Psychopharmacology/Advanced Practice Psychology

[CGOPsych]

I'm still wondering about the charge that RxP has to produce evidence that other prescribers don't. Why the double standard?

I don't know if there is a double standard. Where did you get that information? The APN model is endorsed by the IOM. I suspect they don't do so without empirical support. Perhaps if you inquire you can learn what support the MD, PA and APN models have.

RxP is a proposal to create a new medical profession. Details of the proposal appear to be wildly insufficient. Advocates have had had 11 and 13 years of experimentation in two states and have produced no empirical support for the model's safety or effectiveness. That seems like a perfectly reasonable thing to expect.

---

Members don't see this ad.

 

[WisNeuro]

I am not aware of efficacy/safety studies. The IOM is just as susceptible to bias as the APA is. Which apprises another sort of double standard within that argument framework. If there are such studies, I'd love to see them, honestly. They've had much more time than RxP to produce such empirical support. I think that's also perfectly reasonable.

 

[CGOPsych]

FYI, an RxP bill in Nebraska failed today.
This brings to 182 the number of RxP bills that have failed in 26 states.

 

[WisNeuro]

Miscegenation laws were routinely defeated in legislature in times past. Such examples demonstrate political whim and atmosphere rather than empirical evidence against an action.

 

[Therapist4Chnge]

FYI, an RxP bill in Nebraska failed today.
This brings to 182 the number of RxP bills that have failed in 26 states.

You do understand that "182" isn't actually a meaningful number like you want it to be, right? The legislative process is such that THOUSANDS of proposed bills fail to get out of the initial stages of the process. There are a myriad of reasons proposed bills do not move forward including but not limited to: not enough time in the legislative calendar, competition from a competing bill, unfinished language/sections, put on hold for committee feedback, change in leadership, change in state budgets, etc. The vast majority of bills don't even make it to the floor to be discussed. There are literally DOZENS of reasons, almost all of which have nothing to do with whether or not the bill has sufficient support to move forward. The chances of a piece of proposed legislation actually making it through to become a law…<5%. It is often <1% depending on the jurisdiction and how you classify it.

No matter how many times you bring up the number of "failed" bills, it isn't going to make your forced narrative any less misleading. Anyone who has done any significant work with the legislature understands that your quoting of the number of "failed" bills is a half-baked Straw Man.

*edit to add*: https://www.opencongress.org/articles/view/1180-The-Vast-Majority-of-Bills-Go-Nowhere

This is about proposed legislation at the federal level, but you get the idea…hopefully.

 

[DynamicDidactic]

182 does underscore the difficulty of getting this legislation approved. At the same time, all legislation is difficult to pass.

It seems both points are valid.

 

[CGOPsych]

These responses follow a pattern that is familiar to me in discussing the RxP campaign. This seems to be nit-picking over whether 182 failed bills is significant (it is) and yet avoids the heart of the issue, whether the proposals by the RxP campaign are appropriate and defensible. As I stated earlier, RxP proponents refer to a "master's degree in psychopharmacology" but do not reveal the details of these degree programs. This is for a very good reason, because the majority of psychologists disapprove of the details. Most do not think that one can be properly educated to practice medicine through online classes from a psychology school. A survey of psychologists from ABCT found that only 10 percent said they would be comfortable referring a patient for medication to someone who has had this amount of training. A whopping 89 percent have said that since the RxP model has no scientific basis, yet purports to train non-medical people to practice medicine with what appears to be sub-par education both quantitatively and qualitatively, the campaign should stop proposing such bills until they have obtained empirical support.

There is a question I pose to RxP supporters which has never been answered. It goes like this:
Assume that the National Association of Social Workers starts a national campaign to allow their members to perform all types of psychological assessments, including neuropsych. They set up online programs from private social work schools alleging they can prepare a social worker to do all psychological testing forms in a few courses on their laptops, explaining that psychological assessments are really no big deal and that anyone can learn how to do them in a very short amount of time.

The schools advertise online that social workers can learn to do all the work of a psychologist and thus practice so by taking some courses on weekends in their homes. They submit legislative bills that would allow "Psychological Social Workers" to do all the assessment and therapy that psychologists do, but with a social work license, supervised and licensed by social work boards. Practicum supervision would be done by other social workers. NASW creates its own curriculum with no review by psychology organizations, and no science to show that it is effective. NASW writes its own test to demonstrate graduates' proficiency, but mask it by calling it a "national examination." They argue that there is a shortage of psychologists so that this is necessary, and of course if psychologists object, it's only because they are greedy and are engaging in turf warfare.

This hypothetical is more than fair, since social workers already can be licensed to diagnose and treat mental disorders. It is a far smaller leap for them to do psych evals (and call themselves "psychological social workers") than for psychologists to practice medicine.

So ... would my colleagues support such a campaign?

 

[WisNeuro]

I'm still waiting for an answer to my question about double standards.

Also, OT's and ST's do attempt to do npsych evaluation. It's fairly humorous. Like using the Trails tests to measure their rehab gains, with no understanding of psychometrics and practice effects. No one refers to them for these things, because they're evals are useless in this context. If you do good work, you will get teh work. From the few that I know, they are getting plenty of referrals in NM and LA.

