Psychopharmacology/Advanced Practice Psychology

[Therapist4Chnge]

Back on topic please.....

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[stn2006]

I have been in area with prescribing psychologists who tempted to D/c patients’ clozaril and patients came to ER with their symptoms worsen. Don’t’ their psychopharm classes teach them how to difficult it is to titrate the clozaril and the necessity to check the level? I have seems lithium toxicity in patients prescribe by some privileged psychologists that almost kill that patient.

 

[Shatani]

I have been in area with prescribing psychologists who tempted to D/c patients’ clozaril and patients came to ER with their symptoms worsen. Don’t’ their psychopharm classes teach them how to difficult it is to titrate the clozaril and the necessity to check the level? I have seems lithium toxicity in patients prescribe by some privileged psychologists that almost kill that patient.

i learned that in classes and i havent even attempted to get RxP. ive seen lithium toxicity in patients who were under the supervision of psychiatrists. any individual can do a crappy job! that doesnt necessarily have anything to do with everyone else who has that title.

 

[busi26]

Nobody can know everything. I'm still trying to figure out why some of you even want prescription rights. With your attitudes toward antidepressants, you want the right to prescribe so you can refuse to prescribe I suppose?

I agree! No one can know everything. What we want is for our patients to get the best possible care. Since properly trained psychologists can safely prescribe and UNPRESCRIBE, how does adding the prescription tool to the toolbag hurt anyone?

You hit the nail on the head on the unprescribing issue. In instances where therapy does as well or better than meds, patients should be offered therapy! How often do psychiatrists refer mild/moderatly depressed patients to therapy? How often do they refer kids with ADHD for therapy? How often do they refer panic disorder cases for therapy? Much less than warranted. One caveat, of course some psychiatrists are excellent therapists and can do it all (prescribe and do therapy).

 

[doctorpsych]

I agree! No one can know everything. What we want is for our patients to get the best possible care. Since properly trained psychologists can safely prescribe and UNPRESCRIBE, how does adding the prescription tool to the toolbag hurt anyone?

You hit the nail on the head on the unprescribing issue. In instances where therapy does as well or better than meds, patients should be offered therapy! How often do psychiatrists refer mild/moderatly depressed patients to therapy? How often do they refer kids with ADHD for therapy? How often do they refer panic disorder cases for therapy? Much less than warranted. One caveat, of course some psychiatrists are excellent therapists and can do it all (prescribe and do therapy).

I think most opponents of rxp forget that one of the major impetus for the movement is the reaction to the less than adequate state of our mental health field. It's not like psychologist just woke up one day and decided to pursue rxp for no reason. IMO, the thread re: the 10 min med checks really hits the crux of the problem at many levels. Eg. calculating the minimal time to spend with a pt to maximize profit, I think, at least in part, this is related to a deficient supply of psychiatrists to the level where, in a lot of instances, quality and accountability is largely out the window. Demand is so high that some providers (and I'm willing to guess, a lot of them) can justify the 10 min. mentallity without consideration of what would be appropriate referral and treatment (as pointed above), resulting in poor care and increased expenditure (governmental and private). Also, how many times have you heard how a new patient has to wait weeks to months before they can get an intake appointment with a psychiatrist? Medical psychologists can play a tremendous role here.

 

[RGMSU]

I agree that mental health is not considered to be very important as a medical topic, at least compared to others, though this has improved somewhat. Long wait times and attempts to minimize appointment times are by no means unique to psychiatry. You will find this in many medical fields. Ideally, I would think a combination of therapy and medicine would be most helpful with the ADHD and minor depression instances brought up. A psychiatrist doesn't have to do the non-medical therapy themselves rather than have someone they work with perform the role. The referral should be offered as an option, though, when appropriate, whether the psychiatrist intends to do the therapy themselves or not.

 

[stn2006]

when I as working as the ER PA, I could almost guess who management that patient medications. It is dishearten, when consider there are so few privileged psychologists and more psychiatrists in the area.

 

[doctorpsych]

i learned that in classes and i havent even attempted to get RxP. ive seen lithium toxicity in patients who were under the supervision of psychiatrists. any individual can do a crappy job! that doesnt necessarily have anything to do with everyone else who has that title.

yep, good point, check out this newspaper article that highlights your point. Five MDs (one of them a psychiatrist) missed Li tox.

