Psychopharmacology/Advanced Practice Psychology

[PsychPhDone]

I'm sympathetic to this question, but I wonder how the required standard of psychotherapy training is determined. Is it enough to show that practitioners at a certain level of training have such-and-such level of adverse outcomes (however those are defined)?

I'm still developing what I think a good standard would be. For discussion's sake, what about state's requirements for licensure? I'd prefer something performance-based (as in in-session performance) over hours-based, but is that a start?

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[deleted106747]

I'm still developing what I think a good standard would be. For discussion's sake, what about state's requirements for licensure? I'd prefer something performance-based (as in in-session performance) over hours-based, but is that a start?

Hm. My developing model for this wouldn't be that psychologists meet psychiatrist training standards for meds, or psychiatrists meet psychologist training standards for psychotherapy - otherwise, why pick one field or the other, instead just have one big field that everyone goes to. I think it's more of a shortened training for both, with ongoing supervision. And the psychiatrist's practice would be primarily meds with some psychotherapy, and the psychologist's practice would be primarily psychotherapy with some meds. I think the standard would have to be something entirely new. I'd base psychologist med training on NP training, and psychiatrist psychotherapy perhaps on LMHC, unless someone has a better idea for that? I feel like I have a better sense of NP than I do of LMHC training.

The point of this, to me, is addressing patient need. If the training becomes 20 years long, that goal goes in the toilet. The solution, in my mind, is for us to work together better.

Ideally, a group of psychologists and a group of psychiatrists who are relatively non-defensive about guild issues would get together and plan this. I'd love to be on that board!

 

[thepug]

I've been looking into this and it seems like all the programs MAKE you take 2 years to finish roughly 30 credit hours...what the heck? They split it up so you're taking like one class every weekend. 30 hours can be done in 1 year. I assume the reason for this is because the programs are to new to have a sufficient amount of faculty teaching the classes to run people through in a year.

My question is, can you do the practicum hours while completing the degree and how many hours do you need? It seems some programs make you start the practicum after 2 YEARS of courses. I guess I can stomach that if I am working in a practice in the meantime, but it really depends on how long that practicum is supposed to be following the courses.

Please for the love of God do not "yahoo answers" me on this and give me a link or some non-decisive answer on this; if you don't know, don't post. This kind posting just derails hot-topic arguments.

To sum it up, how many years after graduation does it take to have rxp? I assume the post-doc would be in medical psych.

 

[stigmata]

I've been looking into this and it seems like all the programs MAKE you take 2 years to finish roughly 30 credit hours...what the heck? They split it up so you're taking like one class every weekend. 30 hours can be done in 1 year. I assume the reason for this is because the programs are to new to have a sufficient amount of faculty teaching the classes to run people through in a year.

My question is, can you do the practicum hours while completing the degree and how many hours do you need? It seems some programs make you start the practicum after 2 YEARS of courses. I guess I can stomach that if I am working in a practice in the meantime, but it really depends on how long that practicum is supposed to be following the courses.

Please for the love of God do not "yahoo answers" me on this and give me a link or some non-decisive answer on this; if you don't know, don't post. This kind posting just derails hot-topic arguments.

To sum it up, how many years after graduation does it take to have rxp? I assume the post-doc would be in medical psych.

To demand a clear and concise response one has to form an equally clear and concise question. Every program has its differences, and the laws in NM and LA differ significantly. The specific regs for each state can be found on their psychology board webpages. Although some have completed the training right after their doctorate and/or during their post-doc the programs are meant for more seasoned psychologists. Their is no post-doc with these degrees as post-doc hours are a requirement for licensure as a psychologist and these programs are meant to occur after one is licensed. The practicums vary significantly but involve supervised assessment and prescribing by a physician, so it could take a few months to a few years depending on your access to a medical doctor and patients.

 

[Therapist4Chnge]

Rushing through a program is the wrong way to approach this type of training. The programs are already condensed (for better or worse), so I'm not sure trying to rush through any of them is really advisable.

 

[thepug]

Rushing through a program is the wrong way to approach this type of training. The programs are already condensed (for better or worse), so I'm not sure trying to rush through any of them is really advisable.

Did that really need to be said ? You told me to go to this thread to get an answer then you follow me over to said post and give me a troll answer. Sometimes I think these posts are over-saturated with the opinions of 5 or 6 of the same people.

Go check the websites and you'll see that these programs are not at all condensed. Besides, how is 30 credits over 1 year as opposed to 2 rushing through something? I take 18 credits over 3.5 months in my program now.

Stigmata, you answered a good amount of it though concerning how the practicum is not considered a post-doc and for that I thank you. Can you give me an estimate as to how long it takes to get RxP after graduation, but before post-doc? I know some folks see this as rushing through, but its not. It's called planning a future.

 

[deleted106747]

Did that really need to be said ? Sometimes I think these posts are over-saturated with the opinions of 5 or 6 of the same people.

Go check the websites and you'll see that these programs are not at all condensed. Besides, how is 30 credits over 1 year as opposed to 2 rushing through something? I take 18 credits over 3.5 months in my program now; are you saying clinical programs are rushing people through?

