Hawaii looks to allow psychologists to prescribe drugs (HB 1072 bill)

[zihuatanejo]

An associated press release at the following link <https://www.ksl.com/?nid=157&sid=39...ks-to-allow-psychologists-to-prescribe-drugs> indicates that Hawaii might be on the verge of passing a law to allow psychologists to prescribe medications. It looks like the HB 1072 was passed in conference committee in both the House and Senate in Hawaii and is scheduled for a floor vote on Tuesday, May 3rd. You can view the progress of this bill at the following link: www.capitol.hawaii.gov/measure_indiv.aspx?billtype=HB&billnumber=1072&year=2016

What is being done at the state level by the state medical and psychiatric associations to combat this? I'd appreciate it if anyone practicing or training in Hawaii can fill us in on the details of what if anything is being done about this.

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[splik]

btw Iowa has just allowed psychologists to prescribe... this is what has allowed this hawai'i bill go gain momentum. my spies tell me there are opportunities to kill the bill:

The first opportunity is on the House floor. The HPMA-contract lobbyist has indicated that between 26 and 30 members are solid "no" votes on this bill. The House is scheduled to caucus on Monday morning to see if they have enough votes to pass the bill. If the "no" vote count is close to 26, then the Speaker would likely not take it up. The coalition is planning to work through the weekend and on Monday morning, targeting the "no" votes and requesting that they remain steadfast in their position -- despite any political pressure they may feel from the Speaker.

The second opportunity is with Governor Ige.

The HPMA (state psych association) and APA have been actively involved in this. At the very least if it goes ahead it will have significant restrictions (for example islands except Oahu, and only in collaboration with a psychiatrist) As it stands the bill would allows psychologists to prescribe on any island, without a psychiatrist, and including benzos and stimulants (but not opioids including suboxone).

 

[WingedOx]

...see the recently necrobumped Illinois thread down farther in the forum.

 

[Shikima]

Senator Palpatine from Naboo has the strongest voice.

 

[sunlioness]

The best thing to do would be to move to Hawaii to combat their severe shortage of psychiatrists.

I might take one for the team on this one ...


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[Guyton]

Yet another example of Kissick's Iron Triangle of Health Care...

 

[WingedOx]

The best thing to do would be to move to Hawaii to combat their severe shortage of psychiatrists.

I might take one for the team on this one ...


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I had a patient of mine just relocate there (from IL in March). I'm pretty sure that was a bigger help to her mental health than anything I could have prescribed.

 

[PikminOC]

btw Iowa has just allowed psychologists to prescribe... this is what has allowed this hawai'i bill go gain momentum. my spies tell me there are opportunities to kill the bill:

The first opportunity is on the House floor. The HPMA-contract lobbyist has indicated that between 26 and 30 members are solid "no" votes on this bill. The House is scheduled to caucus on Monday morning to see if they have enough votes to pass the bill. If the "no" vote count is close to 26, then the Speaker would likely not take it up. The coalition is planning to work through the weekend and on Monday morning, targeting the "no" votes and requesting that they remain steadfast in their position -- despite any political pressure they may feel from the Speaker.

The second opportunity is with Governor Ige.

The HPMA (state psych association) and APA have been actively involved in this. At the very least if it goes ahead it will have significant restrictions (for example islands except Oahu, and only in collaboration with a psychiatrist) As it stands the bill would allows psychologists to prescribe on any island, without a psychiatrist, and including benzos and stimulants (but not opioids including suboxone).

The illinois bill that passed really pissed off the psychologists. They have to get pa level training and no controlled subs.

The psychologists spend a lot of money on this every year in many states. Tried over 100 times..

 

[PikminOC]

An associated press release at the following link <https://www.ksl.com/?nid=157&sid=39...ks-to-allow-psychologists-to-prescribe-drugs> indicates that Hawaii might be on the verge of passing a law to allow psychologists to prescribe medications. It looks like the HB 1072 was passed in conference committee in both the House and Senate in Hawaii and is scheduled for a floor vote on Tuesday, May 3rd. You can view the progress of this bill at the following link: www.capitol.hawaii.gov/measure_indiv.aspx?billtype=HB&billnumber=1072&year=2016

What is being done at the state level by the state medical and psychiatric associations to combat this? I'd appreciate it if anyone practicing or training in Hawaii can fill us in on the details of what if anything is being done about this.

