A question about Psych RXP laws? Collaboration agreements?

[R. Matey]

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The study was published as part of a students PHD dissertation on Prescription privileges for psychologists. Happy to post it for anyone interested.

I'm not sure I'd base my entire career trajectory on some rando's dissertation research. That hasn't gone through peer-review yet (the standards for dissertation are usually a bit lower than scientific publication), and even if it has, you don't really know how outcomes were measured, whether the analytic approach makes sense to more than four people, and whether the survey will yield a different answer with another sample. I mean, it's called a body of evidence for a reason.

 

[psych.meout]

I'm not sure I'd base my entire career trajectory on some rando's dissertation research. That hasn't gone through peer-review yet (the standards for dissertation are usually a bit lower than scientific publication), and even if it has, you don't really know how outcomes were measured, whether the analytic approach makes sense to more than four people, and whether the survey will yield a different answer with another sample. I mean, it's called a body of evidence for a reason.

Talk about an understatement. For my comps I did a meta-analysis, which pulled up dissertations from the Chicago School and similar level programs. They were worse than you'd think.

 

[deleted1129370]

@texanpsychdoc Any chance you'd be open to a quick chat to hear more about your decision and how it's going so far? I'm a licensed psychologist working for the DoD (also work in academia) considering the same route. Thank you!

Sure

 

[Psycho Bunny]

So no, not all states require this agreement. Louisiana for example does not. New Mexico I believe recently got rid of theirs. Colorado does, Illinois for sure does (they just love to be completely different than others and fussy).

I'm in my second year of the post-doc M.S.CP program with FDU and live in Texas.

Super late response I know, but I think as of now, Louisiana is the only state that doesn't have mandatory collaboration. I think the law for New Mexico just made it so that now you don't have to collaborate with the PCP, it can be anyone (Psych NPs and such) but I think it's still in effect.

 

[NeuroPsychosis]

What is yall's opinion on the current psychopharmacology training for psychologists? I am about to enter a PhD program that is housed in a medical school but my state hasn't passed RxP yet. On the other hand, The University of Colorado program has a training option at the predoctoral level and is quite intensive in medical coursework and over 750 hours of supervised clinicals (3 years total to completion). Do you recommend for someone to pursue during the PhD or after? Also, are there any Neuropsychologists who can give me their input about becoming a prescriber as a Neuropsychologist or does that just sound like shooting one's self in the foot? Trying to understand how beneficial would it be for some current doctoral trainees to consider this training path.

 

[AbnormalPsych]

I know it isn't specifically what you are asking, but if you are about to start a PhD program, my one piece of advice would be to do the best you can to get acclimated and get a solid foundation in your initial training requirements year 1. Neuropsychologists and prescribing psychologists are psychologists first and foremost. Get a solid base. Do good work. Then, figure out these kinds of specifics after that, when you have more experience and knowledge about what you want to branch out into, can manage, and if your mentors feel like you are ready.

 

[Psycho Bunny]

What is yall's opinion on the current psychopharmacology training for psychologists? I am about to enter a PhD program that is housed in a medical school but my state hasn't passed RxP yet. On the other hand, The University of Colorado program has a training option at the predoctoral level and is quite intensive in medical coursework and over 750 hours of supervised clinicals (3 years total to completion). Do you recommend for someone to pursue during the PhD or after? Also, are there any Neuropsychologists who can give me their input about becoming a prescriber as a Neuropsychologist or does that just sound like shooting one's self in the foot? Trying to understand how beneficial would it be for some current doctoral trainees to consider this training path.

I'm a lowly undergrad but as someone who's looked into this niche a LOT, I think that most of the psych rxp states have rules and restrictions to their prescribing so as to make the path almost impossible, or at least terribly impractical. A bunch of these same states allow psych NPs to prescribe independently. Its sad that Clinical Psychologists, THE experts in human behavior, who undergo years of training to diagnose, assess, and study psychopathology ON TOP of the post doctoral masters degree they would get, passing the PEP exam, years of additional supervision afterwards, can actually be FAR more restricted in their scope of prescribing than a Psych NP who is in school for 2-3 years and can essentially function as a psychiatrist afterwards.

In the case of Colorado, the patients PCP must approve any initial prescription, and you need approval every single time you increase, decrease, or discontinue a medication. You also need to renew the approval in general every 12 months.

In addition to this, if the patient is under 18 or over 65, you need renewed approval from the PCP every 3 months, even if the prescription hasn't changed.


The only benefit to this is that you can still work as a psychologist while undergoing the training, which is kinda huge. If you went the Psych Nurse route, you'd be out of work 2.5-3 years. And I think at that point you'd have to ask yourself if the income boost in prescribing will make up for 3 years of missed work plus the $100k+ student debt you'd aquire to become a PMHNP. That'll probably depend on individual circumstances, but it's tough to justify....

 

[Psycho Bunny]

Ny The committee I've been on and the lobby group we have been working with is crafting our proposal to be where there is ZERO physician collaboration required. Our chair would just as well not have it done at all rather than be like Illinois or Colorado (who do require a collaboration or oversight agreement).

