Has any one considered Med School?

[edieb]

Unfortunately, since he/she selectively responds to information posted, I don't think there is any debating with Nitemagi.

1 - She/he never responded to Therapist4change's assertion that if even 33 percent of prescribing psychologists are practicing in rural New Mexico, does this increase access to care, especially when these places are without psychiatrists?

2 -She/he also never responded to his physician colleague's statement that there is up to a 2-3 month wait to see a child psychiatrist in a large urban area and whether this indicates that prescribing psychologists are increasing access to care in urban areas, too.


3 - She/he never supplied any references for any points made in his/her posts. At the same time, Nitemagi constantly demands references and, when supplied, ignores them...

A

Ultimately my issues with RxP are -
1. The safety data isn't there.

The safety data doesn't support that MD's can practice adequately since they are responsible for most of the medical errors compared to other providers (someone quoted the statistics before). There have been no known medical errors or lawsuits for R x P programs thus far. We can't say that about MD's in general

2. The cost to already poor states may not be worth it.

What about the cost of not providing psychiatric care to someone in need because it takes 2-6 months to get an appointment, especially for a child? This cost is emotional and financial. It is not cost-effective to wait months to see a psychiatrist and its risky/dangerous since it can lead to suicide etc.

3. Are the strong proponents of RxP people with track records in working in underserved communities? Or is psychology unfortunately dealing with a flooded market and reaching for lifelines to stay viable?

I think some psychologists have financial motivations. If they are still serving needed underserved populations, then why does it matter in the end? Most MD's have financial motivations and incentives so what's your point here?

To pose the question back, what do you think is adequate training in each psychotherapy to be "competent." If we set a standard, then it's easy to see who meets that. I did a year of DBT practice and training including supervision groups. Is that enough? 6 months of once a week didactics on CBT plus individual cases with weekly supervision x multiple years? That's what I did. Throw in about a year+ of psychodynamic theory didactices, case discussions, cases with supervision for several years. What's enough? If only someone studied it to see. It seems though that we all want our training to seem relevant. Why go through medical training if it doesn't lead to safer or improved outcomes? Our presumption is it does. Why do 3,000+ hours of therapy training as a PhD unless it leads to better outcomes? Our presumption is it does. But the standards of current organizations for individual branches of psychotherapy don't seem to support the necessity of that many hours.

I think this is a good question. I don't know that standards have been developed yet. However, 1 year or 6 months of CBT or DBT training doesn't tell me anything about the quality and depth. The psychiatrists i know got 1 hour of didactics in CBT and 1 hour of supervision in a group format. Psychologists, on the other hand, get 4-6 hours of individual and group supervision per week for about 5-6 years, then another 3,000 hours of supervised training before licensure. I personally would not practice independently as a CBT therapist without being able to say that i have been able to assess, treat, and formulate at least 40 plus cases using the CBT model under supervision? the relevant questions for me would be: Do you feel comfortable seeing a wide range of cases using a CBT model? Have you successfully carried out exposure therapy, cognitive restructuring, behavioral activation etc. with a diverse group of clients under supervision (GAD, anxiety, depression; unless you want to limit your practice)? Do you consider individual differences and do you have experience treating different cultural/ethnic groups in a CBT model?

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[cara susanna]

Well, maybe I shouldn't have said a poor view. But whenever nitemagi says something about psychologist training, it's followed by a statement that appears to assert that psychiatry training is superior. I think that's true in some areas, but not all of them.

 

[2012PhD]

I would appreciate it if you could cite specific examples of misinformation I provided, or factual responses I ignored. I AM challenging opinions and interpretations of ideas, but that's different than ignoring facts. I will admit I have at times responded to strongly voiced opinions with an equally strongly voiced response. And instead I should be the calm voice of response at all times. On a forum where I am the sole voice of opposition, sometimes one must continue to speak strongly in order to still be heard. Apologies if that has ever been offensive.

--you ignored the points that edieb made above and didn't address them.

--I think you are constantly on the offensive because you think that the psychologists on this forum have completely different views than you and are not listening to your viewpoint. Many psychologists on this forum have agreed with many of your posts (e.g. that our expertise in assessment does not generalize to psychopharm) and are also against R X P training for psychologists so you are not the only opposition here. I am ambivalent about R X P, but for other reasons than you post.

 

[aequitasveritas]

I've read most of what nitemagi posted and I am not offended at all.

