Psychopharmacology/Advanced Practice Psychology

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Psyclops said:
PH pretty much took the words out of my mouth, but of course said it better than I. Be weary of any stats that include "school psychologists" and "counseling" psychologists, as they are diffuse categories and frequently paid less well than an average clinical psych PhD.
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I'm not sure this is the case. Here's some salary info taken from a 2001 APA Salary Survey found at http://research.apa.org/01salary/index.html



The overall 11-12-month salary for licensed doctoral-level respondents providing school psychology services was $77,000 in 2001.

The overall 11-12-month median salary for licensed doctoral-level clinical psychologists was $72,000 in 2001.

The overall 11-12-month median salary in 2001 for licensed doctoral-level counseling psychologists was $66,500.


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I think the best (financial) approach is to split up your time amongst a couple core areas. Sticking strictly to PP may cap you at your earning potential because of reimbursement rates (whether private pay flat rate, insurance, sliding scale...or a combination of those), hours in the day, and pt acquisition limitations. Salaried positions are obviously capped.

I think the most (financially) successful clinicians will have a small PP, consulting (retainer + costs), and maybe moonlight in a 3rd area of interest (neuropsych evals?)

Obviously not for everyone, but you could easily clear $100-$150k/yr.

-t
 
I feel I can speak well on this subject. I was a psychologist for several years. I quit and went to medical school. I am now graduating and will be an emergency room physican.
I think psychologist are great at what they do. But I quit for the reason that the whole structure of the program lacks medical science that psychology will never be able to give.
Not alot of us enjoy the endless hours calculus, general chemistry,organic chemisty and physics and the time consuming Medical College Admissions Test and the years of learning disease and pharmacology. But there is a reason for this, prescribing medication is a dangerous thing.
This summer, I will be starting residency, and I am get very scared when I have to write a drug order which is co signed by my resident as I am a 4th year medical student. I am worried about other diseases and drug interactions. There is alot of relief in knowing someone is co signing and I have had 4 years of premed and 4 years of medical school and I'm scared. 1 year of post-doc training isn't going to cover the diseases and pharm that we spend 6,7,8 years in school and residency learning.

While you want to help those who can't get acess to teatment is admirable, the homeless, Vets, the poor rural many of these people have some of the highest cormorbidities and diseases and prescribing psychotropic medications is way more complex than treating their psych conditions. For instance, many are alcololics with cardiomyopathies, others with heart failure, EKG problems and electrolyte problems and psychtropic meds interfer with some of their medications. What do you do with one of these people who has QT elongation problems that you don't know about because you don't have training in cardiology and disease and you prescribe a drug like imipramine, and causes them to code- are you going to just dump that on the ER doctor who is already overwhelmed by an overcrowded ER? I wanted to learn more about medical science, that's why I left psychology. If you want to have the rights of doctor then accept the responsibility of a doctor and go to medical school.

By the way poditrists are medical doctors and sit for the USMLE exam, dentists are doctors and PA's practice under the licence of a physican. And pharmacists have been through 4 years pre-pharm and 4 years of bone hard science with tons of chemistry. Also, if someone is a foreign student who practices as a psychologist does that mean that they are problably making more mistakes because they are foreign.? Chiropractors want to prescribe too, and why shouldn't social workers prescribe, they do similar work?

I think what psychologists, social workers do is great and they do it well but you have to realize you have someone's life in your hands and you could kill them, drugs are wonderful but scary and take many years of training work to be a skillfull clinician. I would be damm scared to prescrib if I were still a psychologist right now.
 
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Einey, you make valid points, but I feel that much of your criticisms only apply to inpatient or hospital settings. But let's focus here on private practice for a second: Most PP psychiatrists give out mostly SSRIs and perhaps some anxiolytics to higher-functioning clientele with less serious disorders that can pay $200 per visit.

I'm pretty sure psychiatrists in private practice do not do any physiological assessments of their patients along the lines that you are specifying (EKG, electrolyte imbalances, or even overnight cortisol testing to check HPA axis dysregulation). Perhaps through direct observation and questioning, they can assess side effects, but at 15-minutes per visit, once every month or two, its hard to much else besides titrate and try another SSRI.

