Psychopharmacology/Advanced Practice Psychology

[edieb]

maybe you could provide us a better understanding of what Bob McGrath was alluding to when comparing the difficulty of supervision in New Mexico vs. Louisiana.

In New Mexico there is a 2-year , once/week supervision requirement by an M.D. after you receive your post-doctoral master's degree in psychpharmacology then finish your clinicals and pass the Psychopharmacology Examination for Psychologistss (PEP) content areas: (Ethics, Research/Statistics, Pharmacology, Physiology, Pathophysiology, Neuroscience, Psychpharmacology, Labs and Drug Monitoring, Neurology, Physical Assessment, etc) . In Louisiana, as soon as you finish your clinical and pass the PEP, you no longer need supervision. Because physicians are in such a short supply in New Mexico, it is difficult to find a supervisor, especially for 2 years.

A second reason for the lower number of prescribing psychologists in New Mexico is that there are simply fewer psychologists in New Mexico than in Louisiaina

---

Members don't see this ad.

 

[Therapist4Chnge]

I didn't realize it was that different in LA. It's bee 2-3 years since I read through the actually language of the laws.

edieb, I have my degree already and plan to sit for the PEP in early '15 (assuming i successfully finish my ABPP by end of '14). I'm under the assumption I just have to meet general PEP req. of completing the degree to sit for the exam. Correct? My intention isn't to actually practice, but I figured I should get licensed since I have the degree. Thoughts?

 

[edieb]

I didn't realize it was that different in LA. It's bee 2-3 years since I read through the actually language of the laws.

edieb, I have my degree already and plan to sit for the PEP in early '15 (assuming i successfully finish my ABPP by end of '14). I'm under the assumption I just have to meet general PEP req. of completing the degree to sit for the exam. Correct? My intention isn't to actually practice, but I figured I should get licensed since I have the degree. Thoughts?

Yes, that is correct. However, to be sure, contact the APAPO at 202 336 5500

 

[PsyDr]

www.ama-assn.org/resources/doc/clrpd/comparison-psych-prescribing-laws.pdf

 

[edieb]

http://www.kfoxtv.com/news/features...-mental-health-care-crisis-el-paso-4042.shtml

 

[Therapist4Chnge]

http://www.kfoxtv.com/news/features...-mental-health-care-crisis-el-paso-4042.shtml

I got recruited for a position down there a couple years ago and saw first hand how badly the community is lacking for mental health services. There is literally 1 practicing neuropsych in the community for a 300+ mi radius, and she was booked out for months, so patients had to drive/fly to another city to get an eval done. There are a couple at the VA, but they are booked for 6+ months out. In regard to medication management the GPs that work in/around El Paso get saddled with everything, and while they do the best they can…they are really struggling to handle the cases.

A cash only prescriber and a cash only neuropsychologist could make very comfortable livings in/around El Paso, but there are definitely some tradeoffs in lifestyle. El Paso is a cute town, but there just isn't much going on there. The NM border is ~3hr away, so prescribers are available in Las Cruzes…but that is a hike. El Paso is also right across the border from Juarez, Mexico...which is one of the worst cities in Mexico for crime/drugs/human trafficking.

 

[hopefuldoc97239]

Yes, our training includes training in geriatric and pediatric prescribing

yes, and the "Master of Naturopathic Psychology" degree includes training in psychoanalysis. you know their program is legit because it requires not one, but TWO thesis papers of 5,000 words each. so clearly, if someone creates a masters program that includes training on a topic, they are qualified to perform that service.

 

[WisNeuro]

yes, and the "Master of Naturopathic Psychology" degree includes training in psychoanalysis. you know their program is legit because it requires not one, but TWO thesis papers of 5,000 words each. so clearly, if someone creates a masters program that includes training on a topic, they are qualified to perform that service.

Hello Strawman, it's been a while.

 

[CGOPsych]

Yes, our training includes training in geriatric and pediatric prescribing

Let's look at this training in geriatric and pediatric prescribing as an excellent example of how dangerously presumptuous these online RxP programs are. On the CSPP RxP training site, it proudly says that within the 30 semester hours of laptop training they offer to take someone who is completely uneducated in biological sciences to becoming ready to prescribe, they offer this course of 36 online instruction hours:

"Topics include: child/adolescent psychopharmacology, geriatric psychopharmacology (dementia, polypharmacy, and interactions between pharmacotherapy and age associated illnesses); developmental disorders; treatment of chronic pain disorders; psychopharmacological issues for individuals with chronic medical illness, victims of trauma, and patients with personality disorders."