You still have provided no basis of what adequate training should be based on empiricism in this area.

 

[psych844]

There is a question I pose to RxP supporters which has never been answered. It goes like this:
Assume that the National Association of Social Workers starts a national campaign to allow their members to perform all types of psychological assessments, including neuropsych. They set up online programs from private social work schools alleging they can prepare a social worker to do all psychological testing forms in a few courses on their laptops, explaining that psychological assessments are really no big deal and that anyone can learn how to do them in a very short amount of time.

The schools advertise online that social workers can learn to do all the work of a psychologist and thus practice so by taking some courses on weekends in their homes. They submit legislative bills that would allow "Psychological Social Workers" to do all the assessment and therapy that psychologists do, but with a social work license, supervised and licensed by social work boards. Practicum supervision would be done by other social workers. NASW creates its own curriculum with no review by psychology organizations, and no science to show that it is effective. NASW writes its own test to demonstrate graduates' proficiency, but mask it by calling it a "national examination." They argue that there is a shortage of psychologists so that this is necessary, and of course if psychologists object, it's only because they are greedy and are engaging in turf warfare.

I don't think that is a proper example.
If being a doctor was all about writing prescriptions for mental health issues, you might have a point.

 

[CGOPsych]

I don't think that is a proper example.
If being a doctor was all about writing prescriptions for mental health issues, you might have a point.

Non-responsive.

 

[smalltownpsych]

These responses follow a pattern that is familiar to me in discussing the RxP campaign. This seems to be nit-picking over whether 182 failed bills is significant (it is) and yet avoids the heart of the issue, whether the proposals by the RxP campaign are appropriate and defensible. As I stated earlier, RxP proponents refer to a "master's degree in psychopharmacology" but do not reveal the details of these degree programs. This is for a very good reason, because the majority of psychologists disapprove of the details. Most do not think that one can be properly educated to practice medicine through online classes from a psychology school. A survey of psychologists from ABCT found that only 10 percent said they would be comfortable referring a patient for medication to someone who has had this amount of training. A whopping 89 percent have said that since the RxP model has no scientific basis, yet purports to train non-medical people to practice medicine with what appears to be sub-par education both quantitatively and qualitatively, the campaign should stop proposing such bills until they have obtained empirical support.

There is a question I pose to RxP supporters which has never been answered. It goes like this:
Assume that the National Association of Social Workers starts a national campaign to allow their members to perform all types of psychological assessments, including neuropsych. They set up online programs from private social work schools alleging they can prepare a social worker to do all psychological testing forms in a few courses on their laptops, explaining that psychological assessments are really no big deal and that anyone can learn how to do them in a very short amount of time.

The schools advertise online that social workers can learn to do all the work of a psychologist and thus practice so by taking some courses on weekends in their homes. They submit legislative bills that would allow "Psychological Social Workers" to do all the assessment and therapy that psychologists do, but with a social work license, supervised and licensed by social work boards. Practicum supervision would be done by other social workers. NASW creates its own curriculum with no review by psychology organizations, and no science to show that it is effective. NASW writes its own test to demonstrate graduates' proficiency, but mask it by calling it a "national examination." They argue that there is a shortage of psychologists so that this is necessary, and of course if psychologists object, it's only because they are greedy and are engaging in turf warfare.

This hypothetical is more than fair, since social workers already can be licensed to diagnose and treat mental disorders. It is a far smaller leap for them to do psych evals (and call themselves "psychological social workers") than for psychologists to practice medicine.

So ... would my colleagues support such a campaign?

In the state I am in currently they can do assessments all day long. The board of psychology tried to prevent it and lost in the legislature. They don't even have to demonstrate any additional education other than their own appraisal of competence. Do any of them actually do it even though they technically can? Not that I have seen. There are other safeguards in place including their own ethical practice. It seems to me that you imply that licensed psychologists would get the least amount of training possible and start writing scripts without any thought for ethical practice and this would lead to hypothetical increase in harm.

 

[DynamicDidactic]

It seems to me that you imply that licensed psychologists would get the least amount of training possible and start writing scripts without any thought for ethical practice

I think we can definitely extrapolate from our current knowledge that this would indeed happen. Just by being a member on this forum one sees how people attempt to get the lowest level of training to become a psychologist. Almost every regular member on this forum admonishes people from getting online degrees. Yet, we have had numerous people push that agenda. Cal Southern is another winner of a school that often comes up on this forum.

and this would lead to hypothetical increase in harm.

I think the point being made is that we have no evidence whether this would be harmful or not.

I am still surprised by many of the members in this thread that generally agree with me that there are poor training programs in clinical psychology that are harmful to the field and at the same time overlook that when discussing RxP. Does anyone on here advocate for individuals to go to unaccredited programs and internships, acquire fee-for-supervision post docs, and get licensed? When you are over 200K in debt and no one will hire you yet procuring RxP is a simple, mostly online program away, why would you not do it? At the minimum, we should clean our house before expanding our scope of practice. Otherwise, we risk the continued eroding of the minimal training standards we currently enforce.

