from an OR child psychiatrist: the psychologist Rx bill is vetoed!

fiatslug

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so sayeth my program director, who has been very involved in negotiations with Governor Kulongoski. :D
 

whopper

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I wonder how many people who voted for the bill actually read the oft-cited DOD report, the only piece of empirical data ever presented to back the safety of a psychologist prescriber, that didn't say it's results were generalizable to the community, and found a mix of positive and negative results with the practice.

IMHO, the turf-war has been heavily pushed by both sides. If we are to take the high-road, then doctors should do what we can to help those areas with a shortage of psychiatrists, and we need to make sure psychotherapy is encouraged more in training and practice.

Psychologists are not the enemy. Most psychologists I know are against psychologist prescription power.
 
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Therapist4Chnge

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I'm not particularly upset it got veto'd, because it didn't have nearly enough training requirements, it lacked specifics that are needed to ensure no loop-holes, and the collaboration requirements were weakly written at best. I support prescribing psychologists only if there is adequate training, a real mentorship/residency requirement, and on-going collaboration with a physician. Unfortunately the bill lacked all of that, so it isn't very surprising it failed, even though the House and Senate were supportive. I'd like to see the AMA and the two APAs come together and work something out that focuses on collaboration, as the millions wasted and the over-used talking points are definitely not benefiting the general public.
 

whopper

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Here's a bill I could've backed....

1) Enough training. Clearing 250 clinical hours is not enough. I'm not even sure how many clinical training hours there were supposed to be because the 250 number is from a previous draft that was rejected. The bill that actually passed-until vetoed, I didn't see the number of hours.

2) There has to be clarity over who is medically responsible for what. The bill required a collaboration, but it didn't say who was responsible if something went wrong.

With that being the case, I would not want to collaborate with a psychologist prescriber because I wouldn't know if I'd be held responsible if that psychologist prescriber did something without informing me first.

3) Clarify over the allowable formulary. Is this just SSRIs (as was the case in the DOD report, yet the bill seemingly was trying to get many other psychotropics prescribable by psychologists). Would lithium, Clozapine, Depakote, MAO-Is, TCAs, and B-blockers be on the formulary?

4) The bill needs to clarify if the psychologist prescribers can be allowed to interpret labs and EKGs. If not, then clearly, a health professional needs to have the final say on any type of psychotropic that by the standard of care requires labwork.

Would a psychologist prescriber be able to take the recommendations of radiologists or other medical doctors to the degree that they can be held competent to incorporate that into their decision-making process concerning psychotropics? If not, then in any case where a scan is needed, the health professional should have the final say.

5) There has to be some testing to see if the practice is safe, under parameters similar to the proposed bill.

I'm actually thinking just getting an NPA degree would be easier. At least that way if one were to move from one state to another, they wouldn't face the overhwhelming likelihood of losing their ability to prescribe.
 
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Therapist4Chnge

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I'm actually thinking just getting an NPA degree would be easier. At least that way if one were to move from one state to another, they wouldn't face the overhwhelming likelihood of losing their ability to prescribe.
At this point, that is the much more realistic choice. I was not very impressed by the coursework (online) or the training I saw at the 3 or 4 programs I looked at, but at least the system is in place already. I still can't fathom how online training would be sufficient, but maybe I'm just a Luddite.
 

whopper

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I still can't fathom how online training would be sufficient, but maybe I'm just a Luddite.
No you're not.

You've always given good input. I'd be happy to work with you in clinical practice.
 

loveoforganic

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Whopper, are you sure that the psychologists were limited to SSRI's in the DoD paper? I looked through it, and it seemed more expansive than that.

Also, does anyone know an online source for the legislature/regulations for medical psychologists in Louisiana?
 

whopper

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I looked through it, and it seemed more expansive than that.
As did I, but since I will not read through that dang thing again with my current schedule anytime soon, I will yield! (I would've been home by 5 pm today, but the recent debate, well it just had me glued to my computer. And what do you know, I have my taxes to look forward to after I finish m competency evaluation report!)

Also, does anyone know an online source for the legislature/regulations for medical psychologists in Louisiana?
http://www.legis.state.la.us/lss/lss.asp?doc=671533

I suspect there is much more legislation over psychologist-prescribers because this is really simply too little.

From what little I've seen, I find Louisana's laws better than the Oregon's recent vetoed bill because of this simple line...

The medical psychologist shall provide the primary, attending, or referring physician with a summary of the treatment planned at the initiation of treatment.
In other words, if a "medical psychologist" were to prescribe a medication, the psychologist has to inform the patient's medical doctor of the treatment.

The Oregon bill's guidelines of collaboration between the "health professional" and the prescribing psychologist were extremely vague, and that could lead to several problems over who has responsibility, and uncomfortable, but inevitable scenarios where the two disagree.

I don't have the time right now to look through the Louisiana laws, but going through that state's legislative website, putting in the words "medical psychologist" came up with the following results.

http://www.legis.state.la.us/lss/search.asp?ALL=ALL&SearchString=medical+psychologist
 
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Sneezing

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The whole thing isn't even needed in the first place. Oregon already has a psychiatrist who reaches out to rural communities with his army of NP's. http://www.nwtelepsych.com/ He can be replicated.


Although, I prefer this idea better... With technology and telepsych the argument of rural areas really is a moot point. Any psychiatrist can reach a rural area. And if they don't have cable internet, they have satelite internet. Heck, this can even be used to support the concept of being more of a consultant for the PCP's. I've heard this being pushed at several residency interviews I was on.

If PCP's could treat them right, the first time, it lowers the utilzation of psych patients downstream on the system, equating to a broader patient reach, and ultimately no need for psychologists pretending to be what they're not.

My solution is to embrace telepsych.
 

whopper

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From my own experience, few are utilizing telepsyche. I'm not sure of the reasons why, but I suspect it may have to do with the feeling that there's a loss of impression when seeing someone over a television screen. That and doctors may be a bit technophobic and mentally a bit conservative in trying this approach.

The few times I've seen institutions willing to use it was when interviewing a patient to see if that patient should be held for involuntary commitment becuase in those cases, the questions to be answered by the doctor are very specific.
 

Sneezing

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The real issue is a bit broader than just telepsych. It encompasses technology as a whole. EMR. PDAs. Cell phones.

I blame the generation gap, laziness, and those just too close to retirement to give a damn.

Telepsych should be a required three months in residency. One month C&L to an outside hospital, one month inpatient, one month outpatient/primary care consulting. Inpatient units can use their COWS with webcams and skype or what ever program they want to conjur up.

Pagers shouldn't exist. Everyone should be using cell phones with texting. Residents are already making that transition anyway. I'll save that rant for another day.
 

loveoforganic

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Thanks for the legwork Whopper.

DoD prescribing snippet -

The two fellows prescribed a total of 41 different psychotropic medications, including representatives of most drug classes except the monoamine oxidase inhibitors (MAOIs). Both fellows were conservative, favoring safer and newer medications such as the selective serotonin reuptake inhibitors (SSRIs).
 

whopper

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Well, thanks for your legwork, and correction. We should always be open to being corrected.