The state medical and psychiatry associations fight this every time, but it costs a lot to fight. Psychologist and pop up schools pay for lobbyists. Lots of em

 

[Doctor Bagel]

The illinois bill that passed really pissed off the psychologists. They have to get pa level training and no controlled subs.

The psychologists spend a lot of money on this every year in many states. Tried over 100 times..

Do most psychologists actually want this? If you want to prescribe medications, why not just go to medical school (or PA school or NP school)? I agree that psychology seems to be in one of those educational rackets where there are lots of new expensive schools and lots of grads facing fairly low income prospects when accounting for their debt.

Apparently the American Psychological Association thinks it's a good thing. They also were neutral on torture, so I don't know that you can trust those guys. Our APA might have a better record.

http://www.apa.org/news/press/releases/2014/06/prescribe-medications.aspx

 

[splik]

Given that many psychiatrists aren't even interested in treating the mentally ill, I find it hard to believe psychologists are. Most of these diploma mill psychologists eager for the ability to prescribe have never seen an acutely psychiatrically disturbed individual let alone a psychiatric ward or emergency room and probably have no interest in treating psychosis, bipolar disorder (except the made up kind), suicidality, aggression and agitation, sex offenders, violence, severe personality disorders and the like. What then are they good for? A PCP can prescribe antidepressants, benzos, and psychostimulants. Psychologists don't see very many patients anyway, and few psychologists thus far have even availed themselves of the ability to prescribe. Psychologists, much like psychiatrists, tend to cluster in urban areas, so they are not doing anything about the distribution problem, the medicaid problem, or

What we really need more of are skilled therapists who can provide fidelity evidence-based psychotherapies like DBT, prolonged exposure, cognitive processing therapy, interpersonal psychotherapy and so on. There is no shortage of psychotropic drugs. I have yet to see any evidence that there is an actual shortage of psychiatrists (as opposed to geographic distribution, accepting insurance, treating mentally ill). What there is is a shortage of viable alternatives for people who do not want to take drugs or whose problems are better approached by non chemical means.

I would be more disposed to the idea of psychologist prescribing if they were only allowed to practice in mental health professional underserved areas. I would also much rather they get reimbursed the same as psychiatrists for providing psychotherapies rather than incentivizing prescribing drugs.

 

[FutureDO08]

.

 

[NontradCA]

Given that many psychiatrists aren't even interested in treating the mentally ill, I find it hard to believe psychologists are.

What?

 

[Doctor Bagel]

What?

I'm thinking splik is using mentally ill in a particular way, primarily meaning people with severe mental illnesses who are the same people who struggle to access care and cause bigger societal problems. Not people dealing with mild depression, anxiety and existential angst, which is what a lot of us do like to deal with (me, too) although I'm currently with the severe mentally ill.

 

[WingedOx]

I'm thinking splik is using mentally ill in a particular way, primarily meaning people with severe mental illnesses who are the same people who struggle to access care and cause bigger societal problems. Not people dealing with mild depression, anxiety and existential angst, which is what a lot of us do like to deal with (me, too) although I'm currently with the severe mentally ill.

Yeah, I've been doing the severe mental illness thing for a long time. I sometimes forget how many psychiatrists out there don't bother or don't have the skills to do the same.

A couple years ago at Tarrytown, I felt like the only person who wasn't using residency as a means to an end of opening up a cash analysis practice.

 

[erg923]

Do most psychologists actually want this? If you want to prescribe medications, why not just go to medical school (or PA school or NP school)? I agree that psychology seems to be in one of those educational rackets where there are lots of new expensive schools and lots of grads facing fairly low income prospects when accounting for their debt.

