Anyone here go to PA school after PhD/PsyD?

[ReciproGal]

Hello-

Have any clinical psychologists here gone to PA school after completion of the degree/getting licensed? Clinical psych coursework in general tends to be exceptionally lacking in biology/biochemistry and I think having this foundation is exceptionally important. Not sure if several courses in bio bases of behavior and psychopharm are adequate. Also, PAs can prescribe. I guess going into psychiatry is a way to bridge the gap but wanted to see if anyone went PA (I'm interested in doing research on gut microbiome and behavior).

Or- any health psychologists here? Or people that have completed a post-doc master's in psychopharm?

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[PsyDr]

I looked into medical school, PA school, and getting different PhDs throughout training. I also completed the prerequisites for medical school in undergrad IIRC.

As a working professional, the return on investment was neutral if I got into the high paying speciality as a physician, and negative for the rest. Even if Yale’s online PA ever goes active, I’d still be looking at 2 years of lost revenue, ~$200k in educational expenses, a median income of around $120k, and a maximum income of $200k if the ortho sdn boards are accurate and if I am willing to live in the boonies. Not worth it for me.

I’ve never seen a PA as a PI in any medical school or medical center I’ve been in, so I don’t know if that’s a realistic plan. I have seen many many many PhDs doing research in such fields. You might want to look up who is researching psychobiotics. There’s several psychologists in that area.

@Therapist4Chnge and myself have completed post doc psychopharmacology masters. EdieB supposedly also worked as a medical/prescribing psychologist, but he’s no longer active here. Another poster, Mike something was/is a health psychologist who returned to medical school.

 

[NeuroTrope]

I looked into medical school, PA school, and getting different PhDs throughout training. I also completed the prerequisites for medical school in undergrad IIRC.

As a working professional, the return on investment was neutral if I got into the high paying speciality as a physician, and negative for the rest. Even if Yale’s online PA ever goes active, I’d still be looking at 2 years of lost revenue, ~$200k in educational expenses, a median income of around $120k, and a maximum income of $200k if the ortho sdn boards are accurate and if I am willing to live in the boonies. Not worth it for me.

I’ve never seen a PA as a PI in any medical school or medical center I’ve been in, so I don’t know if that’s a realistic plan. I have seen many many many PhDs doing research in such fields. You might want to look up who is researching psychobiotics. There’s several psychologists in that area.

@Therapist4Chnge and myself have completed post doc psychopharmacology masters. EdieB supposedly also worked as a medical/prescribing psychologist, but he’s no longer active here. Another poster, Mike something was/is a health psychologist who returned to medical school.

Aren't you already earning as much or more than most physicians? Why seek the MD route on top of it all?

 

[ReciproGal]

I looked into medical school, PA school, and getting different PhDs throughout training. I also completed the prerequisites for medical school in undergrad IIRC.

As a working professional, the return on investment was neutral if I got into the high paying speciality as a physician, and negative for the rest. Even if Yale’s online PA ever goes active, I’d still be looking at 2 years of lost revenue, ~$200k in educational expenses, a median income of around $120k, and a maximum income of $200k if the ortho sdn boards are accurate and if I am willing to live in the boonies. Not worth it for me.

I’ve never seen a PA as a PI in any medical school or medical center I’ve been in, so I don’t know if that’s a realistic plan. I have seen many many many PhDs doing research in such fields. You might want to look up who is researching psychobiotics. There’s several psychologists in that area.

@Therapist4Chnge and myself have completed post doc psychopharmacology masters. EdieB supposedly also worked as a medical/prescribing psychologist, but he’s no longer active here. Another poster, Mike something was/is a health psychologist who returned to medical school.

I see, thanks for the insight! From the financial standpoint, you're right in that it would make no sense to go PA- it just makes it hard when only 5 states allow prescribing psychologists. I will definitely look around to see if anyone in my area is doing psychobiotics. Cheers!

 

[psych.meout]

Aren't you already earning as much or more than most physicians? Why seek the MD route on top of it all?

...

