How Will Psychologists Practicing Medicine Affect Psychiatry?

[PublicHealth]

http://pn.psychiatryonline.org/cgi/content/full/41/9/3

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[Anasazi23]

 

[Solideliquid]

http://pn.psychiatryonline.org/cgi/content/full/41/9/1

 

[PublicHealth]

That's awesome! Send it to Sharfstein.

http://www.cchr.org/index.cfm/7110

 

[Doc Samson]

I think I've figured out psychology's plan to obtain prescribing privs in all states. They're going to keep bringing the issue up over and over again, to as many psychiatrists as they can, hoping to provoke psychosis and possibly suicide, clearing their path to world domination.

 

[PublicHealth]

I think I've figured out psychology's plan to obtain prescribing privs in all states. They're going to keep bringing the issue up over and over again, to as many psychiatrists as they can, hoping to provoke psychosis and possibly suicide, clearing their path to world domination.

Hmm...

 

[PublicHealth]

I think I've figured out psychology's plan to obtain prescribing privs in all states. They're going to keep bringing the issue up over and over again, to as many psychiatrists as they can, hoping to provoke psychosis and possibly suicide, clearing their path to world domination.

Nah, psychiatrists would dope themselves up with antipsychotics before that happened.

Not to worry, I doubt that Sharfstein (or any other psychiatrist for that matter) has a knife to his wrist.

 

[50960]

Super hero Sampson, we could rule the psych-ish world if we only put our heads together. What is your favorite "sample".....no not you favorite rep.....we all know who "they" are. I vote for "ambien cr"............shhhh I am sleepy

 

[Anasazi23]

I think the title of the article is a misnomer. One who prescribes without comprehensive medical knowledge in their forethought is not practicing medicine. Something else - but not practicing medicine. "Prescribing" maybe.

If I hand someone a PAI and get the computerized printout, or perform a few WAIS subtests, I am not "practicing psychology."

 

[PublicHealth]

I think the title of the article is a misnomer. One who prescribes without comprehensive medical knowledge in their forethought is not practicing medicine. Something else - but not practicing medicine. "Prescribing" maybe.

If I hand someone a PAI and get the computerized printout, or perform a few WAIS subtests, I am not "practicing psychology."

"Psychologists practicing medicine" is one of the scary phrases that psychiatry has used to convince legislators to vote against psychologist RxP. I'm curious to know what Sharfstein, as President of the American Psychiatric Association, recommends that psychiatry do to address the access problem. Pointing it out in an editorial is great, but what are we going to do about it? GPs prescribe more than 75% of psychotropics, NPs and PAs have flocked off to more lucrative specialties, psychiatry residency matching rates have leveled off, and MS programs in psychopharmacology are churning out more and more graduates. What will become of this concoction?

 

[Anasazi23]

"Psychologists practicing medicine" is one of the scary phrases that psychiatry has used to convince legislators to vote against psychologist RxP. I'm curious to know what Sharfstein, as President of the American Psychiatric Association, recommends that psychiatry do to address the access problem. Pointing it out in an editorial is great, but what are we going to do about it? GPs prescribe more than 75% of psychotropics, NPs and PAs have flocked off to more lucrative specialties, psychiatry residency matching rates have leveled off, and MS programs in psychopharmacology are churning out more and more graduates. What will become of this concoction?

PH, you're taking in a lot of psychology catchphrase bullcrap and not using your scientific mind. This was surprising to me in the "psychiatry residency spots are on the decline" thread. Trends....not individual data points. Also, the bantering in the psychology forum that someone pointed out to me about all psychiatrists not knowing how to diagnose or deal with cogwheeling or speaking English? These people are incredibly ignorant and *****ic statements like this make me actually feel embarrased for them. They have absolutely no idea what they don't know. You'll see this in residency.

GPs prescribe most heart and vascular medications. I vote to allow stress-test techs to prescribe beta blockers and Ca blockers and ACE inhibitors to allow increased access to care.


This has nothing to do with access, and them using this as a political tool to advance their own agenda - which is to try and salvage a dying field being taken over by masters and bachelors level therapists.

