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Yes and No...see my rant in the psychology forum about RxP. I think if you set up to care for primary care psych issues you will do fine, but if you are trying to treat major mental illness as a psychiatrist would, it is not a good idea. Psych NP's get a brief course in tx of major mental illness, and can tx such dxs with good supervision...but what about the other 99% who need mental health intervention with meds for generalized anxiety, depression, panic, acute stress........

:confused:
 

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I would be against it unless they received adequate training in psychiatric interventions and diagnosis. That would include pharmacological and psychotherapeutic interventions. My guess is that the average NP wouldn't. I am similarly opposed to psychiatrists setting up practices with the intent to only supply pharmacological Tx. But psychiatrists would presumably have had training in psychotherapy.
 
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Psyclops said:
I would be against it unless they received adequate training in psychiatric interventions and diagnosis. That would include pharmacological and psychotherapeutic interventions. My guess is that the average NP wouldn't. I am similarly opposed to psychiatrists setting up practices with the intent to only supply pharmacological Tx. But psychiatrists would presumably have had training in psychotherapy.
I supervise a very good CNS, who I believe functions at the level of a psychiatrist, mainly with SPMI clients. In terms of years of experience, she's way ahead of the residents. She's also "fluent" in CBT, DBT, etc. As a part of a team, she's fabulous. She'd probably be OK in her own clinic, but the law says she still has to be supervised.
 

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OldPsychDoc said:
I supervise a very good CNS, who I believe functions at the level of a psychiatrist, mainly with SPMI clients. In terms of years of experience, she's way ahead of the residents. She's also "fluent" in CBT, DBT, etc. As a part of a team, she's fabulous. She'd probably be OK in her own clinic, but the law says she still has to be supervised.
And this is why psychiatry gives me great pause. The barrier to her practice is artificial and - should economies prove efficient - cannot (and probably should not) persist.

Judd
 

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Yes and No...see my rant in the psychology forum about RxP. I think if you set up to care for primary care psych issues you will do fine, but if you are trying to treat major mental illness as a psychiatrist would, it is not a good idea. Psych NP's get a brief course in tx of major mental illness, and can tx such dxs with good supervision...but what about the other 99% who need mental health intervention with meds for generalized anxiety, depression, panic, acute stress........

:confused:
how funny :D
see the old med psychologist thread.... :laugh:
 

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Huh? I think you may need to re-read what I wrote. My pt was that Psych NP's tx major mental illness well with meds, but have little training in the more minor and more frequent problems people present with as outpatients that require good psychotherapy skills.

I am missing the funny part :confused:
 

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The four stages of learning:
1. Unconsciouslly unconscious (you don't know that you don't know enough/anything about a subject)

2. The conscious unconscious (you are aware that you don't know any meaningful information about a given subject)

3. The consciouslly conscious (you are actively aware and have knowledge about a subject, which must often be reviewed)

4. The unconscioussly conscious (the information/subject is second nature, is ingrained, and part of your core knowledge base)

Nurses and psychologists operate at level 1 from a practicing psychiatry standpoint.

Bad psychiatrists operate mostly at level 2, possibly even level 1.

The remainder of or most psychiatrists operate at level 3-4.

Maybe this is because I returned from a psychopharm conference this weekend that reminded me of the incredible amount of information that I have to review.
 

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Anasazi23 said:
Maybe this is because I returned from a psychopharm conference this weekend that reminded me of the incredible amount of information that I have to review.
Must be. Because even from a student of psychology's point of view practicing psychiatrists operate around a 2 on that scale. They are aware of what they aren't doing, but are content to ignore it. Medicate on my brother. All we are is C, H, Cl, and K.

:thumbdown:
 

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Sazi...I can't believe you picked a fight after all your saber-rattling to eliminate this kind of stuff between psychologists and psychiatrist on this forum awhile back. So you are saying a psych NP is at your arbitrary rating of 1?? :cool:
 

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psisci said:
Sazi...I can't believe you picked a fight after all your saber-rattling to eliminate this kind of stuff between psychologists and psychiatrist on this forum awhile back. So you are saying a psych NP is at your arbitrary rating of 1?? :cool:
I spend a good amount of time fixing NPs mistakes.

It's not that I'm picking a fight....a similarly reversed structure could be seen for psychiatrists when it comes to modern medical knowledge or psychological testing.

I've spent over two years in psychiatry residency at this point. I'm in my third year. Now, I realize only that I have a tremendous amount left to learn, though I do feel more and more comfortable with my clinical and management skills each day.

