HELP! MSPP, FIT, Argosy, Uni of Hartford, Nova

[JeyRo]

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I think it depends on the setting. Psychiatrists - yes (their turf). However, physiatrists and people in some settings where mental health issues aren't the primary concern may welcome input. But that is just it - input. Not decision-making, not "expertise" in the sense that someone has attended medical school and understands the entire human body.

I don't think we are here to debate the merits of prescription privileges, but from the lobbying efforts of the AMA, I think it is clear that most physicians aren't keen on the idea. There is a reason we only have 2 states that allow it after years of time and money spent lobbying. Personally, I don't think it is a good idea, and I work in a subspecialty (neuro) where I understand things on a neurochemical level fairly well.

Now, someone who has not completed their doctorate at all advising a psychciatrist about what medications to give just sounds ridiculous.

Actually, I recall a survey study I read awhile back that looked at attitudes of phyisicans nationwide regarding prescription privileges for psychologists. primary care and family medicine docs were most supportive, nonpsychiatrist physicians and social workers were generally supportive, and psychiatrists were staunchly opposed. I can't find the ref. but the ones I do find (for example, Klusman et al 1998) seem to suggest this is the case.

I'm for it given appropriate training for the psychologist. APA model training is fine with me, with limited-formulary privileges much like NPs. I don't feel the need to get the training myself (however, I would if the VA I work at would consider funding my training!), but I don't have a problem with others getting it. The physician monopoly on prescription privileges is not something that has to be.

 

[AcronymAllergy]

Actually, I recall a survey study I read awhile back that looked at attitudes of phyisicans nationwide regarding prescription privileges for psychologists. primary care and family medicine docs were most supportive, nonpsychiatrist physicians and social workers were generally supportive, and psychiatrists were staunchly opposed. I can't find the ref. but the ones I do find (for example, Klusman et al 1998) seem to suggest this is the case.

I'm for it given appropriate training for the psychologist. APA model training is fine with me, with limited-formulary privileges much like NPs. I don't feel the need to get the training myself (however, I would if the VA I work at would consider funding my training!), but I don't have a problem with others getting it. The physician monopoly on prescription privileges is not something that has to be.

Not speaking to my own opinions on the matter, I believe (although I don't have the data here to support this belief currently) that it was non-psychiatrist physicians who significantly helped in pushing through RxP in Louisiana. I don't know that the laws would've gone through in either of the two RxP states without some notable degree of physician support, although whether that support generalizes to the national level, I've got no clue.

 

[Pragma]

Actually, I recall a survey study I read awhile back that looked at attitudes of phyisicans nationwide regarding prescription privileges for psychologists. primary care and family medicine docs were most supportive, nonpsychiatrist physicians and social workers were generally supportive, and psychiatrists were staunchly opposed. I can't find the ref. but the ones I do find (for example, Klusman et al 1998) seem to suggest this is the case.

I'm for it given appropriate training for the psychologist. APA model training is fine with me, with limited-formulary privileges much like NPs. I don't feel the need to get the training myself (however, I would if the VA I work at would consider funding my training!), but I don't have a problem with others getting it. The physician monopoly on prescription privileges is not something that has to be.

I don't have a problem with it improving access to care or improving care efficiency. The idea is practicla in that sense. It is my personal opinion that this goes beyond the focus of a psychologist's fundamental training. Taking some extra coursework isn't sufficient, IMO. I recognize that not everyone shares that opinion, but there are many people that do. Agree to disagree.

 

[erg923]

Taking some extra coursework isn't sufficient, IMO.

Who said it is?

And where can you prescribe independently after coursework only?

 

[NotTheHoff]

Who said it is?

Maybe the psychiatrist consulting 4410 on psychopharmacology? 😉

 

[JeyRo]

Who said it is?

And where can you prescribe independently after coursework only?

Hate to be pointing out the obvious, but the APA model training isn't just "coursework only."

 

[JeyRo]

Maybe the psychiatrist consulting 4410 on psychopharmacology? 😉

4410's little aside on drug testing made me cringe.

 

[erg923]

Hate to be pointing out the obvious, but the APA model training isn't just "coursework only."

Kinda steppin on my point there, JeyRo. 😉

 

[Pragma]

Who said it is?

And where can you prescribe independently after coursework only?

http://www.apa.org/education/grad/psychopharm-training.pdf

No offense, but 300 course hours and a brief practicum (100 patients) does not seem like enough training to me to allow someone to prescribe medications independently.

I recognize some believe differently. This issue is controversial. I have my opinion about it. While it may be an unpopular opinion around here, I don't really care. Most of the psychologists I know face to face share similar viewpoints, although I've occasionally met some who are for RxP.

 

[erg923]

Hmm. Of all the psychologist I meet, npsychs tend to favor it the most, it seems. Thts doesnt suprise me either.

 

[Pragma]

Hmm. Of all the psychologist I meet, npsychs tend to favor it the most, it seems. Thts doesnt suprise me either.

I'm of the mind that you stick to your specialty. If I were interested in prescribing medications, I would have gone to medical school.