 

[PublicHealth]

Also, the bantering in the psychology forum that someone pointed out to me about all psychiatrists not knowing how to diagnose or deal with cogwheeling or speaking English? These people are incredibly ignorant and *****ic statements like this make me actually feel embarrased for them. They have absolutely no idea what they don't know. You'll see this in residency.

The person you're referring to completed medical school, psychiatric residency, and law school. Further, you cannot generalize psychiatric care in NYC to the rest of the country where lack of access to appropriate psychiatric care is a major public health crisis. Your penchant for material goods -- BMWs and boats -- shows your true concern for the public mental health needs of this country.

 

[PublicHealth]

This has nothing to do with access, and them using this as a political tool to advance their own agenda - which is to try and salvage a dying field being taken over by masters and bachelors level therapists.

The President of the American Psychiatric Association asserts that it's an access problem. I'll take his word for it.

Political tool or not, professions evolve. You cannot tell me that there is nothing wrong with mental healthcare in this country. Someone has to step up and do something about it. Criticizing others' training as sub-par in order to have a political foothold on mental healthcare is not going to solve the problem. As someone pointed on in the psychology forum, psychiatry and psychology should work together to devise a way to ameliorate the situation. Psychiatrists in HI proposed creating some kind of hybrid family physician/psychology training program, but did not get psychologists' input into how such a program should be structured. Why? Because psychiatry wants to run things, they want to be on top. Clearly, political and financial interests are on both sides of this issue.

 

[Anasazi23]

The person you're referring to completed medical school, psychiatric residency, and law school. Further, you cannot generalize psychiatric care in NYC to the rest of the country where lack of access to appropriate psychiatric care is a major public health crisis. Your penchant for material goods -- BMWs and boats -- shows your true concern for the public mental health needs of this country.

Don't even begin to pretend that you understand my intentions on pursuing this field. A joke about a BMW or boat does not a money-hungry grub make. I spend, as you are, a lot of money on my medical education. I feel I deserve compensation for my time and efforts. And, I won't apologize for that.

The person who I'm referring to (it was two people) doesn't even know how long a psychiatry residency is, and clearly has major league "issues" in promoting para medical professionals. He has more posts in optometry, chiropractics, and podiatry than medicine or psychiatry. Odd, isn't it? Frankly, it appears you do to - apparently in the rubric of promoting mental health issues, and looking at propagandist scientologist-esque websites trashing prominent psychiatrists.

I like you PH, but why is it that you swallow every piece of propaganda put forth by psychologists, but everything said by psychiatrists is false, wrong, motivated by money, or incomprehensible because they can't speak English? I speak English pretty damn well.

You're making a lot of comments about the profession of psychiatry before you've even stepped foot in it. It seems that a large portion of your argument base is coming from psychologists' rants. These people don't know psychiatry, and don't even live in the same world as a psychiatrist when it comes to everyday practice. They are not the self-proclaimed "masters of diagnosis" and see a fraction of the patients that a psychiatrist sees in the same time frame. I hate playing this card, but work in the world a little as a physician and see what it's like.

I'm finished trying to convince. If you want to make 60k, play 3rd fiddle on the treatment team, take orders from neurologists and psychiatrists, and sweat every time you write a benzo prescription, and think about fleeing the country if and when you get sued, then go for it.

 

[Solideliquid]

PH hasn't even taken his boards. After you pass USMLE step 1, step 2 CK and CS come back and talk to us.

After you see the hurdles MDs/DOs have to go through to proudly practice medicine in residency and beyond come back and tell me that you still want psychologists to have RxP with a fraction of the time and education investments.

 

[Solideliquid]

PH, you're taking in a lot of psychology catchphrase bullcrap and not using your scientific mind. This was surprising to me in the "psychiatry residency spots are on the decline" thread. Trends....not individual data points. Also, the bantering in the psychology forum that someone pointed out to me about all psychiatrists not knowing how to diagnose or deal with cogwheeling or speaking English? These people are incredibly ignorant and *****ic statements like this make me actually feel embarrased for them. They have absolutely no idea what they don't know. You'll see this in residency.

