

    I also agree with you about the increasing practice of polypharmacy among physicians in general, not just US-trained physicians. This is one the biggest problems with psychiatry. Example: A 30-year-old healthy woman comes in due to increasing sxs of depression: insomnia, anhedonia, feeling hopeless, lethargy, intermittent SI, etc. These sxs began after her finance of five years, was killed in Iraq. Her psychiatrist immediately Rx's an SSRI (Paxil or Prozac, not sure which) after a 10 min. med review and sends her on her merry way. The SEs of the SSRI were significant, so her doc changes her medication to Wellbutrin. No more side effects. However, by the time she came to me as a new patient, she needed the Wellbutrin to "cope". Had she been my patient initially, I would have diagnosed reactive/situational depression vs. adjustment D/O with depressed mood and done some counseling/grief therapy. I would not have prescribed any meds.

    During my psych residency, I had a clinical psychologist with an Ivy League PhD as a preceptor. I remember him telling the residents about his three magic words: GET OVER IT! His advice, to the residents, was to encourage patients to GET OVER IT without medication. I never forgot that and to this day, 4 years later, I still use it, even for my most recalcitrant patients.

    Nevertheless, medicine in general has become dependent on pharmaceuticals and the "magic pill" theory. That's part of the American way. Fast food, fast sex, fast medicine. Quick and easy. I'm not sure where you're from, but in places like India and China, there is minimal access to drugs, so physicians often have to make do with what they have. True, they learn how to treat patients with less. However, we are not talking about medicine in India or China or Russia. We are talking about the US health care system.

    You say American medicine is inferior to medicine as it is practiced in other nations because American doctors are greedy, robotic, money-grubbing, political, selfish, insensitive pill pushers who don't give a **** about their patients. Shortly after you made that wonderfully stereotypical statement, you stated that I was a hate monger and overgeneralized the quality of care provided by FMGs. Don't you find it ironic that your statements stereotype and overgeneralize ALL US doctors?

    Much of what I wrote was predicated on empirical and objective research. I also included some anecdotal evidence as well. Your statements were completely subjective and predicated upon your personal observations.

    A few comments:

    1. I have encountered some incredibly sensitive US physicians who treat their patients as people, not signs and symptoms. Unfortunately, most of these were DOs, not MDs (I'm an MD, so this bothers me). I have also encountered some incredibly arrogant and rude doctors. In fact, I work with some. It's ridiculous for you to say all US docs are uncaring automatons. Some are, some are not. I have met some incredibly rude and arrogant FMGs. Two years ago, I presented to the ER with right sided lower flank pain. A KUB revealed a 4mm calculus. While I was writhing in pain in the ER, an Indian ER doc, who had such poor English skills, that he might as well have been speaking Dravidian, rudely tells me that I had a gravel pit in my kidney and that I need surgery right away or I would die. I grabbed the KUB and IVP reports, saw a 4mm stone, and laughed. No hydronephrosis, normal labs (creatinine, albumin, BUN, etc.), just pain and hematuria. Why would that kill me? I passed the stone and have been fine ever since. This FMG was rude, arrogant, barely understandable, and had I not been a physician, might have scared me unecessarily.

    I have treated many patients who tell me their previous psychiatrist, who happened to be a FMG, was rude, didn't listen to them, or was not understandable. Many of these foreign docs often imputed their cultural biases onto their American patients. Things like an Asian male psych telling an American woman that she should stop complaining and just give in to her husband's demands for sex and service. If you're going to treat American patients, you have no right to do so under the veil of your cultural biases.


    2. Managed health care often puts unreasonable constraints on physicians. These constraints may appear to be insensitive, greedy, etc.

    3. Many FMGs that I know enjoy driving BMWs, Mercedes, and Lexus just as much as the American docs. Worshipping at the Altar of Mammon knows no geopolitical boundaries, my friend.

    4. Many of the problems with medicine, especially psychiatry, is the basis of my support for RxPs for properly trained psychologists. Psychologists are trained to be better listeners and better problem solvers. As you pointed out, physicians tend to be quick the Rx pad and short with the listening skills. A pharm trained psychologist would most likely Rx less and listen more.