Five Doctors, StumpedExplanation for Woman's
Fast-Growing Tremor Turns Out to Be Elementary By
Sandra G. BoodmanWashington Post Staff WriterTuesday,
May 6, 2008; HE01 A. Bruce Munro wonders how things
might have turned out if he hadn't lost it and dialed
911. The retired obstetrician had watched with
mounting alarm as his wife, Bettie, seemed to get
sicker by the day. For decades her health had been
stable, regulated by medicines she took to control her
cholesterol, blood pressure, Type 2 diabetes, a
thyroid condition and a mood disorder. But in March
2006, Bettie Munro had developed a tremor that became
very bad very fast. Doctors assumed she was suffering
from a rapidly progressive case of Parkinson's
disease, but the neurologist treating her was baffled
about why the increasingly potent drugs he prescribed
didn't seem to help. On Dec. 22, 2006, while Munro was
getting his wife dressed for the day, he snapped. She
had fallen three times and could no longer feed
herself. "I thought, 'This is it, I can't handle this
at home,' " Munro recalled. He picked up the phone and
called for help. An ambulance whisked Bettie Munro
from their house in a Loudoun
County<http://www.washingtonpost.com/ac2/related/topic/Loudoun+County?tid=informline>
retirement community to Inova Loudoun
Hospital<http://www.washingtonpost.com/ac2/related/topic/Inova+Health+System?tid=informline>.
Less than an hour later, a doctor stepped into the
waiting room with stunning news. Bettie Munro didn't
have Parkinson's disease -- or any other neurological
ailment. The cause, so basic a resident should have
suspected it, had managed to elude the four
experienced doctors caring for his wife -- and Munro
himself. "The one smart person in all this was the ER
doctor," said Bruce Munro, who recently celebrated his
80th birthday. "Five doctors learned a lesson that
won't be forgotten." Now 77, Bettie Munro, who spent
three weeks in the hospital and a rehab center, has
recovered completely. She says she remembers little of
her nine-month ordeal. (Memory loss is a symptom of
the problem.) Mostly she recalls feeling perplexed
about her repeated falls. The first occurred in March,
around the time she was recovering from a stomach
virus. She was taking her son and daughter-in-law to
lunch when she fell in the restaurant parking lot for
no apparent reason. She didn't lose consciousness or
hurt herself and insisted she was fine. Soon afterward
she developed a tremor in her hands and consulted a
neurologist. The neurologist said he thought the
problem might be Parkinson's and suggested she take a
drug to control the tremor. Munro decided against it:
Her symptoms were mild, and she was already taking
more than half a dozen medicines. But three months
later, she returned to the neurologist. Her tremor had
gotten worse, and she agreed to start taking a drug
used to treat Parkinson's. Over the summer, her
gastrointestinal problems persisted. Concerned, a
gastroenterologist ordered several tests and then
performed a colonoscopy. He found nothing unusual. In
August, she saw her psychiatrist for a routine
appointment. About the same time, the neurologist
discontinued the first drug, which was costing the
couple $500 a month, and prescribed two less-expensive
medications in an attempt to control the worsening
tremor. But he could not explain why Bettie Munro's
tremor had become so bad. By December, Bruce Munro
said, his wife was "shaking uncontrollably. She'd get
up in the middle of the night to go to the bathroom
and be unable to find the bed. Or she would try to sit
on the edge of the bed, miss, and fall on the floor."
In mid-December her internist saw her. He checked her
cholesterol and blood sugar levels and recommended
that the couple seek a second opinion from a
neurologist. Maybe, he suggested, they should consider
a procedure called deep-brain stimulation, surgery
that involves implanting a pacemaker-like device in
the brain to reduce involuntary movements. Less than
two weeks later, Bruce Munro, who has had open-heart
surgery and was feeling overwhelmed, called 911. He
still vividly remembers the ER doctor's first words:
"He said, 'She's got a lithium level of 2.1,' " Munro
recalled. "I knew that was toxic." A normal level is
between 0.5 and 1.2 millimoles per liter. At high
levels, lithium, which is used to treat mood disorders
including manic depression, can cause tremor,
convulsions, confusion, memory problems, coma and even
death. The drug has a narrow therapeutic range: A bit
too much can be toxic and too little can be
ineffective, which is one reason people taking it
receive blood tests to check their levels. Bruce Munro
was flabbergasted, then chagrined. Despite multiple
work-ups, nobody had thought to order the simple but
essential blood test. Normally, Bettie Munro had her
level checked about twice a year; her most recent test
had been performed several months before her first
fall. Gastrointestinal illness is known to increase
the concentration of lithium in the blood, especially
in elderly patients. The Parkinson's drugs she took
boosted the concentration even further, her husband
said. The symptoms of Parkinson's disease and
persistent intestinal problems were in fact indicators
of lithium intoxication. Her therapeutic dose had
become toxic. "Everyone knew she was taking lithium,
but nobody thought to check it," Munro said. "If they
had, they would have figured out what was going on"
and saved about $100,000 he estimates the tests and
hospitalization cost. Munro's case is not unusual. In
2001, Italian doctors writing in the Journal of
Clinical Neuroscience reported the case of a
72-year-old woman who had been taking lithium and
suddenly developed severe Parkinson's symptoms after a
stomach virus. She was hospitalized with a lithium
level of 3.7; within a few days, after her lithium was
discontinued, her tremor and other symptoms
disappeared. Two days after Bettie Munro was admitted
to Inova Loudoun Hospital, she was able to feed
herself and walk using a walker. She was transferred
to a rehab facility for a few weeks, just in time for
a severe outbreak of norovirus, the highly contagious
intestinal virus, which she contracted. A few weeks
later she was back home, fully recovered. "I feel
great," she said. "I'm back to where I was." Bruce
Munro said that when he informed his wife's doctors
that her problem had been lithium intoxication, they
expressed surprise. One physician said he thought
another had checked her level, so he didn't bother.
"It's the simple things," Munro noted, saying he
wishes he'd thought of it. Bettie Munro is
philosophical. "Having five doctors -- a psychiatrist,
internist, Bruce, a neurologist and a
gastroenterologist -- well, I thought they knew what
they were talking about."

 

[RGMSU]

What is with this anti-physician thing? Folks, there are bad physicians and excellent physicians, just like there are bad psychologists and excellent psychologists. There are bad psychiatrists and excellent psychiatrists. A team of five crappy doctors doesn't prove anything about a physician's ability to manage a patient, nor does it prove anything about a psychiatrist's ability or a psychologist's ability. It proves that five crappy doctors can't manage a patient. So what? You can't make sweeping generalizations about everybody like you folks do on here all the time (eg, psychiatrist = bad, MD=bad, that is the underlying theme over and over). That really doesn't do anything to further your profession. It makes you sound like the quack groups such as chiropractors who are usually anti-physician, and you see how far their profession has gotten.

 

[Therapist4Chnge]

What is with this anti-physician thing? Folks, there are bad physicians and excellent physicians, just like there are bad psychologists and excellent psychologists.

Agreed.

I think it is important to focus on the topic at hand and not get off on anecdotal and largely unproductive "examples".

 

[doctorpsych]

What is with this anti-physician thing? Folks, there are bad physicians and excellent physicians, just like there are bad psychologists and excellent psychologists. There are bad psychiatrists and excellent psychiatrists. A team of five crappy doctors doesn't prove anything about a physician's ability to manage a patient, nor does it prove anything about a psychiatrist's ability or a psychologist's ability. It proves that five crappy doctors can't manage a patient. So what? You can't make sweeping generalizations about everybody like you folks do on here all the time (eg, psychiatrist = bad, MD=bad, that is the underlying theme over and over). That really doesn't do anything to further your profession. It makes you sound like the quack groups such as chiropractors who are usually anti-physician, and you see how far their profession has gotten.

not making "sweeping generalizations", it was a response to stn2006's inflamatory post and just backing up another poster's response that regardless of profession, problems managing patients do occur (that is if stn2006's comments were indeed not based on fabrication). I agree that there are good and bad psychologists and psychiatrists, I've been saying that all along, but I do have the right to respond to a post that I don't agree with. Frankly, I'm sick and tired of physicians/residents/etc who are blatantly attempting to sabotage the rxp movement by using a fear campaign. IMO, that needs to stop, especially in this thread.

 

[RGMSU]

not making "sweeping generalizations", it was a response to stn2006's inflamatory post and just backing up another poster's response that regardless of profession, problems managing patients do occur (that is if stn2006's comments were indeed not based on fabrication). I agree that there are good and bad psychologists and psychiatrists, I've been saying that all along, but I do have the right to respond to a post that I don't agree with. Frankly, I'm sick and tired of physicians/residents/etc who are blatantly attempting to sabotage the rxp movement by using a fear campaign. IMO, that needs to stop, especially in this thread.

Posting a single incident of five physicians who missed lithium toxicity is entirely a sweeping generalization. It is not at all representative of the norm, yet it implies that this somehow proves a psychologist possibly missing a diagnosis is okay because physicians do? Or if a psychologist was on this particular case this wouldn't have been missed? Not really sure what it proves actually. And, it does nothing to prove why psychologists should have prescription rights. Posting instances of psychologists missing/nailing diagnoses and treatments would be much more directly relevant. Like I said, the anti-MD thing really hurts the psychology profession rather than helping it, making it appear fringe like the chiropractic movements and whatnot. If that's the character you want your movement to have, go ahead. That could be why you haven't had a lot of success in many states so far. No skin off my nose. I just don't think it's an effective technique.