The RxP folks may have many reasons for wanting to prescribe. Some may feel competent (and I don't doubt some are...but I don't think that will be systematically true with limited additional education/training), some may want to have a more holistic practice, or some may just have a bad case of physician envy. That is prevalent among neuropsych folks, and it is really obnoxious. (Physician envy in the sense that they want as much decision-making power because they think they know as much or more, or feel that they are looked down upon).

You brought up narcissim earlier. It happens. I much prefer to work as a team than on my own.

Edit: The other obvious reason is that it is financially lucrative.

 

[AcronymAllergy]

Hmm. Of all the psychologist I meet, npsychs tend to favor it the most, it seems. Thts doesnt suprise me either.

Most of the npsychs I know seem to be less-interested overall (relatively speaking) in the whole RxP debate, or at least in pursuing certification. Might have to do with being more assessment- than treatment-focused, perhaps? Dunno. Obviously my experience doesn't generalize much outside of where I am/have trained, though.

Of the prescribers, or at least those eligible to prescribe, that I know, one is a neuropsychologist and the rest are not. Then again, there are more non-neuropsychologist than neuropsychologist providers out there to begin with.

 

[erg923]

I'm of the mind that you stick to your specialty.

But specialties change...

Clinical psychology isnt the same today as it was 50 years ago. There are more specialities within it. You dont think we have expanded our scope of practice? Every single person who who is practicing today who got their ph.d before 1970 has probably extended way beyond what they thought a psychologist was (or was supposed to be limited to) when they came out of grad school.

 

[Pragma]

But specialties change...

Clinical psychology isnt the same today as it was 50 years ago. There are more specialities within it. You dont think we have expanded our scope of practice? Every single person who who is practicing today who got their ph.d before 1970 has probably extended way beyond what they thought a psychologist was (or was supposed to be limited to) when they came out of grad school.

It works both ways. Generally, specializing means limiting your scope of practice to a specialty. Why else would you have to spend 2 years doing full time neuropsychological assessments in order to be board-eligible? Certainly not to be a better therapist or prescribe medication. It is to get really really good at doing a specific thing, and building a strong knowledge base around that specific thing.

I feel quite competent about neuropsychology and what I contribute to the interdisciplinary health care teams I am a part of. Prescribing medication has nothing to do with my training, and I wouldn't see it as an appropriate next step. I talk with patient's about medications and talk with psychiatrists to get answers sometimes. Works pretty well.

 

[JeyRo]

Kinda steppin on my point there, JeyRo. 😉

I'm never subtle. Gets me in trouble sometimes.

 

[erg923]

It works both ways. Generally, specializing means limiting your scope of practice to a specialty. Why else would you have to spend 2 years doing full time neuropsychological assessments in order to be board-eligible? Certainly not to be a better therapist or prescribe medication. It is to get really really good at doing a specific thing, and building a strong knowledge base around that specific thing.

I feel quite competent about neuropsychology and what I contribute to the interdisciplinary health care teams I am a part of. Prescribing medication has nothing to do with my training, and I wouldn't see it as an appropriate next step. I talk with patient's about medications and talk with psychiatrists to get answers sometimes. Works pretty well.

That great, but didnt really get at my point from my last post. You dont actually think you will doing the same kind of neuropsychology in 50 years do you? Dont you think the healthcare system, science, and the subspecialty of neuropsych is gonna change by then.

 

[Pragma]

That great, but didnt really get at my point from my last post. You dont actually think you will doing the same kind of neuropsychology in 50 years do you? Dont you think the healthcare system, science, and the subspeciaty of neuropsych is gonna change by then.

Sure, but I hope to God that we don't start writing scripts.

 

[erg923]

Sure, but I hope to God that we don't start writing scripts.

I would actually really hope npsych becomes more treatment focused in the future (doesn't necessarily mean Rx writing though), as many have argued that its focus on being diagnosticians only is quite limiting for the profession.

 

[Pragma]

I would actually really hope npsych becomes more treatment focused in the future (doesn't necessarily mean Rx writing though), as many have argued that its focus on being diagnosticians only is quite limiting for the profession.

I think the good ones are, or at least make strong recommendations. We have a unique vantage point and a significant amount of time with patients. Some intervention starts with us.

 

[Therapist4Chnge]

I would actually really hope npsych becomes more treatment focused in the future (doesn't necessarily mean Rx writing though), as many have argued that its focus on being diagnosticians only is quite limiting for the profession.

It's called rehabiliation psychology. 😉 I consider myself a neuropsychologist who happens to work in a rehab setting.

 

[Pragma]

It's called rehabiliation psychology. 😉 I consider myself a neuropsychologist who happens to work in a rehab setting.

That's the rub though - do you take a rehab postdoc and risk your board-eligiblity? The "specializing" and constant rebranding of what psychologists do is going to have to slow down at some point. I loved working on rehab earlier in my training, but neuropsychs I talk to scoff at it. It is a fantastic place for neuro skills to be applied.

But they want you to pick a narrow way of working and be loyal to your specialty. I have a problem with that. I also don't see why I need to do another year of training than a rehab postdoc in order to be competent as a practitioner.