I looked into medical school, PA school, and getting different PhDs throughout training. I also completed the prerequisites for medical school in undergrad IIRC.

 

[ReciproGal]

Aren't you already earning as much or more than most physicians? Why seek the MD route on top of it all?

I know at least for me, it's a matter of educational development in which medical background could be really beneficial in conceptualizing a case. Also, physicians make an average of $250k a year- I've only seen several psychologists make this or more and they are largely in private practice (the psychologist I work for makes $300k+ a year but it's a private practice).

 

[NeuroJaguar]

I know at least for me, it's a matter of educational development in which medical background could be really beneficial in conceptualizing a case. Also, physicians make an average of $250k a year- I've only seen several psychologists make this or more and they are largely in private practice (the psychologist I work for makes $300k+ a year but it's a private practice).

Can you say more about this private practice? Do they run a group practice? Is it therapy, assessment, or both? Just curious

 

[ReciproGal]

Can you say more about this private practice? Do they run a group practice? Is it therapy, assessment, or both? Just curious

Sure! Therapy, assessment, and psychiatric services are offered there. A psychiatrist and psych NP do the medication management, masters level therapists do the therapy, and the 2 psychologists do mostly assessment (I am a diagnostician, one of the psychologists owns the practice). It’s a very streamlined process and there are contracts with CPS and the military which allows for a stable referral base.

 

[NeuroJaguar]

Sure! Therapy, assessment, and psychiatric services are offered there. A psychiatrist and psych NP do the medication management, masters level therapists do the therapy, and the 2 psychologists do mostly assessment (I am a diagnostician, one of the psychologists owns the practice). It’s a very streamlined process and there are contracts with CPS and the military which allows for a stable referral base.

So interesting! Sounds like a well-oiled machine. Thanks for the info!

 

[deleted343839]

I guess going into psychiatry is a way to bridge the gap but wanted to see if anyone went PA (I'm interested in doing research on gut microbiome and behavior).

PA school won't help you launch a research career. This kind of work is best done in a multidisciplinary environment with medical and basic science collaborators. You could go the MD route but honestly it's more about the team, the environment, and whether you can convince someone to fund your work.

Or- any health psychologists here?

I am a health psychologist. Not to be confused with "medical psychologists" who often favor prescribing privileges. Health psychologists tend not to, often because we are working collaboratively with physicians anyway.

 

[PsyDr]

Aren't you already earning as much or more than most physicians? Why seek the MD route on top of it all?

As a practicing psychologist, my motivations to consider an alternate career are not solely financial. There's subject matter interest, boredom, lifestyle considerations that are unique to me, significant personality stuff, life expectancy, etc.

Right now, I'm okay with my career. But I'm still exploring getting another degree or two.


@MamaPhD "Medical Psychologist" is the DEA's designation for a prescribing psychologist. Almost by definition, all medical psychologists favor prescription privileges.

 

[Therapist4Chnge]

I know at least for me, it's a matter of educational development in which medical background could be really beneficial in conceptualizing a case. Also, physicians make an average of $250k a year- I've only seen several psychologists make this or more and they are largely in private practice (the psychologist I work for makes $300k+ a year but it's a private practice).

I did the pharma training to strengthen my clinical understanding and also to pursue pharma related research. I figured it could also be a good backup plan for me, but the longer I practice, the less interest I have in prescribing. I work with a bunch of physicians and an NP, and I'd rather focus on my assessment work than deal w the hassle of prescribing. Money-wise, doing assessment and legal work is more lucrative than if I prescribed full-time; it's more interesting too.

 

[NeuroTrope]

I did the pharma training to strengthen my clinical understanding and also to pursue pharma related research. I figured it could also be a good backup plan for me, but the longer I practice, the less interest I have in prescribing. I work with a bunch of physicians and an NP, and I'd rather focus on my assessment work than deal w the hassle of prescribing. Money-wise, doing assessment and legal work is more lucrative than if I prescribed full-time; it's more interesting too.