 

[smalltownpsych]

I think we can definitely extrapolate from our current knowledge that this would indeed happen. Just by being a member on this forum one sees how people attempt to get the lowest level of training to become a psychologist. Almost every regular member on this forum admonishes people from getting online degrees. Yet, we have had numerous people push that agenda. Cal Southern is another winner of a school that often comes up on this forum.


I think the point being made is that we have no evidence whether this would be harmful or not.

I am still surprised by many of the members in this thread that generally agree with me that there are poor training programs in clinical psychology that are harmful to the field and at the same time overlook that when discussing RxP. Does anyone on here advocate for individuals to go to unaccredited programs and internships, acquire fee-for-supervision post docs, and get licensed? When you are over 200K in debt and no one will hire you yet procuring RxP is a simple, mostly online program away, why would you not do it? At the minimum, we should clean our house before expanding our scope of practice. Otherwise, we risk the continued eroding of the minimal training standards we currently enforce.

I completely agree with your position that we need to continue working on making our licensure requirements solid and that any push for RxP would need to incorporate equally solid standards. I also know that in the states where I have been licensed an unaccredited online degree does not equal a license so I am not sure that our standards have eroded as much as you fear. Nevertheless, we all have to stay committed to keeping high standards for our training regardless of scope of practice.

 

[Therapist4Chnge]

RxP licensure could require APA-acred programs (and more), so that would weed out the Capellas of the world.

 

[CGOPsych]

Indeed, Smalltown and Dynamic. Those who challenge RxP do so as a result of their high esteem for our profession and our standards of training. We can't criticize the attempts to dumb-down psychology training and then look the other way when some try to do the same to the practice of medicine.

Unfortunately, APA is working hard to get legislatures to accept this model of grossly inferior training. The campaign has other negative effects as well.

1. It is a 20-year-old publicity campaign that says we need to give people more drugs in order to improve mental health. In Illinois they literally said that the mental health system is broken and the answer is more drugs to people. The message clearly implies that psychology is impotent so we need something better.

2. It makes psychologists look like cheap chiselers. Legislators are fully aware that these are sad attempts to make more money with lower standards, and that RxP advocates often stretch the truth badly (such as never revealing the details of the training.) It is embarrassing to see what they do to try to get their hands on the almighty prescription pad.

3. It has cost millions of dollars. APA has spent $3 million just on lobbying grants to state associations for RxP. You can be sure they haven't spent that much money promoting psychological assessments.

4. It has made enemies out of mental health professionals who should be our allies. In the RxP battle states the psychiatrists have become bitter in seeing how some RxPers, claiming to represent all of psychology when they don't actually consult their colleagues, spin and twist things in a turf war against them. Fortunately, many know that the RxPers do not represent the majority of psychologists.

5. The political campaign of RxP has made sure that better alternatives get no resources, at least from APA and its state association subsidiaries. For example, if they were sincerely interested only in enhancing the mental health system by increasing access to psychoactive medications, they could have created a collaboration program as the Canadian Psychological Association has done, or enhanced opportunities for psychologists to obtain cross-training into professions with appropriate training standards, (PA, APN), or support telepsychiatry. Instead, those alternatives that are far better, safer, more effective, and could be implemented faster become competition to RxP and so they are not promoted. All this actually hurts those persons who do need improved mental health access.

 

[WisNeuro]

Oh, I don't think psychiatry has been an ally for quite some time. I wouldn't blame that rift on RxP, friend. Honestly, I'm more interested in the concept of RxP for better management of psychotropics and reducing the need for them. I do think that the climate is not right for it personally though. But it's not a psychology problem, it's a healthcare problem that insists on treating symptoms instead of diseases, a psychiatrist's primary job.

 

[Therapist4Chnge]

One of the best things an RxP psychologist can do is discontinue meds and utilize non-pharma options. Meds still have a place, but not every problem is a nail and not every solution is a hammer.

 

[DynamicDidactic]

RxP licensure could require APA-acred programs (and more), so that would weed out the Capellas of the world.

I definitely agree with the "and more"

One of the best things an RxP psychologist can do is discontinue meds and utilize non-pharma options. Meds still have a place, but not every problem is a nail and not every solution is a hammer.

I'm more interested in the concept of RxP for better management of psychotropics and reducing the need for them. I do think that the climate is not right for it personally though. But it's not a psychology problem, it's a healthcare problem that insists on treating symptoms instead of diseases, a psychiatrist's primary job.

I completely agree. At the same time, I think that psychologists will be similarly susceptible to the forces from Big Pharma. That is why I would prefer that any RxP legislation include particularly strong requirements for actual psychologists. I believe that any well-trained psychologist would be a safe prescriber. However, it is my impression (anecdotal experience) that the majority of our field do not even serve as well-trained psychologists.

 

[CGOPsych]

Agreed, dynamic. Baker, McFall & Shoham, (2009) made the case that training in psychology has been slipping due mainly to the surge of programs that do not emphasize science. These schools, for the most part stand-alone professional schools, can produce psychologists with little ability or desire to evaluate practices empirically. The article notes that something similar happened in medical education in the early 20th century, and the Flexner Report helped revamp that system. The article marked the start of a new program for accrediting clinical psychology that includes more emphasis on science to better prepare individuals to practice.