GPs prescribe most heart and vascular medications. I vote to allow stress-test techs to prescribe beta blockers and Ca blockers and ACE inhibitors to allow increased access to care.


This has nothing to do with access, and them using this as a political tool to advance their own agenda - which is to try and salvage a dying field being taken over by masters and bachelors level therapists.

I love that example!

 

[PublicHealth]

Don't even begin to pretend that you understand my intentions on pursuing this field. A joke about a BMW or boat does not a money-hungry grub make. I spend, as you are, a lot of money on my medical education. I feel I deserve compensation for my time and efforts. And, I won't apologize for that.

The person who I'm referring to (it was two people) doesn't even know how long a psychiatry residency is, and clearly has major league "issues" in promoting para medical professionals. He has more posts in optometry, chiropractics, and podiatry than medicine or psychiatry. Odd, isn't it? Frankly, it appears you do to - apparently in the rubric of promoting mental health issues, and looking at propagandist scientologist-esque websites trashing prominent psychiatrists.

I like you PH, but why is it that you swallow every piece of propaganda put forth by psychologists, but everything said by psychiatrists is false, wrong, motivated by money, or incomprehensible because they can't speak English? I speak English pretty damn well.

You're making a lot of comments about the profession of psychiatry before you've even stepped foot in it. It seems that a large portion of your argument base is coming from psychologists' rants. These people don't know psychiatry, and don't even live in the same world as a psychiatrist when it comes to everyday practice. They are not the self-proclaimed "masters of diagnosis" and see a fraction of the patients that a psychiatrist sees in the same time frame. I hate playing this card, but work in the world a little as a physician and see what it's like.

I'm finished trying to convince. If you want to make 60k, play 3rd fiddle on the treatment team, take orders from neurologists and psychiatrists, and sweat every time you write a benzo prescription, and think about fleeing the country if and when you get sued, then go for it.

I love you too, sazi.

Convince me to do what? Stop caring about how screwed up mental healthcare is in this country? I've stepped plenty a foot in psychiatry. I spent three years after undergrad working in two well-known psychiatry departments and regularly went on rounds in inpatient and outpatient units at two relatively prestigious hospitals in major metropolitan cities. I was not impressed. About half of the residents were FMGs, patients regularly complained about being overmedicated, and the three attendings consistently told me to avoid psychiatry. Much of my criticisms of psychiatry come directly from psychiatrists, psychiatric publications, and my own personal opinion, which apparently I'm not allowed to have if it conflicts with the moderator of this forum. By the way, your rant about "you don't know psychiatry" sounds a lot like our buddy Tom Cruise. You spent two years in residency (one as a medical intern, one as a psychiatry resident) and now you're the expert?

That said, you still did not address my question about the access problem.

 

[Solideliquid]

I love you too, sazi.

Convince me to do what? Stop caring about how screwed up mental healthcare is in this country? I've stepped plenty a foot in psychiatry. I spent three years after undergrad working in two well-known psychiatry departments and regularly went on rounds in inpatient and outpatient units at two relatively prestigious hospitals in major metropolitan cities. I was not impressed. About half of the residents were FMGs, patients regularly complained about being overmedicated, and the three attendings consistently told me to avoid psychiatry. Much of my criticisms of psychiatry come directly from psychiatrists, psychiatric publications, and my own personal opinion, which apparently I'm not allowed to have if it conflicts with the moderator of this forum. By the way, your rant about "you don't know psychiatry" sounds a lot like our buddy Tom Cruise. You spent two years in residency (one as a medical intern, one as a psychiatry resident) and now you're the expert?

That said, you still did not address my question about the access problem.

Publichealth, you're GLIB, you don't even know what ritalin is!

 

[PublicHealth]

Publichealth, you're GLIB, you don't even know what ritalin is!

Try attacking the issues posted in the thread, not the people posting them.

 

[Anasazi23]

I love you too, sazi.

