California has just filed an RxP bill

excellent!

The SEIU is quite a catch; they've used their pull a number of times in CA to get their way. I am not a fan of unions, but if they can help get this legislation passed....that'd be great.

-t

 

T4C, I agree totally!!

 

I have mixed feelings about that article... I know that there will always be friction between Psychologists and Psychiatrists, but the whole "offsetting the power of medicine" thing is more adversarial than it needs to be. That saying about being careful who your enemies are because you'll end up like them is probably true. If "comprehensive health care" is really the focus (and I believe it should be), then shouldn't psychology and medicine work together rather than viewing the two as opposites that have to overpower each other?

I know this is one of the few "hot topics" in the field these days (just like the PsyD/PhD debate) but I thought I'd throw my 2 cents in.

 

Even more interesting to me is the fact that NAPPP is in the neighborhood of 6000-8000 members in one year and has affiliated with ABP, ABPN and soon the Psych Assessment Board, which is a who's who of assessment gurus. I really think APA and ABPP have blown it.

 

Admittedly the NAPPP has it a bit easier because they aren't as massive as APA......but I think both organizations can really benefit from the other's presence. If it takes the NAPPP to push APA in regard to the more progressive ideas...I'm ok with that.

-t

 

NAPPP definately appears to be more proactive and doing things for psychologist than APA or any other psych org so far... they are definately gaining validity and membership. Healthy competition for membership is always good... keeps them moving forward.

As per cali and rxp: It's bout time! if Cali gets rxp, this will be huge... NAPPP is smart going at it quite and strategizing support. This looks good.

 

I believe Cali to be a tipping point because of its population, economic impact, and visibility.

-t

 

I think people are dreaming if California is going to pass Rx privileges any time soon. I believe that, despite the alliances, it'll be more than a few more years before a big state passes this type of legislation, because the opposing lobbying forces are equally as massive, entrenched and well-funded.

 

*please stay on topic, and do not intentionally side track the discussion with inflammatory posts*

-t

 

millie125: I've deleted your inflammatory posts. I already gave you a warning, and you continued.

This is your last warning. If you are going to post, please stay on topic.

-t

 

i am just offering a dissenting opinion......i am not insulting or agitating anyone....you can never have a true discussion without two sides to a story

 

This has been discussed/flamed ad naseum. The thread is not to argue RxP, it is to talk about the legislation that has been introduced in CA. Please keep your posts relevant to the topic.

If you have any questions or further comments, please drop me a PM.

-t

 

my comments address the legislation, but you didnt want to post them..........

 

what extent of "psychopharmacology training" is required to acquire this prescription privilege? Is this a short day-long course kind of "training"?

 

you can read the bill on the NAPPP.org website

 

i find it interesting that you save this soliloquy for me when the other writers also talked about other things outside of this bill....the only reason that you removed my post is because it was a dissenting opinion...that is very sad indeed

 

I agree, there's too much at stake in CA for it to happen anytime soon. If CA falls, so will everywhere else.

If prescriptive authority passes eventually, I don't think its going to be all that great economically for psychologists in the long run. The glut of CA professional schools (who are going to provide the psychopharm training anyway), are going to churn out droves of psychologists (with $ in their eyes), who are just going to saturate the marketplace all over again, like what happened with therapy.

The APA would better serve clinicians by reigning in the master's levels therapists and professional schools than going after prescriptive authority, but the problem is it would be difficult to do, and I'm not sure the APA cares.

A person told me the other day: "A Ph.D. in Clinical Psychology is a joke nowadays... I saw that you can get that degree online." Way to go APA for approving such garbage, and diluting public perception of the field.

I'm glad the NAPPP is stepping in and being a real advocate, but as long as the APA accredits these programs and shoots the field in the foot, I'm not going to believe that things are going to change for the better.

 

finally an intelligent post

 

Amen. I am a psychiatrist and I think psychologists being able to prescribe after having taking a course in psychopharm is a great idea and not at all threatening. I mean why not? Especially given that there are so many underserved areas in this country that just plain don't have psychiatrists. My only concern is that it would push psychology in the same direction that psychiatry has been going over the last several years; namely adherence to the dogma that all mental illness is biologically/genetically determined and thereby reduce people's access to appropriate and effective psychotherapy. Especially if insurance providers jump on the bandwagon and stop reimbursing for therapy because psychologists could prescribe meds and meds are cheaper. Meds are great and necessary, but I know from my own personal experience that they are nowhere near enough and that psychotherapy is irreplacable.

 

That's EXACTLY what I was trying to say, but you said it much better.

I would hate to see insurance providers start covering therapy even less. Yes it's great that Psychologists could get more training and resources to be able to help even more people, but the big picture is even more important to me. If Psychology is going to truly benefit from this change, things need to happen very slowly and they have to be done right.

