Psychopharmacology/Advanced Practice Psychology

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T4C -- why don't you just remove the post?
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Therapist4Chnge said:
I believe only 15% of psychotropics are prescribed by psychiatrists.....the remaining 85% is done by GP/FP/NP/PA's. I can look up the study later this week, but that is the common % cited. Many FP/GP/NP/PA's get their information from the drug reps. They are put in a really tough position because they are stuck either prescribing something to their patient right then.....or referring to a psychiatrist who may or may not be available, and who the patient may or may not go to see. This is *why* this training makes sense....it is specialized training for someone who will have regular access to the patient.
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You know, this is kind of a misleading statistic in the context of metabolic disorders and agranulocytosis. The majority of psychiatric drugs prescribed by PCPs are SSRIs, what percentage are antipsychotics? Or even mood stabilizers?
 
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PSYDR said:
MO bill was killed 5/16/08 in senate.
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ugh. how many states are retrying for the next round? who's bills are currently in senate?
 
I believe most of them are going to keep trying, but that is more assumption on my part as I am not a member of every state association.


i think there are no more bills in senate this go around.
 
therapist4change- how are you completing the nova southeastern master's already? Correct me if I am wrong, but don't most psychopharm degrees require that you have a doctorate AND be licensed?

How are some doing this while on internship?
 
BellaPsyD said:
therapist4change- how are you completing the nova southeastern master's already? Correct me if I am wrong, but don't most psychopharm degrees require that you have a doctorate AND be licensed?

How are some doing this while on internship?
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When I started they let advanced standing doc. students take the classes and do the practicums (diff than the 1-2 years of supervision needed after the degree), but you can't get your degree until you have your doc. I think they still let advanced standing students take it, but YMMV.

I'd like to see the training be a formal post-doc or something to go back for, though I'm not sure the feasibility of doing it that way. My experience has been that having advanced standing and current professionals has offered a great learning environment. In my cohort, the doc. students tend to do better with the studying and details, while the current clinicians really have brought a lot to the table in experience and nuance of presentation by pts. Being able to spend a lot of time with a mix of professionals has helped outside of the RxP training too.

I think NSU's program is pretty well positioned (pretty good training, all classroom based, small cohorts*), but I think there is still some more work to do for all programs. I think requiring a number of pre-reqs would offer a solid foundation with which to start, instead of including them as part of the training. Additionally, I think the APA needs to accredit programs, as this needs to be controlled from the get go, and I think it is early enough on to do this....hopefully.

*edited to add/change this. It isn't all warm and fuzzies, as there are some short-comings, I think they have the right idea with keeping it classroom based. I wish they had some of the beginning courses be part of the pre-reqs, and added a few more sections of pharma-specific courses. It isn't that it isn't good, but I feel like I got a lot more out of those classes than straight orgo or related courses....which I could learn elsewhere.
 
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^ all good points. I was wondering, as I too would like to do this as soon as possible. It seems that waiting until after I am done with classes, internship, post-doc/residency, sit for licensing and THEN go back to school may not be the very best method. I wish there was some sort of combination offered for the classroom years and internships.
 
^interesting....
 
The DoD Demo Project has been cited in support of this cause. Yet, Congress discontinued the pilot project after the original 10 psychologists were trained. The General Accounting Office cited the following reasons (paraphrased): the military had not proven a need for prescribing psychologists, the program was expensive, and the benefits were questionable.

Also, the training that DoD psychologists received was similar to the training a PA would receive.
 
Definitely paraphrased, and the background training of the clinical psychologists also offers additional benefits above PA training, particularly in regard to diagnosing, assessing, and working with pathology. Meds management is merely one tool that was being utilized by the prescribing psychologists.
 
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Therapist4Chnge said:
Definitely paraphrased, and the background training of the clinical psychologists also offers additional benefits above PA training, particularly in regard to diagnosing, assessing, and working with pathology. Meds management is merely one tool that was being utilized by the prescribing psychologists.
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Are you referring to the DoD 10 or subsequent Rx psychologists? It appears that the DoD 10's training was much more comprehensive than the current Rx training available to psychologists.
 
^ I think that depends on the program you are looking at. The APA definitely needs to regulate the programs; although there are guidelines.
 
aminoacid said:
Are you referring to the DoD 10 or subsequent Rx psychologists? It appears that the DoD 10's training was much more comprehensive than the current Rx training available to psychologists.
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Both.