I think we need to grow some thicker skin folks.

 

[2012PhD]

I've read most of what nitemagi posted and I am not offended at all.

I think we need to grow some thicker skin folks.

I love hearing what professionals in other fields have to say and what their perceptions are of clinical psychologists. I wish there were more on this forum. Many people don't know about our training and areas of expertise. We are commonly lumped together with other therapists, like social workers and counselors.

 

[nitemagi]

--you ignored the points that edieb made above and didn't address them.

--I think you are constantly on the offensive because you think that the psychologists on this forum have completely different views than you and are not listening to your viewpoint. Many psychologists on this forum have agreed with many of your posts (e.g. that our expertise in assessment does not generalize to psychopharm) and are also against R X P training for psychologists so you are not the only opposition here. I am ambivalent about R X P, but for other reasons than you post.

Specific examples please, related to edieb.

You're right I'm not responding to every single post. I have a day job and when there's 10+ posts to every one of mine, it's a little tiring.

As for Edieb's points from this page -
-NP link - requested evidence that NP's are less effective. I addressed that, and furthermore pointed out that NP literature isn't generalizable to RxP.
-Exposure post. I have acknowledged that training varies within psychiatric residencies for therapy. But we have require rotations (during residency, not counting med school) in inpatient psychiatry (9 months), child/adolescent (2 months), Addiction (1month), outpatient (1 year longitudinally), internal medicine (4 months), neurology (2 months), emergency psychiatry, consult liaison (2 months), forensic psychiatry. Plus didactics, continuity and specialty clinics, and psychotherapy patients. All of this is required. During this time residents work usually 50-80 hours/week (less during 4th year, though that's now changing with new ACGME requirements that'll shift longer work hours to all years of residency).
-Post about pointless to study RxP effectiveness and outcomes - already addressed that.
-Post about practices in rural areas. Partially addressed. Part of the question is risk/benefit again. And this is a point of disagreement in general. 1. If financial incentives are a primary motivator to do RxP, then RxP'ers are more likely to serve those that can pay more, essentially the overserved.
2. Bringing med mgmt to those with zero access may be beneficial. You're not going to convince me that medicating more kids with antipsychotics is a good thing.
3. The costs to the state again must be substantial to run a new program and train all the providers, but if only a third help at all, wouldn't MORE people be helped if those dollars were used to recruit in current pathways (mid-level providers and psychiatrists via telemedicine). This is an established model in rural areas in many parts of the country and growing, and bypasses the need for pay more to incentivize individuals to move to the rural areas.
- 2+ month wait in urban areas. Again potentially beneficial. But as I've now posted about RxP in general the safety is too high of a concern. Improve the training, standardize real supervision, then I could be persuaded it's worthwhile. Otherwise it's just dangerous.

And I don't demand references, though I do point out that lack of references is a detriment to an argument. Which point(s) would you like references for? I have posted many many links to references on the psychopharm sticky thread. I could do it again here if you'd like.

 

[nitemagi]

The safety data doesn't support that MD's can practice adequately since they are responsible for most of the medical errors compared to other providers (someone quoted the statistics before). There have been no known medical errors or lawsuits for R x P programs thus far. We can't say that about MD's in general

So that's one interpretation of the data.
To piggyback this logic
1. Physicians are known to be responsible for the most medical errors (your point)
2. Many medical errors go unreported (I can get you citations if you'd like). Reasons vary from ego, issues with identity, loss of job, risk of lawsuit. This is true across healthcare professions, including nurses.
3. Orthopedic surgeons get sued on average every 3 years. Psychiatrists get sued on average every 33 years. Per my malpractice company.
4. The known best protective factor to prevent lawsuits is a strong therapeutic alliance (likely a major factor why psychiatrists are sued less).
5. Less education is associated with more medical errors in physicians.

So based on those numbers, lawsuits shouldn't be expected to be that common with RxP's. That doesn't say anything about actual medical errors. Patients don't really know the difference except when death occurs.

And based on your logic, are you saying that since physicians make the errors, somehow those with less medical education will make less medical errors? Somehow a PhD in psychology is protective from mistakes in pharmacology?

The lack of lawsuits is not evidence of quality care. The data could equally be interpreted as meaning that the patients just don't know any better. Or they like their provider enough to forgive mistakes that're made.