Apparently the American Psychological Association thinks it's a good thing. They also were neutral on torture, so I don't know that you can trust those guys. Our APA might have a better record.

http://www.apa.org/news/press/releases/2014/06/prescribe-medications.aspx

Most, absolutely not. Not that they vehemently object to the idea, but the vast majority, including myself, have no (and have never had) interest in Rxing.

 

[deleted343839]

Do most psychologists actually want this? If you want to prescribe medications, why not just go to medical school (or PA school or NP school)?

I agree with you. I resigned from my state psychological association when they decided to take up the cause of prescribing privileges. I don't support this in general, obviously. But as more of a practical matter, we have a powerful state medical association that has mostly left us alone in recent years, and now we've poked them with a very big stick. Unlike most psychologists, I work with and among physicians every day and I'd rather unite behind upholding doctoral-level training standards for both of our professions.

Apparently the American Psychological Association thinks it's a good thing. They also were neutral on torture, so I don't know that you can trust those guys.

That's kind of a cheap shot, but I acknowledge your point that the "anything to get a foothold" mentality has warped APA's leadership on some issues. The difference is that the Hoffman report described mostly closed-door events and dealings that were shocking and demoralizing to most psychologists. The RxP issue is controversial, but inherent in the composition of the two "sides" is a lot of what I think is wrong with the profession.

 

[deleted343839]

What we really need more of are skilled therapists who can provide fidelity evidence-based psychotherapies like DBT, prolonged exposure, cognitive processing therapy, interpersonal psychotherapy and so on. There is no shortage of psychotropic drugs.

This. I wonder what the professional shortage would look like if we narrowed psychologists to those who were well trained and committed to provide evidence-based psychotherapies. But I suppose "therapy is therapy" in the minds of some - probably the same who think that a midlevel is just as competent in psychopharmacology as a board-certified psychiatrist.

 

[sunlioness]

I don't know a single psychologist who wants this. But I guess they must be out there.


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[WingedOx]

Most, absolutely not. Not that they vehemently object to the idea, but the vast majority, including myself, have no (and have never had) interest in Rxing.

After a day of xanax cleanup in multiple patients, I'd be happy to not have to prescribe anything...

 

[sunlioness]

I just did a prior auth to change adderall 10mg TID to adderall 15mg bid. True story.

If a psychologist wants to do that, let them.


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[MLT2MT2DO]

After a day of xanax cleanup in multiple patients, I'd be happy to not have to prescribe anything...

My gut instinct says, if anything, this'll give you more "cleanup" duties.

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[Extralong]

I do have a few questions. Can they be sued for malpractice? Has that happened? Do they have to register under any system? How does the general public file a complaint about a psychologist that is prescribing medication?

 

[WingedOx]

My gut instinct says, if anything, this'll give you more "cleanup" duties.

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Let it be someone else's problem.

Yeah, that'll be the grand bargain. Psychologists can prescribe all they want, but then I'm absolved of all prescribing responsibility (and I get to bill E&M rates to do therapy all day)

 

[deleted343839]

I do have a few questions. Can they be sued for malpractice? Has that happened? Do they have to register under any system? How does the general public file a complaint about a psychologist that is prescribing medication?

Yes, we can be sued for malpractice. To my knowledge this hasn't happened over a prescribing issue, but I haven't researched it exhaustively. Patients can file complaints through the state licensing board, similar to the mechanism that medical boards have. I'm not sure whether anyone has looked into board complaints in Louisiana or New Mexico. Limited information on board disciplinary actions is publicly available though I do not know whether it's sufficient to trace to prescribing issues.