I'm sure with the required physician collaboration, and post-doctoral coursework in "Anatomy and physiology, biochemistry, neurosciences, pharmacology, psychopharmacology, pathophysiology, health assessment, including relevant physical and laboratory assessment, and clinical pharmacotherapeutics," a medical psychologist will do just as good a job as a psychiatrist in treating higher-functioning clientele with SSRIs.

In fact, since medical psychologists in private practice would probably mostly do 50-minute therapy + med checks, they would probably have the time to address side effects and titrations even more effectively.
 
Actually complete H&P's are done and endocrine labs inaddition to any other testing the differential dx would suggest. But really if you you're going to spend all that time learning A&P, path and pharm it sounds like you want to be doctor you should go to medical school and get the MD or DO after your name and be recongnized as a medical doctor and get the recongnition that you will never have as a psychologist, no matter how many drugs you prescribe.

By the way, are you going to spend 4 years learning Pathofizzy and pharm or is your advanced training 1 year or 2 years? If it is 4 years of training, you're going to spend 4 years in PhD school and then spend 1,2 or 4 years post doc in the biological sciences , why not just go to med school and be done in 4 short years?
We have all heard that same argument from PA's' they say that they can do the same job as a doctor with 2 years of training except that most have to be co signed by a physician. It 's funny psychologists-PA's feel they can get everything in 2 years or less and on the 1st day of medical school one of the first things they tell us is that medical eduation is so intense that it can bearly be completed in 4 years. So I wonder why psychologist, PA's think they can get in 2 or less years what med schools are concerned about teaching in 4 years.
I'm not trying to be nasty but you have no idea how scary prescribing a drug can be. I spend alot of time paying close attention CBC's electrolytes, pt, ptt, BS AFT's ALT's BUN and creatin and GFR's and numerous comorbidities and so do psychiatrists! It's many long years of training that make their quick exam appear simple. While on my psych rotations we did consults, and alot of psychiatry is being able to dx what is not a psych condidtion so you don't prescribe drugs for a condition that is an internal medicine problem. So, no I don't think you can do the same job as a psychiatrists. I think it could be dangerous to the public and I say that as someone who was a psychologist.
 
einey said:
Actually complete H&P's are done and endocrine labs inaddition to any other testing the differential dx would suggest. But really if you you're going to spend all that time learning A&P, path and pharm it sounds like you want to be doctor you should go to medical school and get the MD or DO after your name and be recongnized as a medical doctor and get the recongnition that you will never have as a psychologist, no matter how many drugs you prescribe.

By the way, are you going to spend 4 years learning Pathofizzy and pharm or is your advanced training 1 year or 2 years? If it is 4 years of training, you're going to spend 4 years in PhD school and then spend 1,2 or 4 years post doc in the biological sciences , why not just go to med school and be done in 4 short years?
We have all heard that same argument from PA's' they say that they can do the same job as a doctor with 2 years of training except that most have to be co signed by a physician. It 's funny psychologists-PA's feel they can get everything in 2 years or less and on the 1st day of medical school one of the first things they tell us is that medical eduation is so intense that it can bearly be completed in 4 years. So I wonder why psychologist, PA's think they can get in 2 or less years what med schools are concerned about teaching in 4 years.
I'm not trying to be nasty but you have no idea how scary prescribing a drug can be. I spend alot of time paying close attention CBC's electrolytes, pt, ptt, BS AFT's ALT's BUN and creatin and GFR's and numerous comorbidities and so do psychiatrists! It's many long years of training that make their quick exam appear simple. While on my psych rotations we did consults, and alot of psychiatry is being able to dx what is not a psych condidtion so you don't prescribe drugs for a condition that is an internal medicine problem. So, no I don't think you can do the same job as a psychiatrists. I think it could be dangerous to the public and I say that as someone who was a psychologist.
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you seem to think that psychologists want to prescribe in order to become psychiatrists and that's a common mistake by organize medicine... no, medical psychologists in general do not want to prescribed to be called "doctors", we are doctors already... we don't want to be psychiatrist... psychologist come from a different orientation and that also explains why we would spend the additional years in training in order to provide psychological treatment. Those who are seeking rxp don't want a short cut (as you are alluding) or want to go to med school in order just to prescribe. Psychologist seeking rxp want to be able to privide effective treatment and use medications as an adjunct. This whole argument about how non-mds will kill pts is simply ridiculous, old and a pathetic scare tactic. There is NO evidence for it... btw, you know psychiatry used to argue the same thing about psychologists providing psychotherapy... what a joke!