 

[busi26]

Posting a single incident of five physicians who missed lithium toxicity is entirely a sweeping generalization. It is not at all representative of the norm, yet it implies that this somehow proves a psychologist possibly missing a diagnosis is okay because physicians do? Or if a psychologist was on this particular case this wouldn't have been missed? Not really sure what it proves actually.

I think the point is that psychologists can effectively prescribe and manage psychotropic meds. Four years of prescribing in Louisiana and no mishaps like those depicted in the aformentioned article.

 

[doctorpsych]

Posting a single incident of five physicians who missed lithium toxicity is entirely a sweeping generalization. It is not at all representative of the norm, yet it implies that this somehow proves a psychologist possibly missing a diagnosis is okay because physicians do? Or if a psychologist was on this particular case this wouldn't have been missed? Not really sure what it proves actually. And, it does nothing to prove why psychologists should have prescription rights. Posting instances of psychologists missing/nailing diagnoses and treatments would be much more directly relevant. Like I said, the anti-MD thing really hurts the psychology profession rather than helping it, making it appear fringe like the chiropractic movements and whatnot. If that's the character you want your movement to have, go ahead. That could be why you haven't had a lot of success in many states so far. No skin off my nose. I just don't think it's an effective technique.

wait a minute, I know you are not saying that "anti-md" sentiments are not ok, but anti-medical psychologist is ok in your perspective. You are quick to coment on a response toward one of your colleages posts, but you are not addressing the nature of stn2006's scare tactics. At least, lets not be selective here.

"I have been in area with prescribing psychologists who tempted to D/c patients’ clozaril and patients came to ER with their symptoms worsen. Don’t’ their psychopharm classes teach them how to difficult it is to titrate the clozaril and the necessity to check the level? I have seems lithium toxicity in patients prescribe by some privileged psychologists that almost kill that patient."

Purportedly your stace is neutral, but what do you make of your colleage's example quoted above? and purposely posting in a psychopharm/psychology thread? (I'm bolding "kill" to show you how inflamatory the allegation was). The rxp movement is actually moving right along, I'm not going to go into specifics but it is... and you are right, the movement is not based on anti-physician rationale (at least, it shouldn't be and this is not the overall presentation in lobbying efforts) but on demand, shortage of psychiatrists, an increasing safety record of medical psychologists providing adequate treatment, lobbying, etc...

 

[RGMSU]

I think the point is that psychologists can effectively prescribe and manage psychotropic meds. Four years of prescribing in Louisiana and no mishaps like those depicted in the aformentioned article.

Yes, but the article doesn't address anything relating to psychologists.

 

[RGMSU]

wait a minute, I know you are not saying that "anti-md" sentiments are not ok, but anti-medical psychologist is ok in your perspective. You are quick to coment on a response toward one of your colleages posts, but you are not addressing the nature of stn2006's scare tactics. At least, lets not be selective here.

"I have been in area with prescribing psychologists who tempted to D/c patients’ clozaril and patients came to ER with their symptoms worsen. Don’t’ their psychopharm classes teach them how to difficult it is to titrate the clozaril and the necessity to check the level? I have seems lithium toxicity in patients prescribe by some privileged psychologists that almost kill that patient."

Purportedly your stace is neutral, but what do you make of your colleage's example quoted above? and purposely posting in a psychopharm/psychology thread? (I'm bolding "kill" to show you how inflamatory the allegation was). The rxp movement is actually moving right along, I'm not going to go into specifics but it is... and you are right, the movement is not based on anti-physician rationale (at least, it shouldn't be and this is not the overall presentation in lobbying efforts) but on demand, shortage of psychiatrists, an increasing safety record of medical psychologists providing adequate treatment, lobbying, etc...

You have a point here. I didn't respond to the statement by stn2006, so I'll give you that one. Honestly, I didn't think it was worth responding to because it was difficult to comprehend what the point of the post was. And, no, I don't agree with scare tactics. A psychologist can be taught to recognize the signs of lithium toxicity just like a medical student or nursing student, etc, can. As long as they are working closely with a physician once problems arise, everything should turn out fine. I still believe there are some cases that are better handled by a GOOD psychiatrist if one is available, but that doesn't mean that a psychologist couldn't safely handle SOME prescription/management rights with the proper education, etc. To me, it's the management that's key. Anybody can be taught an appropriate dosage to prescribe. The trick is handling the unforeseen issues that arise in the management of the patient. That can become quite hairy, though it won't be with everybody. The intractable cases where the psychologist has exhausted their knowledge base, the cases where there are extreme medical comorbidities, or the cases where there have already been medical problems in management by a psychologist, in my opinion, should ultimately find their way to a GOOD psychiatrist, as one is available.

 

[doctorpsych]

You have a point here. I didn't respond to the statement by stn2006, so I'll give you that one. Honestly, I didn't think it was worth responding to because it was difficult to comprehend what the point of the post was. And, no, I don't agree with scare tactics. A psychologist can be taught to recognize the signs of lithium toxicity just like a medical student or nursing student, etc, can. As long as they are working closely with a physician once problems arise, everything should turn out fine. I still believe there are some cases that are better handled by a GOOD psychiatrist if one is available, but that doesn't mean that a psychologist couldn't safely handle SOME prescription/management rights with the proper education, etc. To me, it's the management that's key. Anybody can be taught an appropriate dosage to prescribe. The trick is handling the unforeseen issues that arise in the management of the patient. That can become quite hairy, though it won't be with everybody. The intractable cases where the psychologist has exhausted their knowledge base, the cases where there are extreme medical comorbidities, or the cases where there have already been medical problems in management by a psychologist, in my opinion, should ultimately find their way to a GOOD psychiatrist, as one is available.

very nicely put.

 

[edieb]

http://www.division55.org/Tablet/Vol10No3.pdf

 

[Therapist4Chnge]

There are some interesting articles, but the layout is frustrating. Every page was a different article.....

 

[Therapist4Chnge]

MOD NOTE: If someone is obviously trolling, please report their post and I'll take care of it. -t4c

 

[necodaak8]

I was wanting to know if there are any new developments for psychologists in California regarding prescription. Do any of you think it will ever happen?

 

[Keeg]

While I don't know about any current developments, I do see this becoming a national thing within the next 10 or so years. Eventually every state is going to have some form of this in place, it is just a matter of when, and the specifics in each state.

 

[busi26]

While I don't know about any current developments, I do see this becoming a national thing within the next 10 or so years. Eventually every state is going to have some form of this in place, it is just a matter of when, and the specifics in each state.

I agree. The evidence that properly trained psychologists can safely prescribe psychotropics is piling up thanks to Louisiana and New Mexico. Thus, it is becoming more and more difficult for naysayers to convince congressmen and congresswomen that psychologists shouldn't prescribe.