Does any sane person think that in 36 hours of online instruction one can learn all those topics properly? Psychiatrists undergo a two-year special fellowship and get special board certification in child/adolescent psychiatry. These people wrap all that into a course with geriatrics, all chronic illnesses, etc. May the good Lord save us from people who have no idea what they are doing but are eager to do it anyway. I recall the research on that topic, which shows that those in the bottom quartile of expertise were the ones to rate themselves well above-average in skills while those in the highest quartile rated themselves moderately above-average.

 

[WisNeuro]

I don't think anyone will disagree that anything Alliant does is shoddy and dangerous. There are other, more established programs from what I remember. Any research to suggest that those prescribing psychologists have patients with more medication complications, adverse reactions, etc?

 

[hopefuldoc97239]

I don't think anyone will disagree that anything Alliant does is shoddy and dangerous. There are other, more established programs from what I remember. Any research to suggest that those prescribing psychologists have patients with more medication complications, adverse reactions, etc?

except... of course... the students that go there and then enter the workforce

 

[edieb]

Let's look at this training in geriatric and pediatric prescribing as an excellent example of how dangerously presumptuous these online RxP programs are. On the CSPP RxP training site, it proudly says that within the 30 semester hours of laptop training they offer to take someone who is completely uneducated in biological sciences to becoming ready to prescribe, they offer this course of 36 online instruction hours:

"Topics include: child/adolescent psychopharmacology, geriatric psychopharmacology (dementia, polypharmacy, and interactions between pharmacotherapy and age associated illnesses); developmental disorders; treatment of chronic pain disorders; psychopharmacological issues for individuals with chronic medical illness, victims of trauma, and patients with personality disorders."

Does any sane person think that in 36 hours of online instruction one can learn all those topics properly? Psychiatrists undergo a two-year special fellowship and get special board certification in child/adolescent psychiatry. These people wrap all that into a course with geriatrics, all chronic illnesses, etc. May the good Lord save us from people who have no idea what they are doing but are eager to do it anyway. I recall the research on that topic, which shows that those in the bottom quartile of expertise were the ones to rate themselves well above-average in skills while those in the highest quartile rated themselves moderately above-average.

What about Nurse Practitioners? They prescribe to pediatric and geriatric patients... Do they undergo a 2-year fellowship after earning their PhDs?

 

[CGOPsych]

I don't think anyone will disagree that anything Alliant does is shoddy and dangerous. There are other, more established programs from what I remember. Any research to suggest that those prescribing psychologists have patients with more medication complications, adverse reactions, etc?d then enter the workforce

I don't think anyone will disagree that anything Alliant does is shoddy and dangerous. There are other, more established programs from what I remember. Any research to suggest that those prescribing psychologists have patients with more medication complications, adverse reactions, etc?

CSPP is the largest purveyor of these RxP training courses, at a total cost of around $14,000.
The American Psychological Association has designated three such programs as appropriate for RxP training. They are CSPP, the one at Farleigh Dickinson and the one in New Mexico. All three of the major RxP leaders - people who travel often to testify and give speeches to rally RxP troops - are officials of those programs. The Farleigh Dickinson site had a very similar description of their online 3-semester-hour course. They seem to have stopped detailing the course content, or I couldn't find it any longer.

As for research: One would think that there is a large body of research to support this given the fact that there are such obvious concerns about the sufficiency of training and the risks to patients when these courses require only 30 semester hours of online instruction to cover everything from the basics of chemistry and biology to the appropriate prescription of psychoactive (and possibly other) medications to persons of all ages, with all medical conditions, taking all possible ineractive medications and under all other circumstances. However, just the opposite is true.

There has been not a single empirical study to show that psychologists allowed to prescribe in the two experimental states (Louisiana and New Mexico) have been working safely, effectively for their patients, or effective in enhancing the access to psychoactive medications in their communities. This is remarkable considering:
1. The proponents have ample resources for conducting such research
2. They have had ample opportunity since these experiments have been going on since 2002 in NM and 2004 in La.
3. Such research would provide badly needed support to their legislative attempts to pass RxP bills in other states - so far 175 such bills have failed in 26 states.

