And we're at it again -- psychologist prescribing in Oregon

[Candidate2017]

And, as I like to mention when these threads come up, some of those NP's are 23 years old, straight out of a 5 year BS/FNP program with an additional 24 credit hours of PMHNP training. Very little of which is actually clinical.

I continue to find it baffling that NP's often have more independence than PA's, who have more actual medical training.

What's to stop psychiatrists from referring their train wreck patients to RxP and NPs? Let these "prescribers" prove themselves equal.

---

Members don't see this ad.

 

[Shikima]

Anecdotally--being from Louisiana--we still appear to have the same shortage of (and demand for) psychiatrists that other areas of the country continue to experience.

What strikes me the most about mental health care is just how so darn fragmented it all is...everyone from bachelors level (licensed practical counselors), primary care physicians, social workers, psychologists, psychiatrists, pastoral counselors, educational professionals, etc. ad nauseam.

I don't think that in Louisiana (or anywhere else) there is a real 'crisis' in terms of the mentally ill being able to get access to psychiatric medications...my experience is that the real crisis is a lack of access to mental health professionals/teams who know what they're doing (esp. as regards differential diagnosis, case formulation, application of evidence-based interventions, skills at developing appropriate professional relationships with patients (including boundaries), etc.) or who can devote the time necessary to really successfully apply the solid clinical science and methods that exist (so far) in mental health.

Louisiana needs more case managers to teach people how to live healthy lives.

 

[WisNeuro]

Louisiana needs more case managers to teach people how to live healthy lives.

Hey now, if Louisiana wants to be #1 in the nation in obesity rate, why would you try and take that distinction away from them. Next you're going to also want to take away their trophy of #1 in homicide rate as well!

 

[Shikima]

Hey now, if Louisiana wants to be #1 in the nation in obesity rate, why would you try and take that distinction away from them. Next you're going to also want to take away their trophy of #1 in homicide rate as well!

There is little which psychiatry can do to change this.

 

[slappy]

You are not a special snowflake. You are just another physician who thinks they can be successful at an endeavor in which they have no experience. Dr. Phil with a prescribing license could set up a cash pay clinic, staffed entirely by NPs, next door to the world's best psychiatrists and run them out of business.

Yawn.

 

[AcronymAllergy]

At least in my local market, that reminds me of the ridiculousness of group homes around here. Someone gets in a yelling match at group home? Off to the ED for a "safety evaluation" (8 hours of babysitting) and a $1000 bill for the taxpayer. There's gotta be a point at which someone finally realizes that all the $$ we waste on popping these folks in- and out- of the ED (and occasionally psych inpatient) could be better spent hiring better/more people for these group homes. Methinks the incentive structure should be setup such that the group homes are fined for excessive inpt/emergency care of their folks (or rewarded for less care, either way.)

There's so much room for improvement in the "typical" nursing home just from behaviorally-based interventions (on both the patient and staff sides), let alone from also targeting physical health, medication reconciliation, etc.

 

[AcronymAllergy]

Louisiana needs more case managers to teach people how to live healthy lives.

The southeast as a whole. Ballpark, probably 90% of the folks I see are in that boat. And it's not just a matter of people being lazy, of course. There's limited health literacy, lower household income, various cultural factors, limited access to healthy alternatives and resources, etc.

Also, I wouldn't say it applies to just case managers. ALL of a patient's providers can often do better in addressing these issues. A PCP may tell a patient what to do or what meds to take, and the patient may nod and say they understand, but they very well may have no idea what the medicine is, why and how they need to take it, and what will happen if they don't follow the treatment plan. So I see them, and they then tell me, "yeah, I mostly just take my bloodpressure/diabetes/depression pills when I feel like I need them," fully believing that's the optimal way to do things.

Edit: Just for the sake of fairness, I'm no saint, either. I'll see patients a year or two after my initial eval for a re-assessment and will check in on what they remember from the feedback I gave them previously. More often than not, it's little or nothing.

 

[Shikima]

The southeast as a whole. Ballpark, probably 90% of the folks I see are in that boat. And it's not just a matter of people being lazy, of course. There's limited health literacy, lower household income, various cultural factors, limited access to healthy alternatives and resources, etc.

Also, I wouldn't say it applies to just case managers. ALL of a patient's providers can often do better in addressing these issues. A PCP may tell a patient what to do or what meds to take, and the patient may nod and say they understand, but they very well may have no idea what the medicine is, why and how they need to take it, and what will happen if they don't follow the treatment plan. So I see them, and they then tell me, "yeah, I mostly just take my bloodpressure/diabetes/depression pills when I feel like I need them," fully believing that's the optimal way to do things.

Edit: Just for the sake of fairness, I'm no saint, either. I'll see patients a year or two after my initial eval for a re-assessment and will check in on what they remember from the feedback I gave them previously. More often than not, it's little or nothing.