If one isn't constantly exposed to a higher level of understanding, and one isn't pushing their own limits of patient management, then your effectiveness as a doctor stagnates or even diminishes. Psychology training is vastly different from psychiatric training, and does not incorporate any meaningful psychopharm and virtually no medicine, even with the psychopharm masters. It may seem, after completing one of these programs, that some medical knowledge has been obtained. Having just passed Step III, I can tell you that it is one ice chip in the iceburg.

A psychologist may know some facts about medication, but isn't responsible for the sole psychiatric care of patients on a large scale. That is the daily practice that is required to become competent.

A psychiatric NP would have, in most cases, even much less knowledge than this. The rudimentary..."He seems depressed, give an antidepressant." "He seems psychotic and is overweight. I give another antipsychotic besides Zyprexa." Again, correct stuff, but at only a rudimentary, primitive level.
 

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Psyclops said:
Must be. Because even from a student of psychology's point of view practicing psychiatrists operate around a 2 on that scale. They are aware of what they aren't doing, but are content to ignore it. Medicate on my brother. All we are is C, H, Cl, and K.

:thumbdown:
On what basis do you make this assumption? In a way this is proof for my point. How do you know what they don't know if you don't know it?
:confused:
 

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Your last post wast well put. I have spent the last year + managing psych meds for 90% of the pts at a large primary care clinic. This is outpatient work, and I have had under 10 pts with major mental illness, but have seen over 500 pts. I have not killed anyone, and really have only had one problem which was a coumadin/effexor bleed I did not anticipate because the pt did not report the coumadin use and it was not in the chart. Most of my work is titration of simple meds, ordering needed labs etc.., But I have started and monitored zyprexa, lamictal, VPA, and Lico3. YOU have no clue what I have learned in my psychopharm training or my medical psych residency, so donot claim to have that info. You seem to push your opinion in the face of reality, well trained psychologists are doing the majority of psychpharm work in primary care very successfully, and this trend is growing fast. I was recruited to Co to do this by a psychiatrist, and look forward to working with him. You are a convert, get over it and move on.

OK, my rant is over. I respect you even though you are arrogant..... :cool:
 
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Psyclops said:
Must be. Because even from a student of psychology's point of view practicing psychiatrists operate around a 2 on that scale. They are aware of what they aren't doing, but are content to ignore it. Medicate on my brother. All we are is C, H, Cl, and K.

:thumbdown:
Don't forget Na.

Seriously though....no harm/offense/nitpicking/conflict/inciting/etc intended.

I love everyone equally from all races, creeds, religions, walks of life, colors, shoe sizes, IQs, astrological signs equally....except child molesters, like Poety. Them I like only slightly less.

:thumbup:
 

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psisci said:
You are a convert, get over it and move on.

OK, my rant is over. I respect you even though you are arrogant..... :cool:
Thanks. Again, no 'whatever' intended. Arrogant is a funny word in this sense. Who's arrogant - the psychiatry resident who knows that they have a lot to learn, and wonders how a lesser-trained practitioner can do a similar or better job with a fraction of the knowledge base, or a psychologist or an NP (not you per se) that thinks they know more medicine and pharmacology than a psychiatrist, whos primary training is in medicine and pharmacology?

Convert from what? Psychology? That's true. I couldn't stand it there. But, it's that experience that allows me to have the opinions of psychology training that I do. In that sense, I'm not preaching out of a vacuum.

Another question out of genuine curiosity. When the PCP that you're working with gets sued for improper use or damage from a psychotropic, will you be named in the lawsuit for practicing medicine without a license? Seriously, I'm not being facetious...most doctors will be sued in their lifetime. It's really a matter of when, not if.

If the lawsuit is psychotropic related, will you be named? Have they educated you on this in the classes or 'residency?'
 

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Anasazi23 said:
Don't forget Na.

Seriously though....no harm/offense/nitpicking/conflict/inciting/etc intended.

I love everyone equally from all races, creeds, religions, walks of life, colors, shoe sizes, IQs, astrological signs equally....except child molesters, like Poety. Them I like only slightly less.