Convince me to do what? Stop caring about how screwed up mental healthcare is in this country? I've stepped plenty a foot in psychiatry. I spent three years after undergrad working in two well-known psychiatry departments and regularly went on rounds in inpatient and outpatient units at two relatively prestigious hospitals in major metropolitan cities. I was not impressed. About half of the residents were FMGs, patients regularly complained about being overmedicated, and the three attendings consistently told me to avoid psychiatry. Much of my criticisms of psychiatry come directly from psychiatrists, psychiatric publications, and my own personal opinion, which apparently I'm not allowed to have if it conflicts with the moderator of this forum. By the way, your rant about "you don't know psychiatry" sounds a lot like our buddy Tom Cruise. You spent two years in residency (one as a medical intern, one as a psychiatry resident) and now you're the expert?

That said, you still did not address my question about the access problem.

Alright, PH, you know that I'd never squelch your opinion because it's different from mine. And I never asked you to stop posting this stuff. I'm not that bad.

Re: your question about access to care
What solution can there be? There are many options, one of which is to reduce the academic rigor of the provider by eliminating the medical school requirement and allow psychologists, many/most of whom have been buried in non clinically relevant research for years, to do this after coursework taught by nurses and other psychologists, and be certified by a test with no established passing grade written by people who have never even done a psychiatry call in their lifetime. This is allowing the fox to be in charge of the henhouse.

Telepsychiatry, continuation of the upward trend in psych applications, medical school recruitment for psychiatry residents (all of which are happening) are other options.

One must consider just how dire this "access to care" problem is. I see psychotic people running around in the streets here in NYC, and we have more psychiatrists per capita than any other city in America. Will adding psychologists to this mix help? No. Access to psychiatrists is short in some areas, but so is access to every other doc. That's the plague of living in a rural area. California has plenty of psychiatrists. Why would they pursue rxp there? You know the answer - and it's not

Studies have shown that psychologists are distributed in the same geographic area as psychiatrists. There is no reason to believe this would change.

FYI, the medical intern year has 6 months of inpatient psychiatry.

Every field criticizes itself. Psychiatry is no exception. It's expected and in some ways, necessary for change and growth. Psychology does too, but nobody chooses to ruminate over those articles because they don't fit with the prescribing agenda.

About patients complaining of over-medication. Was this an inpatient unit? Patients have a funny way of complaining right after they get out of the seclusion room that even though they threw their breakfast on the nurse's aide and were screaming obscenities, that they are now overmedicated. This is something you'll learn in residency. It's not as simple as this.

Look up rapid neuroleptization.

I had no intention of devaluing your contributions and exposure to the field of psychiatry. I felt the same way when I was in psychology grad school, and believed I had a great understanding of the inner workings of psychiatry when I was there. I couldn't have been more wrong.

The grass is not greener. If you don't believe me, try it. Then again, you could have and chose the med school route. You're a smart guy, so I think you already know the ultimate answer.

 

[Triathlon]

I am finishing my third year of medical school. I have had a fair amount of pharmacology and psychopharmacology. I have even studied above and beyond the required curriculum in psychopharmacology. So that is three years of an introduction to basic medicine and pharmacology, including one year of clinical exposure. I would be scared to death to write a prescription right now with out someone overseeing it !!!!
That is probably why we are so against psychologists having the right. I know that there is no way they would get the training I have just had, and mine is no where near giving me the ability to manage medications safely. Sure I have a good idea of when a medication is indicated and which one is commonly used, but there is many a time that I am wrong (hence the years of training still ahead of me). I don't believe we are trying to protect ourselves, our political positions or anything like that. We just know how much knowledge and experience it takes to do this safely.

To those in residency, when do you start to feel confident in your medication management?

 

[PublicHealth]

Re: your question about access to care
What solution can there be? There are many options, one of which is to reduce the academic rigor of the provider by eliminating the medical school requirement and allow psychologists, many/most of whom have been buried in non clinically relevant research for years, to do this after coursework taught by nurses and other psychologists, and be certified by a test with no established passing grade written by people who have never even done a psychiatry call in their lifetime. This is allowing the fox to be in charge of the henhouse.

Telepsychiatry, continuation of the upward trend in psych applications, medical school recruitment for psychiatry residents (all of which are happening) are other options.