2. The cost to already poor states may not be worth it.

What about the cost of not providing psychiatric care to someone in need because it takes 2-6 months to get an appointment, especially for a child? This cost is emotional and financial. It is not cost-effective to wait months to see a psychiatrist and its risky/dangerous since it can lead to suicide etc.

I think some psychologists have financial motivations. If they are still serving needed underserved populations, then why does it matter in the end? Most MD's have financial motivations and incentives so what's your point here?

1. I think we overmedicate kids.
2. If financial motivations are involved, then we do not know they're serving the underserved. They could be serving cash paying socialites.
3. This doesn't bypass the idea of most efficient use of dollars. If 2/3's of trainees don't help the underserved (one interpretation of the data), then alternative uses of the money should be explored that might do better than RxP in improving access.
4. I don't want people to suffer. But increased access comes at the risk of more iatrogenic problems. A serious disease burden.

I think this is a good question. I don't know that standards have been developed yet. However, 1 year or 6 months of CBT or DBT training doesn't tell me anything about the quality and depth. The psychiatrists i know got 1 hour of didactics in CBT and 1 hour of supervision in a group format. Psychologists, on the other hand, get 4-6 hours of individual and group supervision per week for about 5-6 years, then another 3,000 hours of supervised training before licensure. I personally would not practice independently as a CBT therapist without being able to say that i have been able to assess, treat, and formulate at least 40 plus cases using the CBT model under supervision? the relevant questions for me would be: Do you feel comfortable seeing a wide range of cases using a CBT model? Have you successfully carried out exposure therapy, cognitive restructuring, behavioral activation etc. with a diverse group of clients under supervision (GAD, anxiety, depression; unless you want to limit your practice)? Do you consider individual differences and do you have experience treating different cultural/ethnic groups in a CBT model?

Excellent points. I've already pointed out the lack of requirements for quality of psychotherapy training for psychiatrists. I acknowledge that psychologists get a lot of therapy training. The question I pose is - is 3,000 hours of CBT and EST training lead to better outcomes or competency than say 2,000 hours? Or 1,000 hours? What's enough? Just like the DSM was created by the BOGSAT's method (Bunch of Guys Sitting Around Talking), these are arbitrary numbers that we don't know map out to better clinical outcome. Of course they should be better. Because more is always better, right I'm winking because we get attached via our professional identities that what we went through is required for quality work, because otherwise why would we do it? Until we establish standards for the therapies on what's enough for "competency," we're all just advocating for our professions and have to recognize we speak from that bias.

For RxP'ers my data points of comparison are the DoD RxP study (which noted medical knowledge was equivalent to 2nd-3rd year medical student, not sufficient in my book), and the wealth of data from the Institute of Medicine that shows physicians at earlier training (earlier in residency) make many more medical errors than those that've completed it. Not to mention that the standards for training the DoD program was far more intensive and closely monitored than the current civilian ones. And yet they ended it. And multiple graduates of the DoD program felt their training insufficient enough to decide to go to medical school anyway.

 

[nitemagi]

Unfortunately, since he/she selectively responds to information posted, I don't think there is any debating with Nitemagi.

edieb, you don't seem to have much tolerance for disagreement with your position. It seems to me that holding a contradictory view here equates to narcissism and maliciousness, rather than this being a forum for debate.

As for not addressing every point, I'm doing my best to keep up with the slew of posts! Cut a guy a break.

 

[nitemagi]

And I want to thank those that have posted in my defense and in defense of intelligent discussion, rather than ridicule and debasement of the individual.

 

[2012PhD]

1. I think we overmedicate kids.
2. If financial motivations are involved, then we do not know they're serving the underserved. They could be serving cash paying socialites.
3. This doesn't bypass the idea of most efficient use of dollars. If 2/3's of trainees don't help the underserved (one interpretation of the data), then alternative uses of the money should be explored that might do better than RxP in improving access.
4. I don't want people to suffer. But increased access comes at the risk of more iatrogenic problems. A serious disease burden.

.

overmedicating kids is a big problem. I agree. I think this should be a last resort (psychotherapy should be first treatment choice here).

Yes, we all have our biases in terms of our own training. The psychotherapy training is more of a common sense issue since there is no great data on this. Many of us that have had extensive training really believe that it makes a big difference in terms of our effectiveness.