The lower standards of education, training and practice proposed by the RxP campaign appears to be an extension of the trend towards lower scientific training standards and an over-emphasis on practice preparation and business opportunities (including profitable private schools). This has most certainly been the emphasis of APAPO, which serves as the central organizer of the state associations and to some extent makes them political subsidiaries, a kind of national political machine. The RxP campaign, working through APAPO, is then conducted locally by state associations which in many instances are focused on financial and political benefits of practice expansion rather than the ethical application of clinical science.

Challenging the RxP campaign and the low medical training standards it advocates is consistent with the goals of those who seek the best training standards for clinical psychology in general.

 

[DynamicDidactic]

Hawaii Finance Committee passes HB 1072 re: RxP

Hawaii again? Maybe they felt emboldened after Illinois.

 

[CGOPsych]

Hawaii again? Maybe they felt emboldened after Illinois.

More than you would imagine, Dynamic. The Finance committee amended the bill to throw out virtually everything sought in the APA training model and adopted all the training from the IL bill, the one that was written by the Illinois psychiatrists.

If successful, it means that aspiring psychologist prescribers will have to get the education required of a PA in a program accredited by ARC-PA, the organization that accredits PA training programs.
They would have to get eight undergraduate courses of basics such as physiology, microbiology. That alone is almost what the entire APA RxP training is, which calls for 10 courses to cover all the education.
Then they would need 20 graduate courses in pharmacology, more science, etc.
After that, they'd have to do 14 months, 36 semester hours, of practicum consulting with physicians in medical rotations.
As with the IL bill, this would take 5-6 years of *full time* study.

I ask my colleagues: How many people do you know can afford to be in school full-time for 5-6 years, including a full-time 14-month practicum, so they write prescriptions? If you take one course per semester, it will require approximately 15 years.

Requiring the program to be ARC-PA accredited means they won't be allowed to do online classes from "friendly" psychology schools but instead meet objective educational standards in real classrooms. Also, there is no such program in the United States and it's possible that no university would be willing to go to the trouble of creating one and getting accreditation when they can't imagine anyone wanting to go through it.

Therefore, if Hawaii adopts this bill, RxP is dead in Hawaii just as it is in Illinois.

 

[AcronymAllergy]

More than you would imagine, Dynamic. The Finance committee amended the bill to throw out virtually everything sought in the APA training model and adopted all the training from the IL bill, the one that was written by the Illinois psychiatrists.

If successful, it means that aspiring psychologist prescribers will have to get the education required of a PA in a program accredited by ARC-PA, the organization that accredits PA training programs.
They would have to get eight undergraduate courses of basics such as physiology, microbiology. That alone is almost what the entire APA RxP training is, which calls for 10 courses to cover all the education.
Then they would need 20 graduate courses in pharmacology, more science, etc.
After that, they'd have to do 14 months, 36 semester hours, of practicum consulting with physicians in medical rotations.
As with the IL bill, this would take 5-6 years of *full time* study.

I ask my colleagues: How many people do you know can afford to be in school full-time for 5-6 years, including a full-time 14-month practicum, so they write prescriptions? If you take one course per semester, it will require approximately 15 years.

Requiring the program to be ARC-PA accredited means they won't be allowed to do online classes from "friendly" psychology schools but instead meet objective educational standards in real classrooms. Also, there is no such program in the United States and it's possible that no university would be willing to go to the trouble of creating one and getting accreditation when they can't imagine anyone wanting to go through it.

Therefore, if Hawaii adopts this bill, RxP is dead in Hawaii just as it is in Illinois.

My take after reading the Illinois bill (or at least portions of it) is that it's geared more toward being realistic only when the RxP training is incorporated as part of graduate psychology training. It'd likely add a couple years, but much of it could potentially be integrated with existing coursework and rotations. Sort of like the way MD/PhD programs are setup nowadays. For incoming students, this might then also allow waiving of some/all of the undergrad reqs if they've already been taken.

Although I don't know whether the consultation/practicum hours require that the psychologist be licensed. If so, that might add an additional year.

 

[CGOPsych]

The Illinois bill requires 5-6 years of education and training at a full-time enrollment no matter how you cut it.
The 14-month practicum *must* be full-time and in medical clinics.
APA has a rule that no more than 20 percent of RxP classes can be take predoctorally, anyway. Substituting these classes for psychology classes predoctorally is exactly the nightmare of degraded psychology training at the expense of seeking a prescription pad that people have feared.
There is no such program in Illinois and it appears to be highly unlikely that any will be created.

This is why the RxP advocates have been furious with the one psychologist in Illinois who negotiated with the medical people to approve this bill, without consulting any of her colleagues. This almost certainly ensures no RxP in Illinois.

 

[DynamicDidactic]

There is no such program in Illinois and it appears to be highly unlikely that any will be created.

This almost certainly ensures no RxP in Illinois.

So, here are my concerns.

As you know, the Chicagoland area may contain the most for-profit, low match rate, low EPPP pass rate, large cohort, and high debt programs. I bet if we created a map with clinical/counseling/school psych students, Chicago would have the most per capita. This partially explains the market forces that encouraged and supported the RxP movement in Illinois. While I am sure many current practitioners were very displeased with the passed legislation, this still serves as a victory for the for-profit programs. I understand that the lack of a current program is serving as a gatekeeper. Northwestern Medical Center (and to a lesser extent UIC Medical Center) would be primary candidates with the necessary resources to start such a program. However, they have less motivation to do so, that is until some other school initiates such a program.