Oh I definitely agree. I could never see the benefit of trying to go the prescribing route with the amount of work it entails (even if it becomes easier to achieve, there are issues with malpractice insurance and paperwork that would drive me up the wall). Assessment pays the bills, is interesting, and is a huge lifestyle boost.

 

[Therapist4Chnge]

What a lot of prospective students don't fully understand is that prescribing is a great tool of many tools, but there can be a lot of pressure to write for... something .

Prescribing is so fraught with potential issues that go well beyond just clinical indication and proper diagnosing. What will insurance cover? Can I trust this patient to use as prescribed? What does non-compliance mean in regard to side effects? Who is my coverage if I go on vacation? Who is making the generic version(s)? Does one generic from one company work differently than another generic version? And so on.

While psychiatry is not perfect, more training and more hours matter more than most ppl realize. It's not that psych RxP, NP, and/or PA produces inferior prescribers, it's that there seems to be a greater variance in training and abilities.

(N=1)....Our current NP is a very skilled provider who consistently attends CE talks and stays up on all of the newest medication options and FDA updates. He also worked as an RN for years before going back for his NP, as opposed to direct-entry NP programs that minimize RN training hours and place speed to completion over breadth of training. I prefer referring to him than most of the psychiatrists in my community. That said, there are some NPs in the community who I'd never send a patient, and a psychiatrist or two who I can trust w. a medically complex case more than the neurologist and/or physiatrist already on the case.

If a prospective student w/o any prior advanced training is interested in prescribing, they should strongly consider the MD/DO route first. If there are concerns with the rigors of training and/or not wanting to be exposed to other areas of medicine that are icky/not wanted...then prescribing probably isn't a good fit for them. Mid-level prescribing (NP/PA) is a better "value" in regard to time spent than an MD/DO, but there are a ton of additional things that need to be learned along the way AFTER licensure to be an effective prescriber.

 

[BorderlineQueen]

Curious why are you looking into PA school vs NP school? PAs have to be supervised in all states but NPs have greater autonomy in 23 states essentially they don't need a collaborative agreement and they don't need to be supervised. I know @medium rare is a psychologist and Psych NP.

 

[AcronymAllergy]

Curious why are you looking into PA school vs NP school? PAs have to be supervised in all states but NPs have greater autonomy in 23 states essentially they don't need a collaborative agreement and they don't need to be supervised. I know @medium rare is a psychologist and Psych NP.

If the ultimate goal is primarily to be able to prescribe (or un-prescribe), I would probably agree. NP would seem to be the path of least resistance in that regard. medium rare will of course have a much more informed perspective than me, though.

 

[ReciproGal]

Curious why are you looking into PA school vs NP school? PAs have to be supervised in all states but NPs have greater autonomy in 23 states essentially they don't need a collaborative agreement and they don't need to be supervised. I know @medium rare is a psychologist and Psych NP.

Good point, but my reservations with that are I would probably have to do a 4-year BSN and then 2 more for NP, whereas a PA would take about 2-3 years. I would probably just go MD instead of BSN-MSN-NP at that point especially since I have pre-reqs for all these paths, but I can definitely see the benefits to going NP as you suggested.

 

[BorderlineQueen]

Good point, but my reservations with that are I would probably have to do a 4-year BSN and then 2 more for NP, whereas a PA would take about 2-3 years. I would probably just go MD instead of BSN-MSN-NP at that point especially since I have pre-reqs for all these paths, but I can definitely see the benefits to going NP as you suggested.

If you already have a bachelor's in an un-related field you can do an accelerated BSN program in 12-18 mths.

 

[medium rare]

Hello-

Have any clinical psychologists here gone to PA school after completion of the degree/getting licensed? Clinical psych coursework in general tends to be exceptionally lacking in biology/biochemistry and I think having this foundation is exceptionally important. Not sure if several courses in bio bases of behavior and psychopharm are adequate. Also, PAs can prescribe. I guess going into psychiatry is a way to bridge the gap but wanted to see if anyone went PA (I'm interested in doing research on gut microbiome and behavior).

