Psychopharmacology/Advanced Practice Psychology

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psycscientist said:
They should if the proposed training standards for gaining such privileges are subpar and thus a harm to patients and the profession (which is currently the case). Empirical studies have been done on this issue and even the more rigorous DoD program did not produce prescribing psychologists that functioned better than like 2nd or 3rd year psychiatry residents. The proposed training that APA is lobbying for is much more lax and less rigorous than the DoD program. If psychologists want to function as psychiatrists, then they should go to medical school and complete a psychiatry residency. It's no different than students trying to take a back-way into clinical psychology.
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I haven't read the study in a while, but perhaps another useful comparison (if it wasn't listed) would've been the DoD-trained psychologists vs. psych NPs and/or PAs.

As for the additional training itself, it's currently a two-year post-grad course. Depending on the state, this is followed by some period of what equates to supervised practice.

Edit: Also, having outcome/tracking studies in NM and LA would of course be informative. Although I don't know if it's in the works and/or will ever happen.
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This has already been discussed extensively

http://forums.studentdoctor.net/showthread.php?t=244987

If this is a new thread that's been started, I'll just state that I am against it. We don't have the training and I don't think a 2 year program is enough to address that. I'm not even comfortable with NPs or PAs prescribing psychotropic meds.
 
Same as Cara and PsycScientist.

In theory, I could be in favor of it. I don't think there is anything inherently "wrong" with psychologists being able to prescribe. In reality, rather than asking "How much training do we need to safely prescribe under limited circumstances" the advocates (at least on the national level) seem to be asking "What is the least training we think we can get away with and still make this happen". Given the tremendous quality control issues already in existence, I don't think its a time for us to be expanding into new areas (especially if we're not going to do it well). On the patient care side, I simply ask why prescribing privileges for psychologists is the best solution to a shortage of care. Why not increasing incentives for physicians to work in rural health? Why not dual Psychology/NP programs that would utilize an established path for training prescribers in a similar timeline?

Mostly, I just think its a band-aid some are advocating for in order to enrich themselves at the expense of our professional identity (we then become mid-level providers) and possibly patients. There is nothing wrong with wanting to improve one's income, but there are good and bad ways to go about it. We could push for us to move into areas we are uniquely qualified for and are less likely to see competition. Instead we push to be more and more generic. And spend unholy amounts of money doing it - I always wonder how much better reimbursement rates would be if APA had diverted the millions of dollars it spends launching failed RxP campaigns into fighting for better reimbursement.
 
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It's important to keep in mind that, at least as it exists now, prescribing psychologists are most certainly not taking the place of psychiatrists, therefore they ought not to be compared to them--they are taking over for GPs with very little psych training. This makes it better than the status quo in these rural areas where they exist. I do think increasing incentives for psychiatrists to practice in high needs areas would help. But then we're increasing the gap (income, etc.) between psychiatry and psychology even further and pushing ourselves further into the therapy corner which is no longer fully our domain anyway. I also agree that pro-choice is the way to go and what works in NM or LA cannot be expected to work elsewhere, like NY for example.
 
Psychadelic2012 said:
It's important to keep in mind that, at least as it exists now, prescribing psychologists are most certainly not taking the place of psychiatrists, therefore they ought not to be compared to them--they are taking over for GPs with very little psych training. This makes it better than the status quo in these rural areas where they exist. I do think increasing incentives for psychiatrists to practice in high needs areas would help. But then we're increasing the gap (income, etc.) between psychiatry and psychology even further and pushing ourselves further into the therapy corner which is no longer fully our domain anyway. I also agree that pro-choice is the way to go and what works in NM or LA cannot be expected to work elsewhere, like NY for example.
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Agree with the comparison to PCP's. They are doing the bulk of rx'ing psych meds now (don't have exact #'s but I'm sure they can be found) and doing a TERRIBLE job. I cannot tell you how many cases I have seen of GP's completely screwing up meds and being unwilling to say to patients that they are out of the scope of their competence and they patient needs to see a specialist. So many cases of fairly obvious dx being missed or meds being rx'd in ways that I as a non-rx'er know are going to result in disaster. I also think that a patient seeing an rx'ing psychologist would be less likely to just be shoved on meds when psychotherapy is a viable substitute or augmentation. A PCP has only one tool in his tool box so that is what he is going to use.

This is also not just an issue in rural areas. I live in a major city with a medical school. The wait for a child to see a psychiatrist is 6 months (if they want to use their insurance are unwilling to pay out of pocket). For adults it is 3-4 months. There are no psychiatrists anywhere.