It would really just take a little bit of initiative from one of the for-profit schools to set up an agreement with one of the numerous medical centers in the area to get this program off the ground. At this point, they typical clinical psych doctoral + RxP degree could be expanded to 7 years pre-internship. That would be an additional monetary windfall for the for-profit programs. A chunk of the money could be shared with the participating medical center who gain a bit of free labor at the same time. The only barrier is finding students to commit to such a long program and high debt but Chicagoland is in no short supply of that.

Once a for-profit program starts the process, Northwestern would have extra motivation to be the "premier" RxP Psychology program and would be able to easily set one up.

APA has a rule that no more than 20 percent of RxP classes can be take predoctorally, anyway...

We know the APA can be flexible on what rules they choose to enforce when it comes to accreditation. Furthermore, the rule could easily be amended. And finally, many years pass between accreditation reviews and probationary periods for a program to lose accreditation. By that point, they may not care about accreditation. Similar to the Louisiana where Medical Psychologists are no longer under the authority of the state psychology board. I am also sure you have heard that the RxP'ers in Illinois have been promoting a RxP curriculum that skirts APA's requirements.

 

[CGOPsych]

You're right that Chicago has an extraordinarily large number of professional schools.
Yes, in Louisiana the RxPers moved themselves under the medical board and presently about half of them now prescribe and practice clinical psychology strictly under the licensure and supervision of the medical board, which is a little-known (kept quiet for obvious reasons) and highly controversial political move. The RxPers in Louisiana have been playing very dirty politics, and that's just one example. Another is that they have used the LA law require all RxPers to donate $2,500 to their PAC annually in order to keep their licenses. So we can see that they exploit their own, as well.

As for developing an RxP program, you are very creative. Northwestern and Rush are known to have already said no thank you. There would be little motive to create such a program when there are likely very few possible students. RxP seemed more attractive when you could do it all on your laptop in your jammies on Sunday morning. The professional schools may not be in the mood, either. They were badly burned by the one psychologist who agreed to the IL law, that destroyed their plans to sell RxP courses.

If we are going to fantasize, try this one on: The many psychologists who paid $14,000 a head to take the laptop RxP courses file a class-action lawsuit against the Illinois Psychological Association, which made certain representations about how they will be able to someday prescribe medications with those degrees, and whose representative made sure that, as investments in a more lucrative prescribing practice, they are now worthless. It may not be a big surprise that when IPA disclosed the passage of this law with all the hoopla and self-congratulation possible, they never ... ever ... told people the details of the training. As I said, they exploit their own as well.

 

[Fan_of_Meehl]

I agree that it is insulting, as well as dangerous, to many people to presume that a person with no experience or education in the biomedical sciences can independently prescribe medication to all persons, of all ages, with all medical conditions, and taking all other medications based on education that consists of 30 semester hours of instruction taken online on a laptop on Sunday mornings. Those 10 courses of three semester hours each would have to cover all the fundamentals of organic chemistry, physiology, biology, etc. as well as the most sophisticated practices of treating children, adolescents, seniors, persons with chronic illnesses, pregnancies, developmental disorders, and so on and so on.

Here is one example: One of the most prolific programs selling these courses (for $14,000) purports that in 36 clock hours of online instruction, the aspiring prescriber will learn: “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.”(This is on the website of the California School of Professional Psychology, if you wish to see it.)

Now really, friends. Does anyone here believe that you can learn all this in 36 clock hours of online instruction? Psychiatrists make child/adolescent a specialization with separate boards and fellowships. "Prescribing psychologists" learn it all in 36 hours along with all those other topics. This is just one of many examples of how the details of the RxP proposals are almost absurd, and why they work hard to hide them.

Read any pro-RxP literature and you will see many references to a "Master's degree in psychopharmacology" and you will never, ever, see them admit to how that degree is earned. You may understand why when you see the nuts and bolts.

It's true that those who oppose RxP do not have data to show that these few prescribers who were educated on laptops have worse outcomes than others, and it's true that there are no data at all. This is a failure of the RxP campaign. They have had 11 years in LA and 13 years in NM to develop this data. There is no empirical evidence that these people are prescribing safely, nor that they are doing so effectively for their patients, or that allowing non-medical persons to prescribe drugs based on such an obviously inferior model compared to any other prescribers is in any way improving access to medications or improving the general mental health system. Strangely, proponents claim that it is up to opponents to gather that data, which of course is absurd. It is incumbent on those who have sought special privileges which, on their face, appear to based on dangerously inferior training, to show that what they are doing is safe and effective.

Also, please consider that the proponents, backed by millions of dollars by the APA's political wing (obtained through fraud in collecting the practice assessment, but that is another matter) would benefit tremendously if they had such data, considering that 181 of their bills have failed in 26 states, and that they just suffered a massive defeat in Illinois last year. Such data could bolster their case substantially ... and yet, no data. This seems to suggest that either they don't care about the science, or they can't produce any systematic evidence that this is safe and effective.

