any psychology folks feel they are missing out?

gaki said:

any psychology folks feel they are missing out on not having gone the psychiatry route? maybe are open to going for psychiatry studies one day?

and vice versa for psychiatry people who might be lurking around here..?

i am having a hard time deciding if i should go into psychology or psychiatry.

thanks in advance!

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Give it about 10 years, and psychologists will be prescribing psychotropic medications in more than half (if not most) U.S. States. Thus, by the time you're done training, whether it's MD/DO or PhD/PsyD, you'll be able to function as a pharmacotherapist and psychotherapist.

Click here for more information:

http://www.apa.org/apags/profdev/advancingprof.html

http://www.apa.org/apags/profdev/prespriv.html

http://www.prescribingpsychologist.com

http://www.prescribingpsychologist.com/Training Programs.htm

http://www.apa.org/divisions/div55/

http://forums.studentdoctor.net/showthread.php?t=118082

PublicHealth said:

Give it about 10 years, and psychologists will be prescribing psychotropic medications in more than half (if not most) U.S. States. Thus, by the time you're done training, whether it's MD/DO or PhD/PsyD, you'll be able to function as a pharmacotherapist and psychotherapist.

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That's sad, and ridiculous. If psychologists want to be doctors, they should go to medical school. They are not sufficiently trained to prescribe medications of any kind and are merely trying to increase their billing power by infringing on the psychiatrist's scope of practice.

stinkycheese said:

That's sad, and ridiculous. If psychologists want to be doctors, they should go to medical school. They are not sufficiently trained to prescribe medications of any kind and are merely trying to increase their billing power by infringing on the psychiatrist's scope of practice.

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Whatever your opinion, it is happening, and psychiatrists (who are greatly outnumbered) are waging verbal wars against the persistent lobbying efforts of psychologists. Despite their efforts, some of their own (psychiatrists and primary care physicians) are actually supporting psychologists' efforts to obtain prescription privileges. The train has left the station and is gathering speed, my dear. Good luck trying to stop it.

I don't think that its necessarily true that psychiatrists are missing training in psychology. Those that want to practice psychotherapy and analysis have ample opportunities for training during residency and post-residency. I have worked with many psychiatrists and psychologists and I feel like both groups have strengths. I just don't think that any psychologist has the background or knowledge necessary to prescribe medication. For the record, I am also against OD's, chiropracter's, etc, prescribing meds. I think it's a job best left to MD's, DO's, and the mid-level practitioners working under them.

stinkycheese said:

I don't think that its necessarily true that psychiatrists are missing training in psychology. Those that want to practice psychotherapy and analysis have ample opportunities for training during residency and post-residency. I have worked with many psychiatrists and psychologists and I feel like both groups have strengths. I just don't think that any psychologist has the background or knowledge necessary to prescribe medication. For the record, I am also against OD's, chiropracter's, etc, prescribing meds. I think it's a job best left to MD's, DO's, and the mid-level practitioners working under them.

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That's your opinion, and you're entitled to it. However, your opinion does not sway the efforts of the tens of thousands of psychologists seeking prescription privileges. Are you, "for the record," involved in lobbying against psychologists, optometrists, and chiropractors seeking prescription privileges? Judging by the tone of your posts, you're probably not. Moreover, you're likely a pre-med, medical student, resident, or physician with a "god complex" that obscures any open-mindedness and objectivity that would otherwise fuel good debate.

When discussing issues like this, one has to keep in mind that his or her opinion means nothing. It's who's in bed with legislators that decides such things.

PublicHealth said:

That's your opinion, and you're entitled to it. However, your opinion does not sway the efforts of the tens of thousands of psychologists seeking prescription privileges. Are you, "for the record," involved in lobbying against psychologists, optometrists, and chiropractors seeking prescription privileges? Judging by the tone of your posts, you're probably not. Moreover, you're likely a pre-med, medical student, resident, or physician with a "god complex" that obscures any open-mindedness and objectivity that would otherwise fuel good debate.

When discussing issues like this, one has to keep in mind that his or her opinion means nothing. It's who's in bed with legislators that decides such things.