I agree that shoddy training of psychologists is not a good solution. If we are going to pursue this, we really need to look at a way that we can make this safe.

Best,
Dr. E
 
Psychadelic2012 said:
It's important to keep in mind that, at least as it exists now, prescribing psychologists are most certainly not taking the place of psychiatrists, therefore they ought not to be compared to them--they are taking over for GPs with very little psych training. This makes it better than the status quo in these rural areas where they exist. I do think increasing incentives for psychiatrists to practice in high needs areas would help. But then we're increasing the gap (income, etc.) between psychiatry and psychology even further and pushing ourselves further into the therapy corner which is no longer fully our domain anyway. I also agree that pro-choice is the way to go and what works in NM or LA cannot be expected to work elsewhere, like NY for example.
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This whole extrapolation process based on "how things are happening now" is irresponsible. Every attempt to dilute the training of every profession is in progress now as the competition for middle class American standard of living intensifies.

NP's want free reign. And yet they use us to acquire their training wheels sparing the public the disaster of their graduates entering practice independently. And then turn around and fool the public with a push to subvert laws that ensure safe practice. Any group that wants to impinge on another profession for a cheaper price has a free for all bonanza of powerful forces at their disposal.

Should I refer therapy patients to y'all or use my, likely, crappy pittance of training in it to experiment on patients with.

Just because something is politically feasible and there is a need, doesn't make it prudent to pounce on professional territory.

On the other hand, maybe it does. Maybe everything's just gonna get crappier and we should all take a piece.
 
I've seen this discussion come up plenty of times on different forums. There are often strong objections to the idea that, in my humble opinion, seem a bit excessive in light of my own personal and admittedly anecdotal evidence. So, I figured I would inject some empirical evidence into the debate. Disclaimer: this is just from a quick 10 min search and I am in no way suggesting this comprehensive proof of anything. But it certainly makes the idea of prescribing psychs and NP not such a terrible or harmful concept...at least to me.

The Department of Defense Final Report on the Initial Prescribing Psychologist Program:
http://www.dod.mil/pubs/foi/Personnel_and_Personnel_Readiness/Personnel/966.pdf

From the summary:
2. Medical safety and adverse effects: While the graduates were for the most part highly•
esteemed, valued, and respected, there was essentially unanimous agreement that the graduates
were weaker medically than psychiatrists. While their medical knowledge was variously judged
as on a level between 3rd or 4th year medical students, their psychiatric knowledge was variously
judged as, perhaps, on a level between 2nd or 3rd year psychiatry residents. Nevertheless, all
graduates demonstrated to their clinical supervisors and administrators that they were sensitive
and responsive to medical issues. Important evidence on this point is that there have been no
adverse effects associated with the practices of these graduates! Thus, they have shown
impressively that they knew their own weaknesses, and that they knew when, where, and how to
consult. The Evaluation Panel agreed that all the graduates were medically safe by this standard.
In a few quarters, the criterion for "medical safety'' was equated with the knowledge and
experience acquired from completing medical school and residency, and, of course, no graduate
of the PDP could meet such a test.

So, basically everything was fine...?

Paper Published in JAMA:
Mundinger MO, Kane RL, Lenz ER, et al. Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: A Randomized Trial. JAMA. 2000;283(1):59-68.
http://jama.jamanetwork.com/article.aspx?articleid=192259

Results from Abstract:
No significant differences were found in patients' health status (nurse practitioners vs physicians) at 6 months (P = .92). Physiologic test results for patients with diabetes (P = .82) or asthma (P = .77) were not different. For patients with hypertension, the diastolic value was statistically significantly lower for nurse practitioner patients (82 vs 85 mm Hg; P = .04). No significant differences were found in health services utilization after either 6 months or 1 year. There were no differences in satisfaction ratings following the initial appointment (P = .88 for overall satisfaction). Satisfaction ratings at 6 months differed for 1 of 4 dimensions measured (provider attributes), with physicians rated higher (4.2 vs 4.1 on a scale where 5 = excellent; P = .05).

Granted, this isn't for psych nurse practitioners, but again, no big deal...right?

Another paper:
Pioro MH, Landefeld CS, Brennan PF, Daly B, Fortinsky RH, Kim U, Rosenthal GE.
Outcomes-based trial of an inpatient nurse practitioner service for general
medical patients. J Eval Clin Pract. 2001 Feb;7(1):21-33. PubMed PMID: 11240837.