 

[nitemagi]

overmedicating kids is a big problem. I agree. I think this should be a last resort (psychotherapy should be first treatment choice here).

Yes, we all have our biases in terms of our own training. The psychotherapy training is more of a common sense issue since there is no great data on this. Many of us that have had extensive training really believe that it makes a big difference in terms of our effectiveness.

I hope so. But [some] posters on sdn then make the leap to say that others shouldn't practice therapy at all without it. Which is a leap without data to back it up.

Like all territorial issues. It's a lot easier to expand access and priviliges than it is to take them away.

 

[2012PhD]

I hope so. But [some] posters on sdn then make the leap to say that others shouldn't practice therapy at all without it. Which is a leap without data to back it up.

Like all territorial issues. It's a lot easier to expand access and priviliges than it is to take them away.

I think these attitudes originate because health insurance companies/employers often don't differentiate between clinical psychologists and M.A, level therapists, dwindling salaries, and a supply-demand imbalance in our field. We haven't done a good job of differentiating ourselves. Plus, many job postings mention PhD/Psyd or M.A/MSW/MFT/counselors in the same job posting.

Yeah, it would be really hard to take away privilliges at this point. It is more effective to specialize and differentiate our services from other providers.

 

[nitemagi]

I think these attitudes originate because health insurance companies/employers often don't differentiate between clinical psychologists and M.A, level therapists, dwindling salaries, and a supply-demand imbalance in our field. We haven't done a good job of differentiating ourselves. Plus, many job postings mention PhD/Psyd or M.A/MSW/MFT/counselors in the same job posting.

Yeah, it would be really hard to take away privilliges at this point. It is more effective to specialize and differentiate our services from other providers.

Agreed.

Also I pose the question as to how so many psychologists can be big proponents of EBT's and EST's, and yet also be such staunch proponents for RxP, for which there is no data to support it? Shouldn't there at least be an incentive there to do some research on it?

 

[erg923]

I conduct research on EBTs/ESTs and conduct clinical work solely within that framework. I do not support RxP. I can also say that, anecdotally, most of my colleagues who are either researchers or clinicians who promote and adhere to evidence-based practice also largely don't support RxP.

I've noticed this same split between academics and clinicians on the Rx issue. It actually seem counter-intuitive to me. I would think that clinicians would be the ones most adamant about keeping the profession purely therapy and behaviorally oriented and the ones who would be a little more than intimidated by such a drastic shift in the practice paradigm. In my experience, academics and researchers are the ones who usually advocate for change in techniques, thought, and policy within a profession. However, as I mentioned before, its seems to be the opposite here. Why is this? Anyone care to speculate?

 

[loveoforganic]

Academic psychologists aren't in need of an easy to obtain patient base, would be my guess.

Mostly just wanted to say I'm glad this thread seems to be going back in the civil direction! Creeping away to lurk again...

 

[Ollie123]

It doesn't seem divided up strictly on academic vs. clinician, but I've also noticed a definite trend in that direction. It doesn't help that the lines are blurry (i.e. is a professor in a professional school an academic? Is a staff psychologist who is writing papers at a major VA hospital a clinician?). I think there's something to it, but I suspect there are underlying traits at work here that may partially dictate people's choice of career, rather than a strictly professional divide. I do maintain what I said earlier...I don't necessarily disagree with the "idea" of RxP but I think that 1) Implementation has been, in my eyes, completely insufficient and the push on our side seems to be towards minimizing training rather than maximizing it and 2) The obscene amounts of money would be better spent advocating in other areas. I can understand the point mentioned earlier of getting us a "seat at the table" (forget who said it) but I think that speaks to a larger systematic problem that behavioral interventions getting the short end of the stick (despite still being the standard of care for many disorders) and would rather see efforts focused on changing that. I also worry a little that this will push us more towards being a mid-level profession, and away from being the "experts" in our area. We have a great deal to offer, and not all of it is strictly patient-care related. I am perhaps biased by my own training, but I actually think that may also be a factor in this equation...people who perceive psychology as a "purely" direct patient-care profession may be pushing for RxP so hard because, well, there is little else to push for that fits the mold of direct care. I certainly don't have an objective view of this, but I think it would be wiser to push for better utilization of our other skills in treatment settings that better differentiate us from other professionals, rather than those where we overlap. I think there's room for reasonable disagreement on the issue, though not everyone (on both sides of the fence) seems to feel that way. One of the many reasons I consider politics to be idiocy (albeit a necessary one).