The more people learn of this RxP campaign, the more they oppose it.

 

[CGOPsych]

What about Nurse Practitioners? Do they undergo a 2-year fellowship after earning their PhDs?

No. For example, the Illinois bill now under debate would have someone whose entire biomedical education was taken online, then undergo a practicum supervised by another psychologist with the same inferior training. That practicum would be 400 hours - 10 weeks - and writing at least one prescription for 100 patients. And, this would not have to take place in a hospital or clinic, but in a private psychology office separated from the entire medical system, which of course is rich in applied experience. Furthermore, many important decisions, plus the regulation and licensing of these medical practitioners, would be left up to a board of persons who have no medical training at all - the state psychology board.

So as you can see, it's a new branch of medicine created and managed entirely by psychologists and psychology organizations which
1. Wrote the curriculum
2. Wrote the examination for the course
3. Supervises practicum
4. Regulates and licenses these medical practitioners
5. Wrote the model legislation and paid for the lobbyists to get the law passed.

Pretty neat trick, huh?

 

[WisNeuro]

There has been not a single empirical study to show that psychologists allowed to prescribe in the two experimental states (Louisiana and New Mexico) have been working safely, effectively for their patients, or effective in enhancing the access to psychoactive medications in their communities. This is remarkable considering:
1. The proponents have ample resources for conducting such research
2. They have had ample opportunity since these experiments have been going on since 2002 in NM and 2004 in La.
3. Such research would provide badly needed support to their legislative attempts to pass RxP bills in other states - so far 175 such bills have failed in 26 states.

The more people learn of this RxP campaign, the more they oppose it.

The absence of research for is not proof of evidence against. I'm not taking a firm stance, because I frankly don't know. But if you don't have data that it is dangerous as you say, I don't see how you can make that assertion without any objective data whatsoever.

 

[CGOPsych]

What about Nurse Practitioners? They prescribe to pediatric and geriatric patients... Do they undergo a 2-year fellowship after earning their PhDs?

My apologies, I'm running out the door and didn't read your question accurately, although I may have answered someone else's question
APN's undergo about twice the instruction called for by these RxP programs and they are trained in medical settings with multiple rotations, as are PA's generally. I admit I don't know if they have something like a fellowship.

 

[edieb]

Is there a bill in Illinois this year?

 

[WisNeuro]

Is there a bill in Illinois this year?

SB 2187 I think.

 

[CaliMac]

No. For example, the Illinois bill now under debate would have someone whose entire biomedical education was taken online, then undergo a practicum supervised by another psychologist with the same inferior training. That practicum would be 400 hours - 10 weeks - and writing at least one prescription for 100 patients. And, this would not have to take place in a hospital or clinic, but in a private psychology office separated from the entire medical system, which of course is rich in applied experience. Furthermore, many important decisions, plus the regulation and licensing of these medical practitioners, would be left up to a board of persons who have no medical training at all - the state psychology board.

So as you can see, it's a new branch of medicine created and managed entirely by psychologists and psychology organizations which
1. Wrote the curriculum
2. Wrote the examination for the course
3. Supervises practicum
4. Regulates and licenses these medical practitioners
5. Wrote the model legislation and paid for the lobbyists to get the law passed.

Pretty neat trick, huh?

As a consumer and a parent, that is frightening.

 

[Therapist4Chnge]

Now you have my curious about the IL proposed legislation. The standards (as described) seem too limited, but I'm sure the devil is in the details.

 

[WisNeuro]

As a consumer and a parent, that is frightening.

To date, the only study on outcomes has been positive for prescribing psychologists in the DoD.
http://www.dod.mil/pubs/foi/Personnel_and_Personnel_Readiness/Personnel/966.pdf

http://www.nami.org/Template.cfm?Se...tManagement/ContentDisplay.cfm&ContentID=8375

I have to say that I am skeptical of the AMA's fight against this due to "patient safety." I think it has more to do with protecting their self-appointed turf and money.

 

[Therapist4Chnge]

So as you can see, it's a new branch of medicine created and managed entirely by psychologists and psychology organizations which
1. Wrote the curriculum
2. Wrote the examination for the course
3. Supervises practicum
4. Regulates and licenses these medical practitioners
5. Wrote the model legislation and paid for the lobbyists to get the law passed.

Pretty neat trick, huh?