Abstract:
Although teaching hospitals are increasingly using nurse practitioners (NPs) to provide inpatient care, few studies have compared care delivered by NPs and housestaff or the ability of NPs to admit and manage unselected general medical patients. In a Midwest academic teaching hospital 381 patients were randomized to general medical wards staffed either by NPs and a medical director or medical housestaff. Data were obtained from medical records, interviews and hospital databases. Outcomes were compared on both an intention to treat (i.e. wards to which patients were randomized) and actual treatment (i.e. wards to which patients were admitted) basis. At admission, patients assigned randomly to NP-based care (n = 193) and housestaff care (n= 188) were similar with respect to demographics, comorbidity, severity of illness and functional parameters. Outcomes at discharge and at 6 weeks after discharge were similar (P>0.10) in the two groups, including: length of stay; charges; costs; consultations; complications; transfers to intensive care; 30-day mortality; patient assessments of care; and changes in activities of daily living, SF-36 scores and symptom severity. However, after randomization, 90 of 193 patients (47%) assigned to the NP ward were actually admitted to housestaff wards, largely because of attending physicians and NP requests. None the less, outcomes of patients admitted to NP and housestaff wards were similar (P>0.1). NP-based care can be implemented successfully in teaching hospitals and, compared to housestaff care, may be associated with similar costs and clinical and functional outcomes. However, there may be important obstacles to increasing the number of patients cared for by NPs, including physician concerns about NPs' capabilities and NPs' limited flexibility in managing varying numbers of patients and accepting off-hours admissions.

I see an NP for one of my medical specialists and she is great. I have worked in a hospital setting as an administrator and all of the NPs were well respected and didn't have any significant difference in patient outcomes.

I don't understand why folks have such an objection to prescribing psychs and NPs when it seems that with the appropriate amount of training, accountability, & supervision, things seems to be OK. I'm not trying to judge those with objections, just trying to understand what evidence there is that this shift is actually harmful to patients.
 
My position has generally been one of support ONLY if the training standards increase. I have a real problem with attempts to provide even less training and less oversight. It is true that the "dumbing down of healthcare" is happening across the board, but I think psychology needs to avoid falling into that trap. For full disclosure, I completed RxP training at a residentially-based post-doc MS program (and I'm currently collecting my supervised hours), and while I think it did a better job in training than the other programs available, there were still areas where additional training should be added.

I'm only in favor of residential training, as I do not believe online training (particularly asynchronous) provides a sufficient forum for learning this type of material. I know online training is a popular avenue for NP programs, but that doesn't mean it is the best training method or what we should strive for as our solution. Collaborative prescribing agreements should be required and actually utilized. I'm very hesitant to trust completely independent prescribing, based on my own review of a number of NP and Psych RxP training programs. I looked at a few PA programs, but the training model and professional relationship is a bit different than the former two.

I think the collaborative model is best in most cases for any kind of treatment, particularly when there is already a GP treating the co-morbid medical conditions. GPs/FPs prescribe the most psychotropics, mostly out of need. I have surveyed probably a dozen GPs/FPs and quite a few specialists (non-psych) over the past few years and the vast majority would rather someone else handle the psych meds. They all fully-admitted having experiences where they did not feel very comfortable dealing with psych differentials, polypharma w. psychotropics, etc. The problem is that they are often the ONLY providers available to address these needs for their patients. It isn't just a lack of psychiatrists (who take insurance and don't have a 3+mon waiting list), but also a lack of prescribing midlevels AND a lack of mental health providers in general. They get stuck being the only provider who is available, takes insurance, and can address MH needs.

Working with GPs/FPs should be the niche psychologists fill, and this is how they should approach supporting legislation. Training from real universities, in real classrooms, w. established mentorship, and then collaborative agreements with local GPs/FPs to co-treat. Some argue that people should just go through NP training...but I don't think the training is very good at most programs nor is it a good match for psychologists. The psych training portion of the NP programs I saw were ridiculously weak. Being able to make a proper diagnosis is a HUGE part of prescribing, and that is where I think psychologists can really make an impact. We have the most training in assessment and diagnosis. We have the most training in research and are training to critically evaluate research and research publications. We have the most contact hours with a psychiatric population from our original training, as compared to any of the mid-level providers who already have prescribing privileges. If the medical and pharma knowledge can be taught, good mentorship is provided in training, and a formal collaborative agreement is made after training...I think we can fill a large hole in our current system.
 
JourneyAgent said:
This whole extrapolation process based on "how things are happening now" is irresponsible. Every attempt to dilute the training of every profession is in progress now as the competition for middle class American standard of living intensifies.

