Clinical Psychologist + Psychiatry PA

[PublicHealth]

Has anyone heard of a clinical psychologist PhD who is also a PA with specialization in psychiatry? Could such a beast prescribe psych meds?

I ask because there seems to be a shortage of psychiatrists in many areas of the country. Perhaps having PhD clinical psychologists train as PAs in psychiatry could be solution to this problem? At the very least, it may help calm the battles over prescription rights between psychiatrists and clinical psychologists.

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[MacGyver]

Move to New Mexico if you want to write scripts.

At any rate, the only reason psychologists were given script rights to begin with is in the hopes that they would move to rural areas and help the doctor shortage.

Of course, that didnt happen. Psychologists stick to the big cities just as much as psychiatrists.

 

[deleted6669]

psych pa's can write scripts without being clinical psychologists. there are also residencies for pa's who want to do psych. see www.appap.org

 

[papilloma]

I'm sorry....but I used to be confused about psychogology and psychiatry. Now I understand it a lot better.

Psychiatrist go to medical school and residency not just to prove they went to school for a long time. Aside from the more extensive time of training, from the beginning of medical school to residency, psychiatrists are drilled in anatomy, histology, pathology, pharmacology, physical exam. They are made to do one things, prescribe drugs to psychiatric patients.

Psychologists are trained in another way. Anyone who took a psychology undergrad course or major has a perception of psychology. They are taught to recognize a pattern of behaviors and associate it with a disfunctionality, and tries to cure the problem in a nonpharmacological way, mostly through counseling. They are also trained in conducting research methodologies. They are aware of drugs, but they are not brought up to use drugs.

With that said, psychiatrist have a great understanding of the basic fundamental understanding of all drugs. If a patient comes in with hepatotoxicity, which shows jaundice, increased alkaline phosphatase, esophageal varices, will a psychologist pick up what is the cause? Probably not. But a psychiatrist would easily pick up the interaction of psychiatric drug with cimetidine, used for gastric ulcers. No psychiatrist aware of a patient taking cimetidine, which displaces other drugs from albumin, would give a full dose of any drug to a patient. If they see hepatoxicity, they will reduce the dose of that vary drug, or prescribe a different gastric reflux drug to the patient.

No disrespect to psychologists. They probably do great counseling with patients, and know how to conduct research studies. That is their strength. Every doctorate has a strength/focus and weakness, and drugs is the weakness for psychologists. That doesnt mean psychologist are lower than psychiatrists. Their training and knowledge are just focused in different areas.

 

[papilloma]

Sorry for the few confusing grammar errors on previous post, was in a rush.

 

[timerick]

Now, to say that "Psychiatrists are made to do one thing, prescribe drugs to psychiatric patients" is really not accurate.

A psychiatrist takes medical, family and personal histories, orders diagnostic tests, looks at physical symptoms and aetiologies, comes up with differential diagnoses, orders a broad spectrum of therapies, pharmaceutical and non-pharmaceutical, gives follow-up care and watches for side effects, new symptoms and signs, and drug/food interactions. He/she also interacts with the primary care physician, the psychologist, and any other professional involved in the client's care.

It's quite a job.

 

[PublicHealth]

Originally posted by timerick
Now, to say that "Psychiatrists are made to do one thing, prescribe drugs to psychiatric patients" is really not accurate.

A psychiatrist takes medical, family and personal histories, orders diagnostic tests, looks at physical symptoms and aetiologies, comes up with differential diagnoses, orders a broad spectrum of therapies, pharmaceutical and non-pharmaceutical, gives follow-up care and watches for side effects, new symptoms and signs, and drug/food interactions. He/she also interacts with the primary care physician, the psychologist, and any other professional involved in the client's care.

It's quite a job.

Not to mention that psychiatrists also do basic and clinical research. Although research training throughout medical school is limited compared to psychologists' training, more and more psychiatry residency directors are beginning to incorporate research requirements into their programs. There are also several scholarships and fellowship programs (some of which offer loan repayment) for psychiatrists interested in pursuing research careers. See www.psych.org for more information.

 

[papilloma]

I didnt mean that was the "only" thing they do. To emphasize, a major role of psychiatrist is to diagnose and treat, usually but not limited to pharmacological means.

The emphasis was made because many psychologist can recognize the manifestations of psychiatric illnesses as well. But they do lack a pharmacological fundamental training and systemic pathological manifestations, with strengths in different areas. Like Publichealth said, psychiatrists are somewhat trained in research, but it is not a major emphasis of the medical education.

Originally posted by timerick
Now, to say that "Psychiatrists are made to do one thing, prescribe drugs to psychiatric patients" is really not accurate.

A psychiatrist takes medical, family and personal histories, orders diagnostic tests, looks at physical symptoms and aetiologies, comes up with differential diagnoses, orders a broad spectrum of therapies, pharmaceutical and non-pharmaceutical, gives follow-up care and watches for side effects, new symptoms and signs, and drug/food interactions. He/she also interacts with the primary care physician, the psychologist, and any other professional involved in the client's care.

It's quite a job.

 

[Anasazi23]

Couldn't agree more, Papilloma. As a wise person on this forum once said, "I have no problem with psychologists prescribing medications, as long as they finish med school."

The interactions that you describe with medications and various disease states cannot hope to be understood by a few clinical hours and a "training course," regardless of how extensive it is. I am insistant that a full-spectrum medical school education is mandatory to have the confidence to not kill or seriously someone while prescribing psychotropic medications.

For those of you who will point to the military psychologists with good prescribing track records, I say this: The amount of time necessary to see horrible manifestations is not yet reached. In addition, I find it hard to believe that subtle poor prescribing habits that result in subclinical disease manifestations (i.e. raised BP) will not be "picked up," resulting in the false reinforcement that prescribing psychologists are "doing well."