    5. You are obviously a very insecure person who feels inferior to US trained docs because of your foreign medical education. Your disdain for your American colleagues is palpable and offensive. If you, personally, are a competent physician, then who cares where you went to school? Some of the biggest morons I have met have had an MD, JD, or PhD from places like Harvard, Yale, and Stanford. Some of the best doctors and lawyers I have met earned their degrees from places like Medical College of Ohio/Wisconsin, Thomas Cooley Law School, University of Toledo, etc. Where you went to school is not relevant, it's what you learned and how you apply what you learned coupled with your own personal skills. FMGs are often trained at poor, backward schools with little or no resources. This factor does not mean all FMGs are inferior, but if medical practice statistics can be trusted, and if the US Dept of Health and Human Services stats can be trusted, it would sure seem that many Americans are suffering because of FMGs and their lack of training. One reason is that they quickly try to become like US docs and are quick to Rx without understanding the pharmacology etc.

    6. The VAST majority of inappropriate psych diagnoses I encounter come from master's level therapists (MA and MSW) and FMG psychiatrists, NOT US trained psychiatrists. I've had to sit down with a few colleagues, and a few residents, and explain the DSM IV criteria for true bipolar. I had to explain what schizoaffective D/O was and how it is diagnosed. Most American psychiatrists have no problem in this area. We learn something called the differential dx, which apparently, is not taught in Madras, Bangalore, or Velore.
  33. 50960

    50960 Guest

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    I don't think we should be doing ECT. I think we should be able to order it when needed but not administer it...sorta like general anaesthesia.
  34. ProZackMI

    ProZackMI Psychiatrist/Attorney

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    Good point. There is a big difference between prescribing a medication and actually performing a clinical procedure. Many things can go wrong during ECT, and I don't think a psychologist would be prepared to treat such unforeseen medical contingencies without a medical degree.
  35. Solideliquid

    Solideliquid Members Only

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    You psychologists seem to be a hateful lot. I'd like to point out that when you reply to topics on the Psych/MD forum we respond with common courtesy and do not make comments like the above.


    I really wanted to find out just how much psychologists are willing to be receptive to MDs. I guess the answer is not much.

    I'll be going now, see ya on the MD side.
  36. Jon Snow

    Jon Snow Senior Member

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    The fellow you seem to be arguing with is a psychiatrist, not a psychologist. Also, there seems to be ample tendency to respond negatively on the psychiatry board as well. I think it is a mistake to generalize disdain for MD perspectives based on what I would term "noise in the system."

    Whether or not prescription rights for psychologists becomes a reality, I think we can strive to discuss the issues in a rationale way.
  37. lazure

    lazure Senior Member

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    I'm a clinical psych doctoral student in Canada - no prescription rights anywhere on the horizon here. But I would like to learn about psychopharmacology, particularly as it relates to my children and adolescent clients. Where do I start? I'm capable of doing lit reviews using PubMed but I feel I need a fundamental background from somewhere. Unfortunately, my current school does not offer an overview course of pharmacology like my previous school did.
  38. 50960

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    For you PPR or the psychopharmacology institute would be a good option. PM me, and I can send you some links. Happy to hear you are interested in the training as that is the most important part of all of this talk of RxP in my opinion..getting psychologists some medical training.
  39. PublicHealth

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    psisci,

    Can you tell us more about Prescribing Psychologists Register (http://www.pprpsych.com/) and Psychopharmacology Institute (http://www.nmhc-clinics.com/pages/TPI/ppp.html). Websites for these programs look kind of shady -- is a Diplomate Fellowship in Psychopharmacology really "the most stringent Diplomate in the profession of Psychology?"
  40. PublicHealth

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  41. Flutterbyu

    Flutterbyu Member

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    I go to Massachusetts School of Professional Psych (www.mspp.edu) and we have one of the few psychopharm masters in the country. http://psychopharm.mspp.edu/index.asp?action=10&what=10&type=0 is the direst link to the psychopharm info on the website. You can do distance learning and you only have to attend 9 weekends over 2 years, but you do have to finish grad school first. I plan to do it as soon as I have my Psy.D. :thumbup:
  42. ergo_sum

    ergo_sum psychiatrist

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    Um...you just managed to miss the entire point of my post...

    I have not for one instant felt inferior...don't you get it? I came here and was appalled at what I saw...I count myself blessed for having had such a wonderful medical education.