nitemagi - I agree with your points about psychotherapy training. However, as far as I know the data on prescribing isn't much better (though this may be part of your point). You've brought up the extensive training that MDs get in the influence of medications on other organ systems...I don't doubt it, but unless I'm mistaken that has also been driven largely by tradition and there isn't any research to support a particular cutoff of hours to be deemed "competent" in understanding how antipsychotics effect x,y,z. From my perspective, the standard of care seems to be pretty piss poor across mental health as a whole once you actually see what is going on out there - that goes for psychologists, psychiatrists and everyone else involved. Psychologists providing treatments for years based on some loose, eclectic philosophies they dreamed up 30 years ago. Psychiatrists putting people on ridiculous cocktails of medications based off a 10 minute clinical interview and a monthly "How ya doing?". Yes, we all aspire to do better (and I expect most people on a board like this do) but that's the stuff I've seen going on quite regularly in the community. Doesn't mean we should risk making it WORSE, but I do think it is important to keep in mind that the current system does not exactly seem particularly effective for any profession and it may be worth revisiting some basic assumptions about training.

That said, I also agree with the above that while I may disagree with you on some points and views, you seem perfectly reasonable compared to a couple of your colleagues on the psychiatry board, and quite frankly I have no idea why people have gotten quite as adversarial as they have. People seem to call you out on things they'd never ever call out other posters for, including themselves. Yes, you don't multi-quote a sentence-by-sentence breakdown for every single person who replies to you but many of your points are fair and your opposition certainly doesn't seem to hold themselves to such a standard.

 

[PETRAN]

I've read most of what nitemagi posted and I am not offended at all.

I think we need to grow some thicker skin folks.

+1


exaggerated responses for sure. I sometimes post in the psychiatry forum myself and nitemagi is one of the most laidback of the bunch. You have to read some other psychiatrists attitudes on PhD psychologists to get the real sense of "offensive" (although most people in the psychiatry forums are very friendly in general, a few are definitely malignant)

 

[futureapppsy2]

Hi all,

Just a friendly reminder that we do have a stickied RxP discussion thread here: http://forums.studentdoctor.net/showthread.php?t=244987&page=28

 

[2012PhD]

Hi all,

Just a friendly reminder that we do have a stickied RxP discussion thread here: http://forums.studentdoctor.net/showthread.php?t=244987&page=28

This is the thread above that got really hostile so i'm not sure its very useful.

I am confused about why people think this particular thread was very hostile. We need thicker skins in that regard too. I don't think people on this thread were being unreasonable or hostile towards nitemagi overall. We can ask people to show evidence of what they are saying and respond to things (e.g. he didn't respond to the fact that there is a huge shortage of psychiatrists initially when arguing his viewpoint). This is a reasonable way to debate things.

 

[Therapist4Chnge]

And, on this forum specifically, you see guys like Manicsleep who claim to supervise psychologists and dictate testing choices (only ones he can administer and interpret), and it makes it very easy to say if expertise is minimally necessary or even not necessary for physicians to claim dominion over our stuff, we can get more training (RxP) and prescribe just as ineffectively as these other specialties (nurses, physicians, optometrists). Personally, I see all of these things (physicians using computer programs for cognitive testing and interpreting with no background to do so, nurses prescribing and doing therapy [what the hell? Aren't they supposed to, you know, be nurses?]) as a dumbing down of healthcare. This benefits business people and hurts patients in my opinion.

100% agree.

 

[2012PhD]

And, on this forum specifically, you see guys like Manicsleep who claim to supervise psychologists and dictate testing choices (only ones he can administer and interpret), and it makes it very easy to say if expertise is minimally necessary or even not necessary for physicians to claim dominion over our stuff, we can get more training (RxP) and prescribe just as ineffectively as these other specialties (nurses, physicians, optometrists). Personally, I see all of these things (physicians using computer programs for cognitive testing and interpreting with no background to do so, nurses prescribing and doing therapy [what the hell? Aren't they supposed to, you know, be nurses?]) as a dumbing down of healthcare. This benefits business people and hurts patients in my opinion.