:thumbup:
Overreaction me, maybe. I didn't appreciate being thrown in with the NP lot. As you kindly pointed out again ologists and iatrists are different beasts. When it comes to psychopharmacological tretment I wouldn't argue with your ranking system. But I would take issue if you applied those same numbers to traetment of MH problems in general. :thumbup:
 

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Overreaction me, maybe. I didn't appreciate being thrown in with the NP lot. As you kindly pointed out again ologists and iatrists are different beasts. When it comes to psychopharmacological tretment I wouldn't argue with your ranking system. But I would take issue if you applied those same numbers to traetment of MH problems in general. :thumbup:
Psychiatrists have been throwing the "knowledge and safety" argument around for decades. They did it when psychologists wanted to practice psychotherapy, and they're doing now when psychologists want to practice psychopharmacology collaboratively. Fact is that there are no facts to support this position. Meanwhile, data out of Louisiana indicates that medical psychologists have written more than 10,000 prescriptions for a host of psychotropics without a single adverse event. Many patients are even being taken off medication and are receiving psychological treatment instead. Patient satisfaction ratings are also on the upswing, as their mental health needs may now be met by a single provider who understands the full scope of their needs.

Meanwhile, psychiatry, the AMA, and other physician organizations are pursuing legislation that would not allow medical psychologists in LA to use the term "medical" in their title because it "confuses patients." What a waste of time and money! This money would be much better spent battling forthcoming psychologist RxP legislation, recruiting medical students into psychiatric residencies, and studying the safety and effectiveness of mid-level and medical psychologist prescribing.

Bottom line: If Sazi or anyone else could show me hard evidence (not opinions or anecdotes, no matter how entrenched in NYC psychiatry one may be) that psychiatric NPs/PAs and medical/prescribing psychologists are a threat to safety and ineffective in their prescribing of psychotropic medication, then I will weigh this evidence accordingly. In the meantime, I will hold mid-level psychopharmacology providers and medical/prescribing psychologists innocent until proven guilty.

And now Sazi will move this thread to the Clinical Psychology [PhD] forum or remove it altogether.
 

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In ca it is legel for psychologists to colloborate on medication with physicians, and I would be sued. I have my own malprac insurance. I do not practice medicine, I make recommendations in specific area that help them practice medicine better. BTW I am credentialled at a local hospital to do psychopharmacology consults...threw that in just to piss you off. :cool:
 

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Psychiatrists have been throwing the "knowledge and safety" argument around for decades. They did it when psychologists wanted to practice psychotherapy, and they're doing now when psychologists want to practice psychopharmacology collaboratively. Fact is that there are no facts to support this position. Meanwhile, data out of Louisiana indicates that medical psychologists have written more than 10,000 prescriptions for a host of psychotropics without a single adverse event. Many patients are even being taken off medication and are receiving psychological treatment instead. Patient satisfaction ratings are also on the upswing, as their mental health needs may now be met by a single provider who understands the full scope of their needs.

Meanwhile, psychiatry, the AMA, and other physician organizations are pursuing legislation that would not allow medical psychologists in LA to use the term "medical" in their title because it "confuses patients." What a waste of time and money! This money would be much better spent battling forthcoming psychologist RxP legislation, recruiting medical students into psychiatric residencies, and studying the safety and effectiveness of mid-level and medical psychologist prescribing.

Bottom line: If Sazi or anyone else could show me hard evidence (not opinions or anecdotes, no matter how entrenched in NYC psychiatry one may be) that psychiatric NPs/PAs and medical/prescribing psychologists are a threat to safety and ineffective in their prescribing of psychotropic medication, then I will weigh this evidence accordingly. In the meantime, I will hold mid-level psychopharmacology providers and medical/prescribing psychologists innocent until proven guilty.

And now Sazi will move this thread to the Clinical Psychology [PhD] forum or remove it altogether.
That's why it so important to let Nps(and PAs and MHAs and...) practise independently and to provide more universal care, college grads w/ online certificate courses and couple of weekend seminars should be allowed to prescribe meds-what a easy solution to this country's healthcare access prob. And until a patient dies it'll be considered as safe and effective healthcare delivery system:D
 

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PublicHealth said:
Psychiatrists have been throwing the "knowledge and safety" argument around for decades. They did it when psychologists wanted to practice psychotherapy, and they're doing now when psychologists want to practice psychopharmacology collaboratively. Fact is that there are no facts to support this position. Meanwhile, data out of Louisiana indicates that medical psychologists have written more than 10,000 prescriptions for a host of psychotropics without a single adverse event. Many patients are even being taken off medication and are receiving psychological treatment instead. Patient satisfaction ratings are also on the upswing, as their mental health needs may now be met by a single provider who understands the full scope of their needs.

Meanwhile, psychiatry, the AMA, and other physician organizations are pursuing legislation that would not allow medical psychologists in LA to use the term "medical" in their title because it "confuses patients." What a waste of time and money! This money would be much better spent battling forthcoming psychologist RxP legislation, recruiting medical students into psychiatric residencies, and studying the safety and effectiveness of mid-level and medical psychologist prescribing.