I think the DoD psychs were more than adequately trained, and I think some of the people come out of the RxP programs now are up to standard, while others are not. I generally support RxP, but ONLY if programs implement a stricter and more consistent level of training. Frankly, I don't agree with any online training and any movement to shorten the training. I think the APA needs to accredit programs and set a standard more in line with the DoD training.
 
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^ agreed.
 
The military is very progressive about increasing the training, thus the scope of practice for non-physician providers. I think the fact that the DoD program was discontinued speaks volumes about the need for Rx psychologists. There are health care provider shortages across the board in certain goegraphic areas. I do not think creating a new class of health care provider will mitigate this problem. More incentives are needed to encourage health care providers to go to these areas.

While Rx psychologists will have more psych knowledge in their arsenal than a PA or NP (assuming no prior psych experience), I think the clinical hours are lacking. Prescribing puts a practitioner into the realm of medicine, and I'm not convinced that these programs suffice. Again, I think the DoD model was good because the training was modeled after the PA model (not including the pre-program psych component). If all of the Rx psych programs followed the DoD model, I would be fine with it.
 
Interesting. My only concern is a divergence in training goals (towards less) that some people have talked about in regard to the NAPPP supported path. I am an RxP supporter, but it concerns me that the training isn't a bit more comprehensive in regard to program variance.
 
Does anybody know where I can access "up-to-date" information for RxP legislation, specifically MO?
 
On the NAPPP.ORG homepage, there is a link to Missouri's NAPPP branch. On there, you will find all sorts of updated RxP info.

In addition, the Missouri Psychological Association has an RxP homepage and newsletter up!
 
much appreciated, sir/mam:)
 
so im sitting in my clinical psy class, and my teacher tells me that psychologists have the abilitiy to now participate in psychopharmocology. is this true??? (i havent read all of these posts, sorry if it is repeating)
 
The2abraxis said:
so im sitting in my clinical psy class, and my teacher tells me that psychologists have the abilitiy to now participate in psychopharmocology. is this true??? (i havent read all of these posts, sorry if it is repeating)
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Yes, in some limited places after more training. This thread contains a good amount of information and talks about the pro's / con's of such training.....I'd suggest if you want to learn more about the area, take some time to read through this thread as a primer.
 
The2abraxis said:
so im sitting in my clinical psy class, and my teacher tells me that psychologists have the abilitiy to now participate in psychopharmocology. is this true??? (i havent read all of these posts, sorry if it is repeating)
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I might be reading more into this statement than I should but "participate in psychopharmacology" can mean many things so I feel the need to clarify.

Psychologists have been involved in psychopharmacology for decades, all across the country, in many different capacities. They just weren't the prescribers. That is a fairly recent trend and is currently only the case in just a few states, though there has been increasing pressure to expand that with limited success so far.

I just felt the need to point that out since I've done in the past and am currently involved in psychopharm research, and as a result some folks outside the field have assumed that means I'm getting prescription training. Nope, and zero desire to ever do so. Just be careful in delineating "Participate in psychopharmacology" and "Prescribe psychopharmacology".
 
Good clarification Ollie. I'm using my training to better information my clinical and research work. I won't be done with my current research until maybe this coming summer, but after that I'm looking to get more into pharma research.

Any link to the APA news....I took a quick look around apa.org and Division 55 and I didn't see anything.
 
What most people dont understand is that not only do states laws decide the scope of practice for individuals but hospitals do as well. There is not a single hospital in Louisiana that will give privileges to a psychologist to prescribe medications. It just will not happen, too much opposition from the MD's that sit on the board who decide what privileges an employee has at a hospital. This is the deep south where traditions run deep.

The only place I can see prescribing privileges being useful for psychologists is in private practice. But it is very difficult to open up a practice as a solo psychologist in LA.

First of all it is a very poor state so many of the few, cash only patients go to see well known psychiatrists in the state.

Patients seen in private practice come from referrals, from PC doctors or hospitals and well if a pt needs medication mgmt they will always refer to a psychiatrist. Most SSRI's are prescribed by internists, when psychiatrists do get referrals it is to manage either depression or psychosis that is resistant to any therapy the internist has tried.

Psychotropic medications are very dangerous. Just about every single one has a black box warning. If psychologists want to prescribe medication then they should maybe start with some medications that are safer such a medications for HTN or Antibiotics. I have seen patients end up in the ICU after a single dose of psychotropic medication.