Very much revisionist history. Let's back this up a bit….the DOD study had significant physician involvement in the training and curriculum, and more importantly it had physician support (not 100%, but good support). A bunch of psychologists didn't just get together in someone's basement and start a club, they went through a lengthly review and consultation process with the DOD to setup the pilot study. The transition from the initial pilot program to the first degree-based curriculum definitely weakened the overall training, particularly in the supervision and mentorship area (total hours, etc); so that is a fair critique.

I cannot speak to the IL legislation, though from what I've seen in other states I am not impressed by any of the recent proposals and minimum requirements for training. I haven't seen any compelling research to demonstrate that the lesser training is leading to worse outcomes or adverse outcomes, so I'm not sure I can fairly slam the training, but I have some concerns. Personally, I do not support online training, so that is the biggest fly in the ointment for me. I trained in a residential program and felt like the training better prepared me than what I saw in neighboring NP programs (that friends were in).

 

[CaliMac]

To date, the only study on outcomes has been positive for prescribing psychologists in the DoD.

You're the trained scientist, reserving your opinion until empirical evidence presents itself. I am the novice dilettante, reacting out of concern for my family. Your education, and my lack thereof, is showing

If someone were trained solely online to prescribe psychoactive substances and mentored by someone trained similarly, I wouldn't want them treating anyone I love.

Or maybe I have misunderstood. I re-caulked my shower and have been breathing fumes for an hour...

 

[WisNeuro]

I believe the wording of the bill mentions that the supervisor has to be a psychiatrist, or a prescribing psych who has passed board approval. Granted, I would also argue for fairly stringent standards of training. But, the opposition to Rx privileges has generally not stuck on training practices, but rather the concept in general.

Also, you are assuming that that the MD paradigm is without error?

http://www.bmj.com/content/336/7642/488
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1758003/
http://bmjopen.bmj.com/content/3/1/e002036.full

 

[CGOPsych]

Very much revisionist history. Let's back this up a bit….the DOD study had significant physician involvement in the training and curriculum, and more importantly it had physician support (not 100%, but good support). A bunch of psychologists didn't just get together in someone's basement and start a club, they went through a lengthly review and consultation process with the DOD to setup the pilot study. The transition from the initial pilot program to the first degree-based curriculum definitely weakened the overall training, particularly in the supervision and mentorship area (total hours, etc); so that is a fair critique.

I cannot speak to the IL legislation, though from what I've seen in other states I am not impressed by any of the recent proposals and minimum requirements for training. I haven't seen any compelling research to demonstrate that the lesser training is leading to worse outcomes or adverse outcomes, so I'm not sure I can fairly slam the training, but I have some concerns. Personally, I do not support online training, so that is the biggest fly in the ointment for me. I trained in a residential program and felt like the training better prepared me than what I saw in neighboring NP programs (that friends were in).

Revisionist? Everything I said is true and is ongoing today.

Your are right, though: The DoD project is a completely different animal and cannot be compared with current proposals. They were carefully selected, trained in the uniformed services university, essentially two years and later one year of medical school, followed by intensive supervised training. Furthermore, they only treated persons 18-65 who were free of major and physical illnesses, surrounded by military medical staff who were available for support and to refer to with free medical services. Also, being in the military then the economic influences that are known to alter practice behavior was absent. Nevertheless, the ACNP which studied this group reported that "virtually all" of teh 10 DoD demonstration project psychologists said that the kind of training model proposed in the state legislatures would be "ill advised."

I have to disagree with you about proof. Because the training is so inferior in quantity and quality to the minimal standards now required, it is clearly incumbent upon those who propose this to show evidence that it is safe and effective. You WOULD expect that from a drug company proposing a new drug, I assume, rather than tolerate their telling the FDA that it's up to critics of the drug to show that it is unsafe and ineffective, right>

Also, let's not forget that the proponents have ample resources and opportunity to produce research that they desperately need to help their legislative cause, which is an abject failure, having failed 175 times in 26 states over 29 years, costing millions upon millions of dollars. Therefore, I contend that continuing to push these bills without evidence is unethical and and also strongly suggests that they cannot produce it.

 

[CGOPsych]

To date, the only study on outcomes has been positive for prescribing psychologists in the DoD.
http://www.dod.mil/pubs/foi/Personnel_and_Personnel_Readiness/Personnel/966.pdf

http://www.nami.org/Template.cfm?Se...tManagement/ContentDisplay.cfm&ContentID=8375

I have to say that I am skeptical of the AMA's fight against this due to "patient safety." I think it has more to do with protecting their self-appointed turf and money.