Bottom line: If Sazi or anyone else could show me hard evidence (not opinions or anecdotes, no matter how entrenched in NYC psychiatry one may be) that psychiatric NPs/PAs and medical/prescribing psychologists are a threat to safety and ineffective in their prescribing of psychotropic medication, then I will weigh this evidence accordingly. In the meantime, I will hold mid-level psychopharmacology providers and medical/prescribing psychologists innocent until proven guilty.

And now Sazi will move this thread to the Clinical Psychology [PhD] forum or remove it altogether.
Please post the efficacy, safety, and adverse effect data from the 10,000 prescriptions written from the FDA database. Allow me to examine the PANNS score distributions, the equivical dose curves and titration schedules in blinded studies, and time to adverse effect trend data for us to examine. Then I'll too make a decision.

10,000 scrips of underdosed zoloft doesn't impress me.
 

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psisci said:
In ca it is legel for psychologists to colloborate on medication with physicians, and I would be sued. I have my own malprac insurance. I do not practice medicine, I make recommendations in specific area that help them practice medicine better. BTW I am credentialled at a local hospital to do psychopharmacology consults...threw that in just to piss you off. :cool:
Doesn't piss me off, just makes me wonder how someone can consult on something they've never done before (written independent prescriptions in a clinical unsupervised setting).

Sort of like sending my car in to be fixed by a guy who's never held a wrench before.
;)

Comon Psi, I'm kiddin' ya!
So what's up with the 'soldier' stuff...in what capacity will you be serving this great country of ours?

Semper Fi?!
 

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mdblue said:
That's why it so important to let Nps(and PAs and MHAs and...) practise independently and to provide more universal care, college grads w/ online certificate courses and couple of weekend seminars should be allowed to prescribe meds-what a easy solution to this country's healthcare access prob. And until a patient dies it'll be considered as safe and effective healthcare delivery system:D
MDs/DOs kill people every day because of medical errors. Stop being so elitist.
 

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Please post the efficacy, safety, and adverse effect data from the 10,000 prescriptions written from the FDA database. Allow me to examine the PANNS score distributions, the equivical dose curves and titration schedules in blinded studies, and time to adverse effect trend data for us to examine. Then I'll too make a decision.

10,000 scrips of underdosed zoloft doesn't impress me.
These data are forthcoming.

I do not think anyone is trying to impress anyone else. These are inevitable scope-of-practice changes for clinical psychologists. We're all aware of how desperate that field is to retain their identity as a relevant healthcare profession. Some believe that RxP is the way to do that. With proper training, why should they not be allowed to prescribe collaboratively if it can provide more people with the care that they need?
 
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Understood. I worry about the "giving an inch, taking a mile phenomenon", which is already happening inappropriately. I don't think too many people on either side argue that.

The original question was about NPs having their own psych clinics. I suppose I'm no more opposed to that than I am NP general practice clinics.

Simple stuff is simple. At some point someone will be seriously hurt, or a rare disease go undiagnosed, or condition overlooked because of a lesser knowledge base. I guess we have to decide when too many patients (number wise) will be too much.
 

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Infantry at 36!! Haha. No I am attempting to get a commission to enter as an officer in the medical corps. I am waiting until I move.
 

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psisci said:
Infantry at 36!! Haha. No I am attempting to get a commission to enter as an officer in the medical corps. I am waiting until I move.
I knew a captain in the Army who was a psychologist. He got involved in some flight surgeon regiment...not sure what role he played. I'm not even sure what a flight surgeon does. I know he was constantly driving up to Albany for various training and obligations.
 

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Infantry at 36!! Haha. No I am attempting to get a commission to enter as an officer in the medical corps. I am waiting until I move.
Will you be prescribing?
 