Many psychiatric medications need monitoring of blood levels and well since psychologists do not have privileges to order blood work in any medical institution in LA how will patients be monitored in private practice.

There has also been a big backlash in LA against psychologists. I seem to have noticed that the psychologists that used to work for the hospital are being slowly replaced by social workers who hold doctorates. They have LCSW/ PHD behind their name.

But hey I have a novel idea. Psychologists who want to prescribe should be able to take the USMLE, and any psychologist who can pass USMLE step I, II and III should be allowed to prescribe whatever medication they please!
 
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heimlichboy said:
...well if a pt needs medication mgmt they will always refer to a psychiatrist.
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From people I've talked to down in LA, this hasn't been the case. Most of the referrals seem to be coming from PCPs that have a consulting relationship with the prescribing psychologists.

heimlichboy said:
Psychotropic medications are very dangerous. Just about every single one has a black box warning. If psychologists want to prescribe medication then they should maybe start with some medications that are safer such a medications for HTN or Antibiotics. I have seen patients end up in the ICU after a single dose of psychotropic medication.
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Scare tactics that are unfounded, excellent. Here is an excerpt pulled right from a CA proposal (SB 993) from 2007:
Psychologists with appropriate training and credentials have been prescribing medications to active duty personnel and their families in military facilities since 1991. These prescribing psychologists have consulted and treated over 160,000 patients with no deaths and no adverse outcomes.

For LA and NM, I believe 30,000-40,000 prescriptions have been written without any reported issues....I'll need to look up teh citation for the exact number.

heimlichboy said:
Many psychiatric medications need monitoring of blood levels and well since psychologists do not have privileges to order blood work in any medical institution in LA how will patients be monitored in private practice.
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Since many of the referrals are coming from PCPs, the labs and whatnot can be ordered through the PCP's office, and the meds management is done by the prescribing psychologist. This is why a consulting relationship is so important, so information can be shared.

heimlichboy said:
Psychologists who want to prescribe should be able to take the USMLE, and any psychologist who can pass USMLE step I, II and III should be allowed to prescribe whatever medication they please!
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The same line of "reasoning" was used against the mid-level prescribers, and yet they along with PCPs are the ones prescribing the vast majority of psychotropics (70-80% of prescriptions, depending on which research is cited).
 
It is also statistically impossible for 160,000 people to be treated without an adverse outcome. Since adverse outcomes with psychiatric medications are fairly common due to the nature of the medications.

I live and practice in louisiana. PCP are not working with prescribing psychologists because it increases their liabilility. PCP are overworked they do not want to monitor blood levels of drugs they are not prescribing, they would rather let a psychiatrist do that.

But it seems at this point no matter what arguement is made your opinions are pretty much set. So people will agree to disagree.
 
heimlich boy,

1) your argument rests upon the entire premise that psychologists cannot work in medical institutions. hospitals can only define scope of practice within their walls. they are not recognized as a legislative body by any court in the land.

2) i am sure the psychology staff at children's hospital, one of the largest in in new orleans, would be surprised to hear that they are not allowed to prescribe in the same hospital that demanded that they live in the hospital during the last several hurricanes. i am sure the hospital would also be surprised to learn that they do not allow prescribing psychologists, as they advertise this.


3) in regards to your assertion that private practice is not a lucrative enterprise, as the population is cash poor. however, private practice does not mean cash only. what about third party payors?

4) please explain how a single dosage of a psychotropic within the therapeutic range in an unmedicated individual who has been medically cleared can land someone in the ICU. give specific pathophysiology.

5) if psychologists are to take the USMLE, do you also assert that nurse practitioners should as well? what about RNs? then how about having a patient take these tests prior to being responsible for taking their own medications at home? at what point in the administration of a drug and at what degree of supervision does the USMLE become not necessary?
 
statistically impossible? statistical impossibility requires the measurement of the full population and a finding of absolute zero. so where is this study?

or did you mean highly improbable?
 
I went to school in LA and Heimlich Boy's assertion that psychologists are not prescribing in the hospitals there is an absolute lie. The LPA and APA passed a measure forcing public hospitals and facilities in LA to allow medical psychologists to prescribe. If you search for it, it can easily be found. I worked at a state hospital in Louisiana (Pinecrest Dev Ctr.) where the head of psychiatiry is a psychologist who is prescribing. Not only that, 5 other psychologists were prescribing in the facitliy.

Private hospitals, such as Children's Hospital in New Orleans, also have medical psychologists on-staff who prescribe in the inpatient and outpatient units. This is widely known in LA and makes me wonde in H Boy really lives in Louisiana.