BTW, all the psychiatrists that I worked with in my years of practice almost never paid much attention to H&P including labs as you suggest. In fact, I had more contact with with my pt's pcp than their psychiatrists because psychiatrists were 'too busy' to speak with the pt's pcp. I found that my experience was shared by other professionals as well, including other MDs. I was at a multidiciplinary conference once and during dinner, I sat in in a discussion btwn a couple of pcps and a number of psychiatrists and one of the major complaints that internal medicine physicians had about psychiatrists was that they were rather "transient" and not available. Also, the pcp consistently alluded that most psychiatrists are foreign medical grads. This was a slap on the psychiatrist's faces at many levels.
 
In response to einey's statements

1. Becoming a psychiatrist takes 8 years. Don't push the myth of becoming a doctor in 4 years. Even though medical school takes four years, getting licensed as a general practitioner requires at least an internship. Even then, insurance companies will be reluctant to reimburse you---and patients would rightfully be reluctant to see you---if you aren't board-certified.

2. I think that many psychologists want Rx privileges to prescribe SSRI's as an adjunct to therapy (correct me if I'm mistaken). You don't need years of training to give a set of pills with limited drug interactions and few side effects to otherwise healthy patients. Once you start talking about co-morbidities and the need for a complete metabolic profile, you're going to need to refer to a physician anyway.


To positivepsych:

I am unaware of any psychiatrist that sees patients for only 15 minutes. From my experience, shrinks typically see patients for an hour for an initial visit and 25 minutes for med checks. You are correct that few psychiatrists go into lab tests (or even physical exams) when they are treating solely depression. The real beauty of a shrink and his training comes in when the patient is psychotic or presents with multiple conditions such as Parkinson's and major depression.
 
heimlichboy said:
by reading these articles I can see that we are not all in agreement on this.

http://www.narpa.org/prescribe.htm

http://goinside.com/98/3/oppose.html

http://www.mdpsych.org/Feb96_nWarres.htm
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Hboy, again a sad attempt... from reading their website, NARPA is against psychiatric meds across the board, not just psychologist, that means PSYCHIATRISTS and all other prescribing clinician, and their emphasis is their perception of forced medication. Your last link was written by a psychiatrist, what do you expect. I can't access your second link but, given your other posts, I'm guessing it has no merits as well. There seems to be a trend in your posts... a manipulative and misinforming one... you need to stop... the least that you can do is to be accurate.
 
relax these are all opinions. Nothing more nothing less. Psychologists are fighting for prescribing rights just like all the other allied health professions. These are forums and they exist so people can simply express their opinions. This infighting occurs in many professions you have the podiatrists vs the orthopedists, optometry vs ophthalmology, PMR doctors vs physical therapists. The fight for prescribing rights is nothing new and will most likely rage on forever.

It is understandable that psychiatrists do not want psychologists prescribing medications just as psychologists are against social workers doing psychotherapy. Neither side is going to budge on this issue. But what is it about my post that you find inaccurate?

Secondly I think the field of psychology could be furthered by working in collabaration with MD's not against them. The MD's control the health profession plain and simple. They control hospital hiring and hospital policy. So it is not a good idea to create enemies. I have seen psychiatric institutions hire social workers over Psychologists in recent years. Could this possibly be due to the antagonism between the 2 fields?

Most cases of mild depression are not handled by psychiatrists or psychologists but by the patients primary care doctor. Primary care doctors such as Family medicine and Internal Medicine have been prescribing SSRI's for years. It is usually when the patient needs to be admitted that psychiatry is consulted. And no matter what psychologists will never get admitting privileges at any hospital because these privileges are controlled by you guessed it the MD's. Psychotherapy is an integral part of patient care and plays an important role in mental health. I would hate to see the psychologists get away from that.

Psychologists will never have the rights to admit patients and medically treat complicated cases of psychosis. The psychotropic drugs are too potent and have too many metabolic side effects. So the drugs that psychologists are fighting for are a handful of antidepressant medications such as the SSRI's.
I do not see how this is going to help the field of psychology.
 