 

[Therapist4Chnge]

I agree. The evidence that properly trained psychologists can safely prescribe psychotropics is piling up thanks to Louisiana and New Mexico. Thus, it is becoming more and more difficult for naysayers to convince congressmen and congresswomen that psychologists shouldn't prescribe.

California would be a huge win for prescribing psychologist. It is my hope that states can find one set of requirements that both Psychology and Psychiatry/Physicians can agree on, and use that going forward. My only hesitancy with the movement is that it is often being fought for the lowest common denominator. I want to see psychologists able to prescribe nationally, but I'd like to see some of the requirements be a bit more stringent. I've gone through a program, and while I think the program was pretty good, even it could be improved....and it required more than most of the other programs out there.

 

[appelsoranjes]

While I don't know about any current developments, I do see this becoming a national thing within the next 10 or so years. Eventually every state is going to have some form of this in place, it is just a matter of when, and the specifics in each state.

I agree but the timeline will likely be longer than 10 years. I also think psychiatry will eventually merge back with neurology and their scope will change towards non-pharmacological interventions (e.g., ECT, DBS) - much like their scope changed from therapy to pharmacology during the last "scope creep"

 

[medium rare]

Getting something like RxP through a state legislature requires a united, focused, and unwavering collective effort. The last time Cali tried to push for RxP, there were two groups who dropped bills at the same time - the CA state psychological association and a fringe group of psychologists lead by NAPPP. Needless to say, there was little progress and both bills went down in flames. With this kind of "advocacy," it's better to do nothing than shoot each other in the foot.

 

[RGMSU]

I agree but the timeline will likely be longer than 10 years. I also think psychiatry will eventually merge back with neurology and their scope will change towards non-pharmacological interventions (e.g., ECT, DBS) - much like their scope changed from therapy to pharmacology during the last "scope creep"

Hah, they may merge back with neuro, but they're not limiting their scope to ECT. There are other waves of the future in medicine. ECT is not it.

 

[StacyTXLPC]

I apologize if this has already been addressed, but this thread is huge...

Is there an accurate listing of universities that offer an MS in psychopharmacology?

 

[doctorpsych]

I apologize if this has already been address, but this thread is huge...

Is there an accurate listing of universities that offer an MS in psychopharmacology?

APA's Division 55 website:

http://www.division55.org/index.htm

 

[JazzPsych]

Hi there American psychologists, psych students en medstudents,

For the last couple of days i've been reading up on alot of "studentdoctor" posts considering prescription privileges for properly trained clinical psychologists.

I'd like your opinion on the current Dutch situation regarding this issue.
Since the world always seems to follow America, the Netherlands does too.
Our RxP movement has only started a few years ago conducting literature research and doing surveys and has now progressed into a phase of actually educating people.

The situation:

In the Netherlands the group that is after the prescription privileges are the "clinical psychologists". This group received their official "specialist-status" in 2006. This makes them officially equal to the medical specialist (psychiatrist, internist etc). The Dutch clinical psychologist's education:

- 3 years of bachelor psychology
- 1 year of "master of clinical psychology"
- 2 years of "Healthcarepsychology" (which is a combination of working 4 days a week and studying 1 day a week).
- 4 years of specialization to become a "Clinical psychologist with a BIG regiatration". (Again 4 days of work and 1 day of education/research a week)
--> Dutch clinical psychologists are trained both to conduct research and to practice in the field.

This comes to a total of 10 years. In America it is 6-7 years if i understand correctly.

The Dutch RxP movement has been working closely with the university of New Mexico to create a 2-year curriculum that trains these Clinical Psychologists to prescribe and advice on psychotropic meds.

Their strategy was to first educate one group of about 20 clinical psychologist and then to start the national lobby to gain the actual privileges. This strategy has proven succesful with other professionals acquiring prescription privileges. They started their 2nd year a few months ago, so next year they'll be ready.

The Clinical psychologist, with a 10 year study (12 with the psychopharmacology training) currently makes about 100.000 dollars in salaries employment a year, which is about 65.000 in euro's. In comparison psychiatrists make at least 140.000 dollars a year. In private practice, clinical psychologists actually make less and psychiatrists make ALOT more.
Fortunately, there is now a separate movement that is involved in improving the position and the salary of clinical psychologists.


So what are your thoughts on a clinical psychologist with 10 years of education pursuing prescription privileges. Is it any different form the American situation? And what do you think of rest of the Dutch situation?
You guys seem miles ahead of the Dutch regarding discussion about this issue. So please enlighten me!

Thanks!

 

[Therapist4Chnge]

This comes to a total of 10 years. In America it is 6-7 years if i understand correctly.

In America, it is a bit longer than 6-7 years.

4 years undergraduate education
4-5+ years of graduate training
1 year internship
1 year post-doc
2 year post-doc graduate training
1 year internship/residency
--------------------------------------
13-14 years of education

 

[JazzPsych]

Alright. That's good. Didn't mean to insult the american clinical psychs

If it's 13-14 years for American Clin. Psychs then how many years does it take to become a psychiatrist in America?

In Holland it's 10 as well, like the clinical psychologist. So yearwise they're equally educated. It might shine some light on my psychiatrist/psychologist comparisons.

Besides this, I see people talking about mid-level practitioners. How many years have they been in school?

 

[Therapist4Chnge]

Alright. That's good. Didn't mean to insult the american clinical psychs

If it's 13-14 years for American Clin. Psychs then how many years does it take to become a psychiatrist in America?

In Holland it's 10 as well, like the clinical psychologist. So yearwise they're equally educated. It might shine some light on my psychiatrist/psychologist comparisons.

Besides this, I see people talking about mid-level practitioners. How many years have they been in school?

13-14 would be for prescribing psychologists...the last 2 items I listed wouldn't apply for regular psychology licensure.

As for psychiatrist training:

4 years undergrad
4 years med school
4? years residency (? because it depends if the person is general, child, combo, etc)

Mid-levels would be PAs and NPs, who's training can greatly vary because of "previous experience". Straight through can be problematic because some of the education is based on the assumption the person has outside experience, though not all programs assume that.

From my understanding, PAs require 4 years undergrad, 2 years of PA school, and then a residency training period....which depends on your area of study.

NPs require an RN (nurse) for entry....and I believe a bachelors (BA/MS), though there are bridge programs that can get <BA/BS people through to the NP without adding too much time. This is where the "straight through" part comes into play. The NP was originally setup for experienced nurses to prescribe, though since then there have been some "direct entry" programs that put all of the schooling first, and pop out fresh NPs without much related experience. People seem to argue about which path is better, but that is a discussion outside of the topics here.

 

[doctorpsych]

Alright. That's good. Didn't mean to insult the american clinical psychs

If it's 13-14 years for American Clin. Psychs then how many years does it take to become a psychiatrist in America?