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Hold up. Yeah, its the legislators that are going to decide who has privileges to what in the end, but for now, psychologists don't have the training and aren't qualified to prescribe medications for their patients. I'm guessing new legislation means more extensive training, certification, and some sorts of internships in prescribing, meaning more training that coincides with that of a psychiatrist. Right now, psychologists don't get that kind of training.

In order to do that, you'd have to take a full medical history and know, I'm guessing, at least basic drug interactions and contraindications. I'm not in medical school so I'm just speaking from basic knowledge that I know from having a psychologist and psychiatrist myself and researching myself which pathway I want to go. So to answer the OP, I think that if you are interested in all the organic causes for psychiatric problems and want to be able to diagnose these organic problems (such as the vitamin B-12 deficiency you mentionned) and treat them, you'd be better off going to medical school right now and becoming a psychiatrist. Who knows whats going to happen in 10 years anyways?

Well, I do agree that if you really want to know about serious organic psychiatric diseases that require complex medicaley weren't knowledge you schould definitely go into psychiatry. They are certainly better equipped to handle patients with multiple medications or medical issues. However, I think the issue begins to blur for a person with AD/HD who has no other medical problems and needs strattera or a college student who is clinically depressed. I believe that a psychologist with an MS in psychopharmacology is well equipped to deal with those situations. And that leads me to my second point, I don't know what is going to happen 10 years from now, but I would definitely be concerned because either psychiatrists or psychologists are going to get squeezed in the future. And frankly after putting in the 7-8 years of training an a lot of money in either case I wouldn't want to be on the wrong side of that squeeze. As far as the B-12 issue goes, the psychologists that recommend that antidepressents, were they properly trained in psychopharm or not. If they weren't then I think it can be an argument for prescription rights because at least with legislation comes the certain training thatmust be completed. Frankly, I think it is more dangerous if untrained psychologists are giving these recommendations, even if technically they aren't allowed to.

PublicHealth said:

That's your opinion, and you're entitled to it. However, your opinion does not sway the efforts of the tens of thousands of psychologists seeking prescription privileges. Are you, "for the record," involved in lobbying against psychologists, optometrists, and chiropractors seeking prescription privileges? Judging by the tone of your posts, you're probably not. Moreover, you're likely a pre-med, medical student, resident, or physician with a "god complex" that obscures any open-mindedness and objectivity that would otherwise fuel good debate.

When discussing issues like this, one has to keep in mind that his or her opinion means nothing. It's who's in bed with legislators that decides such things.

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Which, by your tone of voice, implies that you think people who are not in bed with legislators have no right to debate their opinion on an internet forum because it just doesn't matter. Real smart, there.

For the record, I don't have a Gd complex. I have a safety complex. I actually care about the safety of my patients. I don't think that when medical professionals say they don't want RxP for PhD's, it is not an indication that we feel we are better than you, but more of an indication that we feel there are appropriate avenues to prescribing privileges, and graduate training in clinical psychology is not one of them-- weekend psychopharmacology course or not.

gaki said:

Also, do you think psychiatrists have adequate training in psychological theory and practice to handle psychotherapy on their own, even for clients who are more neuroses than severe mental illness? I know that psychiatrists can do some psychotherapy, but can they do it as well as psychologists (but perhaps usually just choose not to?)

Thanks much for your input so far!

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It depends on the training, which is NOT uniform across either psychologists or psychiatrists. My psychiatrist is trained in psychotherapy, analysis, and of course, medical practice. He is an excellent psychotherapist. I am sure he is better than 90% of practitioners out there, whether they are MD's or PhD's. It is not the degree after your name, it is the training you seek out. MD's can be just as qualified to administer psychotherapy as a PhD, and in many cases, better equipped to provide comprehensive mental health care.

stinkycheese said:

Which, by your tone of voice, implies that you think people who are not in bed with legislators have no right to debate their opinion on an internet forum because it just doesn't matter. Real smart, there.