To stigmata, how was my question not clear? Read the last sentence. You answered a good amount of it though concerning how the practicum is not considered a post-doc and for that I thank you. Can you give me an estimate as to how long it takes to get RxP after graduation, but before post-doc? I know some folks see this as rushing through, but its not. It's called planning a future.

And thanks for the little advice at the beginning. Did you enjoy writing that?

Is it your goal to be offensive and entitled in your posts? People took the time out to answer your questions, which they didn't have to do. My suggestion to the others on here would be that until you can learn to ask a question in a respectful manner, and appreciate the answers you get, to offer you no more advice. I certainly hope your attitude on here doesn't translate to the outside world, and especially to your patients.

 

[thepug]

Is it your goal to be offensive and entitled in your posts? People took the time out to answer your questions, which they didn't have to do. My suggestion to the others on here would be that until you can learn to ask a question in a respectful manner, and appreciate the answers you get, to offer you no more advice. I certainly hope your attitude on here doesn't translate to the outside world, and especially to your patients.

Yes, and force your emotional impulses on other people by directing the group how to act toward me. Who are you Bill O'Reilly? I've seen you do this to other posters when they get a little, salty. It's kind of odd of you.

 

[Therapist4Chnge]

I can't resist responding to a good troll post every once in awhile.

Go check the websites and you'll see that these programs are not at all condensed. Besides, how is 30 credits over 1 year as opposed to 2 rushing through something? I take 18 credits over 3.5 months in my program now; are you saying clinical programs are rushing people through?

Apples v. Oranges argument. One type of program is meant to be taken on a part-time basis, and the other program is meant to be taken on a full-time basis. As designed, two years of part-time study makes sense. The material is also different. Cramming everything into a year encourages people to cut corners. Spreading the learning out over two years allows the students more time to work with the information.

As for my opinion if clinical programs are rushing people through...yes, I do think that happens quite frequently. There is a push to get classes out of the way, which often is not in the best interest of the student's training. This happens across program types (research heavy, balanced, and more clinically focused).

To stigmata, how was my question not clear? Read the last sentence. You answered a good amount of it though concerning how the practicum is not considered a post-doc and for that I thank you. Can you give me an estimate as to how long it takes to get RxP after graduation, but before post-doc? I know some folks see this as rushing through, but its not. It's called planning a future.

And thanks for the little advice at the beginning. Did you enjoy writing that?

You may benefit from people who have already walked the path, but that would require considering alternative points of view. Good luck with your attitude as you attempt to navigate your training.

 

[thepug]

I can't resist responding to a good troll post every once in awhile.



Apples v. Oranges argument. One type of program is meant to be taken on a part-time basis, and the other program is meant to be taken on a full-time basis. As designed, two years of part-time study makes sense. The material is also different. Cramming everything into a year encourages people to cut corners. Spreading the learning out over two years allows the students more time to work with the information.

As for my opinion if clinical programs are rushing people through...yes, I do think that happens quite frequently. There is a push to get classes out of the way, which often is not in the best interest of the student's training. This happens across program types (research heavy, balanced, and more clinically focused).





You may benefit from people who have already walked the path, but that would require considering alternative points of view. Good luck with your attitude as you attempt to navigate your training.

I can understand the logic by spanning it out, but is their any proof that people digest the info any better this way? I find the more frequent a class is the more you integrate the info (kind of like summer camp), these programs have you coming in once a week.

You are probably right that the classes are rushed in clinical programs in that most are covered in the first 4 semesters. I think 6 courses plus practicum and research is a bit much. However, 30 credit hours in INTRO courses spread over 2 years is bogus. I think this is done so that the programs don't draw criticism, that is, getting rxp too quickly might raise some eyebrows. I think this is unfounded. Just because something doesn't sit right does not mean it's wrong, just unconventional. Nevertheless, 1 year rxp frightens me.

I do not understand your last comment. I always consider other opinions and frequently change my perspective. I just don't agree that someone can't simply ask the question "how long" without breaking some kind of rule. By the way, you're reading text and cannot see my facial expression. Thus my attitude is really more your perspective than my actual attitude. And I think you questioning my competence as a future therapist to be a lot more offensive than me saying your post was troll-ish.

Oh and I find your emoticons to be very passive aggressive

 

[CGOPsych]

I've been looking into this and it seems like all the programs MAKE you take 2 years to finish roughly 30 credit hours...what the heck? They split it up so you're taking like one class every weekend. 30 hours can be done in 1 year. I assume the reason for this is because the programs are to new to have a sufficient amount of faculty teaching the classes to run people through in a year.

My question is, can you do the practicum hours while completing the degree and how many hours do you need? It seems some programs make you start the practicum after 2 YEARS of courses. I guess I can stomach that if I am working in a practice in the meantime, but it really depends on how long that practicum is supposed to be following the courses.

Please for the love of God do not "yahoo answers" me on this and give me a link or some non-decisive answer on this; if you don't know, don't post. This kind posting just derails hot-topic arguments.

To sum it up, how many years after graduation does it take to have rxp? I assume the post-doc would be in medical psych.