I have had admitting privileges at 4 hospitals. There is an example of your misinformation.
 
heimlichboy said:
admitting privileges you say? Well I bet when you admit patients it has to involve an MD. So you are not really admitting the patients yourself but under and MD's authority.

well anyway we are getting off topic here is your success rate on this topic:

http://i.cmpnet.com/CME/pt/content/p001001a.jpg

http://www.psychiatrictimes.com/p001001a.html
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Busted again! your links are from psychiatry... duh... btw, it's not very impressive when your listing of legislative actions have the latest year of 2000. Your comments are also very inconsistent. You post inacurate but same comments on multiple threads, then you respond with a flare of 'we shouldn't be fighting, we should be working together...' but then disqualify yourself by a respond with a sense of superiority, as in "MD's authority". So what are you, medical doctor, student? anyhow, whatever you are trying to do in the psychology forum is not working.
 
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WOW! you must want prescribing privileges pretty badly. All right if you want them that badly then go ahead. Please I want you to prescribe. Just go tell the state legislature that heimlichboy sent you and everything should be ok.

I am not trying to do anything on this forum its not like anything said on this forum will change anything. It is just a venue for opinions.
 
Nope it was on my privileges to admit, and I was on the credentials commitee of 2 hospitals. I did the admit orders for everything but meds, and the MD's were happy to work with me.
 
heimlichboy said:
WOW! you must want prescribing privileges pretty badly. All right if you want them that badly then go ahead. Please I want you to prescribe. Just go tell the state legislature that heimlichboy sent you and everything should be ok.

I am not trying to do anything on this forum its not like anything said on this forum will change anything. It is just a venue for opinions.
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I agree with you, your comments means nothing but you should not misinform members of this board. That is my point, read it clearly.
 
heimlichboy said:
I have seen psychiatric institutions hire social workers over Psychologists in recent years. Could this possibly be due to the antagonism between the 2 fields?
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No...they are cheaper.

heimlichboy said:
WOW! you must want prescribing privileges pretty badly. All right if you want them that badly then go ahead. Please I want you to prescribe. Just go tell the state legislature that heimlichboy sent you and everything should be ok.
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No worries....states are already deciding to provide prescribing rights.

heimlichboy said:
I am not trying to do anything on this forum its not like anything said on this forum will change anything. It is just a venue for opinions.
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Misinformation is a very dangerous thing.

For someone who is screaming from the rooftops about getting sufficient knowledge.....your inconsistent and inaccurate rants are ironic, no?

-t
 
einey said:
I feel I can speak well on this subject. I was a psychologist for several years. I quit and went to medical school. I am now graduating and will be an emergency room physican.
I think psychologist are great at what they do. But I quit for the reason that the whole structure of the program lacks medical science that psychology will never be able to give.
Not alot of us enjoy the endless hours calculus, general chemistry,organic chemisty and physics and the time consuming Medical College Admissions Test and the years of learning disease and pharmacology. But there is a reason for this, prescribing medication is a dangerous thing.
This summer, I will be starting residency, and I am get very scared when I have to write a drug order which is co signed by my resident as I am a 4th year medical student. I am worried about other diseases and drug interactions. There is alot of relief in knowing someone is co signing and I have had 4 years of premed and 4 years of medical school and I'm scared. 1 year of post-doc training isn't going to cover the diseases and pharm that we spend 6,7,8 years in school and residency learning.

While you want to help those who can't get acess to teatment is admirable, the homeless, Vets, the poor rural many of these people have some of the highest cormorbidities and diseases and prescribing psychotropic medications is way more complex than treating their psych conditions. For instance, many are alcololics with cardiomyopathies, others with heart failure, EKG problems and electrolyte problems and psychtropic meds interfer with some of their medications. What do you do with one of these people who has QT elongation problems that you don't know about because you don't have training in cardiology and disease and you prescribe a drug like imipramine, and causes them to code- are you going to just dump that on the ER doctor who is already overwhelmed by an overcrowded ER? I wanted to learn more about medical science, that's why I left psychology. If you want to have the rights of doctor then accept the responsibility of a doctor and go to medical school.