The California issue makes me both excited to see where the field is going, and concerned for the clients who may get pills thrown at them whether by clinicians or insurance circumstances.

 

...

 

I think it's useful to note that becoming a clinical psychologist involves a little more than "community college". You're forgetting about the hoops that must be jumped through in order to get licensed.

 

Ok , I'm sorry...I was a little sarcastic. I don't know what to say... I guess if the clinical psychologists get near the same training as a psychiatrist why not then...

 

I would like to point out that CA used to offer a D.M.H. degree (doctor of mental health) at Berkeley/UCSF in the 70s/80s that was supposed to combine the rigorous medical training of psychiatrist with the extensive psychotherapy training of psychologists in a true biopsychosocial model.

Unfortunately, it died out since the psychiatrists wanted nothing to do with them, and neither did the psychologists. I heard that they all were hired up by Kaiser and that was the end of that. I actually feel that a revival of this degree in the UC system would be an novel way to address the issue for future generations who have not already gotten their degree. Here's a blurb:

"A prominent psychiatrist, Kubie proposed a new profession (called medical psychology) that combined the best elements of psychiatry and psychology into a new type of practitioner capable of truly integrating biological and behavioral aspects of mental health treatment.

The interest and enthusiasm sparked by Kubie's creative proposal eventually led to the establishment of a doctor of mental health (D.M.H.) degree jointly offered by the University of California's Berkeley and San Francisco campuses (Wallerstein, 1991). As Kubie had proposed, the new program combined behavioral, social science and biological aspects of diagnosis and treatment to prepare graduates for practice in the community and, most controversially as it turned out, to prescribe and administer psychotropic drugs autonomously. The first students were admitted in 1973 amidst great excitement. Unfortunately, this highly innovative program was closed after graduating the class of 1986, primarily because of the jockeying for leadership in the new community mental health movement among the mental health professions and the adamant opposition of organized medicine to the licensure of program graduates for independent practice that included the prescribing of medications."

 

4 years of training (and practicum), 1 year internship, 1-2 post doc. 2 years pharma training, and 2 year residency. That isn't exactly 'community college' training.

The reason I deleted the posts were because they did not in any way contribute to the conversation. They were intentionally inflammatory and meant to derail the topic. As stated earlier, anyone who has any concerns, please PM me.

As an aside....there is an understanding that members don't intentionally post to instigate an argument. ie. psychologists posting over in psychiatry for the pure intention of causing a problem. I'd appreciate the same consideration in here.

-t

 

I wasn't trying to instigate an argument. Maybe my program is odd, but I'm used to having a warm and respectful relationship with psychologists. This antagonism between the 2 fields strikes me as extremely odd and inexplicable.

 

Ok, it sounds like medical school is alot less of a hassel to be able to prescribe a few drugs.... 10-11 years is quite alot of time... Also, these residencies you are talking about, are they the same ones psychiatrists attend.

 

This just happens to be the issue that causes the most animosity. I'd say typically we get a long pretty well. I want to encourage people to post across different forums because it can provide a wider perspective, but just to be aware that this is probably the one area that causes the most issues.

For many (myself included) the training is more than just being able to prescribe. I think it really informs the clinician to the importance and effect of a pharmacological intervention, and can allow the clinician a much more clear understanding of how the medications can effect the clinical/therapy side. Now that I see much more of what a psychiatrist has to go through, I have a much better appreciation for the training.

As for the internship/residency stuff......the first internship and post-doc are on the clinical side, and the residency is on the pharma side (which is similar/the same to a medical residency) There is practicum training throughout both the clinical and pharma training, though that tends to vary by program.

-t

 

I know. I just found it odd to be semi-accused of coming here to create animosity when for the most part I agree with your position. No worries, though.

 

As long as the pharm training is adequate. It's not just a matter of prescribing an SSRI or the like. You have to know the side effects, contraindications, etc. And some or many of the patients will have other meds they are on for which you need to know what you can prescribe together. MD's not only take a year-long Pharm course but rotate through many specialties, including Internal Medicine, and complete a residency in which these pharm issues are dealt with daily.
Not saying Psychologists shouldn't have Rx rights, necessarily. They are an integral member of the mental healthcare team and if we're all doing our jobs right they shouldn't need Rx priv. except maybe in underserved areas. They should be collaborating with the MD's and vice versa.
Finally, does this privilege also extend the liability to Psychologists if something were to happen due to their prescribing actions?

 

I am an MD so I know what training happens. I didn't have a year long pharm course in medical school. We had an organ systems curriculum and our pharm course was 2 weeks long with everything else integrated. Anyway I do understand your objections, but I also think that psychologists aren't stupid. That if they take the required pharm course, they will be able to prescribe within their area of comfort and will consult a psychiatrist when that level of comfort is exceeded. Not to mention that in straightforward cases of depression, the psychologist is likely seeing the patient weekly for therapy and thus can keep a closer eye on side-effects and whatnot than a psychiatrist who is probably seeing the patient no more than monthly.