Medicine isn't properly reimbursed for this level of care. It's very time and energy intensive.

 

[AcronymAllergy]

Medicine isn't properly reimbursed for this level of care. It's very time and energy intensive.

Yep, which is unfortunate (the reimbursement, not the time/energy required). Although I could see how a well-trained case manager could handle much of it, if they're given the time and access to information.

 

[Shikima]

Yep, which is unfortunate (the reimbursement, not the time/energy required). Although I could see how a well-trained case manager could handle much of it, if they're given the time and access to information.

They're cheaper to utilize than what one physician costs.

 

[Doctor Bagel]

So here's the bill. It looks like it's in committee in the house.

https://openstates.org/or/bills/2017 Regular Session/HB3355/

 

[Jules A]

So here's the bill. It looks like it's in committee in the house.

https://openstates.org/or/bills/2017 Regular Session/HB3355/

Its heavily sponsored. Are you going to testify? Interesting that so many of the proposals are "declaring an emergency".

 

[Doctor Bagel]

Its heavily sponsored. Are you going to testify? Interesting that so many of the proposals are "declaring an emergency".

I'd be willing to. I haven't heard of requests yet, but I'm not really in the know. My employer is apparently supporting it.

 

[Jules A]

I'd be willing to. I haven't heard of requests yet, but I'm not really in the know. My employer is apparently supporting it.

If you are willing to go consider contacting the state's medical society. I'm sure they have a legislative committee with a lobbyist setting up testimony who would appreciate the offer of your time and expertise.

 

[Doctor Bagel]

So here's the bill. It looks like it's in committee in the house.

https://openstates.org/or/bills/2017 Regular Session/HB3355/

Adding that the committee it's in is chaired by one of its sponsors, Mitch Greenlick -- he's a guy who is not a friend of doctors as far as I can tell. Long time health care policy/administrator type of person but no actual experience you know providing health care.

 

[Jules A]

Adding that the committee it's in is chaired by one of its sponsors, Mitch Greenlick -- he's a guy who is not a friend of doctors as far as I can tell. Long time health care policy/administrator type of person but no actual experience you know providing health care.

I'm sure the lawyers representing your group are well aware and hopefully on it. I've been involved in similar bills and there are so many points a decent lawyer can use to either adjust or squash a bill. Ensuring the language and terms are precise regarding exactly how many hours, and who will train these new prescribers, under what board their supervision will rest because it doesn't make sense, to me at least, to have the board of psychologists who aren't prescribers oversee an area that is beyond their scope. This draft looks fairly in depth so my guess is they have been hammering on it for a while. As distasteful as it might be I'd consider enlisting your state's NP organization if they have any chops because like it or not they often carry both numbers and clout.

 

[Doctor Bagel]

I'm sure the lawyers representing your group are well aware and hopefully on it. I've been involved in similar bills and there are so many points a decent lawyer can use to either adjust or squash a bill. Ensuring the language and terms are precise regarding exactly how many hours, and who will train these new prescribers, under what board their supervision will rest because it doesn't make sense, to me at least, to have the board of psychologists who aren't prescribers oversee an area that is beyond their scope. This draft looks fairly in depth so my guess is they have been hammering on it for a while. As distasteful as it might be I'd consider enlisting your state's NP organization if they have any chops because like it or not they often carry both numbers and clout.

I've been trying to reach out to NPs I know about this, but I think it's logical that they would oppose it. Apparently in the last psychologist prescribing fight in 2010, some did and some didn't -- they weren't unified in any way against it. So far, I haven't come across any NPs who seem particularly worked up about it, which seems odd as this if anything might be a greater threat to them than to psychiatrists. One of the NPs I talked to mentioned that NPs aren't particularly unified in general, which is probably true, but jeez, they've been a politically successful group. NPs practice expansion and marijuana -- two politically politically unstoppable things these days.

 

[Jules A]

I've been trying to reach out to NPs I know about this, but I think it's logical that they would oppose it. Apparently in the last psychologist prescribing fight in 2010, some did and some didn't -- they weren't unified in any way against it. So far, I haven't come across any NPs who seem particularly worked up about it, which seems odd as this if anything might be a greater threat to them than to psychiatrists. One of the NPs I talked to mentioned that NPs aren't particularly unified in general, which is probably true, but jeez, they've been a politically successful group. NPs practice expansion and marijuana -- two politically politically unstoppable things these days.

That is unfortunate although in my experience there are a few who do the heavy lifting and the rest sit back and reap the rewards. I'd suggest contacting the state's NP organization which hopefully is organized and active. I would guarantee there is a position on this issue and I'd wager a guess would be against other professions starting to prescribe. My state's NP organization interjects their two cents into anything and everything sometimes its overkill but it seems to keep a hold on the power.