Your comment on the length of the RxP program is astute. APA's campaign fodder refers to it as a "two year master's degree". In reality, it is one year of online courses stretched out to two years. Heck, make it a five-year degree and take it easy! In fact, legislation proposed by APA's surrogates has specified only 300 contact hours, which is 20 semester hours equivalent.

As for the "master's degree" this was originally a certificate program that got some lipstick put on it (and the fees went up). There is no master's thesis or project. The curriculum was designed by APA and students take a "national test" which was designed by APA solely for this, which also decided the passing grade. In other words, the training and certification are entirely in-house projects by the organization that spends millions lobbying for it.

Supervised hours do vary from state to state. In Missouri the proposed bill only called for "weekly supervision" by someone who can prescribe. Thus, it could have been 30 minutes on the phone with a dermatologist from anywhere in the country. That's how weak the standards have been, and that's why 162 bills have failed in 16 years. This year 12 bills failed in 7 states, the seventh straight year of shutouts with worse prospects than ever for next year.

The supervised hours would not be medical psychology. Medical psychology refers to psychologists who practice in a medical setting and/or assess and treat individuals psychologically who have medical disorders. The term has been bastardized by the APA RxP campaign to mean those very few psychologists who are practicing medicine based on non-medical training.

However, RxP is and has ALWAYS been available to psychologists. We can simply take the extra medical training available to anyone, including your mailman, to get this authority. In my state a "true" two-year program will make you a PA and give you far, far more authority to prescribe and treat patients. (And anyone taking that route will be worth their weight in gold.) However, APA doesn't want you to do that because then the organization will not reap the financial and political benefits.

A dual-trained psychologist will be able to practice far more broadly. In New Mexico prescribing psychologists cannot prescribe off-label. Additionally, they have to be supervised, and have all their prescriptions approved, by the patient's primary care physician anyway.

Thus, the RxP campaign is not only bad for public health, it's a ripoff of psychologists who do indeed want to add medical practice to their repertoire. Those who are truly interested in this should be telling APA to stop with the power politics and help them get the proper medical training.

 

[thepug]

Your comment on the length of the RxP program is astute. APA's campaign fodder refers to it as a "two year master's degree". In reality, it is one year of online courses stretched out to two years. Heck, make it a five-year degree and take it easy! In fact, legislation proposed by APA's surrogates has specified only 300 contact hours, which is 20 semester hours equivalent.

As for the "master's degree" this was originally a certificate program that got some lipstick put on it (and the fees went up). There is no master's thesis or project. The curriculum was designed by APA and students take a "national test" which was designed by APA solely for this, which also decided the passing grade. In other words, the training and certification are entirely in-house projects by the organization that spends millions lobbying for it.

Supervised hours do vary from state to state. In Missouri the proposed bill only called for "weekly supervision" by someone who can prescribe. Thus, it could have been 30 minutes on the phone with a dermatologist from anywhere in the country. That's how weak the standards have been, and that's why 162 bills have failed in 16 years. This year 12 bills failed in 7 states, the seventh straight year of shutouts with worse prospects than ever for next year.

The supervised hours would not be medical psychology. Medical psychology refers to psychologists who practice in a medical setting and/or assess and treat individuals psychologically who have medical disorders. The term has been bastardized by the APA RxP campaign to mean those very few psychologists who are practicing medicine based on non-medical training.

However, RxP is and has ALWAYS been available to psychologists. We can simply take the extra medical training available to anyone, including your mailman, to get this authority. In my state a "true" two-year program will make you a PA and give you far, far more authority to prescribe and treat patients. (And anyone taking that route will be worth their weight in gold.) However, APA doesn't want you to do that because then the organization will not reap the financial and political benefits.

A dual-trained psychologist will be able to practice far more broadly. In New Mexico prescribing psychologists cannot prescribe off-label. Additionally, they have to be supervised, and have all their prescriptions approved, by the patient's primary care physician anyway.

Thus, the RxP campaign is not only bad for public health, it's a ripoff of psychologists who do indeed want to add medical practice to their repertoire. Those who are truly interested in this should be telling APA to stop with the power politics and help them get the proper medical training.

Thank you for your support!

How much practicum is required in the second year? I would not mind taking a full year off to knock out the classes offered in that first year, but I'd like to be able to be working if possible, at least in the second year. I know there is also the PN route, but that takes 3 years and the medical psych certificate seems more desirable than that, even if it does kind of hamstring a person into working in certain states.

So if I am understanding you correctly, you have full, unsupervised rxp with a PA?

 

[Therapist4Chnge]

PA requires physician oversight. NP can be fully independant in some states but not others.

 

[thepug]

Please, tell me the basics on the M.S. in psychopharm...

Can you practice part time while completing the courses and practicum?

How long is the practicum?

What is meant by "supervision"? How independent will I really be?

Is there a marked boost in income once you get this degree (or a few years after)?

Thank you so much for your support.


And Therapist, could you answer this question in regards to NP?

 

[medium rare]

Please, tell me the basics on the M.S. in psychopharm...

Can you practice part time while completing the courses and practicum?

How long is the practicum?

What is meant by "supervision"? How independent will I really be?

Is there a marked boost in income once you get this degree (or a few years after)?

Thank you so much for your support.


And Therapist, could you answer this question in regards to NP?