NP's want free reign. And yet they use us to acquire their training wheels sparing the public the disaster of their graduates entering practice independently. And then turn around and fool the public with a push to subvert laws that ensure safe practice. Any group that wants to impinge on another profession for a cheaper price has a free for all bonanza of powerful forces at their disposal.

Should I refer therapy patients to y'all or use my, likely, crappy pittance of training in it to experiment on patients with.

Just because something is politically feasible and there is a need, doesn't make it prudent to pounce on professional territory.

On the other hand, maybe it does. Maybe everything's just gonna get crappier and we should all take a piece.
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I really do think this is going to happen in the next few decades. The gates have been opened and there's really no going back at this point. It may take awhile for some states, but that's the direction we're headed. That's a separate issue than whether it SHOULD happen.

People get their hackles up about professional encroachment, and I do understand why. It annoys me when a physical therapist administered trails A and B as part of their standard evaluation. It can also lead to poor practice, like those CogStat batteries that neurologists sometimes administer. I do think that psychologists, particularly those trained in medical environments such as health, neuro, or behavioral medicine, can competently acquire prescriptive privileges. We wouldn't want PsychoDynamic Joe prescribing out of his private practice, but there should be ways to institutionally build methods of demonstrating prescriptive competence that holds patient care in its best interest. Proactive development in this direction would ultimately do more good than trying to fight or suppress this trend.
 
NeuroTrope said:
People get their hackles up about professional encroachment, and I do understand why. It annoys me when a physical therapist administered trails A and B as part of their standard evaluation. It can also lead to poor practice, like those CogStat batteries that neurologists sometimes administer.
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..and OTs/SLPs/Nurses/etc attempt to address cognition.

NeuroTrope said:
I do think that psychologists, particularly those trained in medical environments such as health, neuro, or behavioral medicine, can competently acquire prescriptive privileges. We wouldn't want PsychoDynamic Joe prescribing out of his private practice, but there should be ways to institutionally build methods of demonstrating prescriptive competence that holds patient care in its best interest. Proactive development in this direction would ultimately do more good than trying to fight or suppress this trend.
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In PsychoDynamic Joe's defense....it isn't his fault that all of his patients' parents didn't [fill in the blank] when they were growing up. Don't get mad at him, he's just the messenger! ;)

I regularly am asked by non-psych physicians for feedback on prescribing options for patients on my units. I stick with what I know about the related pharma literature and what I know about mood/cognition, and I think it works out well. I'd like to see a path for prescribing, though I think that'd be a long way off. I'm happy with having the extra knowledge I've acquired, as it helps me be a better psychologist/neuropsychologist....and I don't get hit up for pain meds, benzos, methadone, etc.
 
this topic has been discussed ad nauseam on here.

at the current rate all the states should have RxP in about a few hundred years.
 
psycscientist said:
They should if the proposed training standards for gaining such privileges are subpar and thus a harm to patients and the profession (which is currently the case). Empirical studies have been done on this issue and even the more rigorous DoD program did not produce prescribing psychologists that functioned better than like 2nd or 3rd year psychiatry residents. The proposed training that APA is lobbying for is much more lax and less rigorous than the DoD program. If psychologists want to function as psychiatrists, then they should go to medical school and complete a psychiatry residency. It's no different than students trying to take a back-way into clinical psychology.
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Wouldn't it be great if psychiatrists who wanted to function as therapists were required to get a degree in clinical psychology...
 
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DoctorLion said:
As you know, clinical psychologists (in the US) are already permitted to supervise the hospital care of their Medicare patients under current law. The new Medicare Mental Health Access Act (S. 483/HR 831) undermines necessary medical training and would allow clinical psychologists to supervise the overall care of patients in inpatient facilities that receive Medicare reimbursement. Furthermore, if this bill is passed, it could provide momentum for legislation in states to expand scope of practice and grant clinical psychologists the ability to prescribe potent psychiatric medications without a medical degree.

How do you guys feel about psychologists potentially having prescribing privileges in the future? Are you all for or against it?
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The general public already don't really know the difference between psychologists and psychiatrist. I think the paths should be merged into one. Clinical psychologists should be able to prescribe, but they should need to take a course to prescribe.
 
pearible said:
Wouldn't it be great if psychiatrists who wanted to function as therapists were required to get a degree in clinical psychology...
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I think there are many programs that provide more than just an intro into traditional therapy. However, it appears that a lot of these programs are still very psychodynamic and CBT seems to be a catch all phrase that describes anything not psychodynamic.