So true

I know interpreting psychological tests is limited to licensed psychologists (unless you are a school psychologist and are using tests for educational purposes). Are there legal ramifications if someone without the training interprets these tests for patients? For example, why don't psychologists report these physicians to the AMA or some other governing board for unethical conduct since they are practicing outside their area? Why don't psychologists inform the physicians they are working with that they are unable to use these tests without the training and report this to the hospital they work at? We would lose our licensure in one second if we illegally prescribed medication.

How is the AMA able to successfully block us for so many years for R X P privilleges? I don't get how nurses can do therapy at all? Why doesn't the apa sue the hospitals or block them from getting these privilliges? It would be interesting to consult with lawyers on this. Maybe its time for psychologists to start taking legal action since other means have not been effective (e.g. we have tried differtiating ourselves and limiting testing to a licensed psychologist)?

 

[Therapist4Chnge]

First of all, what physicians have you seen that actually give and interpret psychological tests beyond screeners or symptom inventories? I don't really think that psychiatrists are trying to encroach on testing at all. No one would refer a patient to a psychiatrist for a neuropsyc battery and they wouldn't know how to give it to begin with (and I highly doubt the vast majority of them would try).

Neurologists & psychiatrists. I have seen both speciality areas take stabs at interpreting neuropsych data, with some pretty scary results. Neurologists are trying to use computer programs to get the data and canned interpretations. Anyone who is properly trained understands why this cannot work. Psychiatrists will often administer some random neuropsych assessments and try and interpret the data. This is especially problematic in the forensic arena.

I don't include my raw data in any of my reports because I do not trust non-neuropsych clinicians with it. Go read some of Manicsleep's malignant posts in the psychiatry forum about neuropsychology, and you'll see why psychiatrists shouldn't be involved in this area.

ps. I do appreciate nitemagi's approach to these discussions, as some of the other regular posters on this topic choose to type from the gutters and do not attempt to have a reasonable discussion.

 

[roubs]

It baffles me that people without medical training think that prescribing medications is a "right" that they deserve.

This statement doesn't make sense to me. Rights are defined by the law, so the proposal is to change the law to both give the right to prescribe medicine AND require medical training to do so. So we would no longer be "people without medical training". That being said I agree with Ollie's above points about the difficulty in implementing it or doing so in a substandard way.

 

[deleted106747]

Neurologists & psychiatrists. I have seen both speciality areas take stabs at interpreting neuropsych data, with some pretty scary results. Neurologists are trying to use computer programs to get the data and canned interpretations. Anyone who is properly trained understands why this cannot work. Psychiatrists will often administer some random neuropsych assessments and try and interpret the data. This is especially problematic in the forensic arena.

I don't include my raw data in any of my reports because I do not trust non-neuropsych clinicians with it. Go read some of Manicsleep's malignant posts in the psychiatry forum about neuropsychology, and you'll see why psychiatrists shouldn't be involved in this area.

ps. I do appreciate nitemagi's approach to these discussions, as some of the other regular posters on this topic choose to type from the gutters and do not attempt to have a reasonable discussion.

I have unfortunately also seen this happen fairly regularly.

So the turf wars essentially boil down to everyone wanting a larger piece of the mental health treatment pie, with a good deal of mid-level providers taking over (nurses and social workers, for both med management and psychotherapy). I talked with a psychiatrist at one hospital who expressed frustration that he used to be treating a mix of severe psychopathology and less severe, and now he only treats severe because NPs and PAs have taken over the less severe group, and that this is exhausting and lowers his job satisfaction. I think it's an interesting question, would psychologists pursue med management if they didn't feel job opportunities were being destroyed by too many psychology graduates, and social work/nursing; additionally if this didn't drive down the medical culture's respect for psychology.

A few pages earlier, I was pro; I am uncertain where I stand now. I maintain that an NP degree or the equivalent training would create prescribing psychologists who can at least function at the level of a mid-level prescriber with supervision. But whether or not that is something to be pursued is a whole other question, because if we as a field are devaluing psychotherapy as provided by a doctoral level clinician, what can we really expect from the public or the medical world. I also remain uncertain about whether I would even want to prescribe. I went to psychology school for a reason, not med school.

The question I come back to is how to address this with patient need. From my experience there is a great deal of unanswered need, which may be why (I claim no evidence base for this, but I wonder) NPs and PAs have been so important; there simply aren't enough physicans to go around. I myself almost always see an NP or a PA as a medical provider because my health is good and I don't need high-level treatment.