NPs have full autonomy in 15 states at the present time. In these states, NPs practice completely independently without legally required physician oversite. The vast majority of the other states require a collaborative agreement with a physician in the NP's specialty area in order to practice.

Typically, the collaborative agreement is a written document essentially saying that said physician is the identified source of consultation should the NP require it. In most cases, this translates to the NP seeking the input of the collaborating physician when they deem it necessary. A remaining few states (2 or 3?) still require physician supervision - usually in the form of a certain number of hours/month or a % of patient charts to be reviewed.

 

[thepug]

NPs have full autonomy in 15 states at the present time. In these states, NPs practice completely independently without legally required physician oversite. The vast majority of the other states require a collaborative agreement with a physician in the NP's specialty area in order to practice.

Typically, the collaborative agreement is a written document essentially saying that said physician is the identified source of consultation should the NP require it. In most cases, this translates to the NP seeking the input of the collaborating physician when they deem it necessary. A remaining few states (2 or 3?) still require physician supervision - usually in the form of a certain number of hours/month or a % of patient charts to be reviewed.

How long does it take to be a PN?

Can I do this while earning an income as a clinical psychologist?

What is the curriculum like? For example, mostly classes the first year or two?

 

[PsychMonkey]

This is a topic my cohort developed a strong interest in during the previous year. Of our group of 7, some plan to seek prescriptive privileges, and some have no such desire. What we did discover during our discussion is how much money the pharmaceutical companies spend on marketing vs. research, and it is pretty outrageous. We also found a lot of research demonstrating the greater efficacy of therapy compared to medication (which surprised us a bit to be honest). We decided to make a commercial for therapy that is kind of a parody of the the drug ads. Its on YouTube, and we have it submitted as a poster at APA. Feel free to see the poster, "Direct-to-Consumer Marketing of Psychotherapy: A Response to Pharmaceutical Ads", at the 10 am Session in the D and E hall on Sunday (Media Psych Div 46) or come by and see the video on Friday at 11:30 in Division 22's hospitality suite at the Grand Hyatt. Here is the youtube link:
http://youtu.be/3ds85kHHvME

 

[CGOPsych]

NPs have full autonomy in 15 states at the present time. In these states, NPs practice completely independently without legally required physician oversite. The vast majority of the other states require a collaborative agreement with a physician in the NP's specialty area in order to practice.

Typically, the collaborative agreement is a written document essentially saying that said physician is the identified source of consultation should the NP require it. In most cases, this translates to the NP seeking the input of the collaborating physician when they deem it necessary. A remaining few states (2 or 3?) still require physician supervision - usually in the form of a certain number of hours/month or a % of patient charts to be reviewed.

Indeed, the NP credential is an excellent pathway for psychologists to obtain RxP, and it allows them to do far more than prescribe psychoactives. PA's may practice with "functional" autonomy in many states as well. In Illinois I'm told they can practice with a collaborative agreement that requires the "supervising" physician to be within a 30-minute drive of the PA, which seems very reasonable.

For psychologists serious about prescribing safely, practicing even with a collaborative agreement should not be a barrier at all. After all, this allows them to practice psychology independently and prescribe with backup from a physician. That seems to be an excellent model.

 

[Buzzwordsoldier]

This is a topic my cohort developed a strong interest in during the previous year. Of our group of 7, some plan to seek prescriptive privileges, and some have no such desire. What we did discover during our discussion is how much money the pharmaceutical companies spend on marketing vs. research, and it is pretty outrageous. We also found a lot of research demonstrating the greater efficacy of therapy compared to medication (which surprised us a bit to be honest). We decided to make a commercial for therapy that is kind of a parody of the the drug ads. Its on YouTube, and we have it submitted as a poster at APA. Feel free to see the poster, "Direct-to-Consumer Marketing of Psychotherapy: A Response to Pharmaceutical Ads", at the 10 am Session in the D and E hall on Sunday (Media Psych Div 46) or come by and see the video on Friday at 11:30 in Division 22's hospitality suite at the Grand Hyatt. Here is the youtube link:
http://youtu.be/3ds85kHHvME

Very nice work.

 

[stigmata]

I find it odd that most are holding up NP training as somehow being a very good option to Rx psychiatric medications. Sure it will get you the rights and DEA#, but it is as unsafe to prescribe these medications when you don't know much about them as it is to have minimal medical training. Similarly, assuming I agree that NPs have better medical training than prescribing psychologists, how can that make up for not understanding how a drug works?? Obviously solid medical training AND solid pharmacology training are vital but don't get blinded by the arguments stating RXP providers don't have medical training and therefor can't prescribe safely.

 

[Therapist4Chnge]

I find it odd that most are holding up NP training as somehow being a very good option to Rx psychiatric medications. Sure it will get you the rights and DEA#, but it is as unsafe to prescribe these medications when you don't know much about them as it is to have minimal medical training. Similarly, assuming I agree that NPs have better medical training than prescribing psychologists, how can that make up for not understanding how a drug works?? Obviously solid medical training AND solid pharmacology training are vital but don't get blinded by the arguments stating RXP providers don't have medical training and therefor can't prescribe safely.