Or- any health psychologists here? Or people that have completed a post-doc master's in psychopharm?

If you are already a clinical psychologist and want to pursue prescriptive authority, psych NP training is the best route to pursue at this time, IMO. I thoroughly researched multiple programs among the different disciplines and psych NP training was clearly the best option.

There is really no need to go to medical school when you are already a clinical psychologist if your interest in doing so is solely to prescribe; medical school (and the following residency) would be a colossal waste of time, energy and money for that objective.

RxP training is a good option but only if you plan to live in one of the states where it is permitted and the RxP movement has been slow to progress; I wouldn’t hold my breath. Training as a PA is a viable option but there are things to consider. As has already been stated, you will not be able to practice independently as a PA. A psychologist/PA combination could be tricky when you are accustomed to practicing independently as a psychologist and then require supervision as a PA. Personally, this arrangement would not work well for me. Additionally, NP training requires you to select and train in an identified specialty. Your training is specific to that specialty and you are expected to practice within your scope. PA training is more broad and, when it comes to psych, quite limited. There are few psych PAs in practice - they exist, but they are few and far between.

Dual clinical psychologist/psych NP training will put you in a very in-demand and unique position, clinically and marketability speaking. As I’ve said before, there is a strong demand for integrated psychotherapy and medication management services and very few mental health professionals are qualified and licensed to do both.

As far as physician disdain regarding NPs and NP training, it does exist but this has in no way impacted me personally. Any concerns about NP training have been assuaged by my also being a clinical psychologist. Yes, there are shortcomings in NP training - some are significant. But as a clinical psychologist and psych NP, you will have very broad and well-rounded training (provided you avoid the diploma mills out there).

I run a very busy, thriving self-pay practice. Several of my patients are physicians. Currently, I have a dermatologist, ophthalmologist, OB/GYN, 2 anesthesiologists, 2 radiologists, 2 family medicine and a psychiatrist as patients. I have several NPs, PAs, RNs, other psychologists, PTs, SLPs, OTs, PharmDs as patients as well. I see children and adolescents whose parents are physicians. I have treated professional athletes, professional coaches, 2 well-known celebrities/public figures and my being a NP/clinical psychologist has never been an issue. On the contrary, several patients have commented they sought me out specifically because of my unique credentials.

 

[Tukenkamen]

I did the pharma training to strengthen my clinical understanding and also to pursue pharma related research. I figured it could also be a good backup plan for me, but the longer I practice, the less interest I have in prescribing. I work with a bunch of physicians and an NP, and I'd rather focus on my assessment work than deal w the hassle of prescribing. Money-wise, doing assessment and legal work is more lucrative than if I prescribed full-time; it's more interesting too.

Would you be willing to share how much you could expect to make from a purely assessment-based private practice (e.g., autism evaluations, jail evals, etc.) and how much the typical RxP would expect to make (I recognize it's a young field and those numbers are hard to find).

I know there are a million and one variables, such as location, but I've been curious to hear what those numbers generally look like.

 

[Therapist4Chnge]

Would you be willing to share how much you could expect to make from a purely assessment-based private practice (e.g., autism evaluations, jail evals, etc.) and how much the typical RxP would expect to make (I recognize it's a young field and those numbers are hard to find).

I know there are a million and one variables, such as location, but I've been curious to hear what those numbers generally look like.

Well, @medium rare & @PsyDr can best speak to RxP practice revenue. It can also depend on how much overhead you are willing to take on (if any). Some prescribers I know are solo ppl who run pretty lean, this allows the most flexibility and favors contracted work where you go into an existing space. Others will sublet space, maybe hire a counselor, and run a small but productive practice. The least common but probably most upside option is to buy a building, rent out space, and hire contractors (or employees), but it's the biggest risk.

Assessment practices similar overhead decisions. I've ballparked some numbers over the years, and I can make the same or more doing assessment work if I mix in some forensic work. Forensic work isn't more or less of a headache, just a diff type of headache that I'm more willing to do at this stage of my career. You can make plenty of $ doing cash pay med management in affluent areas....but that requires a lot of hustle, usually a better than average CV, and not be fresh out of fellowship. Assessment work can be similar, it just depends what kind of schedule you want and the type of work you want to do.