For the record, I don't have a Gd complex. I have a safety complex. I actually care about the safety of my patients. I don't think that when medical professionals say they don't want RxP for PhD's, it is not an indication that we feel we are better than you, but more of an indication that we feel there are appropriate avenues to prescribing privileges, and graduate training in clinical psychology is not one of them-- weekend psychopharmacology course or not.

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From one of the above articles: Over 70% of psychotropic medication in the United States is currently prescribed by non-psychiatric physicians who have minimal training in the detection and management of mental and emotional problems. Psychologists are much better trained and equipped to accurately diagnose and treat mental disorders.

Funny, as I write this, Dateline NBC is discussing how easy it is to purchase narcotics and other controlled substances from "online pharmacies." One man died after overdosing on narcotics he purchased on-line. Apparently, physicians (the one interviewed was from the Netherlands) who "rubber stamp" these prescription requests are paid thousands of dollars per month to do so. A prescription for Valium was approved and delivered to the reporter's dog! According to the story, several physicians in the U.S. are involved in facilitating such prescription requests as well. Maybe psychologist prescribing is not so bad after all!

PublicHealth said:

From one of the above articles: Over 70% of psychotropic medication in the United States is currently prescribed by non-psychiatric physicians who have minimal training in the detection and management of mental and emotional problems. Psychologists are much better trained and equipped to accurately diagnose and treat mental disorders.

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Nobody disagrees that psychologists are well-equipped to diagnosed mental health problems. This does not translate into being better-equipped than a family physician to dole out medications. Psychologists should work with medical personnel to obtain the best care for their patients; they shouldn't assume that it is safer or better to just dole out the meds themselves.

Funny, as I write this, Dateline NBC is discussing how easy it is to purchase narcotics and other controlled substances from "online pharmacies." One man died after overdosing on narcotics he purchased on-line. Apparently, physicians (the one interviewed was from the Netherlands) who "rubber stamp" these prescription requests are paid thousands of dollars per month to do so. A prescription for Valium was approved and delivered to the reporter's dog! According to the story, several physicians in the U.S. are involved in facilitating such prescription requests as well. Maybe psychologist prescribing is not so bad after all!

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A. What does this story have to do with the issue at hand?

B. Are you saying that since people can easily get illegal prescription drugs online, that we should just not care about who has prescribing privileges? Hey, let's give RxP to everybody, since you can get drugs online anyway! Loosening up regulations on prescription drugs is not the answer to a crisis of overavailability of dangerous drugs.

gaki said:

Hi stinkycheese, how does a psychiatrist insure that s/he has had enough training in psychotherapy?

I know there have been lists posted about psychiatry programs that have more emphasis on psychotherapy and such (and I took notes from those posts). I also heard of "analytic institutes" where people can get additional training.. how formal of a training is this? are they easy to find? The only institutes for further training in psychotherapy have been psychoanalytic institues in New York.. what alternatives are there and how easy are they to come by?

In any case, to the best of your knowledge, what else should a psychiatrist or would-be psychiatrist do, in your opinion?

Thanks much!

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There are analytic institutes all over, not just in NY. There's a very well known training center in Boston. MD's can pursue post-doctoral/post-residency training in psychotherapy and analysis at these places. They should also seek residency programs with a heavy emphasis on training in psychotherapy, CBT, analysis, and other non-pharm aspects of psych.

For the record, the training psychologists training to prescribe currently receive is not a "weekend pharmacology course." The programs are post-doctoral master's programs of typically 30 credit hours. They take 2-4 years to complete.

Graduates of the programs receive MORE training in pharmacology, psychopharmacology, and developmental psychopharmacology than in any medical school. Tennessee's program requires 226 didactic hours in these, while, according to www.AAMC.org, the average medical school provides just 99 didactic hours in all of pharmacology. You may not believe it, but it's true.

bcdenis said:

For the record, the training psychologists training to prescribe currently receive is not a "weekend pharmacology course." The programs are post-doctoral master's programs of typically 30 credit hours. They take 2-4 years to complete.