It is much harder to argue against RxP for psychologists if they don't keep pushing this point, regardless if it has merit or not.

 

[medium rare]

I find it odd that most are holding up NP training as somehow being a very good option to Rx psychiatric medications. Sure it will get you the rights and DEA#, but it is as unsafe to prescribe these medications when you don't know much about them as it is to have minimal medical training. Similarly, assuming I agree that NPs have better medical training than prescribing psychologists, how can that make up for not understanding how a drug works?? Obviously solid medical training AND solid pharmacology training are vital but don't get blinded by the arguments stating RXP providers don't have medical training and therefor can't prescribe safely.

I'm not sure NP training for psychologists is better than RxP training, but it is certainly much more practical. Right now, if you want to Rx as a psychologist and you complete RxP training, you only have 2 locations to practice - NM & LA, not practical for most people.

Your quality as a prescriber will depend much on the quality of the psychopharm training you receive in your program (among other content areas). My experience has been that this factor varies more by program than by discipline. For example, I've met several psychiatrists with a surprisingly limited knowledge of pharmacokinetics and pharmacodynamics and know psych NPs with a very solid mastery of these areas. In my city, there is a respected psych NP who leads a monthly psychopharm consultation group and half of the attendees are psychiatrists.

Moreover, the didactic content areas of the RxP training programs I've seen (Farleigh Dickinson and New Mexico State) are more comprehensive and practice appropriate than any psych NP program I know. I wish my NP program had had more of these courses when I was attending; I went to a very reputable psych NP program and was generally satisfied with my training, but I had to learn a considerable amount on my own after graduation.

The prescribing psychologists I know in NM seem well-trained and I've noticed no apparent knowledge deficits through the conversations I've had with them. My opinion is that as more states allow RxP, prescribing psychologists will emerge as another group of competent (and much needed) prescribers.

 

[stigmata]

I agree, and certainly was not trying to speak poorly of NPs. We are both better trained to Rx psych meds than most physicians.

 

[nitemagi]

I agree, and certainly was not trying to speak poorly of NPs. We are both better trained to Rx psych meds than most physicians.

Again, the leap in logic. Knowing more about a certain group of medications, doesn't necessarily make one better trained to prescribe them. Understanding an animal group doesn't mean one understands ecosystems, or even other animals, and ignores how messing with one affects all the others, and how the others affects the one. Such hubris.

Classic repetition of not knowing what you don't know. Yet repeating it here on this thread as if the fluffing of the peacock feathers really makes one capable.

 

[stigmata]

Again, the leap in logic. Knowing more about a certain group of medications, doesn't necessarily make one better trained to prescribe them. Understanding an animal group doesn't mean one understands ecosystems, or even other animals, and ignores how messing with one affects all the others, and how the others affects the one. Such hubris.

Classic repetition of not knowing what you don't know. Yet repeating it here on this thread as if the fluffing of the peacock feathers really makes one capable.

It is so sweet that you care

 

[roubs]

Again, the leap in logic. Knowing more about a certain group of medications, doesn't necessarily make one better trained to prescribe them. Understanding an animal group doesn't mean one understands ecosystems, or even other animals, and ignores how messing with one affects all the others, and how the others affects the one. Such hubris.

Classic repetition of not knowing what you don't know. Yet repeating it here on this thread as if the fluffing of the peacock feathers really makes one capable.

Really? After going through 2 classroom + 2 practical years of training only in how to prescribe psychotropic medication, including the ecosystem they live in, you're calling it "hubris" to suggest that that individuals thus trained can proficiently prescribe? Sounds a bit dramatic, especially considering that such prescribing is already taking place.

In nearly every post you suggest that because drugs affect the whole body we cannot possibly appreciate the complexity and ramifications of pharmacotherapy with a mere 4 year training program. That's hogwash, as any appropriate program should include such training and practice. After all, these programs can and should provide all relevant medical training to graduate proficient prescribers.

 

[nitemagi]

Really? After going through 2 classroom + 2 practical years of training only in how to prescribe psychotropic medication, including the ecosystem they live in, you're calling it "hubris" to suggest that that individuals thus trained can proficiently prescribe? Sounds a bit dramatic, especially considering that such prescribing is already taking place.

In nearly every post you suggest that because drugs affect the whole body we cannot possibly appreciate the complexity and ramifications of pharmacotherapy with a mere 4 year training program. That's hogwash, as any appropriate program should include such training and practice. After all, these programs can and should provide all relevant medical training to graduate proficient prescribers.

You're inflating the depth of such programs, as if they're equivalent to other pathways. As has been described in this thread many many times, they aren't. The teachers themselves have little expertise, the supervision is loose, the general medical teaching is superficial at best.

And I was critiquing stig's statement that RxP's are better trained to prescribed psychotropics than most doctors. That's a bravado statement with nothing to back it up. "should" provide all relevant medical training? As defined by whom? When it's a group with no expertise deciding what qualifies as expertise and convincing politicians who just take their word for it to pass legislation to enforce this standard, that is no standard at all that is connected to outcome.

 

[roubs]

You're inflating the depth of such programs, as if they're equivalent to other pathways. As has been described in this thread many many times, they aren't. The teachers themselves have little expertise, the supervision is loose, the general medical teaching is superficial at best.