 

[splik]

It would very unlikely that a prescribing psychologist would be sued for a prescribing issue (as opposed to say sexual boundary violation or patient suicide). Given that psychologists see far fewer patients than the average psychiatrist or NP, they spend more time, see them more often, know them better, tend to treat people with less severe mental health problems (all of which reduce the risk of a malpractice suit) I wouldn't expect it to be too much of an issue. Also psychologists cannot use E&M codes, and the psychologist prescribing CPT code is worth 0 RVUs (because the AMA assigns RVUs to CPT codes) so it is up to the state medicaid programs and private insurance companies to decide whether to cover it and how much to pay. In short, it probably isn't the road to riches they thought it might be which is probably another reason there are so few RxPs even in the states that have had this for many years. Most psychologists are not going to be prescribing clozaril, MAOIs etc (probably prescribe very little in the way of neuroleptics at all). I'm not sure that medicare covers psychologist prescribing (techically it shouldn't but medicare has been known to pay for prescriptions issued by people who don't have any prescription privileges at all - like massage therapists in the past).

Typically they will be receiving supervision from a physician, and it would be the supervising physician who would feel the full force of any malpractice suit. as is the case in most malpractice suits you go after the organ grinder, not the monkey.

 

[deleted343839]

I quickly skimmed the disciplinary actions posted on the LA & NM psychology board sites. I didn't see any that were obviously linked to prescribing. Looked like the usual suspects - inappropriate relationships, billing fraud, midlevel practice issues, malpractice in forensic cases, etc.

 

[nitemagi]

It would very unlikely that a prescribing psychologist would be sued for a prescribing issue (as opposed to say sexual boundary violation or patient suicide). Given that psychologists see far fewer patients than the average psychiatrist or NP, they spend more time, see them more often, know them better, tend to treat people with less severe mental health problems (all of which reduce the risk of a malpractice suit) I wouldn't expect it to be too much of an issue. Also psychologists cannot use E&M codes, and the psychologist prescribing CPT code is worth 0 RVUs (because the AMA assigns RVUs to CPT codes) so it is up to the state medicaid programs and private insurance companies to decide whether to cover it and how much to pay. In short, it probably isn't the road to riches they thought it might be which is probably another reason there are so few RxPs even in the states that have had this for many years. Most psychologists are not going to be prescribing clozaril, MAOIs etc (probably prescribe very little in the way of neuroleptics at all). I'm not sure that medicare covers psychologist prescribing (techically it shouldn't but medicare has been known to pay for prescriptions issued by people who don't have any prescription privileges at all - like massage therapists in the past).

Typically they will be receiving supervision from a physician, and it would be the supervising physician who would feel the full force of any malpractice suit. as is the case in most malpractice suits you go after the organ grinder, not the monkey.

There's a long sticky in the psychologists forum which I've ranted on plenty on this topic. Generally there's not just lack of transparency, but lack of follow-up, and most importantly the nature of the relationship is what prevents both complaints and being sued. The best protection against being sued is having a strong relationship. So honestly a psychologist (or psychiatrist) could make terrible medical errors and still not get sued if the patient feels some kind of a connection to them. Furthermore the general population doesn't really know what to look for in terms of medical errors with psychotropics, and so don't really know when someone's screwing up vs. just a failed med trial.

 

[birchswing]

My gut instinct says, if anything, this'll give you more "cleanup" duties.

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AFAIK, psychologists in states with prescribing rights can't prescribe controlled substances.

 

[WingedOx]

Wouldn't stop them from loading up on unnecessary abilify and seroquel Rx's

AFAIK, psychologists in states with prescribing rights can't prescribe controlled substances.

 

[birchswing]

Wouldn't stop them from loading up on unnecessary abilify and seroquel Rx's

Possibly (I'm not sure why a psychologist would be more likely to do that than anyone else) . . . but while those neuroleptics have their risks (hyperglycemia, hyperlipidemia, TdP, tardive dyskinesia), there isn't really a "mess" to clean up that is comparable to benzos in that you can safely stop them relatively quickly without physical dependence.

 

[Roy3333]

Possibly (I'm not sure why a psychologist would be more likely to do that than anyone else) . . . but while those neuroleptics have their risks (hyperglycemia, hyperlipidemia, TdP, tardive dyskinesia), there isn't really a "mess" to clean up that is comparable to benzos in that you can safely stop them relatively quickly without physical dependence.

But not emotional dependence...