Similarly, as many psychology programs are adding training in psychopharm we are still miles away from they education of a psychiatrist.

At the end, a team approach to treatment using all the allied mental health professions is optimal.
 
SmoothJams said:
I don't understand why folks have such an objection to prescribing psychs and NPs when it seems that with the appropriate amount of training, accountability, & supervision, things seems to be OK. I'm not trying to judge those with objections, just trying to understand what evidence there is that this shift is actually harmful to patients.
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I personally don't take issues with NPs prescribing. Regarding psychology...the data you cite is from the DoD study. I agree it is supportive of the notion that psychologists COULD be trained to prescribe. However, that framework entailed more intensive training and more oversight than what we are now pushing for. That is where my objection comes in...if I felt like we were pushing for that level of training or beyond I would not object as strongly (though I still feel its not the right direction for us to be moving, nor is the campaign an efficient use of human/financial capital). Instead, its the usual "Race for the bottom". Haven't read the other stuff, but I'm sure I could pick it apart when I have the time...a general objection I have is that many of these studies are political and VERY poorly designed to get at the truth of the matter (though admittedly, the good studies are much more difficult to do).

Mostly, I object to anything where the guiding philosophy seems to be "What is the worst level of care/lowest level of competence we can get away with that will still increase our compensation" rather than how we can strive to provide the best care possible moving forward. Unfortunately, RxP has been rife with the former.
 
pearible said:
Wouldn't it be great if psychiatrists who wanted to function as therapists were required to get a degree in clinical psychology...
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I think that would be very appropriate. Most of our seniors who consider making therapy a large part of their practice consistently talk about how you need to seek training on your own. A masters program that could be completed at night/weekends would be ideal.

You know the kind of thing everyone else does when they eat our lunch.

Funny thing is this: everyone wants to talk our talk but nobody else wants to walk it but us. Nobody wants to carry the pager and get worked to the bone. Everyone wants the rights, but nobody wants to work the nights.

Hospitals grind their gears on our guts. We keep the motherf@ckers open so all of you have a place to dump your patients in crisis at any inconvenience.

You guys know all kinds of stuff we don't. And if I end up doing therapy I'm going to be humping your legs for knowledge.

But the fact is, just like NP's, y'all don't know the first thing about what kind sacrifice we make to be medical doctors. You wouldn't be so cavalier about it if you did.
 
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JourneyAgent said:
But the fact is, just like NP's, y'all don't know the first thing about what kind sacrifice we make to be medical doctors. You wouldn't be so cavalier about it if you did.
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Uh-huh...go on...

*pulls up a chair*

---

That Strawman doesn't really work here. I'd like to keep this discussion on track.
 
Therapist4Chnge said:
Uh-huh...go on...

*pulls up a chair*

---

That Strawman doesn't really work here. I'd like to keep this discussion on track.
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I'm not bothered by arguments. Nor do I care about persuasion. Or straw people.

I've yet to see any one of your groups push for residency type work schedules. Which is how we know what we do. You could short cut a good deal, but there's no way around being a new intern. And what that teaches you.

Nobody wants anything to do with that **** enchilada. Including us. But we do it because we practice a time honored tradition that so far has yet to be bettered for teaching medicine, including psychiatric medicine. And because we don't want hurt people.

All the elaborate tactics in the world cannot ignore that.

The public can. You guys can. The NP's can. But it doesn't alter the reality of its superiority. If that's made of straw to you it doesn't matter to me. It helps me to move the rigors of training with this huge debt. Just knowing that when it comes to what I am training for I'm not cutting corners or bull****ting.

I hope you feel the same way about your field. It will help to refer to you when I sense that. But anyone who wants to do what we without going through the training has a hole a mile wide in their game. Why would I think otherwise?

Whatever...pull up chair or don't. It's a nice break from studying.
 
But the fact is, just like NP's, y'all don't know the first thing about what kind sacrifice we make to be medical doctors. You wouldn't be so cavalier about it if you did.
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I'm on your side in this argument. But, um, getting a PhD isn't exactly a walk in the park, either. Yes, residency sucks and we don't have that sleep deprivation issue, but you also get paid far more after you're done with everything than we do.

As for my issue with NPs/PAs, I've had very bad experiences with them as a patient. I know, anecdotal evidence. But my experiences have definitely biased me.
 
cara susanna said:
I'm on your side in this argument. But, um, getting a PhD isn't exactly a walk in the park, either. Yes, residency sucks and we don't have that sleep deprivation issue, but you also get paid far more after you're done with everything than we do.