In Holland it's 10 as well, like the clinical psychologist. So yearwise they're equally educated. It might shine some light on my psychiatrist/psychologist comparisons.

Besides this, I see people talking about mid-level practitioners. How many years have they been in school?

I don't think anybody got insulted... in anycase, I'm glad to see that rxp movement has been making headways in other countries as well... heard that the Canadians and the Aussies are making movement as well. In the U.S. it takes about 4 years of undergrad in psychology (or in some cases, related major), then 6+ years of graduate training (including master's and including at least 2-3 externships--part time and 1 year of full time internship), then 1 year of supervised post-doc, than take the licensing psychology exam...so to get licensed as a psychologist it could take as much as 10+ years of coursework. If you want to pursue psychopharm, then 2+ years of coursework plus 1 year of supervised experience and take the exam...so total to practice psychopharm as a psychologist is 12+ years...

For psychiatrists, I believe is the following (feel free to correct me if I'm wrong) it's 4+ years of undergrad, 4 years of medschool (including rotations) and 5 years of residency (1 year internship and 4 years actual residency). There is also the option to pursue fellowships (e.g. forensics, child/adolescents, substance abuse, psychosomatics, geri, etc) which they can run from 1-2 additional years... so total to practice psyschiatry is 13+ years...

But this is purely a time comparison, training content is different off course.

As per mid-levels... if you are talking about social workers, it's 4+ year undergrad, 2+ years of gradwork...I believe for mental health counselors is similar in terms of years... again different emphasis in content.

Is the medical coverage in Holland socialized? (fully/partially) how are healthcare providers reimbursed? Have there been any bills introduced in holland in terms of rxp? Is it a national movement or local (e.g. regional, like here it's by State). What's the timeframe to anticipated passage of legislation?

 

[JazzPsych]

Right, those numbers are pretty interesting.

It seems then, that in America prescribing psychologists and psychiatrists are about equally educated, yearwise that is.

In Holland the curriculi are pretty strict. For both the clinical psychologist and the psychiatrist it's 10 years. Some parts of it (like the postdocs) are harder to get into for psychologists though. Since there's a shortage of psychiatrists they have an easier time getting into them.

With 2 years of RxP training the clinical psychologists would have a 12-year training, where the psychiatrist only has 10. I guess this is somewhat of a advantage we Dutch clin. psychs have in the "competency" discussion.

Responding to your questions Doctorpsych, the Dutch movement has really just started. They have chosen the strategy of starting out with the training and pursuing the passage of the legislation after. They have just started their 2nd year of training and will be done in september 2010.

About a year ago, when they started the 2-year course (in collaboration with the university of New Mexico) the Dutch Psychiatric Association responded by saying: "the clinical psychologists are playing doctor, it's ridiculous they have no medical background or whatsoever".

The laypersons and even fellow university students I speak to seem awfully narrowminded. Without even thinking it over, they often just respond by saying psychologists shouldn't prescribe. That ticks me off, you'd expect more from academics. At least give it some thought? Ofcourse I never let them get away with it and seem to always persuade them. That's what every psychologist should do right? To me that's part of showing you're proud of your profession and giving it a solid name.

Holland is but a small country, so there's no need for us to pursue it state by state. Not sure if that is an advantage though. What do you guys think? I'm glad America does use this system though. It is providing all of us with data showing clinical psychologists prescribe safely.

In private practice, psychotherapy is reimbursed for about 90% for 8 sessions. After that, it's up to the patient to pay the full price of the remaining sessions that year.

The hourwages are about: 110-120 Dollar for a clinical psychologist and 210 Dollar for a psychiatrist. This is the current situation (psych not prescribing yet).

On a side note, a recent Dutch study (2008) has shown that non-MD-professionals prescribe as good and often better than MD's! Patients actually often seem more with satisfied with non-MD prescribing.
Of course we already knew this but more scientific proof is never a bad thing imo.

Another thing that i'm curious about is the salary thing. We all know psychiatrists make more than psychologists do.

Assuming they have an equal education (at least yearwise) is there ANY reason that a psychiatrist should make more money than a prescribing psychologist? And is this any different when you compare it to the Dutch situation where the prescribing psychologist will have a 12-year edu, in comparison to a psychiatrist with 10?

 

[doctorpsych]

About a year ago, when they started the 2-year course (in collaboration with the university of New Mexico) the Dutch Psychiatric Association responded by saying: "the clinical psychologists are playing doctor, it's ridiculous they have no medical background or whatsoever".

yeah, well that's the general sentiment here in the US as well, but it's really a generic statement with no critical thinking behind it.

The laypersons and even fellow university students I speak to seem awfully narrowminded. Without even thinking it over, they often just respond by saying psychologists shouldn't prescribe. That ticks me off, you'd expect more from academics.

well, that's a good question that I would like to ask other members for their opinion? Why do you think that the group of psychologist who oppose rxp tend to be academics (not all off course) and what do you think is their rationale (overt and covert)?

what I can think of is that there is the inherent belief that by pursuing rxp, psychologist are selling out to medicine... others may think that it creates a caste system with medical psychologists being on top... others fear that medical psychologists will drive up insurance costs onto non-medical psychologists (which is btw completely untrue)... perhaps academics may also be resistant in the idea of change, for all these years, they have been teaching psychology... with the movement gaining more ground, now they have to incorporate additional knowledge base into unfamiliar territory...

In anycase, IMO, the academics would benefit from embracing rxp, opens the door for more research, grants, and dissamination of applicable and applied knowledge...in addition to a more comprehensive view on human behavior and pathology.

On a side note, a recent Dutch study (2008) has shown that non-MD-professionals prescribe as good and often better than MD's! Patients actually often seem more with satisfied with non-MD prescribing.
Of course we already knew this but more scientific proof is never a bad thing imo.

interesting...can you cite the study, is it online?

Assuming they have an equal education (at least yearwise) is there ANY reason that a psychiatrist should make more money than a prescribing psychologist? And is this any different when you compare it to the Dutch situation where the prescribing psychologist will have a 12-year edu, in comparison to a psychiatrist with 10?[/QUOTE]

well, lets give credit to where its due... going to med school and finishing up residency is no walk in the park. There are psychiatrists that are great at what they do and should be compensated for that... the problem that I have are with the quality of some of the psychiatrists... not sure about Holland, but in the U.S. psychiatry as a field in medicine is not ranked as high as compared to other medical specialties, so the field tends to draw not the best candidates from the pool. In many instances, this opens the door for individuals outside of the U.S. whose goal is to use psychiatry residency as a path of least resistance into the U.S., which on some situations, they are not motivated to keep best practices as the main goal in treatment. Some off course are very good...

 

[Ollie123]

well, that's a good question that I would like to ask other members for their opinion? Why do you think that the group of psychologist who oppose rxp tend to be academics (not all off course) and what do you think is their rationale (overt and covert)?

As someone planning on an academic career, I can answer for myself, though I suspect many of my colleagues have similar concerns.