And I was critiquing stig's statement that RxP's are better trained to prescribed psychotropics than most doctors. That's a bravado statement with nothing to back it up. "should" provide all relevant medical training? As defined by whom? When it's a group with no expertise deciding what qualifies as expertise and convincing politicians who just take their word for it to pass legislation to enforce this standard, that is no standard at all that is connected to outcome.

In no way do I support the APA putting flimsy programs out there, and yes I know the programs are not rigorous enough. If psychologists support loose standards they will only hurt themselves in the end. Really it should be psychiatrists recommending the training standards and psychologists would be wise to simply accept them. Unfortunately for their own turf reasons many psychiatrists are unwilling to even entertain the idea of medically training psychologists and apparently just want us to have to use the PA/NP path when a better one should be designed.

A properly trained RxP who spends every day prescribing in this area will probably be better at it than a GP who rarely does it (and when they do, it involves "are you feeling sad all the time? alright here's your SSRI) and does not follow the lit.

 

[edieb]

http://www.usphs.gov/pdf/Navy prescribing Psychologist job.pdf

 

[Therapist4Chnge]

Nice!

I'm wondering if we will start seeing more of this?

 

[stigmata]

New advert in this month's National Psychologist for medical psychologists is Guam. 130K and up.

 

[roubs]

New advert in this month's National Psychologist for medical psychologists is Guam. 130K and up.

How will Guam survive after the reign of terror psychologists have inflicted on LA and NM???

You know, the actual risk to patients would be reduced if psychiatry could focus their criticism on what shortcomings the psychopharm masters programs(and supervised prescribing 'residency' period) have. That would involve leaving the turf war stuff behind.

 

[nitemagi]

Though it depends on the critiquer, a lot of the criticism has been on that program. And a lot of the defensiveness has been in trying to justify those programs as an adequate amount of training.

 

[roubs]

Though it depends on the critiquer, a lot of the criticism has been on that program. And a lot of the defensiveness has been in trying to justify those programs as an adequate amount of training.

Well, as I said in the post from a few weeks ago, I think psychologists are only hurting themselves by reacting defensively. If we are moving into an area that was previously outside the scope, it makes sense to incorporate all components deemed necessary by those who currently practice in that area.

Btw, is there a summary somewhere of the requirements of the program you're referring to?

 

[DynamicDidactic]

New advert in this month's National Psychologist for medical psychologists is Guam. 130K and up.

I think they will need to pay someone a lot more to move to Guam.

 

[edieb]

Job Title: Clinical Psychiatrist OR Psychologist: U.S. Coast Guard Academy,New London, CT (O6 billet) Job Description: The U.S. Coast Guard is seeking a psychiatrist to provideevaluation, diagnosis, and treatment at the U.S. Coast Guard Academy, NewLondon, CT (O-6 billet). Responsibilities include ongoing care and treatmentof college age recruit population, active duty members, and otherbeneficiaries. The incumbent shall apply U.S. Coast Guard policy andprocedures, and performs fitness for duty evaluations on CG members. Hoursare generally 07:30 AM- 4:00 PM M-F. No inpatient duties, limited call bytelephone. Serve your country in uniform and have fun doing it! Call us. Psychologists with additional training and credentialing to prescribemedications are encouraged to apply. Preference will be given to applicantswith previous military psychologist background, particularly those comingfrom recent duty in other services who are often well embedded into both theoperational and healthcare systems. Training: License: A current, unrestricted, and valid license as a clinicalPsychiatrist or Psychologist from a U.S. State, District of Columbia,Commonwealth, Territory, or other jurisdiction is required. Geographic stability in this position can be expected for 5 years. Location of Position: New London, CT Contact Information: To apply please e-mail your CV and cover letter to CAPTWade McConnell [email protected]<mailto:[email protected]> Application deadline: Open until filled [https://public.govdelivery.com/images/share_this.gif?1278100473]<http://lin

 

[drjcc]

As a Medical Psychologist who has been prescribing for 5 year, having written over 10,000 scripts (by estimate) and have been training others for for year, I can speak to a lot of these issues. I regularly interact with other medical profesionals (physicians, dentists, nurses, etc.) and understand both the training and practical issues very well. There is a wealth of both misunderstanding and mischaracterization throughout this thread. But, in short, Medical Psychologists in Louisiana have been very successful, are easily accepted by their medical colleague, engage in (or have been engaged in minimal to zero) turf issues with psychiatry, and had no complaints lodged regarding their care. I think that most MP's are a pretty conservative group, understand the science(s) of pharmacology far better than some of you appreciate, and it's going to be an ongoing/developing viable option in other states.

Other opinions or thoughts available, but one this is clear: Medical Psychology is not going away. It will evolve to all 50 states because, well, it works. Furthermore, there are more patients than psychiatry can manage, general physicians do not want to manage them and aren't trained to manage them, and NP's are far less qualified than a psychologist with Pharm training. Period.