As for my issue with NPs/PAs, I've had very bad experiences with them as a patient. I know, anecdotal evidence. But my experiences have definitely biased me.
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A phd is a mountain of work.

Forgive my disrespect.

I had an enlightening conversation earlier in a different forum. The fact that we are slaves to the hospital does not mean others cannot gain perfect competence to prescribe by alternate means.

It's just a tough pill to swallow. Hundreds of thousands in debt. And all the sleepless nights. And it could've been done differently.

Tough pill to swallow.

We'll hold on to enough economic weight for my cohort to cover the spread. But the future of the medicine is hanging tenuously for those that come soon after.

I won't recommend it for them.

If society looses a trace of the art in the process. It deserves what it gets.

Good luck to all of you. I can assure that these concerns don't prohibit good working relations.
 
If it helps, we understand what it feels like to have people who've invested far less in time/money/etc and have less training advocate for legal permission to do the same exact work that we spent so many years learning how to do.
 
JourneyAgent said:
A phd is a mountain of work.

Forgive my disrespect.

I had an enlightening conversation earlier in a different forum. The fact that we are slaves to the hospital does not mean others cannot gain perfect competence to prescribe by alternate means.

It's just a tough pill to swallow. Hundreds of thousands in debt. And all the sleepless nights. And it could've been done differently.

Tough pill to swallow.

We'll hold on to enough economic weight for my cohort to cover the spread. But the future of the medicine is hanging tenuously for those that come soon after.

I won't recommend it for them.

If society looses a trace of the art in the process. It deserves what it gets.

Good luck to all of you. I can assure that these concerns don't prohibit good working relations.
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The changing healthcare situation is certainly an environment that we're all having to find ways to which to adjust.

As for training to prescribe, I haven't looked into the training enough to know whether or not I think it even comes close to leading to competence in that realm. I know people who've gone through with it and are prescribing, and they seem to be ok with it (obviously), but that's of course going to present a skewed perspective.

As cara said, though, we have a few tough pills of our own, so we can understand the sentiment.
 
DynamicDidactic said:
a whole course?
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Yeah. A course on prescribing. I don't think psychologists learn the pharmacology that psychiatrists do. Either way, clearly there would need to be a change to training, but considering that the difference between the two professions is already muddied, why not combine them.
 
Having worked in an academic medical center, I find that there's plenty of opportunity to learn about medication. This is all informal, mind you, as I'm not learning how to prescribe. However, simply by extension of reviewing medical records and seeing patients who are often on more than one psychotropic med, I've developed a familiarity with the different medications out there and how they might effect patients.

I will stress at this point that I am not competent in prescribing, and do not think this is a way to learn how to prescribe.

What I do think, however, is that if two-year post-doctoral prescriptive programs selectively accept applicants who can demonstrate some past experience working in a multidisciplinary environment, they will increase the quality of trainees and in turn produce competent prescribing psychologists. I think of it like the current training models we have for other specializations, where top candidates are selected based on their prior training settings and experiences.

Of course, I see the rather convenient fact that I'm advocating a model that I'm in a position to benefit from, so I'm open to alternative suggestions. But psychologists are obtaining RxP. It's slowed down but when NPs, PAs, heck even podiatrists, dentists, and optometrists and other non-MD specialities obtain prescriptive privileges, it will eventually reach us as well.
 
JourneyAgent said:
You guys know all kinds of stuff we don't. And if I end up doing therapy I'm going to be humping your legs for knowledge.
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My first response to leg humping would be "lets not get carried away" Upon reflection I'd love a psychiatrist who is

1) Not a foreign medical school grad who can't get boarded in their original area of training and who enters psychiatry by default.

2) Fluent in idiomatic American English

3) Is proficient in the provision of culturally appropriate services.

Give me a psychiatrist like that and y'all can hump away! :love::love::love::laugh::laugh:
 
Neuropsych2be said:
My first response to leg humping would be "lets not get carried away" Upon reflection I'd love a psychiatrist who is

1) Not a foreign medical school grad who can't get boarded in their original area of training and who enters psychiatry by default.

2) Fluent in idiomatic American English

3) Is proficient in the provision of culturally appropriate services.

Give me a psychiatrist like that and y'all can hump away! :love::love::love::laugh::laugh:
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:laugh:

Yeah. The amount of psychiatrists who were just mercenary applicants to American medicine in general and could give a crap about psychiatry is embarrassing.

It really sucks to be interested in one of least competitive specialties and be confronted by such imbeciles at every turn.