I don't care about the insurance issues, and I'm hugely biologically focused so I'd love to see it infused more into the curriculum. As for as it opening new doors...I'm not sure how. Plenty of us do pharm research already, and many have been for decades. I doubt RxP will change how we're doing any of that.

Your first point...that "medical psychologists" will be on top, is actually the opposite of the concern that I have heard. That RxP is actually going to demote us from a group that to some extent is able to operate outside the medical hierarchy, and is on top of the food-chain as therapists, to being viewed as just another mid-level. I can see the concern, though it seems a relatively minor one in my eyes and more of an excuse than a reason.

I think you'll find that many more academics are not opposed to RxP in principle, just the current system being set up, and the driving force behind them. I place myself in this camp, I know of at least one prominent academic who has expressed a viewpoint very similar to my own in writing, and a number of others I've spoken to on the issue. Largely, the concern is that the push for RxP and RxP training is largely coming from institutions we don't trust to begin with. We have huge quality control issues in the field already, and I'm not sure how we can justify pushing to expand our practices when we aren't even doing a good job within our current scope of practice. If I was convinced people were going to be adequately trained to prescribe, I'd be all for it. Many of us think a sizable number of schools are not even adequately training people to be therapists at the present moment. To be fighting to expand our practices right now seems (pardon the language) - incredibly ballsy. These are frequently the schools where the RxP push is coming from, and I suspect the schools that are likely to throw together haphazard training programs as soon as there is an adequate market for it, and welcome in anyone with a checkbook.

 

[doctorpsych]

These are frequently the schools where the RxP push is coming from, and I suspect the schools that are likely to throw together haphazard training programs as soon as there is an adequate market for it, and welcome in anyone with a checkbook.[/QUOTE]

that is certainly an issue to be concerned about... but there is always going to be good and bad programs... not all Psy.D. programs are bad, there are some really excellent ones (e.g. Rutgers comes to mind) that I would be happy to exchange my Ph.d. with... IMO, there's definately a need for quality assurance for the existing psychopharm programs, but at the same time, at this stage of the movement, we need programs to sustain the movement. Ideally, reputable institutions should also be in the market to drive competition and also direction of the field. In any case, the PEP is also screening out quite a bit of the not so great apples of the bunch. The issue of quality control is in pretty much in every field as you can imagine but IMO, given the huge need, we shouldn't be stepping on the breaks on full force but we should fix the problems along the way (e.g. accreditation, more stringent guidelines, etc).

 

[AlaskanJustin]

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?

So just to correct some inaccuracy, PAs arent just bachelors degrees, they go through extensive (2-3 years, sometimes more) of post graduate training, see UCHSC's program for details.

I would also fix some of the other bits i.e., nurses, even practicing nurses, prescribe under the guidance of a medically trained doctor, and for our sake we will say MDs because I have my own issues with DO programs which are beside the point here. Remember a doctor is the responsible party but in the case of a PA, isnt always the prescribing clinician, problematic I know but that skews the data, OF COURSE a PA will have safer practice, simply because he is not responsible, the MD is.

Now this is not to say that a PhD psychologist couldnt prescribe pills, say in a limited manor similar to how Dentists can only prescribe basic pain pills and anaesthesia. I have two qualms with this.

1) It takes far more than a basic psychopharm class and maybe a basic med class to understand things like drug interactions, drug effects on physiology, etc. So IF you are to give privilages, the extent of training needs to be vast, the extent of the privilages well-defined and limited, and there needs to be a standardized testing criteria (hopefully similar to the DEA license given to MDs) before giving such privilages.

2) This still does not account for an underlying issue that is at the heart of the psychology/psychiatry difference, psychologists treat the underlying problem related to the behavioral and cognitive issues that lead to the manifested abnormal psychopathologies while psychiatrists treat the outlying symptoms of such psychopathologies. For instance, give a psychiatrist a MDD patient and he prescribes an anti-depressant, give that same MDD patient to a clin. psychologist, and he tries to treat the underlying problem. Now imagine giving the clin. psychologist the same prescription privilages as the MD (psychiatrist), due to the recession and insurance restrictions, I guarantee the psychologist will prescribe an anti-depressant too. Now who will take care of the underlying problem???

I know for a fact that option 1 could be handled, but I fear that by allowing for option 1 you open a whole new pandora's box in option 2. It sounds so nice and pretty to be able to prescribe pills to a patient, and in fact in some cases such as schizophrenia or autism that may be true, but I still don't see it being necessary.

Your true battle, if you really want to be an advocate should be for the extended insurance coverage of clinical psychological treatments that have a basis from evidence. Riding a golden horse for prescription privilages, in my honest opinion, will cause more harm than good in the long run, ultimately its exactly what both insurance companies AND pharmaceutical companies want, but is not what is best for the patient.

Very sincerely,

Justin

 

[edieb]

Coming from a state wit RxP, I can tell you that psychologists who prescribe just don't hand out pills. They prescribe judiciously and when they do prescribe, they combine it with psychotherapy. There is data in the DOD study corroborating this..

I am paraphrasing the findings but the researchers discovered that when patientys saw psychiatrists, they were almost guaranteed to receive medications. However, when they saw a psychologist, they were much, much less likely to receive meds. Level of psychopathology, based on the patients' diagnoses and symptoms per objective rating scales, were controlled for among the patients

However, I definitely agree with you that psychaitrists, unlike psychologists, do nothing to treat the underlying problem.

 

[AlaskanJustin]

Coming from a state wit RxP, I can tell you that psychologists who prescribe just don't hand out pills. They prescribe judiciously and when they do prescribe, they combine it with psychotherapy. There is data in the DOD study corroborating this..

I am paraphrasing the findings but the researchers discovered that when patientys saw psychiatrists, they were almost guaranteed to receive medications. However, when they saw a psychologist, they were much, much less likely to receive meds. Level of psychopathology, based on the patients' diagnoses and symptoms per objective rating scales, were controlled for among the patients

However, I definitely agree with you that psychaitrists, unlike psychologists, do nothing to treat the underlying problem.

I would be curious which state that is, New Mexico? I say this because I only question the sample pool, the economy in the area, all the other socio, and especially socioeconomic factors in the area. I have a friend/roommate that is from NM and she said the same thing, but when it came down to it, the sampling was not of newly licensed psychologists it turned out it was of long-time practicing psychologists, so it makes sense they would be far more likely to stick to their "old ways" so to speak.

J

 

[edieb]

Yes, psychologists "sticking to their old ways" MUST be the explanation, lol!

 

[medium rare]

...nurses, even practicing nurses, prescribe under the guidance of a medically trained doctor...