I think we need some research. Big time. On med management efficacy, psychologist efficacy, social worker efficacy, nursing efficacy, psychiatrist effacacy, PCP efficacy... I think what complicates things is the very aspect of our work that is so frequently underscored: the relationship. That kind of muddles, in its own way, the efficacy outcomes. Research states that if a client likes their hairdresser, she or he will stay with that hairdresser, regardless of whether the hair looks any good.

 

[Therapist4Chnge]

A few pages earlier, I was pro; I am uncertain where I stand now. I maintain that an NP degree or the equivalent training would create prescribing psychologists who can at least function at the level of a mid-level prescriber with supervision. But whether or not that is something to be pursued is a whole other question, because if we as a field are devaluing psychotherapy as provided by a doctoral level clinician, what can we really expect from the public or the medical world. I also remain uncertain about whether I would even want to prescribe. I went to psychology school for a reason, not med school.

I compared my RxP training with that of my friend who is an NP, as we both went through the training at the same time. I found that the RxP training for psychologists was more in-depth because we didn't have to spend much time on differential diagnosis, which is something my friend said was one of the hardest things for her because she didn't not have a MH background. It is worth noting that my training was 100% residential and her training was almost exclusively online with the exception of her supervision hours. I personally think the psych RxP training (and NP training) need to beef up their required hours of supervision, and ultimately should require at least consultation.

When I first consider psych RxP 7 years ago I was much more pro-RxP, however now that I have learned more about the history and seen the actual training....I am much more hesitant to support it in its current form. I want to see supportive data, and I want to see more supervision because I just don't trust that all providers will seek out consultation if they aren't required to have it. I definitely agree with the idea that most people don't know what they don't know. I have a much greater respect for what should be known to prescribe.

I'm in academic medicine now, and frankly I don't have much interest in prescribing because my interested have evolved. The knowledge is very helpful on a daily basis, but there is a large difference between consulting about something and being the person to write the script. I don't work much with psychiatric patients (outside of the typical prevelance rates), and the severe cases don't stay on my unit, which is honestly the way I prefer it. Dealing with serious psychiatric pathology is very draining, and I understand why psychiatrists are frustrated that NPs/PAs/Psych RxP are picking off most of the low hanging fruit.

Psych RxP is not going to go away, so I hope that the bar can be raised and data collected to support the existance of it. I think it can have a net benefit effect, and I think clinical psychologists are uniquely positioned to provide that help, I'm just a little shakey on the "how much training is enough?"

 

[deleted106747]

I'm also in fairly good health, but I'd never go to an NP or a PA for medical care.

Speaking personally, I've not yet found a direct relationship between level of provider and level of service. I've gotten good service from NPs and PAs and good service from physicians, and bad from both.

I don't cite this as a reason for psych RxP because as has been repeated here often, anecdotes are not evidence, and I am about the furthest thing from a complicated medical case.

 

[aequitasveritas]

Speaking personally, I've not yet found a direct relationship between level of provider and level of service. I've gotten good service from NPs and PAs and good service from physicians, and bad from both.

how do you know what "good" is?

 

[deleted106747]

how do you know what "good" is?

Detailed clinical interviewing, detailed med management, appropriate bloodwork, timely follow-up, specialist referrals when necessary, clear instructions and advice. Good rapport with the provider, sense that they cared about me, sense that they knew my history well enough to get a good sense of who I am, both physically and mentally. Not overdoing it - not prescribing when not necessary or being pushy with meds. Meds appropriate - e.g. allergist appropriately diagnosed me with exercise induced asthma, got an inhaler and saw a difference in my running speed, longevity and breathing.

I of course can't talk about it from the medical side, can't say if everything they did was comprehensive, but I am physically quite well and am rarely ill. And with all medicine, I carry my side of it by eating well, exercising, going to regular appointments, etc. So I'm "good" too.

 

[2012PhD]

NP's can be "better" in the sense that they spend more time with the patient.

how do you go about finding an NP through your insurance? They are not listed under providers anywhere? Some MD's charge 350 for a 10 minute appt. Such fraud!

 

[cara susanna]

My GP has an NP who practices under him and sometimes they ask me if I want to see the NP instead when I schedule an appointment. That did not go well when I did it and now I always politely decline.

I also had an NP for a while as a specialist when my OBGYN left the practice and I needed my prescriptions. That also did not go well.

Keep in mind though that I have a lot of health problems.