    And you ARE a xenophobe. Are you not?
  43. ProZackMI

    ProZackMI Psychiatrist/Attorney

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    Nope, I'm Dutch and Norwegian. :p

    I'm not a Xenophobe.

    Here's a novel concept. If you're so appalled by the medical profession in the United States, then you should pack your stuff, buy a plane ticket back to your place of origin, and go back there to practice medicine where you can put your wonderful medical education to good use. You are an Americanophobe, to coin a new word, and your contempt for this country is patently offensive.

    YOU missed my whole point, which was objective and empirical research has shown that non-physician prescribers are not a danger to the public as the AMA would have everyone believe. Additionally, more people die each year from errors/incompetence from physicians prescribing meds rather than non-physicans prescribing meds.

    To me, that is a good indicator that properly trained psychologists would not pose a threat to their patients by gaining RxPs. This is not a place to bash American physicians, but rather, to discuss potential advances to the scope of practice of clinical psychology. If you have comments to add about clinical psychology, then make them, otherwise kindly cease and desist posting in this thread.
  44. PublicHealth

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    Yes! Some threads have a strange way of devolving into hostile discussions of topics that are unrelated to the original question or topic.

    Flutterbyu, how do you like MSPP? I took a human neuropsychology course at the Jamaica Plain VA during my undergraduate training and really enjoyed it. I recall some MSPP PsyD students being in the course. Are most students in your program considering the Master's in psychopharmacology? What is the status of the psychologist RxP bill in Massachusetts?
  45. ergo_sum

    ergo_sum psychiatrist

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    Only reason I posted here was that after you had gone on your little racist rant there, an IMG who stood up to you (even just a little) was yelled down. I was trying to show you that there can be different opinions about American Greatness, and you should not be so certain of your superiority.

    Mister, you are not in charge of this thread, this is not your courtroom, and you ain't gonna tell me where I can post.

    I cannot compete however with your productivity in terms of sheer word volume, and I do not intend to try.

    It is easy to be nasty and racist. I see that no evidence to the contrary will sway you from your very-dearly-held-opinion. You could have a thousand eloquent, educated IMG's posting here, you could meet a thousand rude and ignorant american docs, and you would still hold on to your opinions. It is clear that I have failed in my mission here on this thread, and you will persist in spreading these malignant views.

    Signing off.

    Ergo_sum.
  46. PublicHealth

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  47. 50960

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    No not the most stringent by any means, but good enough, and very good for someone in Canada who just wants some training. :)
  48. pschmom1

    pschmom1 Senior Member

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    I agree with Zack, if it is so terrible here in the U.S, than go home!!! The only racial comments came from you!!! I would like to know what your motivation to come to the U.S was? Was it a career opportunity? Family? I mean, concidering you obtained your degree elseware, you must have had some opportunity in your own country to practice medicine eh? What was the motivation to bring you here AMERICA!!!!!!!!! Until us Americans, or should I say American BORN citizens go on your countries medical forums and degrade your countries physicians, please have some self control and respect, and refrain from posting on ours!!!!! Thanks! By the way, your name says Ergo_sum, (therefore I (you) am) what???

    Cogito Ergo Sum-I think, therefor I am... Rene Decartes!
  49. pschmom1

    pschmom1 Senior Member

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    Thanks for the invite Psisci, I read your invite on the psych forum a few days ago, and I'm glad you want to have informative and respectful conversations. Some more willing than others :laugh: . But great idea :)
  50. PublicHealth

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    In keeping with the topic of this thread, here's a .pdf of Tennessee psychologists' "back and forth" with Tennessee psychiatrists regarding psychologist RxP. Tennessee's mental health system is a mess!

    http://www.tpaonline.org/leg/rxp.pdf

    TN bill: http://www.legislature.state.tn.us/bills/currentga/BILL/SB0723.pdf

    I have a feeling that Tennessee will gain prescriptive authority for psychologists this upcoming legislative cycle -- they successfully passed it through the Senate and were ONE VOTE shy of passing it through the House last cycle (http://www.tpaonline.org/leg/id155.htm). Hawaii looks promising too. Anyone else have any insight regarding legislation for psychologist RxP in these or other states?

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