 

[Doctor Bagel]

That's kind of a cheap shot, but I acknowledge your point that the "anything to get a foothold" mentality has warped APA's leadership on some issues. The difference is that the Hoffman report described mostly closed-door events and dealings that were shocking and demoralizing to most psychologists. The RxP issue is controversial, but inherent in the composition of the two "sides" is a lot of what I think is wrong with the profession.

I don't know that it's a cheap shot. American Psychological Association leadership has a lot of issues just based on the torture issue. It's a huge thing. At least the American Psychiatric Association stood firm on that.

http://www.theguardian.com/us-news/2015/jul/14/apa-senior-officials-torture-report-cia

http://www.huffingtonpost.com/david-moshman/torture-psychology-and-th_b_7962826.html

 

[waldenwoods]

Typically they will be receiving supervision from a physician, and it would be the supervising physician who would feel the full force of any malpractice suit.

I suppose this would be in the context of a psychologist prescribing medications without direct supervision of the case prior to the medication being prescribed. I can't imagine wanting to take a job where liability for someone else's prescribing practices would be my responsibility. Has anyone been involved in a similar situation?

 

[deleted343839]

This was posted early this morning on an APA division listserv that I belong to. I can't vouch for the accuracy of all the information (I think there actually have been more surveys than this person suggests) but it validates some concerns:

"
Colleagues who value the evidence-based and safe treatment of our patients over efforts to enhance financial and political opportunities will be pleased to learn of a legislative victory.

Yesterday the Hawaii House of Representatives effectively rejected a bill to let psychologists practice psychiatric medicine based on training that is extraordinarily poor both in quantity and quality. The entire educational component of this training, which would cover everything from the undergraduate-level basics of biology, chemistry and physiology up to the most advanced forms of treating all persons of all ages with all forms of medical and mental illness who are also taking all forms of other medications, would have been 400-450 contact hours, or the equivalent of 8.8-10 semester courses. This education would take place online with open-book tests. Other details of this and similar bills are equally disturbing.

Even though the campaign to obtain such prescribing rights is 21 years old, there has been only one survey of psychologists' opinions of such details of these proposals. This 2014 survey, by the Association for Behavioral and Cognitive Therapies, found that the great majority of psychologists - up to 89 percent on some aspects - oppose details of these proposals.

Proponents have been encouraged that practicing psychiatric medicine in this manner will assure their financial futures. No empirical evidence exists that it is safe or effective. Such bills are submitted to legislatures around the country in a campaign coordinated and financially supported by the American Psychological Association and its political subsidiary organizations.

It has been discovered that persons granted this authority, in two states more than a decade ago based on the above-noted training standard, are commonly and grossly overstepping reasonable bounds of practice and are prescribing medications for cardiovascular and endocrine disorders. Lawsuits have been filed against some with this authority.

Psychologists are organized in actively opposing these bills for ethical and empirical reasons. Anyone interested in becoming more familiar with these efforts is welcome to contact [REDACTED]."

 

[Doctor Bagel]

I suppose this would be in the context of a psychologist prescribing medications without direct supervision of the case prior to the medication being prescribed. I can't imagine wanting to take a job where liability for someone else's prescribing practices would be my responsibility. Has anyone been involved in a similar situation?

I suspect this would come up if you were the medical director for a community mental health organization or something like that.

 

[calvnandhobbs68]

This was posted early this morning on an APA division listserv that I belong to. I can't vouch for the accuracy of all the information (I think there actually have been more surveys than this person suggests) but it validates some concerns:

"
Colleagues who value the evidence-based and safe treatment of our patients over efforts to enhance financial and political opportunities will be pleased to learn of a legislative victory.

Yesterday the Hawaii House of Representatives effectively rejected a bill to let psychologists practice psychiatric medicine based on training that is extraordinarily poor both in quantity and quality. The entire educational component of this training, which would cover everything from the undergraduate-level basics of biology, chemistry and physiology up to the most advanced forms of treating all persons of all ages with all forms of medical and mental illness who are also taking all forms of other medications, would have been 400-450 contact hours, or the equivalent of 8.8-10 semester courses. This education would take place online with open-book tests. Other details of this and similar bills are equally disturbing.