My 2 cents.

jc

 

[nitemagi]

As a Medical Psychologist who has been prescribing for 5 year, having written over 10,000 scripts (by estimate) and have been training others for for year, I can speak to a lot of these issues. I regularly interact with other medical profesionals (physicians, dentists, nurses, etc.) and understand both the training and practical issues very well. There is a wealth of both misunderstanding and mischaracterization throughout this thread. But, in short, Medical Psychologists in Louisiana have been very successful, are easily accepted by their medical colleague, engage in (or have been engaged in minimal to zero) turf issues with psychiatry, and had no complaints lodged regarding their care. I think that most MP's are a pretty conservative group, understand the science(s) of pharmacology far better than some of you appreciate, and it's going to be an ongoing/developing viable option in other states.

Other opinions or thoughts available, but one this is clear: Medical Psychology is not going away. It will evolve to all 50 states because, well, it works. Furthermore, there are more patients than psychiatry can manage, general physicians do not want to manage them and aren't trained to manage them, and NP's are far less qualified than a psychologist with Pharm training. Period.

My 2 cents.

jc

Funny you make these statements about how strong RxP is in LA and yet represent yourself as an "attending," a term for physicians who have completed residency. Seems like misrepresentation.

SDN has a title for psychologist for your profile, and yet you need to list yourself as "attending." Interesting.

 

[stigmata]

Maybe he/she works at a residency? I do and serve as attending, but that is certainly not my primary title.

 

[nitemagi]

Maybe he/she works at a residency? I do and serve as attending, but that is certainly not my primary title.

Um, sorry Stigmata, but you're not an attending. Even if you're a supervisor, you're not an attending. Besides "Attending" being short for "Attending Physician," it means the person ultimately responsible for care of the individual in a hospital setting, including medication choices. So that residents are not the ultimate one responsible if something bad happens, You are. Does Wyoming allow for psychologists to be physician of record in medication changes and problems in a hospital setting?

This is just further obfuscation of actual roles through blurring of titles.

 

[roubs]

Um, sorry Stigmata, but you're not an attending. Even if you're a supervisor, you're not an attending. Besides "Attending" being short for "Attending Physician," it means the person ultimately responsible for care of the individual in a hospital setting, including medication choices. So that residents are not the ultimate one responsible if something bad happens, You are. Does Wyoming allow for psychologists to be physician of record in medication changes and problems in a hospital setting?

This is just further obfuscation of actual roles through blurring of titles.

You chose to ignore the entire substance of the post and instead focus on a drop down menu selection on a website? And that doesn't seem petty at all?

 

[nitemagi]

You chose to ignore the entire substance of the post and instead focus on a drop down menu selection on a website? And that doesn't seem petty at all?

You miss the point. By questioning title and thus misrepresentation, that questions credibility of substance.

I can't speak to the individual's experience in Louisiana, nor would I want to speak to it. But I take any predictions by someone saying that "it works, period," thus dismissing any area for discussion (and is misrepresenting him/herself), but who nonetheless extrapolates from their narrow experience that it will spread to all 50 states, with a grain of salt. A large grain.

 

[stigmata]

Like a typical psychiatrist you have no idea what happens in the rest of medicine. When I worked in Ca, at a hospital I was an attending psychologist, and we used psychiatry as a consult only. Now, I teach in a residency program and am attending for all psych issues and a primary care doc is attending for non-psych. Yes, the ultimate authority is on me for psych issues. I get it that you want to live in a world where psychiatrists are the only providers who can do anything, but it simply is not the case...anywhere. You were a resident, likely in a psych hospital where a residency takes place, and that world is quickly dying. Most psych patients are treated in primary care and regular hospitals.

 

[roubs]

You miss the point. By questioning title and thus misrepresentation, that questions credibility of substance.

I can't speak to the individual's experience in Louisiana, nor would I want to speak to it. But I take any predictions by someone saying that "it works, period," thus dismissing any area for discussion (and is misrepresenting him/herself), but who nonetheless extrapolates from their narrow experience that it will spread to all 50 states, with a grain of salt. A large grain.

No, I get that you want to make the point that selecting Attending on a SDN profile is some kind of misrepresentation, I just think it's silly. The only thing that would be sillier is questioning the credibility of his anecdote(yes I'm well aware it is an anecdote) because you don't like what he selected on a drop down menu.

 

[nitemagi]

Like a typical psychiatrist you have no idea what happens in the rest of medicine. When I worked in Ca, at a hospital I was an attending psychologist, and we used psychiatry as a consult only. Now, I teach in a residency program and am attending for all psych issues and a primary care doc is attending for non-psych. Yes, the ultimate authority is on me for psych issues. I get it that you want to live in a world where psychiatrists are the only providers who can do anything, but it simply is not the case...anywhere. You were a resident, likely in a psych hospital where a residency takes place, and that world is quickly dying. Most psych patients are treated in primary care and regular hospitals.

Like always Stigmata, it's a pot-kettle situation with you. YOU are the psychologist claiming to have admitting psych privileges and manage "all psych issues" when it's illegal to make decisions such as med prescribing in California, as it is out of your scope of practice. I've worked in primary care clinics, private, academic, VA, and county hospitals, in more medical settings than just psychiatric or primary care, yet I'M the one who doesn't know what happens in "the rest of medicine!" HILARIOUS. It's so rich that you as a psychologist believe your medical expertise and exposure is more realistic because you get to teach family medicine residents in Rural America.