This is not accurate for all states. Nurse practitioners have fully autonomous practice including Rx authority in 13 (now 14 counting Colorado) states and jurisdictions. In these areas, there is no requirement for physician involvement in any aspect of NP practice. In most other states, NPs practice independently within a written collaborative agreement with a physician in their specialty. This is not supervision, per se, unless it is set up that way. Some states (2-3) do require actual supervision by a physician. http://webnp.net/downloads/pearson_report09/pearson09_tables_maps.pdf

This is different from PAs. PAs always require physician supervision to practice even if this supervision is informal or 'on paper' only.

This difference is the main reason I pursued the NP over PA when I wanted to add Rx authority to augment my practice as a psychologist.

 

[Summit02]

I have read some of the arguments made here and I think there are some good ones and some really stupid ones.

Yes we need more people to treat mental illness.
Yes they should come from a mental health background.

However, having a psychology degree (which I also have in addition to my chemistry degree) does nothing to prepare you for medicine.
The idea that you can take a pharmacology course and an "assessment" course is absurd.
Your PhD almost useless and the PsyD isn't much better (although it is better).

Having said that, there are things you can do to get prescription rights.
1) The easiest would be (which I doubt most egos would allow) is working like an NP or PA. You wouldn't be an independent practitioner (at least with medications) but you would increase access to care.
2) Undergo a thorough clinical program that is 'hard' science based and includes all basic aspects of medicine. I would suggest the 1+1+2 program which is basic science+rotations+mini residency in 4 years.
3) Be willing to undergo a rigorous testing program that weeds out the chaff and is Biologic/Physical science based. Akin to the MCAT, or just take the MCAT.
4) This should be open to RNs/LCSWs as well as long as they meet the admission criteria. If turf is that important, incorporate this into the PhD or PsyD or get a medical school to sponsor you. However I doubt a medical school will sponsor you unless you do #1 first.

Just my few cents. As a psychiatrist I think psychologists that want to prescribe often (not always) have a chip on their shoulder and a self esteem problem. You could have had prescription privileges in every state by now if you didn't want your way and your way only.

Work with the system a little more and your goals are that much closer. Play the politics game and you are going to be out of luck for much longer.

 

[Summit02]

This is not accurate for all states. Nurse practitioners have fully autonomous practice including Rx authority in 13 (now 14 counting Colorado) states and jurisdictions. In these areas, there is no requirement for physician involvement in any aspect of NP practice. In most other states, NPs practice independently within a written collaborative agreement with a physician in their specialty. This is not supervision, per se, unless it is set up that way. Some states (2-3) do require actual supervision by a physician. http://webnp.net/downloads/pearson_report09/pearson09_tables_maps.pdf

This is different from PAs. PAs always require physician supervision to practice even if this supervision is informal or 'on paper' only.

This difference is the main reason I pursued the NP over PA when I wanted to add Rx authority to augment my practice as a psychologist.

This is true in many states although there has to be 'an understanding' of sorts. This is the route psychologists should pursue. I have many colleagues who are simply scared of psychologists prescribing because they truly believe that they aren't capable. After prescribing with physicians, psychiatrists or probably other PCPS for a few years, they could easily expand their scope.
I think medical schools would be more willing as well to get into the arena of teaching psychologists, giving them more legitimacy.

One of the main problems is where and how you can get a doctorate in psychology. A "medical psychologist" or whatever you would call them, would have to be fully vetted and there would be no questions as to the quality of their training (of course that doesn't mean their won't be idiots, as in psychiatry).

I'm not saying that the elitism of the medical profession will end after this but then again, I often see psychologists making sure RNs and LCSWs call them 'doctor' while the pharmDs on the wards are 'mike' and 'alice'

 

[edieb]

This is true in many states although there has to be 'an understanding' of sorts. This is the route psychologists should pursue. I have many colleagues who are simply scared of psychologists prescribing because they truly believe that they aren't capable. After prescribing with physicians, psychiatrists or probably other PCPS for a few years, they could easily expand their scope.
I think medical schools would be more willing as well to get into the arena of teaching psychologists, giving them more legitimacy.

One of the main problems is where and how you can get a doctorate in psychology. A "medical psychologist" or whatever you would call them, would have to be fully vetted and there would be no questions as to the quality of their training (of course that doesn't mean their won't be idiots, as in psychiatry).

I'm not saying that the elitism of the medical profession will end after this but then again, I often see psychologists making sure RNs and LCSWs call them 'doctor' while the pharmDs on the wards are 'mike' and 'alice'

You act like you're so objective and egalitarian in regards to whom should be called "doctor" and then make an elitiist remark about psychology and the term "doctor" ....You MUST be kidding?. As far as where you can get a PhD in psychology, I am sure you know that you can get an M.D. from many medical schools based in third world countries. My ex bf, a U.S. citizen, got his in Grenada, lol. On top of that, many (most) psychiatrists come from medical schools located in the third world! How is that for standards???

A PhD program in clinical psychology is harder to get into than a medical school and PhDs are the original doctors. Anyway, you're degree in psych is a bachelor's degree, BIG DIFFERENCE from a PhD, bud!

PLEASE get your facts right!

 

[Therapist4Chnge]

who are simply scared of psychologists prescribing because they truly believe that they aren't capable.

What are their opinions of the prescribing psychologists in New Mexico, Louisiana, and the Armed Forces? There has been a decade of prescribing, though the bulk of it has happened in the last few years.

After prescribing with physicians, psychiatrists or probably other PCPS for a few years, they could easily expand their scope.

I am supportive of a collaborative model (and not an independent one), so we agree on this point. I think being able to collaborate will benefit everyone involved.

I think medical schools would be more willing as well to get into the arena of teaching psychologists, giving them more legitimacy.

While I'd argue we don't need help with legitimacy, I do think it'd be useful to have MDs/DOs more involved in teaching some of the classes. I took classes from DOs, PharmDs, and PhDs, and I think the mix provided a better education than if all were PhDs or MDs/DOs.

I think it'd be an easy transition considering psychologists are already involved at medical schools, in the hospitals and on the faculty. The vast majority of the fellowships I am applying to have appointments to faculty and require teaching/mentoring medical students during the fellowship years. If the politics can be worked out (big if), I think there is an opportunity to tighten up the standards, provide a solid education, and leverage the expertise of the instructors.

 

[CGOPsych]

I have read some of the arguments made here and I think there are some good ones and some really stupid ones.

Yes we need more people to treat mental illness.
Yes they should come from a mental health background.

However, having a psychology degree (which I also have in addition to my chemistry degree) does nothing to prepare you for medicine.
The idea that you can take a pharmacology course and an "assessment" course is absurd.
Your PhD almost useless and the PsyD isn't much better (although it is better).

Having said that, there are things you can do to get prescription rights.
1) The easiest would be (which I doubt most egos would allow) is working like an NP or PA. You wouldn't be an independent practitioner (at least with medications) but you would increase access to care.
2) Undergo a thorough clinical program that is 'hard' science based and includes all basic aspects of medicine. I would suggest the 1+1+2 program which is basic science+rotations+mini residency in 4 years.
3) Be willing to undergo a rigorous testing program that weeds out the chaff and is Biologic/Physical science based. Akin to the MCAT, or just take the MCAT.
4) This should be open to RNs/LCSWs as well as long as they meet the admission criteria. If turf is that important, incorporate this into the PhD or PsyD or get a medical school to sponsor you. However I doubt a medical school will sponsor you unless you do #1 first.