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No I will not be prescribing. I will be in the medical corps working with soldiers who have experienced trauma, limb loss, PTSD etc.. I feel I need to do my part, and not just be another gluttonous, SUV driving, baby making middle class person expecting others to keep them safe. I am tired of rewarded mediocrity. I love this country and somebody has to do what I am volunteering to do...I wish more would. Freedom does not come free.......... ;)
 

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psisci said:
No I will not be prescribing. I will be in the medical corps working with soldiers who have experienced trauma, limb loss, PTSD etc.. I feel I need to do my part, and not just be another gluttonous, SUV driving, baby making middle class person expecting others to keep them safe. I am tired of rewarded mediocrity. I love this country and somebody has to do what I am volunteering to do...I wish more would. Freedom does not come free.......... ;)
:thumbup: :thumbup:
 
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MDs/DOs kill people every day because of medical errors. Stop being so elitist.
you are missing the point.. why can't college grads w/ ".." hrs of psychopharm training can't prescribe antidepressants or antipsychotics? Who determines the level of sophistication they need? If a policymaker decides to make it official to address health care need who are you to argue against that? How will you prove that this is unsafe for any individual patient? I'll wait for your non-elitist reply. :)
 

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you are missing the point.. why can't college grads w/ ".." hrs of psychopharm training can't prescribe antidepressants or antipsychotics? Who determines the level of sophistication they need? If a policymaker decides to make it official to address health care need who are you to argue against that? How will you prove that this is unsafe for any individual patient? I'll wait for your non-elitist reply. :)
Exactly. It's an empirical question. Who's to say that antidepressants and other psychotropics could not be prescribed by individuals with X amount of training in psychopharmacology?

MDs/DOs should not look down on other professionals from their thrones on high and make this decision. PAs, NPs, ODs, DPMs, and other professionals have demonstrated that a formal medical education (MD or DO) is NOT a prerequisite for safe and effective prescribing. Who is to say that psychologists with additional training in clinical medicine and psychopharmacology cannot do the same? Will it be the same training that psychiatrists receive? No. But that's the whole point! Prescribing/medical psychologists will and are providing (in LA and NM) a unique approach to psychological and psychiatric treatment that emphasizes both biological and psychological approaches. Is this approach unsafe and ineffective because MDs and DOs think so? No. The data indicate otherwise. Formal reports of these findings are forthcoming. The train has left the station. If you are passionate about this issue, start lobbying.
 

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At risk of continuing another discussion that will not change anyone's mind, I simply state that if all goes well, the term 'medical' anything that are not physicians will no longer be allowed in the near future.

http://www.medicalnewstoday.com/medicalnews.php?newsid=46289

And actually, it IS within the scope of physicians and the AMA to determine medical competence. There is an independent regulatory board for this.

God, I can't believe I replied to this thread. I only blame myself.
:laugh:
 

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Anasazi23 said:
At risk of continuing another discussion that will not change anyone's mind, I simply state that if all goes well, the term 'medical' anything that are not physicians will no longer be allowed in the near future.

http://www.medicalnewstoday.com/medicalnews.php?newsid=46289

And actually, it IS within the scope of physicians and the AMA to determine medical competence. There is an independent regulatory board for this.

God, I can't believe I replied to this thread. I only blame myself.
:laugh:
What will become of emergency MEDICAL technicians, MEDICAL sociologists, and MEDICAL anthropologists, among others?
 

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By the way, these proposed regulations did not make shat of a difference in getting MEDICAL psychologists in LA to provide psychopharmacologic treatment in LA state facilities:

An Exciting Journey: [Louisiana Psychological Association
President Jim Quillin, a private practitioner]: “The culmination of a
decade of work and four legislative sessions came in 2004 when the Governor
of Louisiana signed the Medical Psychologist statute authorizing specially
trained psychologists (medical psychologists) [MPs] to prescribe
medications in the management of psychiatric disorders. Following
implementation of this statute with the promulgation and publication of the
necessary enacting regulatory language by the Louisiana Board of Examiners
of Psychologists, appropriately credentialed MPs began practicing with this
expanded capability. However, the state mental health system, dominated
and controlled by psychiatrists who had vigorously opposed this
legislation, refused to make the necessary allowances for state service MPs
to practice within the fullest extent of the law. The low mark (to date)
for this opposition came immediately following Hurricane Katrina when the
state’s Office of Mental Health quietly scrapped plans to utilize its own
state employed MPs in the delivery of emergency psychiatric services
associated with the storm and its aftermath, reassigning key state office
MP personnel instead to non-clinical activities and support services of
various kinds. Thus, in late 2005, the Louisiana Psychological Association
(LPA) and its sister organization the Louisiana Academy of Medical
Psychologists (LAMP) again joined forces with APA’s Practice Directorate
and CAPP to address this unacceptable state of affairs.
“Early on an antiquated ‘Mental Health’ statute was targeted for
revision as, among other problematic provisions, it held that only a
physician could order or prescribe medication for patients in the state’s
mental health system. Interestingly, during the development of a
legislative strategy to correct this problem, it was learned that the
Louisiana Nurse Practitioners Association had also been eyeing this statute
and, in the hopes of revising it so that nurse practitioners (NPs) could
function independently within the state psychiatric system, had planned to
pre-file a bill in the 2006 legislative session that would make NPs and MDs
functionally equivalent within this system. We elected to amend this
legislation, after its introduction so that MPs could prescribe within the
state’s mental health system and to work cooperatively with the NPs toward
some of our common interests. Politics, as you know, however, can make for
some strange bedfellows.
“At the outset, the psychiatry controlled Office of Mental Health,
upon learning of our plans to amend this bill approached the NPs with the
intent of trying to work out a compromise that would give NPs some
increased role in the public mental health system. The crux of the
proposed bargain, however, was to have been the rejection of any effort to
pass an amendment involving the explicit recognition of MPs in this
legislation. Understandably, the NPs needed to seriously consider such a
compromise as it might have been in their best interest to help throw MPs
under the bus if it would help assure the passage of their
legislation. However, at the initial legislative hearing it quickly became
clear to the NPs that psychology was an exceptionally formidable player and
that the best way to avoid the underside of the bus themselves was to tuck
in behind us and follow our blocks. At that committee hearing, the matter
was deferred for a week and the Office of Mental Health ceased to be a
significant player in this matter. However, the Louisiana State Medical
Society, the Louisiana State Psychiatric Medical Society, the Louisiana
State Board of Medical Examiners and, interestingly, the Office of
Louisiana Advocacy Services (who were vehemently opposed to NPs having the
authority of issuing ‘emergency certificates’ or PECs for short term
commitments, as could physicians and certain psychologists under prevailing
law) all opposed the legislation on the table. In an interesting turn of
events, at a second hearing in the same committee the following week,
psychology was approached by the Medical Society. It seemed that their
greatest concern was the emerging independence of the NPs and, unlike their
psychiatric-counterparts, they were relatively less exercised by the
prospects of MPs being explicitly recognized in this
instrument. Understandably, we were interested in how our joint interests
could be achieved but we were not willing to jettison the NPs, and as the
session unfolded we continued to work with all sides toward a framework of
language that might be acceptable to the principles in this matter.
“Here I must honestly tell you that of all the sides on this
issue, the Medical Society was the easiest organization with which to
work. They were straightforward and open to equitable compromise. In the
end, with our assistance, much work and the leadership of the Chair of the
House Health Committee, such a compromise was struck. It removed the
language recognizing NPs in the mental health statute and instead
recognized only Psychiatric Mental Health Nurse Practitioners. For
psychology in general, the compromise language changed a provision limiting
the authority to execute a PEC to only clinical or counseling psychologists
to psychologists with ‘a clinical specialty,’ specialties that will be
determined by the Louisiana Board of Examiners of Psychologists. It also
included psychologists, medical psychologists and psychiatric mental health
nurse practitioners in the definition of ‘primary care providers’ of mental
health services. Moreover, the compromise language provided for the
specific credentialing of medical psychologists and psychiatric mental
health nurse practitioners to practice within the fullest extent of their
respective authority within the state’s mental health facilities. Lastly,
the language restricting the prescribing of medications in the state system
to physicians was changed to read as follows: ‘No medication may be
administered pursuant to the provisions of this Chapter, except upon the
order of a physician, medical psychologist or psychiatric mental health
nurse practitioner. The physician, medical psychologist or psychiatric
mental health nurse practitioner is responsible for all medications which
he has ordered and which are administered to the patient.’
 