Even though the campaign to obtain such prescribing rights is 21 years old, there has been only one survey of psychologists' opinions of such details of these proposals. This 2014 survey, by the Association for Behavioral and Cognitive Therapies, found that the great majority of psychologists - up to 89 percent on some aspects - oppose details of these proposals.

Proponents have been encouraged that practicing psychiatric medicine in this manner will assure their financial futures. No empirical evidence exists that it is safe or effective. Such bills are submitted to legislatures around the country in a campaign coordinated and financially supported by the American Psychological Association and its political subsidiary organizations.

It has been discovered that persons granted this authority, in two states more than a decade ago based on the above-noted training standard, are commonly and grossly overstepping reasonable bounds of practice and are prescribing medications for cardiovascular and endocrine disorders. Lawsuits have been filed against some with this authority.

Psychologists are organized in actively opposing these bills for ethical and empirical reasons. Anyone interested in becoming more familiar with these efforts is welcome to contact [REDACTED]."

Impressive self reflection and insight compared to other professional groups that come to mind (**cough** NPs **cough**). Imagine, a group of professionals realizing that they should have equivalent training requirements if they're going to have prescribing responsibilities.

 

[smalltownpsych]

The only reason I would want to be able to prescribe is because I could do better than the NPs in our community. In my mind it just wouldn't be worth it though to deal with low functioning non-mentally ill patients who have been told that a pill will help them. Not to mention the higher functioning medication seeking types of individuals. The NP sees people with Bordeline PD all day long, you know the type, "I have really bad Bipolar." Every so often one comes into my office and using interventions that have been demonstrated efficacious, they can actually improve. Even providing supportive psychotherapy for the low-functioning non-mentally ill is surprisingly helpful. Definitely more so than prescription for med that will decrease their already limited cognitive capacity.

 

[deleted343839]

Imagine, a group of professionals realizing that they should have equivalent training requirements if they're going to have prescribing responsibilities.

To be clear, there has always been a large group of psychologists who needed no convincing of this. Frankly, it's easy to dismiss some of the RxP advocates when you hear what comes out of their mouths. But my hope is that more like-minded professionals will embrace advocacy as an alternative to resignation or apathy.

 

[vistaril]

I think whether or not psychologists get prescribing rights or not is a relatively minor issue(although if it became more widespread that would definately hurt us. The psych nps are the much much bigger threat, and I think we are seeing some of the early effects of that now. And the numbers there are only starting to grow, so I anticipate 5+ years from now their impact will be even more obvious.
I think our field is not moving in a good direction from a future financial standpoint.

 

[smalltownpsych]

I prefer being a good psychologist than to be an inferior pseudo-psychiatrist. If I really wanted to be a psychiatrist, I could always go to med school although I'd have to change my tag to old psych doc by then.

 

[PikminOC]

I've fielded 11 calls today, all from practitioners, who are essentially seeing the IL RxP bill as a 'total loss' to the national RxP objectives; indentured servanthood; and ultimately a 'political decision', for 'Beth', but a lhuge oss for practice and a massive step backwards.

Not sure if you are willing, but it may be useful to have your points thrown out in the list serve as counter punches...

I'm personally chewing on your optimism.. as I personally feel extremely disillusioned with what I perceive was given up for what we got....

I'm not discussing my opinion openly with anyone... outside you... but with so much traffic, I think your voice might be received on the list.
....
When illinois bill passed, this is what list serve psychological association thought

 

[PikminOC]

Yeah, I've been doing the severe mental illness thing for a long time. I sometimes forget how many psychiatrists out there don't bother or don't have the skills to do the same.

A couple years ago at Tarrytown, I felt like the only person who wasn't using residency as a means to an end of opening up a cash analysis practice.

You are making a lot of assumptions and are extremely judgmental.