By the way poditrists are medical doctors and sit for the USMLE exam, dentists are doctors and PA's practice under the licence of a physican. And pharmacists have been through 4 years pre-pharm and 4 years of bone hard science with tons of chemistry. Also, if someone is a foreign student who practices as a psychologist does that mean that they are problably making more mistakes because they are foreign.? Chiropractors want to prescribe too, and why shouldn't social workers prescribe, they do similar work?

I think what psychologists, social workers do is great and they do it well but you have to realize you have someone's life in your hands and you could kill them, drugs are wonderful but scary and take many years of training work to be a skillfull clinician. I would be damm scared to prescrib if I were still a psychologist right now.
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Thanks, einey. I think this is an excellent post and sums up what a lot of us in the MD camp feel. I don't mean this to fuel the fire, it is just a fact that many MDs think this way. As a future psychiatrist, I have tremendous respect for psychologists and look forward to working and learning from you guys. I'm also open to the idea of changing my mind about prescription privileges, but at this point it is a hard pill to swallow (no pun intended). What I think would be an unfortunate outcome of all this, however, is that MDs and PhD/PsyDs become even more entrenched in their respective little worlds and do an even poorer job of working together.
 
positivepsych said:
I'm pretty sure psychiatrists in private practice do not do any physiological assessments of their patients along the lines that you are specifying (EKG, electrolyte imbalances, or even overnight cortisol testing to check HPA axis dysregulation). Perhaps through direct observation and questioning, they can assess side effects, but at 15-minutes per visit, once every month or two, its hard to much else besides titrate and try another SSRI.

In fact, since medical psychologists in private practice would probably mostly do 50-minute therapy + med checks, they would probably have the time to address side effects and titrations even more effectively.
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I think you make an excellent point that most PP psychiatrists do not do full assesments. But this is unfortunate and the good ones do perform a full work up.

I think your idea of the 50-minute therapy + med check is also excellent. More psychiatrists should be doing med checks in conjunction with therapy as well.
 
maranatha said:
I think your idea of the 50-minute therapy + med check is also excellent. More psychiatrists should be doing med checks in conjunction with therapy as well.
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That'd be ideal, but I know very few psychiatrists who carry a therapy based private practice. I think medical psychs will use the prescribing as an adjunct to therapy.

-t
 
I think social workers and psychologists pretty much do the same job. I mean I have worked with social workers who are great at psychotherapy.
 
I just wanted to say that I am a PhD student in a state with prescribing psychologists. Matter of fact, my major professor prescribes psychotrops and has been for over 1 year. She has had NO trouble with malpractice; matter of fact, the APA covers it. Secondly, her rates have NOT gone up. and she is being reimbursed at the same rate as a psychiatrist by ALL insurance companies, and medicare/aid.

Lastly, she still sees patients for one hour sessions. If people do a google search, there are some scripts on the web that provide examples for presciribing psychologists to segue from therapy to meds in a non-jarring way
 
I work in a child psych unit and the social workers are great they hold group therapy sessions with the kids. I dont notice a difference. Neither do the kids they sometimes call the social worker doctor.

There are 2 states that let psychologists to prescribe louisiana and new mexico. I dont know much about new mexico but i know in LA the psychologists have the privileges but do not get the opportunity to use it for various reasons. But I have yet to see an influx of psychologists moving to LA or NM to take advantage of these prescribing privileges.

Oh and admitting privileges are not privileges because psychologists need an MD to be present to admit a patient. They cannot do it themselves.
 
heimlichboy said:
I work in a child psych unit and the social workers are great they hold group therapy sessions with the kids. I dont notice a difference. Neither do the kids they sometimes call the social worker doctor.
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One thing we learn in training..... N=1 may not be representative of the general population, and to assume so can be problematic.

heimlichboy said:
I have yet to see an influx of psychologists moving to LA or NM to take advantage of these prescribing privileges.
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It will take some time. I'm considering it down the road (that is just me, N=1), though I'm not sure what others are thinking. I've heard there are opportunities that provide re-payment/bonuses (because it is a disaster area/'in need', etc) for psychological/psychiatric services.

-t
 
I see you are not listening, but just trying to spout off your misguided point. I have admitted patients, ordered consults, written orders, and all this in a non RxP state. APA covers RxP, but you still say you know something in spite of the fact that most psychs have APA malpractice insurance, and YES they cover RxP. :thumbup:
 
heimlichboy said:
I work in a child psych unit and the social workers are great they hold group therapy sessions with the kids. I dont notice a difference. Neither do the kids they sometimes call the social worker doctor.