How do you expect to operate in such a communication oriented arena with pidgin English, a horrible personality and 8th century views on the role of women in society?

It's ridiculous.
 
Just want to say that not all psych NP programs are the same. There are many that aren't online and that actually offer pretty rigorous training. It definitely varies. I actually don't have issues with people taking classes online (how many people do we know who just podcast lecture and don't go to class). It's more that many online programs don't have any quality control and have low standards for entry, or at least that's what I take issue with. A cynical part of me believes that most college education is going to be online in the next 10-20 years.

I have a question about prescribing psychologists - what's their scope of practice? Do they rotate through basic physical health assessment and management before focusing on psych? For example, if they prescribe a patient an antipsychotic and the patient develops metabolic syndrome and/or diabetes, are they able to manage that or at least start them on something? What if there's no one to refer out to (or maybe the patient refuses to see anyone else) and now you're stuck with a diabetic patient? Can they order labs or interpret ECGs? I'm curious.
 
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Interesting. I guess I'm wondering what happens when you can't refer out/patient won't see anyone but you and now they have DM2 or HTN caused by psych meds. We've seen this happen when working with patients before. Then again, there's a big push in this state for PMHNPs to provide basic primary care services (along with their psych specialist duties). It's different in other states, but we spend a significant part of our time learning basic physical health management and are expected to incorporate that into our practice.

So they teach prescribing psychologists the basics of labs, ECGs, etc? Interesting. Do you guys learn about basic physical health management, or is the focus entirely on psych?
 
Yet another reason I support formal collaboration, pref. w a local GP/FP who eats that stuff for Bfast. ;) I haven't really done much w my training bc I did it for the knowledge, not for formal use in practice.

Ps. Yes to teaching basic labs, etc. However, I know enough to know I want a collaborator to review any of the lab stuff, as there are plenty of zebras and other pitfalls out there. On the flip-side, I get consulted a lot about med interactions and psych/cog impact. I'm actually giving a talk in a couple of weeks on this very topic.
 
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Why is it that these measures always seem to want to reduce/minimize the training standards? Besides the obvious implications for patient safety and practitioner competence, wouldn't better training requirements satisfy some critics, look more respectable, and actually have a chance at passing? Naturally, psychiatrists are going to resist, but why not mitigate that with a respectable training model? I know I am probably oversimplifying, but who is planning this stuff? What am I missing? :confused:
 
Therapist4Chnge said:
To be more fair...,the views of psychiatrists, as many FPs, GPs, etc are more supportive of it than their -iatry colleagues.[/QU

+1

I am a prescribing psychologist and 90 percent of my referrals come from family practice physicians around the area. They are very supportive and are always wanting to send more clients my way. At this point, over 90,000 prescriptions have been written by psychologists in New Mexico, Louisiana, the Department of Defense, and the Indian Health Service and not one complaint has been filed against a prescribing psychologist, not one.
Click to expand...
 
edieb said:
I am a prescribing psychologist and 90 percent of my referrals come from family practice physicians around the area. They are very supportive and are always wanting to send more clients my way. At this point, over 90,000 prescriptions have been written by psychologists in New Mexico, Louisiana, the Department of Defense, and the Indian Health Service and not one complaint has been filed against a prescribing psychologist, not one.
Click to expand...

Yeah, my understanding is that garnering the support of other (I would imagine predominantly primary care) physicians was a key contributing factor to Louisiana psychologists' success in getting the legislation pushed through.
 
I'm mixed...really. Do we want this? Insurance rates will spike and it's not really what we signed up for. Add in the number of folks going through diploma mills and we're in trouble.
 
Malpractice rates only go up $75 a year. THis is because there have been malpractice claims against any psychologists who are prescribing. This despite over 90K prescriptions written. I earned my post-doctoral master's program at a brick and mortar university, New Mexico State University. The program is fully integrated into the APA-approved counseling psychology department. Here is the link:

http://education.nmsu.edu/cep/
 
My curiosity is where psychologists who prescribe are not trained in neurology and other medical fields will they be able to recognize disorders that are neurological or internal that simply produce symptoms that are psychiatric? I.e Lime Disease, Fibromyalgia, brain lesions, etc.

Do any of you think Clinical Psychology should aim to incorporate training in other areas of training and understanding general human psychology and function in later years?
 
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serenade said:
My curiosity is where psychologists who prescribe are not trained in neurology and other medical fields will they be able to recognize disorders that are neurological or internal that simply produce symptoms that are psychiatric? I.e Lime Disease, Fibromyalgia, brain lesions, etc.