It's difficult to talk numbers because there are so many variables....but in general most will recommend limiting commercial insurance, limiting medicare cases, and finding your niche. Depending on the type of assessment work you want to do and where you want to do it, clearing $150k-$180k/yr isn't terribly difficult...but that has more to do w. running a lean business, not really anything to do w. being a solid or great clinician. Prescribing and taking contracting work can earn a similar amount.

 

[Tukenkamen]

Great thank you for your response. Is that 150-180 gross numbers or after overhead/taxes? I really love my assessment work right now (working in a forensic and private practice externship currently as a 4th year). Would you say (in your personal experience) that doing assessments/writing reports all day every day gets overly monotonous?

 

[WisNeuro]

Great thank you for your response. Is that 150-180 gross numbers or after overhead/taxes? I really love my assessment work right now (working in a forensic and private practice externship currently as a 4th year). Would you say (in your personal experience) that doing assessments/writing reports all day every day gets overly monotonous?

Doing some back of the napkin math, I could easily clear 150k gross if I saw 1 medicare eval a day, assuming 6-7 weeks off for vacation. That'd be purely clinical work. Throw in better paying insurances and some IME work and you blow past those numbers if you're full and working FT.

As for the monotony, I don't get too much of that. With the mix of clinical and IME work, it's pretty variable. And, I actually like the higher stress evals with the IME work, so that keeps me going. I do miss teaching and supervision somewhat, though.

 

[PsyDr]

• The Sweet survey shows a mean initial salary of ~$115k, moving up to 130k after 5 years, and hitting ~250k at 25 years in.
• Google says that psych NPs have a mean salary of ~117k.
• RxPers report a median salary (not income, salary) of ~197k.
• IME, 200k is not difficult in purely clinical neuro. It's actually a pretty great lifestyle.

 

[Tukenkamen]

Ya I really love assessment work and even (can't believe I'm saying this) report writing. I just wonder if that work would get repetitive after several years.

Doing some back of the napkin math, I could easily clear 150k gross if I saw 1 medicare eval a day, assuming 6-7 weeks off for vacation. That'd be purely clinical work. Throw in better paying insurances and some IME work and you blow past those numbers if you're full and working FT.

As for the monotony, I don't get too much of that. With the mix of clinical and IME work, it's pretty variable. And, I actually like the higher stress evals with the IME work, so that keeps me going. I do miss teaching and supervision somewhat, though.

I'm also curious about realistic timetable for getting a full(ish) Case load of assessments up and running after licensure? Again, I know there are so many but but are we looking at a few years or several months? Also any advice or general tips for networking as a new practitioner for assessment work specifically

 

[WisNeuro]

I'm also curious about realistic timetable for getting a full(ish) Case load of assessments up and running after licensure? Again, I know there are so many but but are we looking at a few years or several months? Also any advice or general tips for networking as a new practitioner for assessment work specifically

Depends somewhat in terms of how saturated your market happens to be. Waitlist here is generally 4+ months, so as soon as people knew I was open for business, referrals started coming regularly. I am also poaching evals from my old hospital system now as the neurologist that I used to work with is very frustrated with in house options and the wait list there. So yeah, if you made some appointments with some local neurology clinics and maybe some primary care clinics and let them know you could get patients through in less than three months, you should pretty quickly be as full as you want to be.

 

[medium rare]

…how much the typical RxP would expect to make (I recognize it's a young field and those numbers are hard to find).

I know there are a million and one variables, such as location, but I've been curious to hear what those numbers generally look like.

PMHNPs start at $150k/year and up at CMHCs in my area. I know several who have worked in those settings anywhere from 2 to 10+ years and earn anywhere from $155k - $200k/year; I’m sure some earn more. Hospitals and private clinics tend to pay more. Private practice is considerably higher. It’s quite easy to earn $300k/year in an insurance-based private practice for less than 40 hours/week. Self-pay private practice is really dependent on how much you want to work but can clear $500k/year or more for 40 hours/week, 48 weeks/year.