The more details people learn of the RxP proposals, the less they like them. Thus, the best thing for opponents to do is to simply spread the word.

As a psychologist in a state that currently allows medical psychologists to prescribe I have a great deal of ambivalence regarding the issue. I will say that the remote 'online' nature of the instruction has been a bit of a turn-off for me. I have a pretty strong background/interest in the natural sciences (compared to the average psychologist) and I completed (with all A's and a couple of B+'s) all of the pre-med courses save two (physics and organic chem) at Birmingham-Southern College (which is pretty much a pipeline for pre-meds to UAB medical school so their pre-med courses are not flimsy) the undergrad level before deciding that I wanted to study psychology and teach at a small liberal arts college (then went on to PhD grad school and found out how cool and effective psychotherapeutic approaches could be and that they were based on solid science/research). I have seen colleagues who were of the 'research is icky' type and who clearly had no native interest/aptitude in the natural sciences be the first to fork over money to support the local political lobbying organization for RxP and to become the first cohort of prescribing psychologists in the state (and I have been holding my breath ever since). I am hoping that this is a historical phase we can work through to establish more rigorous selection and training processes within the field to ensure that the 'research is icky,' 'I have no idea (or interest in) what a covalent bond is but I desperately want big $$$, to wear a white coat, and be seen as a 'real doctor' crowd does not embarrass the profession of psychology by over-representing us in the current practicing cohort.

 

[PikminOC]

All this vitriol.
Let social workers prescribe.
Heck, let high school students with one class of psychology prescribe.
Wait, make all meds OTC so patients can just get them themselves..

Who cares?

 

[erg923]

All this vitriol.
Let social workers prescribe.
Heck, let high school students with one class of psychology prescribe.
Wait, make all meds OTC so patients can just get them themselves..

Who cares?

How
Does
That
Further
This
conversation?

 

[PikminOC]

How
Does
That
Further
This
conversation?

It stops the arguing!

 

[CGOPsych]

Who cares?

Good question. If successful, the RxP campaign would alter the profession of psychology forever, incorporating the practice of medicine into a non-medical profession. This is generally regarded as indisputable. This has a number of ramifications which should be considered carefully, discussed openly and decided transparently. Instead the RxP campaign has thrived by operating in the dark whenever possible and without consensus of the psychology community. In fact one outspoken leader has said that the opinions of psychologists should not be considered in this matter.

There is good evidence that the majority, in some cases the vast majority, of psychologists oppose the contents of the RxP legislative proposals. Yet, the campaign moves on because a small group of politically influential persons (many with direct ties to private schools selling the controverisal RxP online degrees) has obtained disproportionate influence within APA and can pursue their agenda in spite of the opinions of most psychologists. In this forum, I believe the best argument against RxP has been made just by revealing the otherwise hidden details of the proposals made by these persons. Therefore, open debate in a forum such as this is healthy for the sake of the integrity of the profession, not to mention questions of patient safety and ethical clinical practice.

 

[PikminOC]

Good question. If successful, the RxP campaign would alter the profession of psychology forever, incorporating the practice of medicine into a non-medical profession. This is generally regarded as indisputable. This has a number of ramifications which should be considered carefully, discussed openly and decided transparently. Instead the RxP campaign has thrived by operating in the dark whenever possible and without consensus of the psychology community. In fact one outspoken leader has said that the opinions of psychologists should not be considered in this matter.

There is good evidence that the majority, in some cases the vast majority, of psychologists oppose the contents of the RxP legislative proposals. Yet, the campaign moves on because a small group of politically influential persons (many with direct ties to private schools selling the controverisal RxP online degrees) has obtained disproportionate influence within APA and can pursue their agenda in spite of the opinions of most psychologists. In this forum, I believe the best argument against RxP has been made just by revealing the otherwise hidden details of the proposals made by these persons. Therefore, open debate in a forum such as this is healthy for the sake of the integrity of the profession, not to mention questions of patient safety and ethical clinical practice.

Chiropractors prescribe in New Mexico.

And Im not closing the debate. I'm just wondering where the line is. And if there should be one..

 

[smalltownpsych]

All this vitriol.
Let social workers prescribe.
Heck, let high school students with one class of psychology prescribe.
Wait, make all meds OTC so patients can just get them themselves..

Who cares?

Many countries already do this. It makes me wonder about the whole concept of controlled substances. Why do we have to be the gatekeepers to try to control patient's addictions? Especially since control issues are at the heart of addiction.

 

[Therapist4Chnge]

Many countries already do this. It makes me wonder about the whole concept of controlled substances. Why do we have to be the gatekeepers to try to control patient's addictions? Especially since control issues are at the heart of addiction.

*insert War on Drugs propaganda*

 

[Fan_of_Meehl]

Many countries already do this. It makes me wonder about the whole concept of controlled substances. Why do we have to be the gatekeepers to try to control patient's addictions? Especially since control issues are at the heart of addiction.

I think I read/heard somewhere that in countries where they tried de-criminalization of controlled substances, epidemiologically you see an uptick temporarily in rates of substance use disorders but, over a few years time, things normalize back to the base rate of serious addiction pre- de-criminalization. I'm too lazy to look up the stats but I know that alcohol prohibition sure didn't reduce levels of alcohol problems/addiction. Is there any solid empirical epidemiological work addressing the 'success' or 'failure' of wars on drugs/alcohol historically?