Just my few cents. As a psychiatrist I think psychologists that want to prescribe often (not always) have a chip on their shoulder and a self esteem problem. You could have had prescription privileges in every state by now if you didn't want your way and your way only.

Work with the system a little more and your goals are that much closer. Play the politics game and you are going to be out of luck for much longer.

Summit,
I agree with all your statements about medicine, though not about psychology. I don't agree with the notion that Psy.D.'s as a group are more capable clinicians than Ph.D.'s trained in a scientist-practitioner model. For the latest, see Baker et. al in Psychological Science in the Public Interest, available to the public through the Association for Psychological Science. While "Psy.D." sounds like an interesting idea - focusing only on practice - in reality it is the degree most often issued by proprietary schools with highly controversial reputations for undertraining in clinical psychology as a health science. Individual Psy.D.'s may indeed be very proficient, but in comparing groups, the Psy.D.'s have a troubled reputation.

But let's move on ...
There are always two main issues here: One is whether psychologists can be trained to prescribe safely and appropriately. The answer is yes, but the details are obviously important. I mean, your mailman can be trained to prescribe if "properly trained", true?.

The other issue is whether that "yes" is an endorsement of the national political turf war waged by the American Psychological Association and its ludicrous model for allegedly training psychologists to practice medicine. The answer is a resounding "NO". However, the propaganda from APA consistently conflates the two issues so as to imply that most psychologists support APA's turf war model, and all the political, educational, professional and ethical lines it crosses.

Under the APA model the following would be true:
A psychologist qualified for this "medical education" could have entered his psychology graduate school with no biological sciences coursework. He could (and almost always does) get his doctorate in psychology having taken only one such course that is required, a survey course called "biological bases of behavior."

To be admitted for this "medical education" program, no coursework in biological sciences is required. There is no entrance exam. Therefore someone almost totally naive to biological science could begin this program to learn to practice medicine.

The APA model calls for 300 "contact hours", a term that is part of their misleading marketing, since semester hours wouldn't sound very impressive, about 6.6 semester courses of 3 credit hours each. That is the full curriculum standing between someone with no education, or experience, in medicine or biological sciences, and practicing medicine. But wait, it gets worse:

This medical education can be and most often is taken through correspondence school. Excuse me, I mean "Distance Learning." For example, about half those trained by CSPP get their medical education online, and the entire Farleigh-Dickinson program is through correspondence school. They used to call it a certification, but that doesn't sound very good, does it? So they changed it to a "Master's Degree in Psychopharmacology" ... and they charged the students more for the master's rather than just a certification. Hey, it's a business after all.

Such graduates have to pass a test. And who wrote the test? Oh ... it's the American Psychological Association. Fancy that.

This what APA has been pushing for years, but they hide under phony statistics like "most psychologists support obtaining prescription privileges for properly trained psychologists."

I'll give you a REAL statistic from a well-managed survey published in an APA journal (though it was buried in the article): 78 percent of licensed clinical psychologists say that prescribing psychologists should meet the same training standards as other non-physician prescribers. So the rank-and-file psychologists mainly show good sense, as opposed to the political power-players at APA.

So is 300 "contact hours" online for persons with absolutely no other biomedical education equivalent to what PA's or APN's undergo? I don't think anyone in their right mind would allege that. I checked a local university with a PA program, and they require 300 "contact hours" (20 semester credits) in biological sciences as pre-requisites just to be admitted to their program. Then it's 27 months long, full-time, including a year of practica, and not online. In fact, from what I could tell, a graduate of the APA medical education system would not be qualified to even be admitted to such a program.

Your idea of training psychologists through the medical education system is a good one. However, APA will never, ever agree to that, and here's why:
1. A major force behind this is the proprietary psychology schools that profit from this training. CSPP charges $10,000 a person and can do it online. These schools are the major industry influencing policy in the practice-oriented sectors of APA. Requiring medical training would freeze them out.
2. This would fail to incorporate medicine into psychology and deprive APA of the additional political power its leaders crave to set mental health policy. If they can weaken psychiatry, then APA could be the biggest player at the healthcare table.
3. APA would also fail to fully reap the financial benefits of incorporating medicine into psychology, mainly from the massive resources of the pharm industry. Fact is, a very large portion of the American Psychiatric Association's annual convention is paid for with drug money. Look at how much advertising is in psychology journals compared to medical journals, which look like Good Housekeeping with all their color multi-page ads. It's a no-brainer. The American Psychological Association is in financial straits and has been in the red several years in the past decade. I'm told they're laying people off.

This is about money and power, and it's not about the truth, professionalism, or the good of those who do indeed need better mental health treatment.

Summit, you are right that thousands of psychologists could be prescribing by now if they took the route you suggest and got a real medical education. In fact, a psychologist with PA training would be worth his weight in gold. But APA has no interest in that.

 

[Summit02]

When I say the PsyD is better, I mean the idea is better. I have very little practical idea of this program. Most of my knowledge is theoretical or second hand as none of the big university programs I know of support this program.

I jsut mean that they should follow it by mandating strict admissions process with science prerequisites, a science/medicine based program that would make it more legitimate.
Whether or not you think it needs legitimacy, it does. From physicians, nurses, PAs, NPs and also psychologists. Most importantly from patients.

As far as the last post and 300 hours. I agree. That is just ridiculous even if it was hands on care. Considering that medical students and residents work 80 hours a week, thats less than a month of work.
I would never let an intern (who has completed 4 years of medical school) with a month of experience prescribe medications independently to me.

The politics I don't know about but thats something thats up to the psychologists. There are politics on all sides. As a recent graduate I know that residents have complained about pharma for years and now most large institutions don't allow them on site. If you yell and scream to your own institution, they will change.

 

[Summit02]

[/B]

You act like you're so objective and egalitarian in regards to whom should be called "doctor" and then make an elitiist remark about psychology and the term "doctor" ....You MUST be kidding?. As far as where you can get a PhD in psychology, I am sure you know that you can get an M.D. from many medical schools based in third world countries. My ex bf, a U.S. citizen, got his in Grenada, lol. On top of that, many (most) psychiatrists come from medical schools located in the third world! How is that for standards???

A PhD program in clinical psychology is harder to get into than a medical school and PhDs are the original doctors. Anyway, you're degree in psych is a bachelor's degree, BIG DIFFERENCE from a PhD, bud!

PLEASE get your facts right!

1) I was kidding.
2) Be the OG original doctor all you want. Yell it from the rooftops chief.
3) Your xenophobia is disgusting.