 

[Therapist4Chnge]

That's the rub though - do you take a rehab postdoc and risk your board-eligiblity?

That was a *really* tricky thing to navigate when I was narrowing down my fellowship choices. I only considered fellowships that offered solid training in both neuropsych and rehab psych. I found about 6-7 programs that could meet both sets of board requirements: Hopkins, Michigan, Baylor, etc. The rub was that no matter which fellowship I chose, I would still need some additional mentorship and training to really feel confident with my training and board elligibility requirements. I was lucky in that I had amazing mentorship during my intern year and I spent most of my time doing neuro evals and related evals (capacity, medicolegal, etc), so that helped with some of the required areas of competency outlined in the Houston Guidelines. My plan is to pursue both boards. I've talked with ABPP, Div 40, and Div 22 throughout my training to ensure I will meet their requirements. It is definitely not the easiest way to do things, but I love my niche.

 

[niknok]

I'm of the mind that you stick to your specialty. If I were interested in prescribing medications, I would have gone to medical school.

The RxP folks may have many reasons for wanting to prescribe. Some may feel competent (and I don't doubt some are...but I don't think that will be systematically true with limited additional education/training), some may want to have a more holistic practice, or some may just have a bad case of physician envy. That is prevalent among neuropsych folks, and it is really obnoxious. (Physician envy in the sense that they want as much decision-making power because they think they know as much or more, or feel that they are looked down upon).

You brought up narcissim earlier. It happens. I much prefer to work as a team than on my own.

Edit: The other obvious reason is that it is financially lucrative.

One of the arguments for RxP is access to psychiatrist. There are places (rural) that there might not be enough psychiatrist to provide medication management and PCP are less familiar with psychotropics than psychologists.

With the that said, there's just too much liability involved in RxP and at least for me the risks are greater than the advantages.

 

[Ollie123]

Not to turn this into another RxP thread - while its true that access is a problem there is little evidence that RxP for Psychologists is helping alleviate that, and even if it is to some degree it seems a relatively inefficient way of doing so in the grand scheme of things.

I don't have any problems with the profession evolving (and as long-time posters will know - am actually all for pushing in that direction). I seriously question whether RxP is the "right" direction for us to be evolving. Investing of millions of dollars campaigning for things that make us more like any other generic healthcare provider (and arguably makes us into mid-levels) seems far less useful (and sustainable) than finding ways to differentiate ourselves.

 

[JeyRo]

Not to turn this into another RxP thread - while its true that access is a problem there is little evidence that RxP for Psychologists is helping alleviate that, and even if it is to some degree it seems a relatively inefficient way of doing so in the grand scheme of things.

I don't have any problems with the profession evolving (and as long-time posters will know - am actually all for pushing in that direction). I seriously question whether RxP is the "right" direction for us to be evolving. Investing of millions of dollars campaigning for things that make us more like any other generic healthcare provider (and arguably makes us into mid-levels) seems far less useful (and sustainable) than finding ways to differentiate ourselves.

Does advocating for RxP mean that all psychologists will become "generic" as a result? It looks to me like if prescribing psychopharmacology became a specialty practiced in all 50 states then we'd just have another, distinct clinical specialty out there, making clinical psychology more diverse overall and more relevant to more niches - I'm a big advocate of specialization as a way for psychologists to remain relevant in todays market.

I would be surprised if there was a consensus out there that that there is no evidence RxP for psychologists improves access to psychiatric medication, although I confess I haven't looked into the issue.

 

[psychguy819]

Now I'm curious to know what changed your mind lol

lol A current student of Hartford's program PMed me and told me about his/her bad experiences at the program. I would give you more details, but I'm afraid it may identify him/her since (s)he seems to have a pretty specific case.

 

[AcronymAllergy]

Does advocating for RxP mean that all psychologists will become "generic" as a result? It looks to me like if prescribing psychopharmacology became a specialty practiced in all 50 states then we'd just have another, distinct clinical specialty out there, making clinical psychology more diverse overall and more relevant to more niches - I'm a big advocate of specialization as a way for psychologists to remain relevant in todays market.

I would be surprised if there was a consensus out there that that there is no evidence RxP for psychologists improves access to psychiatric medication, although I confess I haven't looked into the issue.

I don't know if any in-depth and/or large-scale studies have been done, but I know other posters (primarily psychiatrists, I believe) have mentioned that data indicate most prescribing psychologists don't work in these underserved areas. No clue about the veracity of that, though.

Of the prescribers I know personally, two or three work in underserved populations and/or areas (e.g., rural and/or low-SES urban, community mental health), while two or three conversely work primarily in private practices in medium-sized cities serving (likely) predominantly middle to upper-middle class patients.

 

[Ollie123]

Not certain what the overall effects on the view of the profession would be. For me its just a matter of resources...there has been a truly shocking amount of resources dedicated to RxP. I'm not sure I see that much advantage to having it all under "one" board rather than simply encouraging people to pursue dual-training as psychology-NPs (maybe creating some combined programs would be both easier and cheaper)?

With infinite time and money...sure, we should pursue this. Given we've had a miserable success rate given how long we've been working at this, I think there are much more effective ways to be focusing our efforts.