I’ve commented on this before, but if you’re a psychologist who wants to prescribe, training as a PMHNP is the best route to go - at least for now.

 

[PsyDr]

PMHNPs start at $150k/year and up at CMHCs in my area. I know several who have worked in those settings anywhere from 2 to 10+ years and earn anywhere from $155k - $200k/year; I’m sure some earn more. Hospitals and private clinics tend to pay more. Private practice is considerably higher. It’s quite easy to earn $300k/year in an insurance-based private practice for less than 40 hours/week. Self-pay private practice is really dependent on how much you want to work but can clear $500k/year or more for 40 hours/week, 48 weeks/year.

I’ve commented on this before, but if you’re a psychologist who wants to prescribe, training as a PMHNP is the best route to go - at least for now.

As a fellow workaholic: Are you including all the BS work in that less than 40 hrs (e.g., preauthorizations, lab results, referrals, phone calls)?

 

[medium rare]

As a fellow workaholic: Are you including all the BS work in that less than 40 hrs (e.g., preauthorizations, lab results, referrals, phone calls)?

I run a lean machine and not taking insurance cuts down on administrative BS significantly. I have an amazing office manager who deals with >95% of admin stuff and I typically have only about 1 maybe 2 hours/week dealing with non-clinical stuff: prior auths, calling in Rx’s, letter writing, phone calls, etc.

Insurance-based practices have more to do, but it is very difficult to practice without office help as a prescriber. If you have good help, they can considerably cut down the amount of administrative crap you have to manage, even when taking insurance.

 

[Sanman]

PMHNPs start at $150k/year and up at CMHCs in my area. I know several who have worked in those settings anywhere from 2 to 10+ years and earn anywhere from $155k - $200k/year; I’m sure some earn more. Hospitals and private clinics tend to pay more. Private practice is considerably higher. It’s quite easy to earn $300k/year in an insurance-based private practice for less than 40 hours/week. Self-pay private practice is really dependent on how much you want to work but can clear $500k/year or more for 40 hours/week, 48 weeks/year.

I’ve commented on this before, but if you’re a psychologist who wants to prescribe, training as a PMHNP is the best route to go - at least for now.

This is good info to have. I have toyed with the idea of going back and getting my NP vs doing some forensic/legal work.

 

[WisNeuro]

This is good info to have. I have toyed with the idea of going back and getting my NP vs doing some forensic/legal work.

Just do forensic/legal work at this point. No time lost for training and education, and you can pretty easily get within the 200-400k with the education and skills you likely already have, though I'd suggest some reading up on legal stuff and finding a colleague to consult with.

 

[medium rare]

This is good info to have. I have toyed with the idea of going back and getting my NP vs doing some forensic/legal work.

Depends on your interests and what you want to do. Personally, I have no interest whatsoever in legal/forensic work and avoid that area like the plague. With assessment, making the higher end of income almost necessitates legal/forensic work to some extent-often to a significant extent. So, if you don’t mind legal work, this would be a quicker point of entry.

I enjoy direct clinical work with patients and being the ‘treating’ provider. I never much enjoyed the assess and refer nature of assessment. I also like not having to answer to anyone other than the patient regarding their care and the decisions we make collaboratively.

Another thing to consider is mobility-you can relocate much easier as a prescriber than as a therapist or an assessment-based provider should that be necessary. Good paying Rx jobs are plentiful while relocating in other roles often means starting over.

 

[WisNeuro]

Depends on your interests and what you want to do. Personally, I have no interest whatsoever in legal/forensic work and avoid that area like the plague. With assessment, making the higher end of income almost necessitates legal/forensic work to some extent-often to a significant extent. So, if you don’t mind legal work, this would be a quicker point of entry.

I enjoy direct clinical work with patients and being the ‘treating’ provider. I never much enjoyed the assess and refer nature of assessment. I also like not having to answer to anyone other than the patient regarding their care and the decisions we make collaboratively.