Graduates of the programs receive MORE training in pharmacology, psychopharmacology, and developmental psychopharmacology than in any medical school. Tennessee's program requires 226 didactic hours in these, while, according to www.AAMC.org, the average medical school provides just 99 didactic hours in all of pharmacology. You may not believe it, but it's true.

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Great point. People call these programs "weekend pharmacology" because the courses are typically offered every other weekend for about two years (some have on-line and face-to-face coursework). The reason for this is that psychologists who attend these programs work during the week.

I would imagine that as time goes on, some of these programs will allow students to complete the curriculum in 1-2 years full-time/during the week, if they don't already allow students to do so (http://pn.psychiatryonline.org/cgi/content/full/39/15/1). Of course, clinical psychology programs should also offer students the option of taking pharmacology courses in graduate school in order to better prepare them for postdoctoral training in clinical psychopharmacology. Perhaps a combined PhD/PsyD in clinical psychology and MS in clinical psychopharmacology is in order?

euromd said:

I was one of the people who called it a "weekend pharma course". However, after reading the link, I will say that the course is slightly more in depth than I originally thought. I believe I saw the words neurosience and pathophysiology. But no biochem??? That is the crux of it all!!

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Wrong. Most programs require biochemistry.

euromd said:

Wouldn't you need to refer the patient to a doctor? Wouldn't it have been better to have these patients supervised by someone who could do something in the first place?

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Have you read any of the relevant literature on psychologist RxP? Have you read the New Mexico or Louisiana laws? Are you aware of what psychologists have to go through before they can independently prescribe? Have you ever met an MS-trained psychologist?

You should also look into the literature that suggests that psychologists are better diagnosticians than psychiatrists. Combine this problem of misdiagnosis with that of overmedication and now you're really looking out for the patient's best interests. Behavioral healthcare is a mess. No one will deny that. The question is how do we clean it up? I'm not so sure giving psychologists RxP is the best way to do that, but it may increase access to psychopharmacotherapeutic care in regions of the country that do not have such care readily available.

People fear change. Most psychiatrists as well as some dinosaur psychologists fear equipping psychologists with RxP. The "what ifs" race through their minds. Over time, however, psychologists in NM and LA will most likely demonstrate that they could prescribe safely and effectively as was shown in the DoD project. When optometrists first suggested that they wanted to prescribe for diagnostic purposes, ophthalmologists were in an uproar! Some even threatened to cut off all ties from optometrists. But what has happened since then? ODs now safely and effectively prescribe for diagnostic AND therapeutic purposes in all 50 U.S. states. PAs and APRNs are even prescribing, and with MUCH less training than psychiatrists.

Your "holier than thou" argument does not hold water. American healthcare is undergoing substantial change and is shifting toward having a greater number of nonphysician healthcare providers serving the public. Managed care loves it. But is what is good for business necessarily good for the people?

psisci said:

I understand the anger on both sides of this argument, and I think alot of it comes (from both sides) directly from ignorance. Most psychiatrists have no idea what the breadth and depth of RxP training is, and they assume psychologists are taking some trumped up CEU course hoping to write scripts and then hoping all goes well. This is not the case, nor would any psychologist I know stand for this professionally or ethically. Psychologists assume that MD's have a clue what RxP is; they do not. Psychologists need to educate the medical community about what this training entails and what it would allow/not allow. Most programs I have seen are comparable in depth to a FNP program, but clinically focused on psych/med issues. Does this mean they do not include biochem, pathophys, phys assessment, labs etc.., No! They all do, as well they should. There is much to say about this, but I feel the best thing psychologists can do is begin to educate MD's about this training.

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Excellent point. Psychiatrists have already begun to educate themselves about these programs. A recent issue of Psychiatric News actually had an article describing current postdoctoral clinical psychopharmacology training programs for psychologists (http://pn.psychiatryonline.org/cgi/content/short/39/15/1). Note that some of the newer programs (e.g., http://cecoe.tamu.edu/psychopharm/) were not included in this review. Whether or not current MS training in clinical psychopharmacology provides an appropriate level of basic medical education has been discussed in the now epic thread on psychologist RxP in the psychiatry forum.