There are 2 states that let psychologists to prescribe louisiana and new mexico. I dont know much about new mexico but i know in LA the psychologists have the privileges but do not get the opportunity to use it for various reasons. But I have yet to see an influx of psychologists moving to LA or NM to take advantage of these prescribing privileges.

Oh and admitting privileges are not privileges because psychologists need an MD to be present to admit a patient. They cannot do it themselves.
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do you live in a vacum? have you not notice that everyone of your points have been shot down. Listen, the rxp ball has been rolling and it has picked up a whole lot of steam. It's a matter of time that psychology as a whole is going to get rxp, whether you agree or not, most psychiatrists know this... and the ones who are logical about it are not threatned by medical psychologists because there are plenty of patients out there and psychologists with rxp are going to be well trained providers who can trully collaborate with physicians.

but then again, If you don't know the difference between psychologists and social workers... then maybe you are living in your own little world. Sad dude, very sad...
 
heimlichboy said:
I think social workers and psychologists pretty much do the same job. I mean I have worked with social workers who are great at psychotherapy.
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what type of psychotherapy are you referring to? what kind do you practice?
 
edieb said:
and she is being reimbursed at the same rate as a psychiatrist by ALL insurance companies, and medicare/aid.
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That's interesting. I just wanted to clarify that you're talking about reimbursement for her med checks being the same reimbursement a psychiatrist makes for the same check. Is this correct?

Thanks.
 
maranatha said:
That's interesting. I just wanted to clarify that you're talking about reimbursement for her med checks being the same reimbursement a psychiatrist makes for the same check. Is this correct?

Thanks.
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From my understanding (talking with a number of LA and NM med psychs), that is correct.

-t
 
Therapist4Chnge said:
From my understanding (talking with a number of LA and NM med psychs), that is correct.

-t
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I wonder if this will eventually change once there are more rxp psychologists... I don't think NP and PA get reimbursed the same as MDs, do they? those insurance companies will eventually find some why to cut cost...
 
I've only seen one program for medical/clinical psychology. Are there other programs that I'm unaware of?
Thanks!
 
:confused: :confused:
Therapist4Chnge said:
This is what we need to happen! Academics may recoil at the thought (turning into a med-school look-alike)....but psychology and medicine are converging. I think we need to embrace a more biological approach, and use what we do know about science the best way we know how. I chose to get further training because I thought it necessary. I'd like to see everyone get the training (or at least some additional training), because I believe it really can help clinically.

-t
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(This quote is actually from the Cali Rx one, but I thought it would be more appropriate here.)

I ask the following question in outmost sincerity and mean absolutely no disrespect at all, nor do I have any desire to create a flame war. I am honestly interested in hearing your response with an open mind. As a future psychiatrist I would like to be informed on your position.

When you say that medicine and psychology are converging, the first thing that comes up in my mind is "it already has--it's psychiatry." It seems like what you are proposing sounds like it's going in the direction of a medical model and it would make more sense just to go through the psychiatry route. Please don't take that the wrong way, this is just what myself and many others on the MD side are thinking. Where am I wrong? I will fully grant you that psychiatry has unfortunately paid too little attention to the wonderful contributions from psychology and has gone too far off into a medical model. We also need to do a much better job of incorporating more therapy into our training. As such, it is one of my professional goals to work in a psychiatry training program and push more evidence-based therapy into our training. I would also like to develop, in conjunction with experts in therapy (i.e. psychologists), a fellowship for psychiatrists that would help them incorporate additional therapy into medical management (SUNY already has one).

Thank you.
 