 

[WisNeuro]

Look at data from Sweden, they have a tough drug policy. Although, they way that they handle offenders differs quite a but from the US, which may help explain some of the good numbers.

 

[wesleysmith]

I'm surprised their crime doesn't sky rocket with prisons like those... just beautiful.

 

[WisNeuro]

Also, Yale just announced that is will be offering an online PA degree.

 

[freemontie]

You do understand that "182" isn't actually a meaningful number like you want it to be, right? The legislative process is such that THOUSANDS of proposed bills fail to get out of the initial stages of the process. There are a myriad of reasons proposed bills do not move forward including but not limited to: not enough time in the legislative calendar, competition from a competing bill, unfinished language/sections, put on hold for committee feedback, change in leadership, change in state budgets, etc. The vast majority of bills don't even make it to the floor to be discussed. There are literally DOZENS of reasons, almost all of which have nothing to do with whether or not the bill has sufficient support to move forward. The chances of a piece of proposed legislation actually making it through to become a law…<5%. It is often <1% depending on the jurisdiction and how you classify it.

No matter how many times you bring up the number of "failed" bills, it isn't going to make your forced narrative any less misleading. Anyone who has done any significant work with the legislature understands that your quoting of the number of "failed" bills is a half-baked Straw Man.

*edit to add*: https://www.opencongress.org/articles/view/1180-The-Vast-Majority-of-Bills-Go-Nowhere

This is about proposed legislation at the federal level, but you get the idea…hopefully.

For any particular piece of legislation, what you say is very true: in a word "political inertia." But if virtually the exact same piece of legislation fails 182 times that is a clear indictment against it. To claim its' failure is due mainly to politics and not substance is fantasy. And I think you know it.

Also, Yale just announced that is will be offering an online PA degree.

Are you comparing a program with almost no admissions standards (RxP) to Yale?

 

[PsyDr]

Yeah, a program which requires a BA, an MA/MS, a PhD/PsyD, a post doc, and passing a national licensure exam really has almost no admissions standards.

 

[freemontie]

Yeah, a program which requires a BA, an MA/MS, a PhD/PsyD, a post doc, and passing a national licensure exam really has almost no admissions standards.

You're right- didn't mean to be insulting. I meant admissions standards relevant to a graduate medical program (e.g. competition with other applicants on the basis of performance in pre-med coursework and a standardized exam along with other lesser factors). RxP from my understanding is a graduate medical program that is virtually open-admission to any psychologist.

 

[WisNeuro]

I am equating the delivery method of said education, which was derided in earlier parts of this thread.

 

[DynamicDidactic]

Also, Yale just announced that is will be offering an online PA degree.

Approval from the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) and various state licensing agencies is pending.

I am pretty sure that the Illinois legislation did not required accreditation anyway.

This would definitely be a workable method to meet the requirements in IL. The 14 month full time internship would still be a big barrier for someone actively working. Individuals could also enroll in this while they are students but aligning the psych internship with the PA internship seems very difficult.

 

[CGOPsych]

The Illinois law requires that the graduate program providing the RxP coursework be accredited by ARC-PA, the physician assistant accreditation organization. This is a major hurdle for the RxP advocates. The only feasible location of such a program is a university that already has an accredited PA program, and those universities apparently won't consider something this shaky.

No matter how you count it, the program requires 5-6 years of full-time equivalent work. If someone does it one course per semester it would take 15 years.

The Yale online PA program is innovative to be sure, and may be controversial, but that doesn't free the RxP online programs from being challenged for very poor and low standards. The Yale program "would include hands-on clinical experience at field sites selected by Yale School of Medicine faculty and chosen with each student’s location and career goals in mind. In the past, the PA program has had students who conduct their clinical clerkships away from New Haven in areas as diverse as Kentucky and Maine, and those opportunities provided valuable learning experiences. The program would also feature in-person immersive experiences that allow students to collaborate with classmates and professors on-site at Yale’s campus in New Haven, Connecticut."

Now, back to the RxP online degrees: The one offered by Farleigh Dickinson is literally 10 courses of pre-recorded lectures and the only interaction is online chatting. The CSPP course's tests are easily aced because the answers are right there in the computer. It seems very clear that the purpose of these courses, which are "approved" by APA is that they be easy and convenient, rather than substantial. APA's own task force on RxP in the 1990s cut down the recommended coursework but still called for a curriculum that was far greater. The politicians pursuing RxP must have figured no one would be willing to do all that work, (an executive program to train psychologists to be APN's in New Jersey failed for a lack of interest) so they cut it down much more.

There is just no getting around the fact that APA's RxP campaign calls for grossly inadequate training to allow psychologists to prescribe medication. You can put lipstick on this pig all day and it will still oink.

 

[CGOPsych]

For any particular piece of legislation, what you say is very true: in a word "political inertia." But if virtually the exact same piece of legislation fails 182 times that is a clear indictment against it. To claim its' failure is due mainly to politics and not substance is fantasy. And I think you know it.