PublicHealth,

you are a freaking hypocrite of the highest order. In 10 or 15 years, when they have special MS programs in psychology that combine pharmacology training, you will have masters level therapists pushing for script rights, and you will be on the front lines declaring how they are unqualified.

You want all psychologists to have script access? Fine, but its going to cost you down the road. Surely you dont believe that only doctoral level professionals are going to write psych scripts do you? You are contributing to the pandoras box phenomenon.

Midlevels and outsiders have been screaming for 30 years about how we need to expand script rights so more people supposedly have access to health care. What a joke. There are now more "underserved" areas in medicine ever.

New Mexico, Louisiana, and the other states will bear this out. I GUARANTEE YOU in 10 years there wont be one iota of difference in access to healthcare in these states. Psychologists love the big cities just as much as the psychiatrists.

MacGyver said:

PublicHealth,

you are a freaking hypocrite of the highest order. In 10 or 15 years, when they have special MS programs in psychology that combine pharmacology training, you will have masters level therapists pushing for script rights, and you will be on the front lines declaring how they are unqualified.

You want all psychologists to have script access? Fine, but its going to cost you down the road. Surely you dont believe that only doctoral level professionals are going to write psych scripts do you? You are contributing to the pandoras box phenomenon.

Midlevels and outsiders have been screaming for 30 years about how we need to expand script rights so more people supposedly have access to health care. What a joke. There are now more "underserved" areas in medicine ever.

New Mexico, Louisiana, and the other states will bear this out. I GUARANTEE YOU in 10 years there wont be one iota of difference in access to healthcare in these states. Psychologists love the big cities just as much as the psychiatrists.

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Same tired argument. Do you have any thoughts of your own on this topic or do you plan on plagiarizing all of purpledoc's and anasazi's comments from the original thread?

gaki said:

this is the second time i have seen it stated in a thread that psychologists might be better diagnosticians than psychiatrists. i have tried looking for information on this but i have not found any. one person said that this is just not true.

can you paste any links or names of articles or researchers i should be looking for for more information about this? anyone anyone?

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Its just more BS pandering by PublicHealth. There is no truth to the claim.

In order for these clowns to get prescription rights they need to be supervised by a physician while they train. So as a physician just refuse to contribute to this "mini-psychiatrist" training. After all what they want is just a slice of the pie that psychiatrists have access to. I for one, will never refer a patient to one of these undertrained clowns.

I for one, will never refer a patient to one of these undertrained clowns.

And I, for one, will never refer my clients to you or similarly minded physicians for physical health needs. Do some research on psychologists' training before you make ignorant statements.

lazure said:

I for one, will never refer a patient to one of these undertrained clowns.

And I, for one, will never refer my clients to you or similarly minded physicians for physical health needs. Do some research on psychologists' training before you make ignorant statements.

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You make it sound as if you are a gatekeeper who will decide which patient is referred to whom. I doubt that, as a psychologist, you would be referring many patients to MDs. When a patient of yours needs a doc, he/she won't come to you to ask you if/when he or she could see a doctor. They will just go to one. You are vastly overstating your importance in an area in which you have no leverage.
I would venture to say that your referral note would look something like this:

"Dear Dr. So and So. I have a patient whom I have been treating for the past three years for a broken heart s/p past relationship gone awry and now she needs to see you for ...hmmm....well I am not sure but maybe you can figure it out"

siguanabo said:

You make it sound as if you are a gatekeeper who will decide which patient is referred to whom. I doubt that, as a psychologist, you would be referring many patients to MDs. When a patient of yours needs a doc he/she won't come to you to ask you if/when he or she could see a doctor. They will just go to one. You are vastly overstating your importance in an area in which you have no leverage.
I woud venture to say that your referral note would look something like this:

"Dear Dr. So and So. I have a patient whom I have been treating for the past three years for a broken heart s/p past relationship gone awry and now she needs to see you for ...hmmm....well I am not sure but maybe you can figure it out"

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Is siguanabo really MacGyver?

Is siguanabo really MacGyver?

It doesn't matter.... but God bless their patients...