Forget the AMA. Think about the ethical treatment of the mentally ill.
By the way, let me ask you this hypothetical.

The NASW conducts a national campaign to allow social workers to do all the assessment duties of psychologists after taking a few online courses taught by social workers in social work schools. They are then supervised in practicing just as psychologists by other social workers and they are licensed and regulated by social workers and practice with social work licenses. They are then legally called Psychological Social Workers. After all, there are shortages of psychologists in many parts of the country, especially rural areas, so they would be able to enhance access to care. I know of people who have to wait months to get their children tested for school, and I know psychologists who charge huge fees for assessments not covered by insurance. Social workers could increase access to psychological assessments and also lower the costs so that low-income people could also get proper servcies.

So ... would you support this? Or would you be trying to protect your turf.
By the way, I would oppose that AND RxP.

 

[WisNeuro]

School assessments are not the sole "turf" of clinical psychologists. These assessments are provides by both clinical and school psychologists. And, if they have become adequately trained to do so, and have passed adequate licensure, more power to them.

 

[CaliMac]

To date, the only study on outcomes has been positive for prescribing psychologists in the DoD.
http://www.dod.mil/pubs/foi/Personnel_and_Personnel_Readiness/Personnel/966.pdf

http://www.nami.org/Template.cfm?Se...tManagement/ContentDisplay.cfm&ContentID=8375

I have to say that I am skeptical of the AMA's fight against this due to "patient safety." I think it has more to do with protecting their self-appointed turf and money.

Ok, point received. Very select sample, of course, but the premise makes sense. A key quote from the first link was in Findings summary, point 2, where they subjects "knew when, where, and how to consult." That, combined with stringent standards of training, as you mention below, makes more sense.

I believe the wording of the bill mentions that the supervisor has to be a psychiatrist, or a prescribing psych who has passed board approval. Granted, I would also argue for fairly stringent standards of training. But, the opposition to Rx privileges has generally not stuck on training practices, but rather the concept in general.

Also, you are assuming that that the MD paradigm is without error?

http://www.bmj.com/content/336/7642/488
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1758003/
http://bmjopen.bmj.com/content/3/1/e002036.full

And no, of course, I'm not suggesting that anyone is without error, MDs included The reason I opted out of pre-med years ago was that the medical profession seemed more of an industry than anything else to me; I believed that, after training for years within that industry (funded by pharma interests, and staffed by relatively bright-eyed youngsters like my former self), I would have had a harder time keeping sight of my initial interests in the profession. That's a much bigger issue than simple human error, of course, that's a seismic fault within the paradigm. The stakes are just tremendously high with patient w0rk, however; hence, your suggestion of training standards. Then, at least, poor judgement and inexperience can be mostly controlled for.

Personally, given that 70% of psychotropics are prescribed by PCPs (your NAMI link, above), it makes much more sense for psychologists to have a more active role in an area in which they are expert. With the coming age of medical record integration (I know it's harder for paper-based practitioners to grasp; it's a slow transition), one would hope that patients would have greater ability and safety in conferring with, and being referred to, whichever expert most suited their needs. With that, again there exists the hope that each expert could access the patient's record and be properly trained to accurately assess whether or not This Anti-Depressant (let's not get into the over-use of those... another interesting thread lately) reacts with That Anti-Hypertensive or The Other Grapefruit Seed Extract the Pt is taking for their eczema.

 

[CGOPsych]

School assessments are not the sole "turf" of clinical psychologists. These assessments are provides by both clinical and school psychologists. And, if they have become adequately trained to do so, and have passed adequate licensure, more power to them.

Tsk tsk tsk, you dodged the question.
But you're not alone. In fact, I've never seen an RxP advocate answer that question, and the reason is obvious.
If you want to expand the scope of psychologists in such a tawdry and unethical way, then the AMA is just fighting for turn.
If someone else tries to pull the same stunt with us ... um, no comment.

Is there anyone who really wants to debate this? All I find is people who don't want to face up to the issues without the hype and the talking points.

 

[WisNeuro]

I did answer the question. If they were trained in the requisite areas to do the job, and passed a test of licensure that approximated a minimum standard, then sure.