If I recall, he was cited earlier on this board for troll-like comments.
 
heimlich: I think we'll agree to disagree. :)

edieb said:
Private hospitals, such as Children's Hospital in New Orleans, also have medical psychologists on-staff who prescribe in the inpatient and outpatient units.
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From the May 2008 edition of the APA's Monitor (v.39, 5):

[FONT=verdana, sans serif, helvetica, arial]The range of practice settings that have incorporated prescriptive psychology as described in the February Monitor did not mention their inclusion as full-time subspecialists on the staff of medical hospitals. Partially in response to an abiding shortage of psychiatrists in New Orleans, the first prescriptive (medical) psychologist in New Orleans joined the staff of Children's Hospital in 2006. This position was rapidly embraced by primary-care physicians in the community, and the prescribing psychologist wrote more than 2,000 prescriptions in the first year. The success of that decision has led to the hiring of two additional medical psychologists. .
[FONT=verdana, sans serif, helvetica, arial] .
[FONT=verdana, sans serif, helvetica, arial]Douglas S. Faust, PhD
John Courtney, PsyD
New Orleans.​

​
 
Also from the APA Monitor:

Louisiana’s psychologists earned prescriptive authority in 2004 and started prescribing in 2005. However, until this year, medical psychologists were not included in the state statute among the categories of health professionals authorized to prescribe psychotropic medications in the state’s public psychiatric health-care facilities. So, to preclude psychiatry from impeding medical psychologists’ ability to practice fully in these settings, the Louisiana Psychological Association helped pass a bill giving medical psychologists the explicit authorization to prescribe in state psychiatric facilities.
 
Therapist4Chnge said:
heimlich: I think we'll agree to disagree. :)



From the May 2008 edition of the APA's Monitor (v.39, 5):

[FONT=verdana, sans serif, helvetica, arial]The range of practice settings that have incorporated prescriptive psychology as described in the February Monitor did not mention their inclusion as full-time subspecialists on the staff of medical hospitals. Partially in response to an abiding shortage of psychiatrists in New Orleans, the first prescriptive (medical) psychologist in New Orleans joined the staff of Children's Hospital in 2006. This position was rapidly embraced by primary-care physicians in the community, and the prescribing psychologist wrote more than 2,000 prescriptions in the first year. The success of that decision has led to the hiring of two additional medical psychologists. .

[FONT=verdana, sans serif, helvetica, arial]Douglas S. Faust, PhD.

[FONT=verdana, sans serif, helvetica, arial]John Courtney, PsyD.
[FONT=verdana, sans serif, helvetica, arial]New Orleans.​
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I am not sure about pineville for I have never been there but the big four hospitals LSU, Tulane, OMH, and ochsner do not have psychologists with prescribing privileges.
 
edieb said:
Also from the APA Monitor:

Louisiana’s psychologists earned prescriptive authority in 2004 and started prescribing in 2005. However, until this year, medical psychologists were not included in the state statute among the categories of health professionals authorized to prescribe psychotropic medications in the state’s public psychiatric health-care facilities. So, to preclude psychiatry from impeding medical psychologists’ ability to practice fully in these settings, the Louisiana Psychological Association helped pass a bill giving medical psychologists the explicit authorization to prescribe in state psychiatric facilities.
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Obviously your not familiar with louisiana politics. Just because its law does not mean it is being followed.
 
4) please explain how a single dosage of a psychotropic within the therapeutic range in an unmedicated individual who has been medically cleared can land someone in the ICU. give specific pathophysiology.

NMS, Stevens Johnson, Hypotension,

anyway I tire of this discussion.
 
so how would the outcome of ANY of these conditions vary between those treated by a psychiatrist? who utilize a PCP to medically clear the patients prior to tx?

uh oh......
 
*LSU does...one of the reasons I was going to apply there for internship...

sorry T4C- just wanted to insert that point :)

Back on topic!
 
PSYDR said:
so how would the outcome of ANY of these conditions vary between those treated by a psychiatrist? who utilize a PCP to medically clear the patients prior to tx?

uh oh......
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yes in a utopian world everyone would follow up with their pcp. But many psychiatric patients do not even have a pcp. Not all patients need to be cleared by medicine to see a psychiatrist, because we can clear our own patients. Being medical doctors we know how to treat the above conditions. Where the prescribing psychologist would have to have someone else clean up their mess.
 
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