And yes, of course if psychologists could prescibe meds, they would be liable for any consequences of having done so and responsible for following any required lab monitoring.

 

I appreciate your mature and understanding posts. Psychs who are trained to prescribe have far more bio-medical training that you avergae NP or PA. We take A&P, biochem, neurochem, neurophys (yes a separate course), six months of pharmacology and 1 year solid of clinical medicine taught by MD's. The training is good, what is missing is the residency. See the post in the psych forum about NAPPP, and the article called "PhD Syndrome". I have done a medical psych residency, and the RxP training and have been managing meds for years for psych patients. I have Dx'd Stevens-Johnson's, many thyroid conditions, one case of Kluver-Bucy syndrome, and more than anything I have taken many people of of meds that were added by a midlevel or PCP that were causing many more problems. You are right we are smart, effective doctors if we get the right training. However organized psychology is a joke in this country, and training lags far behind where it should be. People like me who really want to treat patients in the bio-psycho-social model can NOW get the training to do this. The biggest reason for psychologists to get this training has nothing to do with Rxing, money, serving the underserved etc... but to be able to work synergistically with MD/DO's who don't know psych well to give great Tx to patients. I am asked all the time if Colorado passed a bill for me to Rx would I?? Yes I would, but it would not be much different than what I do now. I prefer to work collaboratively with the physicians at my clinics/hospitals. Sure I would order a LiCo3 level, CBC, alter a dose etc...alone if need be but my first choice would be to talk with the PCP and make a dually-informed decision.

 

This is my reasoning for it. I think it informs the clinician in an area that is not as fully addressed as it should be during the initial clinical training. I think clinical training needs to move to a more health-centric / neuro focus to really meet the changing needs. People may argue that they won't use this in every day practice, but that doesn't mean they shouldn't learn it.

This is what I'm looking to do. I think collaboration is key in providing the best treatment for any given pt. My preference is the hospital/in-patient setting, but even in a private practice setting, I can see the benefits of consulting with the PCP. I've talked to a number of PCPs and they prefer the consulting relationships, because it helps them in an area that many aren't as comfortable with. They can also speak to any medical conditions or other vital information that the pt. may fail to report.

-t

 

I may be misreading your tone, but if not and I offended you I apologize. I wasn't making assumptions. My post was more directed at the general issue and thread, not you alone. I quoted your post b/c that is what got me thinking.
As far as level of comfort, would you not agree that PCP's prescribe out of their comfort level? That is, some argue psychiatrists are better judges of the psych meds.
It'd be interesting to see what the medication regiment the average person on psychotropics is.

 

Yes, I think some PCPs do. The funny thing is, I know some psychologists I'd rather have prescribing psychotropics than some of the PCPs I know.

 

i am interested in knowing what has happened to the malpractice premiums of the psychologists in New Mexico and Louisiana who chose to write meds.....this is a genuine question............

 

The answer is nothing. Actually some have gone down as so many MP suites were being filed because psychs could not properly treat their patients with meds.

 

To answer you post I am very concerned about public saftey and the Calif bill. I did alot of talking with the Calif legislature to research my decision about pulling my application for psychiatry.

Sunlioness-actually it is very important how this bill effects the employment outlook, that is an absolulty reasonable and accurate concern, most of us are not independly wealthy. The concern in Lousiana right now is that this will upset the balance of medical training. What they mean is people are less willing to go into psychiatry if the employment looks poor and the training takes to long. One of the arguments is that there aren't enough psychiatrists to serve not only the rural areas but mental health in general. The concern is that these bills will drive more people away from psychiatry- which is loosing the battle in the end. You have several prescribing psychologists but now you have lost medical doctors.

psisci- to answer you question,to get more information before " blowing your horn" as you stated. My school does require 1 full year of pharmacology inaddition to 3 months of straight psychopharmacology,combine with 3rd and 4th year psych rotations where we actually practice writing orders under the supervision of an attending and then 4 straight years of psych residency. I would say that is way more training than 2.5 years. I not trying to flame you but these issues are critical to patient saftey which is why the legislatures are justifably concerned. Alot of what we learn is how to recognize what is not a psych problem and what is an internal medicine problem and how to treat it accordingly, which is not training you get as a psychologist Since I was a practicing psychologist before going to medical school I can speak very authoritativly because I went through the training and worked in the field.

I think psychologists do wonderful work but prescribing medications makes me very nervous honestly from a patient saftey standpoint and from an economic standpoint and can upset the fabric of medical training needlessly.