And where is the ethical conundrum if someone gets the requisite training? Mind you, I am more for the DoD/Nova training model. But there is zero data saying that those psychologists are any less safe in prescribing psychotropics than psychiatrists?

 

[CGOPsych]

I believe the wording of the bill mentions that the supervisor has to be a psychiatrist, or a prescribing psych who has passed board approval. Granted, I would also argue for fairly stringent standards of training. But, the opposition to Rx privileges has generally not stuck on training practices, but rather the concept in general.

Also, you are assuming that that the MD paradigm is without error?

http://www.bmj.com/content/336/7642/488
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1758003/
http://bmjopen.bmj.com/content/3/1/e002036.full

The bill does not specify a psychiatrist for supervision but "an appropriately trained physician or a prescribing psychologist determined by the board as competent to train the applicant." So it could be any physician. And who is making this determination of who is competent to train people to practice medicine? It's the state psychology board whose members have no medical training so they are not competent to make such a decision in any rational person's eyes. And they are appointed with input from the state psychological association, which is conducting this campaign and spending massive amounts of money from a fund whose donor list is secret. As I wrote earlier, this is an inside job by some psychologist.

I beg to differ, but the opposition to RxP is very much focused on details such as the quantity of training and its quality as well as the practicum supervision. For example, these persons would start their online medical training without having to take any pre-requisite courses. For example, the PA school nearby required 300 contact hours of chemistry and biology as a condition for entry to the school's full-time education. Good grief, the entire RxP online course is 450 contact hours. It doesn't come close to comparing.

 

[PsyDr]

No. For example, the Illinois bill now under debate would have someone whose entire biomedical education was taken online, then undergo a practicum supervised by another psychologist with the same inferior training. That practicum would be 400 hours - 10 weeks - and writing at least one prescription for 100 patients. And, this would not have to take place in a hospital or clinic, but in a private psychology office separated from the entire medical system, which of course is rich in applied experience. Furthermore, many important decisions, plus the regulation and licensing of these medical practitioners, would be left up to a board of persons who have no medical training at all - the state psychology board.

So as you can see, it's a new branch of medicine created and managed entirely by psychologists and psychology organizations which
1. Wrote the curriculum
2. Wrote the examination for the course
3. Supervises practicum
4. Regulates and licenses these medical practitioners
5. Wrote the model legislation and paid for the lobbyists to get the law passed.

Pretty neat trick, huh?

That is patently false.
1) The program of study was created by MDs and PharmDs.
2) The examination for the courses were written by MDs and borrows many of the same questions from the psychiatry boards.
3) The practicum, by its very nature, requires an MD to supervise. You know, because the rxp psychologist doesn't have a license to prescribe yet.
4) The license is covered by the medical board in two jurisdictions.
5) The fifth point is accurate

 

[CGOPsych]

I did answer the question. If they were trained in the requisite areas to do the job, and passed a test of licensure that approximated a minimum standard, then sure.

And where is the ethical conundrum if someone gets the requisite training? Mind you, I am more for the DoD/Nova training model. But there is zero data saying that those psychologists are any less safe in prescribing psychotropics than psychiatrists?

No, you fell back on the "properly trained" gizmo.
My friend, I believe that properly trained postal workers and shoe salesmen should prescribe.
Oh, and there's no licensure test for RxP ... although there IS one test they must pass. And lo and behold, that test was written by APA and the cutoff was set by APA ... did I mention this is an inside job by a few psychologists and a couple of politically minded psychology organizations?

Data ... once again, you are looking through the telescope from the wrong end. Does the FDA allow a new drug to be sold without empirical support for safety and effectiveness unless someone proves otherwise? It is unethical for psychologists to pursue an apparently risky form of treatment without data. Ethical psychologists base their practices on data when possible. The RxPers have ample opportunity and a desperate need to produce the data, and they have not.

 

[WisNeuro]

I beg to differ, but the opposition to RxP is very much focused on details such as the quantity of training and its quality as well as the practicum supervision. For example, these persons would start their online medical training without having to take any pre-requisite courses. For example, the PA school nearby required 300 contact hours of chemistry and biology as a condition for entry to the school's full-time education. Good grief, the entire RxP online course is 450 contact hours. It doesn't come close to comparing.

I bet to differ. The opposition was there even for the more stringent programs, DoD included. I don't think the AMA will relent even if the training is double what MD's go through.