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“LAMP, LPA, the medical society, the psychiatric society, and the
nurse practitioners all signed off on this language (the Advocacy Office
still opposed psychiatric nurse practitioners having PEC
authority). Unfortunately, sweeping compromise such as this take a great
deal of time and effort and, while it subsequently swept through the House
Health Committee unanimously (an earlier version had passed the Senate at
both the committee and floor levels), it languished on the House floor late
in the session jammed up behind hundreds of other bills. In order for it
to become law, it had to pass the House floor and return to the Senate
floor for concurrence, as it was considerably altered from its original
language. All of this had to occur in the last week of the legislative
session.
“On the Friday before the last day of the session the following
Monday, our bill was scheduled to be heard on the House floor. Just as it
was called up, a term limited Representative asked the Speaker for a
personal privilege and rose to say his formal good-byes to his fellow
legislators. He finished at 6:05 PM and as our bill was then called up,
the Secretary of the House advised the Speaker that under changes made in
the Louisiana Constitution several years earlier, no bill, except those
being heard for concurrence from the other chamber could be heard after the
85th day of the legislative session or 6:00 PM that day!! After quickly
reviewing the constitution, it was determined, however, that with a
two-thirds vote by both chambers this provision of the Louisiana
Constitution could be overridden and a bill kept alive.
“While this had never successfully been done before, we were
determined to be the first to do so and, after making the appropriate
motions, had this historic move put to a vote on the floor. However, the
House was in a foul, late session mood and angry that the Senate was not
moving on House bills at this late hour. Two former Speakers of the
Louisiana House rose in opposition as ours was a Senate bill and, requiring
a two-third vote margin we received only 67 of the 70 necessary votes.
“We (LAMP/LPA lobbyists, Bud Courson and Jim Nickel, the NP
lobbyist and myself) retired to the quiet of the by now nearly deserted
area just outside the House chamber and were joined by the House sponsor of
this bill who, physically and psychologically exhausted, was weeping and
apologizing because we had failed. In a scene that will stick with me
forever, Bud gently hugged this long time champion of health causes and
told her not to feel badly. He spoke softly to us as we huddled in the
gathering dimness of the evening, whispering that we had come too far and
reminding us that miracles are our specialty. We resolved to return again
Sunday evening, Father’s Day, to make another run at this historic
effort. A few minutes later after we had coordinated our schedules and
said our good-byes, I walked to a nearby bench where my wife had been
waiting so that we could go to dinner when suddenly, out of the corner of
my eye, I saw Bud sprinting back toward the House Chamber. I caught him as
he reached a side doorway gazing in at something only he could see. After
what seemed an eternity, he turned to me and simply said, ‘Now is the
time.’ We eased into seats in the empty gallery behind the floor. One of
the former Speakers who had spoken in opposition to us was seated just in
front of us. He whirled in his seat towards us and said defiantly that
this vote would also fail. Moments later, he was proven wrong, as the
Louisiana House of Representatives voted by a vote of 81 to 10 with 13
absent to override the constitution and allow our bill to be heard. Later
that night just before adjournment, we moved to the other Chamber where the
Senate voted by 35-0 to likewise suspend the constitution and allow a vote
on our bill. On Father’s Day, the Louisiana House of Representatives took
up our bill and voted it out favorably by a 90 to 7 margin with 7 others
absent. The following day, the last day of the 2006 legislative session,
the Louisiana Senate followed suit and passed out bill out with a favorable
35-0 vote. Governor Kathleen Blanco signed this bill into law on June 29th
as Act 664. It becomes effective August 15th.
“As I tried to sleep the night we were able to override a
constitutional barrier to keep our hopes alive, my mind replayed the
history I’d been privileged to witness that evening. I thought about
psychology and how far we’ve come. I thought about those who have
despaired of achieving legislative success and wished they had been with
me. I thought of a cold day in a duck blind many years ago when my father
told me that there would come times in my life when I’d remember what he
was to tell me – ‘Son, if you don’t quit, you win.’ He was right.”
For those who are personally interested in pursuing the RxP
agenda, there are outstanding training programs targeted towards full-time
practitioners. And, I would suggest that one should seriously consider
becoming credentialed as a “medical psychologist” in the State of
Louisiana. Licensure mobility was a very high priority for APA Past
President Ron Levant and Russ has been working closely with the Association
of State and Provincial Psychology Boards (ASPPB), the American Board of
Professional Psychology (ABPP), and the National Register of Health Service
Providers in Psychology to make this a reality and thereby bring our
profession into the 21st century. In an era of telehealth technology and
instant virtual communications, geographical distances will no longer be an
acceptable rationale (i.e., excuse) for less than optimal healthcare. The
21st century will present exciting opportunities for those with vision and
those who dare to vigorously pursue the future and especially for those
“who don’t quit.”
 

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Even though the above post is related to the main topic of this thread, you can now go ahead and close it, Sazi.

The American Psychiatric Association is sad. Instead of attempting to derail RxP legislation in other states, they target semantics of the term "medical psychologist" under the well-worn and tattered umbrella of "it's a safety issue." Why not spend this money on more practical endeavors, such as offsetting RxP legislation? What a bunch of cry-babies: "WAAAAAH! Psychologists want to use the term 'medical' WAAAAAAH!" (in best Artie Lang impersonation). Give me a break.
 

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PublicHealth said:
Even though the above post is related to the main topic of this thread, you can now go ahead and close it, Sazi.