 

[PikminOC]

It would very unlikely that a prescribing psychologist would be sued for a prescribing issue (as opposed to say sexual boundary violation or patient suicide). Given that psychologists see far fewer patients than the average psychiatrist or NP, they spend more time, see them more often, know them better, tend to treat people with less severe mental health problems (all of which reduce the risk of a malpractice suit) I wouldn't expect it to be too much of an issue. Also psychologists cannot use E&M codes, and the psychologist prescribing CPT code is worth 0 RVUs (because the AMA assigns RVUs to CPT codes) so it is up to the state medicaid programs and private insurance companies to decide whether to cover it and how much to pay. In short, it probably isn't the road to riches they thought it might be which is probably another reason there are so few RxPs even in the states that have had this for many years. Most psychologists are not going to be prescribing clozaril, MAOIs etc (probably prescribe very little in the way of neuroleptics at all). I'm not sure that medicare covers psychologist prescribing (techically it shouldn't but medicare has been known to pay for prescriptions issued by people who don't have any prescription privileges at all - like massage therapists in the past).

Typically they will be receiving supervision from a physician, and it would be the supervising physician who would feel the full force of any malpractice suit. as is the case in most malpractice suits you go after the organ grinder, not the monkey.

Yes. Deeper pockets

 

[PikminOC]

I quickly skimmed the disciplinary actions posted on the LA & NM psychology board sites. I didn't see any that were obviously linked to prescribing. Looked like the usual suspects - inappropriate relationships, billing fraud, midlevel practice issues, malpractice in forensic cases, etc.

They've also been very protected in the places they work. Dod, etc

 

[notdeadyet]

A couple years ago at Tarrytown, I felt like the only person who wasn't using residency as a means to an end of opening up a cash analysis practice.

By "a couple of years ago," do you mean 25? Are NY folks still flooding the psychoanalytic institutes? Because that train left the station out my way decades ago.

 

[deleted343839]

They've also been very protected in the places they work. Dod, etc

The DoD demonstration project was a long time ago. It was over (and DoD ultimately abandoned the model) before the laws in NM & LA were on the books. To my knowledge no one has systematically tracked the outcomes of the private practice psychologists who obtained prescribing privileges in those states. That's the greater concern to me, because integrated health systems like that of the DoD aren't generalizable to the private practice world, yet the results from the DoD project are still upheld as justification for the RxP proposals.

 

[WingedOx]

By "a couple of years ago," do you mean 25? Are NY folks still flooding the psychoanalytic institutes? Because that train left the station out my way decades ago.

probably not like it ever was, but you saw WAY more people with plans to go into it than you do here in the middle of the country. Not exactly sure who is filling the Chicago institute, but it still exists, so I guess that's something.

in the ~70 residents in my program that overlapped with my training, we had only one make any effort to do analysis, and that person gave it up after a short while to do full time neuropsych. To sit at a table of 10 and have 4 people who were setting up analysis mentors (or whatever you call them) is way more than I'm used to seeing.

 

[PikminOC]

The DoD demonstration project was a long time ago. It was over (and DoD ultimately abandoned the model) before the laws in NM & LA were on the books. To my knowledge no one has systematically tracked the outcomes of the private practice psychologists who obtained prescribing privileges in those states. That's the greater concern to me, because integrated health systems like that of the DoD aren't generalizable to the private practice world, yet the results from the DoD project are still upheld as justification for the RxP proposals.

They still cite dod. Your post from the list serve shows what they are doing. They also don't go to undeserved areas. And once they get to prescribe, they do minimal therapy

 

[Merovinge]

probably not like it ever was, but you saw WAY more people with plans to go into it than you do here in the middle of the country. Not exactly sure who is filling the Chicago institute, but it still exists, so I guess that's something.

in the ~70 residents in my program that overlapped with my training, we had only one make any effort to do analysis, and that person gave it up after a short while to do full time neuropsych. To sit at a table of 10 and have 4 people who were setting up analysis mentors (or whatever you call them) is way more than I'm used to seeing.

The Chicago institute exists based on its length history with the training programs in the city (NW and UIC particularly). By everything I have observed it has heavily fallen out of favor with residents/younger docs and just has a few older attendings, some of which have a fair bit of influence, working to keep it propped up.