Good question. I am a medical psychologist, meaning I completed a residency in medical/health psychology, and am trained to prescribe. I work exclusively in primary care. One answer to your question is that psychology is integrating with primary care medicine to provide a synergistic treatment approach; this is a very hot field called integrative behavioral medicine. The other answer is that YES many psychologists are realizing they need a basic medical eduction and are getting that by way of RxP training and other means. Having said that psychiatry and psychology are very different creatures. You are trained to medically treat severe mental illness, and we are trained to thoroughly understand the mind, cognition, memory, emotions, and are better trained to treat the so called walking-wounded. I do not see alot of overlap in what prescribing psychs do and what psychiatrists do, but there will be some. I have treated bipolar people, and some psychosis, but 90% of what I treat is depression, anxiety, ADHD, adjustment disorders etc... Meds are often a helpful adjunct in this population, but there really is very little need for a psychiatrist to see most of these patients when myself and the PCP treat them quite well.
 
Ack!

Stupid forum crash.

Here is a synopsis of what I wrote.....

Med school was more of an academic interest of mine, with psychiatry being the logic place for me. Clinical is what I enjoy reading/doing. My career goals are more in line with the clinical training, but I want to be as informed a clinician as I can; the pharma training will provide that. I only want to do part-time clinical work, and manage the meds for my pts (not the really severe cases/in-patient....psychiatry is more than welcome to handle that part :laugh: ), and I think this was the best route.

-t
 
NOW...here come the clin. psychologists who are asking to be one of the "boys" and treated as true health care providers, not glorified social workers. Organized medicine doesn't want yet another competitor. The insurance companies, however, love it. Lawyers love it!

Another obstacle you guys have is the older psychologists who feel this change is eroding the practice of clin psychology. Psychology, according to them, is NOT medicine. They argue, "if you want to Rx meds, go to medical school!" You guys are divided and not unified. Almost all ODs advocated for enhanced scope of practice powers, but you find psychologists divided into two or three factions: 1) those strongly for RxPs, 2) those strongly against RxPs, and 3) those who don't care. Until you guys unify, you will continue to lose the battle.

Another obstacle, the public's perception. Many folks get confused between psychiatrists, psychologists and

even MSWs. (the condescension!!!)

Both psychiatrists and psychologists are "doctors", but one is a "talking doctor" as one of my colleagues likes to say, and the other is a "pill pusher". If they both have the same "powers and privileges", what's the difference? If psychologists become more like psychiatrists, will the MSWs attempt to fill the void and become more like psychologists? Can you see MSWs trying to perform TATs, Rorschachs, MMPIs, WAIS, WISCs, WIATs, etc.?

Yes, as a matter of fact I can....and with RxPs as well....just call me DOCTOR Social Worker....
and whats with this "glorified social worker" stuff, anyway???:smuggrin: :mad: :idea:
 
DoctorLCSW said:
Another obstacle you guys have is the older psychologists who feel this change is eroding the practice of clin psychology. Psychology, according to them, is NOT medicine. They argue, "if you want to Rx meds, go to medical school!" You guys are divided and not unified. Almost all ODs advocated for enhanced scope of practice powers, but you find psychologists divided into two or three factions: 1) those strongly for RxPs, 2) those strongly against RxPs, and 3) those who don't care. Until you guys unify, you will continue to lose the battle.
Click to expand...

There are definitely some conflicting opinions within clinical psych, but we also have some allies in psychiatry and related areas.

DoctorLCSW said:
Another obstacle, the public's perception. Many folks get confused between psychiatrists, psychologists and even MSWs. (the condescension!!!)
Click to expand...

Some of this can be addressed by doing some community outreach projects. It is a great way to educate and get your name out. I don't need everyone understanding what I do, I just need enough patients (my patients) to understand what I do.

DoctorLCSW said:
Both psychiatrists and psychologists are "doctors", but one is a "talking doctor" as one of my colleagues likes to say, and the other is a "pill pusher". If they both have the same "powers and privileges", what's the difference? If psychologists become more like psychiatrists, will the MSWs attempt to fill the void and become more like psychologists? Can you see MSWs trying to perform TATs, Rorschachs, MMPIs, WAIS, WISCs, WIATs, etc.?
Click to expand...

Nothing says fun like painting with broad strokes. :laugh:

pscisi did a nice job addressing some of the differences.

-t
 
The idea that an LCSW even one with a PhD in social work bears any resemblance to a psychologist is like saying psychologists are psychiatrists because we are both doctors...makes no sense.
 
psisci said:
The idea that an LCSW even one with a PhD in social work bears any resemblance to a psychologist is like saying psychologists are psychiatrists because we are both doctors...makes no sense.
Click to expand...

psisci said:
The idea that an LCSW even one with a PhD in social work bears any resemblance to a psychologist is like saying psychologists are psychiatrists because we are both doctors...makes no sense.
Click to expand...