Indeed, 182 almost identical bills failed in 26 states. That is a lot of "No" to a lot of proposals. In Montana they argued that it would help native Americans. In Ohio they argued that they could improve access to drugs in the prisons. They've tried everything except making the proposals reasonable and scientifically supported, which they can't or won't do. The bills have to be the same because RxP is a political campaign directed by the RxP advocates in APA, and many of the campaign's leaders are connected to the RxP online programs that sell these classes. Therefore, variation in the bills and negotiation is very limited.

In Illinois the IPA's RxP committee once negotiated higher training standards for a proposed bill. After a thunderbolt from APA struck, IPA officially disowned that proposed bill and those RxP committee members subsequently left their positions. In Missouri, some legislators who favored the bill added more training to make it more likely to pass out of their committee. The RxP advocates (all from the local professional school, the Forest Institute) walked away from it ... didn't even attend the committee's hearing on the bill.

I'm very curious about whether the RxP advocates have disowned the Hawaii bill, which was amended by legislators to adopt the Illinois training standards. Representatives of the Tripler pharmacology program (a pork-barrel project created by Sen. Daniel Inouye, the patron of RxPer Patrick DeLeon ... another example of politics over professionalism) have said they will not support it. As an APA-model RxP program, they would become obsolete the moment such a bill passes.

 

[arottenapple]

Here's my inquiry.

I am not interested in the regular psychotropic medications to a terrible degree, the SSRIs, the methylphenidates, the anxiolytics. I mean they're cool to talk about and all just theyre not interesting to me that much. What interests me is how illegal drugs, cocaine, heroin, meth and the like, effect ones psychology. Also I am interested in the possibility of medical marijuana for psychological use as well as the resurgence in psychedelic therapies with psilocybin and LSD. Would a psychopharmacology degree be good for me, if I were to go on to a Ph.D program eventually?

Edit: forgot to add I am a junior undergraduate psychology student

 

[erg923]

Here's my inquiry.

I am not interested in the regular psychotropic medications to a terrible degree, the SSRIs, the methylphenidates, the anxiolytics. I mean they're cool to talk about and all just theyre not interesting to me that much. What interests me is how illegal drugs, cocaine, heroin, meth and the like, effect ones psychology. Also I am interested in the possibility of medical marijuana for psychological use as well as the resurgence in psychedelic therapies with psilocybin and LSD. Would a psychopharmacology degree be good for me, if I were to go on to a Ph.D program eventually?

Edit: forgot to add I am a junior undergraduate psychology student

The effects on ones "psychology" (whatever you mean by that) are well know. Addiction to the substances you mentioned is treated everyday millions of times oevr throughout the US.

Regarding therapuetic uses of psychedelics, my peronal position is that Leary ****ed up that possibility many moons ago. Nevertheless, there continues to be some legitimate research in using cannabis and MDMA within the larger context of psychological treatment for certain disorders.

 

[CGOPsych]

Latest from the front ...

In Hawaii the RxP bill is being considered by the Senate. The Hawaii Psychological Association's listserve shows that supporters of RxP are very happy with this. BUT ... the RxP insiders have not yet told the HPA members that the bill was gutted and changed to use the Illinois law training standards, the ones that will require 5-6 years of full-time training to be credentialed to prescribe. The members still think it's the APA model bill that requires only 30 semester hours of online classes.

This is the sad level of dishonesty I have unfortunately come to expect from the RxP campaign. In Illinois the RxP advocates did not tell state association members the details of the newly enacted bill while they patted themselves on the back and soaked up the accolades from members, including those who paid $14,000 for the online courses thinking they would be able to prescribe. Instead, all those courses are worthless in terms of allowing them to prescribe medication.

If any readers of this know anyone in Hawaii, you may wish to do them a favor and inform them that they are being conned.

 

[bcliff]

What's the timeline for RxP in LA? How soon after grad school can PhDs/PsyDs start working toward RxP (i.e. start their postdoctoral training, take PEP, etc.)? Do they need to be a licensed psychologist for some period of time before they can start their RxP training?

 

[CGOPsych]

Another RxP bill has just failed ... for the second time.
In North Dakota a bill to allow psychologists to prescribe medication was headed for failure so its sponsor changed it to a bill to authorize a study of RxP. The state Senate just voted against even studying the issue, 41-6.

 

[CGOPsych]

Another RxP bill has just failed.
The Idaho legislature adjourned yesterday and an RxP bill died as a result. This brings to 183 the number of RxP bills that have failed since 1995. Idaho was a new state for the RxP campaign conducted by APA, spending millions of practice assessment dollars in the process. This raises the number of states where RxP bills have failed to 29, plus the Virgin Islands. So far this year bills have also failed in Nebraska and North Dakota. They remain alive in New Jersey, where three previous bills have failed, and Hawaii, where 36 have failed.

The reason that this massively failed and expensive campaign continues is that the RxP advocates have exercised disproportionate political influence within APA to use its resources without the consensus of the membership, which the campaign has studiously avoided consulting. Many of the most outspoken RxP leaders have connections to private schools which sell the RxP online courses for up to $14,000. The campaign also survives because the APA public relations machinery produces what is quite literally propaganda extolling the virtues and alleged possibilities of RxP, and ignoring the failures and expense.