 

[WisNeuro]

No, you fell back on the "properly trained" gizmo.
My friend, I believe that properly trained postal workers and shoe salesmen should prescribe.
Oh, and there's no licensure test for RxP ... although there IS one test they must pass. And lo and behold, that test was written by APA and the cutoff was set by APA ... did I mention this is an inside job by a few psychologists and a couple of politically minded psychology organizations?

Data ... once again, you are looking through the telescope from the wrong end. Does the FDA allow a new drug to be sold without empirical support for safety and effectiveness unless someone proves otherwise? It is unethical for psychologists to pursue an apparently risky form of treatment without data. Ethical psychologists base their practices on data when possible. The RxPers have ample opportunity and a desperate need to produce the data, and they have not.

If the postal worker goes back and receives all of the required training, degrees, and passes all of the licensing tests for said degrees and certifications. Then, let's go. We have a couple decades of prescribing psychologists now, and I have yet to hear about a multitude of dead patients because of it. We have some data suggesting that it works, zero data suggesting it does not.

 

[CGOPsych]

That is patently false.
1) The program of study was created by MDs and PharmDs.
2) The examination for the courses were written by MDs and borrows many of the same questions from the psychiatry boards.
3) The practicum, by its very nature, requires an MD to supervise. You know, because the rxp psychologist doesn't have a license to prescribe yet.
4) The license is covered by the medical board in two jurisdictions.
5) The fifth point is accurate

The curriculum was developed by APA
The examination , the PEP, is a product of APA
APA decided the cutoff score
APA also wrote the model legislation, and helps pay for lobbyists.
The current proposals are that they will be licensed and regulated by the state psychology board. Please note SB2187 in the Illinois Assembly
In La. they were originally under the state psychology board and they moved themselves under the medical board to gain greater advantages. I happen to agree with that move, although the way it was done was grossly unethical.
In NM there is a joint board that oversees some aspects of practice, although the the RxPers are licensed and regulated by the state psychology board.
As for point 3, you are wrong. The NM and LA prescribers will have reciprocity so they can move in and cash in. And even if there were not reciprocity, an MD would be needed for Prescriber No. 1, and none afterward.

 

[WisNeuro]

The PEP work group contains psychologists and physicians.

 

[CGOPsych]

If the postal worker goes back and receives all of the required training, degrees, and passes all of the licensing tests for said degrees and certifications. Then, let's go. We have a couple decades of prescribing psychologists now, and I have yet to hear about a multitude of dead patients because of it. We have some data suggesting that it works, zero data suggesting it does not.

All the required? Who requires? That's the point.
And again I ask: What are these people so special that they must be allowed to practice psychiatric medicine with 20 percent of a psychiatrist's training and 50 percent of a non-physician prescriber?
We can find not a single RxPer who, after 19 years of failure, including 15 years in Illinois, just went ahead and got the non-physician training. That says something about the willingness to get the proper training and prescribe.
RxP is an attempt to dumb-down medicine. Many elements of psychology have been trying to dumb down our profession. How about if we don't dumb-down the practice of something that can cause harm in thousands of ways?

 

[CGOPsych]

The PEP work group contains psychologists and physicians.

The PEP was developed by APA. And by the way, RxP activists never reveal that, but call it a "national examination," which is dishonest. Why not have an examination by an outside agency? Why not the psychiatry board?
In fact, why not just get the same training and pass the same tests that every other prescriber of these medications in the United States must undergo?

Could it be that those are TOO HARD?

 

[WisNeuro]

I would imagine with the thousands of ways it can harm then we would have plenty of examples from LA, NM, or the D0D to show the folly. Where are those examples?

 

[PsyDr]

1) Show me evidence.
2) I have passed the PEP. I cannot further elaborate without violating test security. You are wrong.
3) I never disagreed with the lobbyist point.
4) You are now changing your assertion. In all states, physician oversight is required for practicum.
5) I do not understand why you are changing your assertion from no physician oversight to which board will oversee psychologists. In all states psychologists are required to receive physician agreement to the treatment plan. The one exception is advanced practice LA license. See my previous posts for info from the AMA.

 

[WisNeuro]

The PEP was developed by APA. And by the way, RxP activists never reveal that, but call it a "national examination," which is dishonest. Why not have an examination by an outside agency? Why not the psychiatry board?
In fact, why not just get the same training and pass the same tests that every other prescriber of these medications in the United States must undergo?