 

I was just in louisiana which is one of the states that lets psychologists prescribe meds. But this has not had much of an impact because guess what the psychologists cannot find any insurance company that will cover their malpractice if they prescribe meds. It is a bit of a liability. So just because you have the right to prescribe does not mean that you will.

 

APA's own insurance covers them???

 

when you throw in prescribing rights its a whole new ball game. The liability increases so the psychologists in louisiana, mind you they are a few who can prescribe cannot get malpractice to cover their prescription liability.

 

Yes, and my point is that APA's own insurance is covering the Rx liability.

 

If this is true, then all of this rhetoric is pointless

 

The APA (#1 provider of malpractice insurance for psychologists) offers coverage. That is like saying you can't get a gov't student loan...if you ignore Sallie Mae.

-p

 

Either way there are several questions need to be answered.

This bill will cause a decrease in the amount of medical students going into psych residents. WHY would a student spend 4 years of pre med( gen chem, org chem, physics, cell and molecular bio etc.) the Medical College Admissions Test, 4 years of medical school and then 4 years of residency when someone can go to grad school and then post doc and for less time tuition too. There is a medical doctor shortage anyway, is it worth loosing more medical doctors? I am upset because it caused me to change my ERAS applicaltion already.

When I was in grad school, there was a major reaction against the medical model and the client centered approch was promoted and it appears to be that way today. WHY do you want to prescribe medications as that really embraces the medical model. I would think you would look to alternative forms of treatment. Also, as one of your writers informed "We are doctors." , I would think you would want to be called therapist it's less medical. When you prescribe medication and want to be called doctor this seems to be contradictory to the client centered philosophy. What's up with that?

If want you say is true about psychiatrists not doing their job, H&P's checking labs (which I have not seen. If fact the residency programs where I interviewed stressed the importance of skillfull internal medicine skills as we are responsible for not only managing the psychiatric conditions but the patient's medical problems as well. It was stressed in my interviews that there is a comming trend for psych patients to be medically managed by psychiatrists as increasingly more PCP's don't want to manage psych patients.
Also , at many of the programs there is a major research forcus for genetic causes for the biological cause for mental illness, so both medical and research skills were being recruited. So if there are problems with psychiatrists not doing there job then the psychiatrists need a kick in the pants, but not to cause the decrese of badly needed medical doctors by licensing non medical people.

Why shouldn't social workers have prescribtion rights? They do similar work, there are some great MSW's doing couseling that I'm sure would love to use some Haldol on a few of their patients?

 

No, if we put in the work for a doctorate, I don't want to be called a therapist. I can only speak for me, but I want to do what is best for my patient....which may be a therapeutic intervention, Therapy + Pharma, etc.

Again, do some research on the curriculum of an SW program, and that of a clinical program. I know clinicians are suppose to be the 'researchers', but this shouldn't be that hard.

-t

 

I was reading this post and was going to post a note in favor of RXP. I think it is a good idea and appropriate. the pa bashing above is really not pertinent to this arguement(or correct).I see that you claim 1 yr of rotations with physicians. is this in fields outside of psychiatry? did you deliver babies and 1st assist on appendectomies? did you round on post-op orthopedic pts? can you tell the difference between a copd and chf exacerbation in a pt with a hx of both based on clinical exam alone? did you have > 2000 hrs of clinical rotations in MEDICINE supervised by physicians with rotations in surgery, ob, internal medicine, family practice, peds, emergency medicine, etc? didn't think so....were you aware that the prereqs for pa school and medschool are now basically the same and that microbio, a+p, biochem, o-chem , etc are standard prereqs? did you know that we get a full yr of pharmacology covering all types of medications?. in fact at many pa programs this course is taken alongside medstudents......
look, rxp is a great idea and definitely appropriate. bashing other health care providers is really not needed to achieve your goals and will just alienate folks who would otherwise support you.

 

With all due respect, nothing "caused" you to change your ERAS application. If you changed your choice of specialty, it was your choice. There are plenty of us still going into psychiatry and who are happy to be psychiatrists. And the relative shortage of psychiatrists was a problem even before any psychologist gave a thought to prescription privileges. But I wish you luck in EMed. I hope it ends up being the right decision for you.

Also I don't think that the path to PhD/PsyD is any less in duration than the path to becoming a psychiatrist. And I don't know that it's any less expensive. The main reason I would think it might be more attractive to some is that you don't have to spend time learning about and rotating through fields you already know you don't want to do.

Also, I think there is a still a different between a psychologist who can prescribe meds and a psychiatrist. Just because psychologists gain a new privilege doesn't mean that the two jobs are now identical or that psychiatrists are obsolete. I see psychologists prescribing meds almost exclusively as an adjunct to psychotherapy. I don't think they will want to take on patients that are med management only unless they are the only ones in the area able or qualified to do so.

 

I apologize, I meant in regards to psych only. If I wanted to know all that other stuff I wouldn't do what I do.