The American Psychiatric Association is sad. Instead of attempting to derail RxP legislation in other states, they target semantics of the term "medical psychologist" under the well-worn and tattered umbrella of "it's a safety issue." Why not spend this money on more practical endeavors, such as offsetting RxP legislation? What a bunch of cry-babies: "WAAAAAH! Psychologists want to use the term 'medical' WAAAAAAH!" (in best Artie Lang impersonation). Give me a break.
Jeez....if things are so great, go be a psychologist.

Enjoy. You really don't belong in the medical camp. Or at least in the psychiatric end of it. The above statement borders on disturbing and bizarre.
 

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This is silly, you cannot legislate language...not in this country at least. This will never fly. Even if it does, nothing can stop me and others from calling themselves a medical psychologist if they specialize in treating the medical issues involved with medical Dx. I agree with PH this is a pathetic attempt where real efforts to control scope of practice have failed... :D
 

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psisci said:
This is silly, you cannot legislate language...not in this country at least. This will never fly. Even if it does, nothing can stop me and others from calling themselves a medical psychologist if they specialize in treating the medical issues involved with medical Dx. I agree with PH this is a pathetic attempt where real efforts to control scope of practice have failed... :D

Doesn't this build on the same premise that a physician licensed in say Nevada is not a doctor in New York were he/she is not licensed, and this physician cannot, for example sign MD next to his name in a state where he/she isn't licensed?
 

Anasazi23

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psisci said:
This is silly, you cannot legislate language...not in this country at least. This will never fly. Even if it does, nothing can stop me and others from calling themselves a medical psychologist if they specialize in treating the medical issues involved with medical Dx. I agree with PH this is a pathetic attempt where real efforts to control scope of practice have failed... :D
By that logic, a master's or bachelor's level psychology person can call themselves a psychologist if they 'feel' that they're treating a psychological condition.

This isn't the first time language has been regulated in the medical field. Why is this a 'pathetic attempt' when it brings the issue of misrepresentation to light in the public eyes, and serves to protect, on at least one front (who ever said this is the only active legislation the APA has?) the premier healthcare provider...physicians. Physicians are also allowed to protect their identities. Just because they're at the top of the food chain, doesn't mean everyone should root for the 'underdog'.

Scope of practice has been kept under relative control for 30 years. It'll be another 30 before psychologists have half the rights of physicians, and will never be medically licensed - therefore limiting your ability to practice under a full medical scope. For those that find this to battle so glamorous, I encourage you to become a psychologist and see how 'greener' the grass is.

But, I'm not going to start/continue this quickly developing flamewar. I'm done responding.
:)
 
P

Pterion

I spoke to the executive VP of our state medical association about these issues during the yearly convention. He told me they are keeping track of outcomes, legal claims and even practice locations of non-physician prescribers. Particular interest is of course centered around schedule drugs and psychotropics (this is not an "RxP" state). He noted this was also done in other states. I don't know which ones - ask the medical association in your state for info.

We were interrupted before I could find out more, but I did discover that the "underserved" areas remain so. It seems that NP's and PA's are mysteriously not flocking to these areas to provide care to the downtrodden and ignored. Hmmm.

Sazi: hope this didn't trod too far down forbidden paths.
 

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Anasazi23 said:
By that logic, a master's or bachelor's level psychology person can call themselves a psychologist if they 'feel' that they're treating a psychological condition.
This is faulty logic, as "medical psychologist" is a term recognized by law.
"Master/bachelor-level psychopharmacologist" is not.

Pterion brings up a good point. Data and dollars will speak louder than physicians' "holier than thou" attitude (e.g., Sazi: "the premier healthcare provider...physicians"). Nonphysician groups are equally, if not in some cases, BETTER qualified to provide clinical services. Patients should be able to decide from whom they want to seek services, not the AMA. Check out this site: http://www.patientsrightscoalition.org/

Psychologists who seek RxP do not want to be physicians (and neither do NPs seeking specialty training in psychiatric nursing for that matter). They want to add psychopharmacology as another tool in their clinical arsenal, for the betterment of the patients they serve. As noted in Russ Newman's statement above, psychologists seek to follow a different model of prescribing than physicians. Unfortunately for psychiatry, once the safety of psychologist RxP is demonstrated and the severity of the access problem laid out, psychiatrists' ranting and hand waving about "they will kill patients!" will not fly.
 

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Anasazi23 said:
Jeez....if things are so great, go be a psychologist.

Enjoy. You really don't belong in the medical camp. Or at least in the psychiatric end of it. The above statement borders on disturbing and bizarre.
Thank you for rolling out the welcome mat! ;)
 
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