Doctors of Social Work (DSW) are poised to supplant, not supplement, Psy.Ds, esp. those of the fly-by-night degree-mill, industrial office complex/warehouse Argosy/Alliant/Nova paradigm. We are frequently housed in REAL, frequently Ivy-league universities such as Columbia, U. Chicago, etc. We receive rigorous didactic training with advanced, supervised practica in DSM-IVTR, adult/child psychopathology, and evidence-based interventions such as CBT, DBT, and IPT. We get a min. of two years training in multivariate quantitative research, including things like Structural Equation Modeling and Path Analysis, in addition to integration with naturalistic, anthropological methodology including critical ethnography and symbolic interactionism. Moreover, we are conversant with and comfortably ensconsced in managed-care friendly, cost-containment oriented mental health administration. We have a formidable social advocacy/social justice lobbying arm in NASW. We see you, Psy.Ds, and have our sights squarely on your foreheads...we will soon be lobbying for RxPs, admitting privileges, psychometric and neuropsych testing, and all the accoutrements....vive la DSWs!!!
 
You are basically just flaming, but I will indulge you with 2 thoughts. You are failing to realize or address that no matter what degree you get you are still licensed as an LCSW, and RxP for them is way off; not to mention you would still need to complete yet another 3+ years of training like psychologists do. Second, we really do not care. I say go for it, more power to you.... I wish you luck.
 
well, given our "market saturation" and how amenable third-party payers are to us, I am certainly sure savvy Psy.Ders and their "trainers" are very concerned......
 
DoctorLCSW said:
well, given our "market saturation" and how amenable third-party payers are to us, I am certainly sure savvy Psy.Ders and their "trainers" are very concerned......
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From what I have seen, the persons educated at professional schools are a lot lower quality than those educated at universities. Two of the interns at my site are from prof schools (Argosy and Illinois School of Prof Psychology). Their education seems to be very applied driven versus a theory driven model. Hence, they don't come off as practicing psychology by numbers. One of them is psychodynamic but matched with this site that deals with intellectual disability....
 
DoctorLCSW said:
Doctors of Social Work (DSW) are poised to supplant, not supplement, Psy.Ds, esp. those of the fly-by-night degree-mill, industrial office complex/warehouse Argosy/Alliant/Nova paradigm. We are frequently housed in REAL, frequently Ivy-league universities such as Columbia, U. Chicago, etc. We receive rigorous didactic training with advanced, supervised practica in DSM-IVTR, adult/child psychopathology, and evidence-based interventions such as CBT, DBT, and IPT. We get a min. of two years training in multivariate quantitative research, including things like Structural Equation Modeling and Path Analysis, in addition to integration with naturalistic, anthropological methodology including critical ethnography and symbolic interactionism. Moreover, we are conversant with and comfortably ensconsced in managed-care friendly, cost-containment oriented mental health administration. We have a formidable social advocacy/social justice lobbying arm in NASW. We see you, Psy.Ds, and have our sights squarely on your foreheads...we will soon be lobbying for RxPs, admitting privileges, psychometric and neuropsych testing, and all the accoutrements....vive la DSWs!!!
Click to expand...

wow, a social worker that knows a little stats and thinks he/she knows it all... buddy, congrats, I do have to give it to you since the vast majority of social workers can't even read and understand a scientific article. You should be basking yourself in your glory since you've reached such a high achievement in your field.... which pretty much all mediocre doctorate psychology programs have, wow congrats!

and you certainly seem to have your social work passion for advocacy (which usually dissapears after a sw becomes an administrator), but again, wake up, LCSW's are never going to get rxp, if your are saying DSW's will, hmmm, how many of you guys are there anyway? us psychs don't have to worry since the majority of LCSW's don't have any interest to purse a higher degree. Most sw that I know openly admit going the social work route in order to avoid taking GRE's... even as your celebrated IVY school such as columbia don't require them... that's just sad...

sw are insurance friendly because they are cheap and willing to take the low payments. That's the reality.
 
I could hear the sound of LCSW being put in the proper place all the way from Colorado!!
 
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