The examination manual clearly states that the APA professional group created the exam. And it clearly states who developed the questions. And, do you have any evidence to suggest that the PEP leads to more inadequate providers than the exam give to MD's and NP's?

 

[CGOPsych]

1) Show me evidence.
2) I have passed the PEP. I cannot further elaborate without violating test security. You are wrong.
3) I never disagreed with the lobbyist point.
4) You are now changing your assertion. In all states, physician oversight is required for practicum.
5) I do not understand why you are changing your assertion from no physician oversight to which board will oversee psychologists. In all states psychologists are required to receive physician agreement to the treatment plan. The one exception is advanced practice LA license. See my previous posts for info from the AMA.

Look at SB2187 and you will see that a physician does not have to supervise the practicum.
NM's law does require physician oversight. Subsequent proposals in other states have not. The RxPers tried in vain to shake off that oversight in NM and they lost.

 

[CGOPsych]

The examination manual clearly states that the APA professional group created the exam. And it clearly states who developed the questions. And, do you have any evidence to suggest that the PEP leads to more inadequate providers than the exam give to MD's and NP's?

I said what I said.
The exam was created by APA, which also created the curriculum.
APA also wrote the model legislation.
APA also helps pay for lobbyists.

Once again, the burden of evidence for safety and efficacy falls on those who propose.
And this is one reason why such proposals have failed 175 times in 26 states.

 

[WisNeuro]

We do have some evidence, 10 years following DoD RxP's with zero legal complaints. And, we have zero evidence against. Do you hold NP's to the same standard. What level of supporting evidence is enough?

 

[PsyDr]

I 'm starting to think that CGOPsych, who only shows up during RxP legislation times, is a hired troll.

 

[WisNeuro]

I 'm starting to think that CGOPsych, who only shows up during RxP legislation times, is a hired troll.

I believe you may be right

http://lunatickfringe.wordpress.com/2010/02/26/oregon-gives-psychologists-power-to-drug/
http://www.thelundreport.org/content/psychologists-continue-push-prescribing-rights
http://www.oregonlive.com/opinion/index.ssf/2010/04/a_veto_is_the_proper_prescript.html

Check the comments.

 

[CGOPsych]

I believe you may be right

http://lunatickfringe.wordpress.com/2010/02/26/oregon-gives-psychologists-power-to-drug/

Check the comments.

If you can't win on the debate, then just go for the ad hominem.
Very disappointing.

 

[WisNeuro]

Meh, we're used to the trolls hired by Alliant and Argosy, they pop up now and then. I wouldn't expect this issue to be any different. Just seems a bittoo convenient. And, as far as the available evidence suggests, RxP is winning the debate.

 

[CGOPsych]

We do have some evidence, 10 years following DoD RxP's with zero legal complaints. And, we have zero evidence against. Do you hold NP's to the same standard. What level of supporting evidence is enough?

Whoa, hold on. Have you been reading this?
First the DoD project is in no way relevant. I've already explained how much more training they had and the ideal conditions in which they practiced. Also the ACNP report said that "virtually all" the DoD psychologists said that the kinds of proposals we are now debating (at least I am, but maybe you want to just call names) was "ill-advised".

If you have data on legal complaints against members of the military in health care practice I'd love to see it. In fact, most of them are long gone. Two of them went on to go to medical school, etc.
Actually there is plenty of evidence supporting NP's, thank you very much. The IOM issued a report saying that nurse practitioners practice safely. I would be VERY impressed if IOM said the same thing about RxPers being trained online getting the same endorsement.

This is getting repetitious and tiresome. Is there anyone who really wants to discuss this or just toss out the same old tired cliches about how opponents have not proven that these people are unsafe.
By the way, there is a licensed psychologist in Illinois who actually advertises that he treats depression by helping people communicate with dead relatives to ease their bereavement. I looked and I find no evidence of malpractice lawsuits or ethics complaints against him. By the RxP standard, he is practicing safely and effectively.

If there are any real arguments based on data I'm all ears. However, if you want to play an anecdote game, I have one for you. I can quote the Louisiana prescribing psychologist who said on a list that the RxP training was "woefully insufficient" and that if he hadn't gotten a lot of help from friendly psychiatrists and other physicians, his RxP training alone would have left him a "menace."