Another thing to consider is mobility-you can relocate much easier as a prescriber than as a therapist or an assessment-based provider should that be necessary. Good paying Rx jobs are plentiful while relocating in other roles often means starting over.

The good part of IME work is that I only have to answer to no one but myself.

 

[medium rare]

The good part of IME work is that I only have to answer to no one but myself.

Unless your recommendations alienate your referral source. I don’t know about your situation, but I’ve known several people who’ve done IME work and quit doing it because they felt their ‘independent’ evaluations were regularly being questioned (sometimes subtly, sometimes not so subtly) when their recommendations weren’t consistent with the position of the referral source.

 

[Tukenkamen]

PMHNPs start at $150k/year and up at CMHCs in my area. I know several who have worked in those settings anywhere from 2 to 10+ years and earn anywhere from $155k - $200k/year; I’m sure some earn more. Hospitals and private clinics tend to pay more. Private practice is considerably higher. It’s quite easy to earn $300k/year in an insurance-based private practice for less than 40 hours/week. Self-pay private practice is really dependent on how much you want to work but can clear $500k/year or more for 40 hours/week, 48 weeks/year.

I’ve commented on this before, but if you’re a psychologist who wants to prescribe, training as a PMHNP is the best route to go - at least for now.

I can't imagine why, because as far as I know, the billing codes are the same (could have gotten misinformation there), but would those figures be the same for someone with the MSCP vs the PMHNP?

 

[medium rare]

I can't imagine why, because as far as I know, the billing codes are the same (could have gotten misinformation there), but would those figures be the same for someone with the MSCP vs the PMHNP?

Not necessarily. There are ‘prescribing psychologist’ billing codes that Medicare, Medicaid and some insurances use. Since there are so few prescribing psychologists, this really hasn’t been addressed fully and I do not know how this is varies between the states that have RxP. But there are different codes than the E&M codes used by ‘physicians’. Remember, psychologists are not included in the Medicare definition of physician; I believe we are the only doctor-level, healthcare profession still excluded.

 

[WisNeuro]

Unless your recommendations alienate your referral source. I don’t know about your situation, but I’ve known several people who’ve done IME work and quit doing it because they felt their ‘independent’ evaluations were regularly being questioned (sometimes subtly, sometimes not so subtly) when their recommendations weren’t consistent with the position of the referral source.

There is a LOT of this work to go around. Also, I don't make recommendations in my work, I simply answer questions according to the available data and extant literature. I also don't work directly with law firms, and that's been working pretty well. IME, you do a good job and you'll be turning away work for being so busy pretty quickly. I've never had a request to change anything substantive in my reports thus far, and would reject any attempt to get me to change anything beyond simple typos or requests for clarification.

There's definitely a few outfits that we know to stay away from, but there are many good ones. My colleagues and I have not had any of the problems with findings being questioned.

 

[Tukenkamen]

Not necessarily. There are ‘prescribing psychologist’ billing codes codes that Medicare, Medicaid and some insurances use. Since there are so few prescribing psychologists, this really hasn’t been addressed fully and I do not know how this is varies between the states that have RxP. But there are different codes than the E&M codes used by ‘physicians’. Remember, psychologists are not included in the Medicare definition of physician; I believe we are the only doctor-level, healthcare profession still excluded.

Interesting. I'd be really curious to see the landscape in 10 years or so. I don't know your exact career path, but did you find it hard going back to get the NP degree after getting your doctorate? I apologize if you've answered this here before, but did you not need to go and get a BSN or something equivalent and then the NP degree after? What are your thoughts on the caliber of training the MSCP offers (I'm sure there are differences from program to program)? Do you think the MSCP (+psych PhD) provides sufficient training to be a competent and safe prescriber?