After reading the laws more thoroughly of most of the RXP states as they stand since I made this thread, my God I hope your legislation succeeds. Even if the final bill compromises somewhat, it's one thing to be able to immediately prescribe and then just have to send some notes to a PCP after the fact (or in New Mexicos case any mental health provider) but it's a whole other nightmare to have to get approval every time you start or adjust treatment.

 

[Therapist4Chnge]

In the case of Colorado, the patients PCP must approve any initial prescription, and you need approval every single time you increase, decrease, or discontinue a medication. You also need to renew the approval in general every 12 months.

In addition to this, if the patient is under 18 or over 65, you need renewed approval from the PCP every 3 months, even if the prescription hasn't changed.

I read that they were still figuring out the details about collaborating with a physician. I still think the best path for prescribing is to become a psychiatrist or NP, as pursuing psych RxP is cumbersome and limited to a handful of states, indian land, military bases, etc. I say this as someone who completed the psych RxP training. I did it moreso for the added knowledge, and it fit into my area of research. Financially, I make more doing forensic work, it increases my liability as a clinician, and most importantly I don't have to be tethered to my practice or find backup coverage when I travel. I think the training helps communities, but that's more about having really bad & limited current prescribing options.

 

[Psycho Bunny]

I read that they were still figuring out the details about collaborating with a physician. I still think the best path for prescribing is to become a psychiatrist or NP, as pursuing psych RxP is cumbersome and limited to a handful of states, indian land, military bases, etc. I say this as someone who completed the psych RxP training. I did it moreso for the added knowledge, and it fit into my area of research. Financially, I make more doing forensic work, it increases my liability as a clinician, and most importantly I don't have to be tethered to my practice or find backup coverage when I travel. I think the training helps communities, but that's more about having really bad & limited current prescribing options.

Yeah the Psych RXP route is horribly inefficient. From what I read, the Colorado bill didn't have nearly as many restrictions when it passed their house. Their senate tacked on a ton of regulations at the last minute.


Since you completed the RXP training, are you able to speak to how it compares to Psych NP training? Also, if you don't mind me asking, how frequently do you travel as part of your work? As a forensic psychologist, do you testify alot? Also do you mind if I ask the ballpark of how much you earn doing what you do?

 

[WisNeuro]

Yeah the Psych RXP route is horribly inefficient. From what I read, the Colorado bill didn't have nearly as many restrictions when it passed their house. Their senate tacked on a ton of regulations at the last minute.


Since you completed the RXP training, are you able to speak to how it compares to Psych NP training? Also, if you don't mind me asking, how frequently do you travel as part of your work? As a forensic psychologist, do you testify alot? Also do you mind if I ask the ballpark of how much you earn doing what you do?

Just as a quick point of reference, forensic encompasses many things. Some things have a much heavier legal component (PI/criminal) and will have more depo/trial testimony than something like WC. Rates will vary a lot between settings as well. In some state work, the courts limit rates, but not everywhere. In civil work, pretty much the sky's the limit to a point.

 

[NeuroPsychosis]

I think that most of the psych rxp states have rules and restrictions to their prescribing so as to make the path almost impossible, or at least terribly impractical. A bunch of these same states allow psych NPs to prescribe independently. Its sad that Clinical Psychologists, THE experts in human behavior, who undergo years of training to diagnose, assess, and study psychopathology ON TOP of the post doctoral masters degree they would get,

Yeah I understand your input. I am not anti-RxP and actually feel like there could be more benefit than harm to it especially with those who have good physio/bio backgrounds like clinical neuro and health psychologists (This is my initial eval as I am still following the debate and learning evidences).

For me, however, I personally would NOT want to touch prescribing if I do not get the adequate medical knowledge needed to prescribe. I worked with a research physician (psychiatrist) for 4 years of my post-bacc and I can tell you that there already bad prescribing MDs so they have valid concern about handing out additional prescribing privileges. Also, polypharmacy knowledge is necessary and you need medical education for that. Now, my say is that you do not need to go to medical school to accomplish successful prescribers as we have seen worst prescribers are those who came out of med school (and this is not evidence to anything let me be clear- just a factual statement). My questions would be 1) How well put together are the psychopharmacology programs to ensure psychologists are competent prescribers and have room to become experienced? 2) should medical school housed programs and more health trained subspecialities of psychology be prioritized to prescribe (getting more selective with who to train)?

In my opinion, I do not see the issue is an issue of gaining the necessary medical knowledge (if you are able to create new knowledge might as be able to learn existing one), but rather as shall we want to play with the chances and give psychologists a chance to prescribe. Bad psychiatrists vs bad psychologists is a competence and training issue not a "which program you went to/degree type" issue.

 

[Therapist4Chnge]

Since you completed the RXP training, are you able to speak to how it compares to Psych NP training?

I did my training at the same time as a friend did her NP, and there were some pretty notable differences. I’ve written about it on here before, so let me see if I can find the post(s). If I find the post(s), I’ll copy to this thread.

The other questions I copied and will answer in another thread bc otherwise it could derail this thread topic.

IME payrate

For those who do IMEs, what do you bill per hour? I've got a company proposing a contract with a few per year and want to gauge rates. They're offering between 200-250 an hour depending on the eval, max hours billable of 8 for general diagnostic and 12-20 for more complex cases Thanks.

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