Call yourself an "Attending" if you want. California now requires you to specify to all patients what group regulates YOU(the psychology board), and what your credentials are in. You can't skate by on patient ignorance presenting yourself as the "Attending Doctor" anymore in this state.

And I actually spit up my coffee at your comment that the psychiatric hospital with residencies is a dying system. You're a pretty funny guy. Generalizing your rural lack of resources to the rest of the country, and the fact that one sad little family medicine program is so starved for resources that they took YOU to teach them psychopharm, just makes your statements more and more laughable. And frankly sad. Psych hospitals aren't going anywhere, as there will always be a need for inpatient treatment of the severe mentally ill.

Now an accurate response, rather than stating I don't know "what happens in the rest of medicine," would be to say "You really don't know what happens in medicine in a small town family medicine program in the middle of Wyoming." That would have been astute and true. But to think that YOUR limited experiences at a family medicine clinic in Wyoming and some small community hospital that was so desperate they made YOU an attending reflects "the rest of medicine" is quite a leap. YOU are the outlier. Not the mean, nor the AUC. Nor do you represent a trend line that if projected forward sees RxP in all 50 states and the demise of psychiatric hospitals.

 

[nitemagi]

No, I get that you want to make the point that selecting Attending on a SDN profile is some kind of misrepresentation, I just think it's silly. The only thing that would be sillier is questioning the credibility of his anecdote(yes I'm well aware it is an anecdote) because you don't like what he selected on a drop down menu.

That's a fair critique. But doesn't bypass that this individual believes that because they have a comfortable RxP existence in Louisiana that it will spread to all 50 states. Gimme a break.

The misrepresentation was just reflective of a lack of perspective. There's a choice involved when a psychologist chooses from a drop-down menu "Attending" rather than "Psychologist." It's not like they need to discriminate themselves from "Psychology Student." It's a choice, and should be owned as such, and recognized that it's another attempt to blur lines and titles and scope of practice.

Love the avatar btw, roubs.

 

[roubs]

That's a fair critique. But doesn't bypass that this individual believes that because they have a comfortable RxP existence in Louisiana that it will spread to all 50 states. Gimme a break.

The misrepresentation was just reflective of a lack of perspective. There's a choice involved when a psychologist chooses from a drop-down menu "Attending" rather than "Psychologist." It's not like they need to discriminate themselves from "Psychology Student." It's a choice, and should be owned as such, and recognized that it's another attempt to blur lines and titles and scope of practice.

Love the avatar btw, roubs.

Thanks. As far as the poster, he hasn't come back to somehow defend his choice of "attending" so I think you maybe pulled out your jump to conclusions mat a little early. Or maybe he'll get in a huge argument with you over it, who knows.

Whether or not it will spread to all 50 states is really a matter of lobbying and maybe shifting attitudes in one direction or the other. What the LA experience(aka, collection of anecdotes over time ) does show that if a horrible disaster does not befall mental health patients in LA, it is unlikely to befall people in other states if similar systems and requirements are adopted.

If I ever go this route I'm inclined to go the NP or PA direction as the psychologists seem to be embracing further restrictions on the license as a way to get their foot in the door to the system. Given that I'd only really want to manage uncomplicated cases, I'm curious as to whether psychiatrists would be more/less annoyed to have Ph.D. / PAs running around out there?

Edit: FYI, the reason I am considering this is because I work in community mental health and there are no psychiatrists. When we find a private one who will take someone, there is a waiting list. When they get in it usually goes like this: 1) Doc spend 10-15 min for an initial appointment, give an inadequate amount of information on the medications. 2) Pt goes home to google everything and freaks out 3) Follow up with them is in 3 months, pt is afraid to take anything and freaks out to me. 4) I am stuck between not giving medical advice and someone who is repeatedly asking me for medical advice because they can't get any for 3 months.

 

[edieb]

Like a typical psychiatrist you have no idea what happens in the rest of medicine. When I worked in Ca, at a hospital I was an attending psychologist, and we used psychiatry as a consult only. Now, I teach in a residency program and am attending for all psych issues and a primary care doc is attending for non-psych. Yes, the ultimate authority is on me for psych issues. I get it that you want to live in a world where psychiatrists are the only providers who can do anything, but it simply is not the case...anywhere. You were a resident, likely in a psych hospital where a residency takes place, and that world is quickly dying. Most psych patients are treated in primary care and regular hospitals.

Pay no mind to Nitemagi, Stigmata. If you look at the numbers, you have much more training in the diagnosis and treatment of mental illness than a psychiatrist and I am sure he feels threatened.

 

[nitemagi]

Pay no mind to Nitemagi, Stigmata. If you look at the numbers, you have much more training in the diagnosis and treatment of mental illness than a psychiatrist and I am sure he feels threatened.

I've posted multiple times about the numbers of hours of training and patient-hours in particular, and psychiatrists have many many more. So I haven't found anything to feel threatened about yet. Especially from Stigmata.

 

[futureapppsy2]

Everyone: refrain from personal attacks, please.