 

[medium rare]

Interesting. I'd be really curious to see the landscape in 10 years or so. I don't know your exact career path, but did you find it hard going back to get the NP degree after getting your doctorate? I apologize if you've answered this here before, but did you not need to go and get a BSN or something equivalent and then the NP degree after? What are your thoughts on the caliber of training the MSCP offers (I'm sure there are differences from program to program)? Do you think the MSCP (+psych PhD) provides sufficient training to be a competent and safe prescriber?

Going back to train as a psych NP was a major career shift for me and I gave it a lot of thought and thoroughly researched all options before making the decision to do so. I did my dissertation on RxP and knew as much as anyone on the topic. The reality was (and still is) that the RxP movement was slow and has struggled to get solid footing in professional psychology. I wanted to go the RxP route but it was quite apparent that would be a waste of time with regard to actual prescribing as only New Mexico and Louisiana had passed RxP legislation at the time and I did not want to be restricted geographically.

I did an accelerated BSN which took 16 months and then became a RN after passing the NCLEX. I then immediately did a MSN in the PMHNP specialty which took another 12 months and became a PMHNP after completing the program and passing the national board certification exam. I had to take a leave of absence from my psychology practice for the BSN portion and did very part-time practice during the PMHNP part. It was a significant undertaking but it has been more than worth it for me in several ways.

At times, it was challenging going to nursing school and I got the “so you’re a doctor going back to be a nurse” joke a couple times but it really wasn’t bad; in fact, I quite enjoyed nursing school. I’m proud to say I can start an IV, insert a Foley catheter, place a NG tube, etc. if I ever need to. And, I give all the injections to my patients who are on LAIs which is something very few psychiatrists do.

RxP training for psychologists is generally adequate, IMO, as long as there are adequate clinical training experiences to go along with the didactics. Prescribing psychologists are few in number and it is difficult to get a sense of their prescribing expertise as a group because of their scarcity. The prescribing psychologists that were part of the DoD demonstration project were found to be competent by their psychiatrist colleagues as reported in the federal GAO report put out several years ago but there were only 10 prescribing psychologists in the project. The prescribing psychologists I know in New Mexico seem competent via the conversations I have had with them at various psychopharmacology conferences. The RxP training program at New Mexico State University is generally viewed as reputable and is administered in conjunction with the Family Medicine Residency Program. The RxP training programs at other schools/institutions are more variable and the ones administered by for-profit schools have poorer reputations.

Honestly, I don’t know how much will change in the next 10 years with regard to psychologist prescribing. I used to be more optimistic but that was more than 10 years ago and little has happened since. There have been some psychologists who have moved to RxP states to train and then prescribe but not nearly enough to consider it a movement and there are not a lot of psychologists going into RxP training now. I think many clinical psychologists have little desire to go back for 2 more years of training - particularly since RxP opportunities are very geographically limited and uncertain - unless you just want the knowledge.

Personally, it was much more practical and advantageous for me to go the PMHNP route especially given the more established training and prescriptive authority of NPs. I do think RxP will eventually be present in most (if not all) states, I just think it will take a long time to get there.

 

[AcronymAllergy]

There is a LOT of this work to go around. Also, I don't make recommendations in my work, I simply answer questions according to the available data and extant literature. I also don't work directly with law firms, and that's been working pretty well. IME, you do a good job and you'll be turning away work for being so busy pretty quickly. I've never had a request to change anything substantive in my reports thus far, and would reject any attempt to get me to change anything beyond simple typos or requests for clarification.

There's definitely a few outfits that we know to stay away from, but there are many good ones. My colleagues and I have not had any of the problems with findings being questioned.

Another point is that you may not necessarily want to be working with folks who are continually pressuring you to provide the outcomes they want, and pushing back when your findings and responses are not in line with what they might've been hoping.

IME, you may end up irritating a few referral sources, and they then may not come back to you frequently or at all. But if you consistently do good work and remain objective and impartial in your evaluations, it seems to be appreciated by most.

But yes, it's definitely different than clinical work, including being both interesting and stressful in different ways. If someone is adamant about prescribing, I would agree with what medium rare has said that the NP route is probably the best bet overall at this time. And there's of course nothing stopping a psychologist/NP who then decides they also want to do forensic work.