Do any of you think Clinical Psychology should aim to incorporate training in other areas of training and understanding general human psychology and function in later years?
Click to expand...

Did you bother reading the course curriculum? I have one year of pathophysiology training
 
serenade said:
My curiosity is where psychologists who prescribe are not trained in neurology and other medical fields will they be able to recognize disorders that are neurological or internal that simply produce symptoms that are psychiatric? I.e Lime Disease, Fibromyalgia, brain lesions, etc.
Click to expand...

In addition to required training through the pharma curriculum noted by edieb, some psychologists also work/research/lecture on these topics at AMCs and medical schools. I have given multiple talks on neuroanatomy, neurophysiology, pharmacology, etc. for lecture series and grand rounds at my AMCs. I don't want to imply that all psychologists do this type of work, though I know plenty of neuropsychologists, rehab psych, some researchers, etc. who are very well versed in organic conditions that can mimic psychiatric disorders.
 
Imagine this:
I get a degree from an online university that is not accredited but has just enough in-person supervision to make it ok. I find an unpaid internship that is willing to work me like a slave. Similarly, I find an unpaid post-doc. I am able to convince some state board somewhere to license me. Now, I am on equal footing with most other clinical psychologists. Except there are very few jobs b/c I have such poor training. Well, than I get an online masters in psychpharm and add an additional 70k to my already astronomical debt. Well, now I am in high demand b/c I can push pills. All of a sudden this route becomes a lot more appealing.

Sound like I am exaggerating? This is very possible at the moment. Unless the field does something to clean up training then this would be pretty easy to accomplish.

At the basis of it I believe a properly trained psychologist can prescribe. However, my biggest concern is for the field in general. The end result would be some people getting rich and the field changing drastically. I would love to see legislation that at least sets a bar for psychological training that is above the minimum requirement of APA-accreditation before talking about psychopharm training. I have a hard enough time with MDs from the Caribbean without having to worry about prescribing psychologists with online Caribbean degrees.
 
why do you lie so much, dynamic didactic? You know the psychopharmacology courses are not $70,000, rather they are $15,000-$18,000 total. Your posts are always filled with so much disinformation that I have to believe you are either lying or just not very well informed



QUOTE=DynamicDidactic;13859260]Imagine this:
I get a degree from an online university that is not accredited but has just enough in-person supervision to make it ok. I find an unpaid internship that is willing to work me like a slave. Similarly, I find an unpaid post-doc. I am able to convince some state board somewhere to license me. Now, I am on equal footing with most other clinical psychologists. Except there are very few jobs b/c I have such poor training. Well, than I get an online masters in psychpharm and add an additional 70k to my already astronomical debt. Well, now I am in high demand b/c I can push pills. All of a sudden this route becomes a lot more appealing.

Sound like I am exaggerating? This is very possible at the moment. Unless the field does something to clean up training then this would be pretty easy to accomplish.

At the basis of it I believe a properly trained psychologist can prescribe. However, my biggest concern is for the field in general. The end result would be some people getting rich and the field changing drastically. I would love to see legislation that at least sets a bar for psychological training that is above the minimum requirement of APA-accreditation before talking about psychopharm training. I have a hard enough time with MDs from the Caribbean without having to worry about prescribing psychologists with online Caribbean degrees.[/QUOTE]
 
edieb said:
why do you lie so much, dynamic didactic? You know the psychopharmacology courses are not $70,000, rather they are $15,000-$18,000 total. Your posts are always filled with so much disinformation that I have to believe you are either lying or just not very well informed
Click to expand...

I think the point regarding the variability in training across clinical psych programs is a valid one nonetheless, though. It's something that needs to be addressed for the health of the field in general, and particularly if we're going to start ratcheting up the very-identifiable amount of harm we could do by prescribing medications. I realize 90k scrips have apparently been written thus far without apparent incident, which is of course great, but that could be highly related to the general quality of the current MPs and their pre-pharm training.

Relatedly, I would imagine that especially early on, many of the LA and NM prescribers were folks who were already fairly established, and who thus already had solid bases of knowledge (and trained largely in the pre-FSPS era). Also, many of these folks may have already had high amounts of medical psych exposure (such as that mentioned by T4C above). This certainly holds true for the MPs I've met--they were all highly competent to begin with, and had long and well-established AMC-type careers.

If we start throwing in waves of variably-trained individuals, though, the chances for pharm-associated adverse outcomes would likely rise.
 
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