One must consider just how dire this "access to care" problem is. I see psychotic people running around in the streets here in NYC, and we have more psychiatrists per capita than any other city in America. Will adding psychologists to this mix help? No. Access to psychiatrists is short in some areas, but so is access to every other doc. That's the plague of living in a rural area. California has plenty of psychiatrists. Why would they pursue rxp there? You know the answer - and it's not

Studies have shown that psychologists are distributed in the same geographic area as psychiatrists. There is no reason to believe this would change.

FYI, the medical intern year has 6 months of inpatient psychiatry.

Every field criticizes itself. Psychiatry is no exception. It's expected and in some ways, necessary for change and growth. Psychology does too, but nobody chooses to ruminate over those articles because they don't fit with the prescribing agenda.

Great post!

Regarding the access issue, I have also heard that psychiatrists are making an effort to offer telepsychiatry services to primary care physicians who are prescribing psychotropics. There is also talk of providing educational programs in psychopharmacology for primary care physicians. But will this be enough to meet the growing need?

The RxP lawsuit in CA is going to be a long, uphill battle. It's a strange strategy that some medical psychologists in LA have adamantly opposed. But if they pass psychologist RxP, other states would likely follow suit. Do I think psychologist prescribing is the ultimate solution to this country's mental health crisis? Of course not. Do I think that having more prescribers in the mental health workforce will increase access to much needed care in some areas? Of course. It's by no means a permanent solution, but it's a way to increase the manpower and begin to address the need. It's a public health matter: If a conservative estimate of 5% of people in some community have a mental illness that is untreated and they can receive the services that they need promptly and safely from a prescribing psychologist, then you've got thousands of people who are receiving the care that they need. Making them wait for months to years to receive adequate treatment is equivalent to leaving those poor folks in New Orleans stranded for weeks without food and water. As Sharfstein pointed out, there will always be a need for psychiatrists, as only a small percentage of psychologists will go on to pursue psychopharmacology training and prescriptive authority. Psychiatrists will always remain the experts at treating complex psychiatric disorders that often present with comorbid medical conditions. But that does not mean that other healthcare providers cannot be trained to treat psychopharmacologically through educational routes other than medical school.

I think that both psychiatry and psychology need a re-examination. It's unfortunate that the issue has been reduced to an expensive legislative battle.

 

[Dreamin]

By the way, your rant about "you don't know psychiatry" sounds a lot like our buddy Tom Cruise. You spent two years in residency (one as a medical intern, one as a psychiatry resident) and now you're the expert?

Can't we all just get along!

Public Health, by the way psychiatrists have a FOUR year residency (6 months internal medicine + 3.5 years psychiatry and yes they are the experts). I also believe psychologists are experts too...just not on the side of medical treatment (ex: prescribing psych drugs to patients...their effect on the body, interaction with other drugs, comorbid medical conditions etc). You seem to keep getting upset about this "money issue." Maybe you should fight a more realistic fight, like higher compensation for psychotherapy, performing psychiatric testing etc.

 

[PublicHealth]

By the way, your rant about "you don't know psychiatry" sounds a lot like our buddy Tom Cruise. You spent two years in residency (one as a medical intern, one as a psychiatry resident) and now you're the expert?

Can't we all just get along!

Public Health, by the way psychiatrists have a FOUR year residency (6 months internal medicine + 3.5 years psychiatry and yes they are the experts). I also believe psychologists are experts too...just not on the side of medical treatment (ex: prescribing psych drugs to patients...their effect on the body, interaction with other drugs, comorbid medical conditions etc). You seem to keep getting upset about this "money issue." Maybe you should fight a more realistic fight, like higher compensation for psychotherapy, performing psychiatric testing etc.

1. I was referring to Anasazi's current position. I am well aware of the length of a psychiatry residency.

2. I am a lowly second-year osteopathic medical student. I considered clinical psychology but opted for medical school instead. Currently considering psychiatry, neurology, and radiology.

 

[deuist]

The person who I'm referring to (it was two people) doesn't even know how long a psychiatry residency is, and clearly has major league "issues" in promoting para medical professionals.

I read that post recently and wondered how someone who claims to be a psychiatrist could botch the explanation so poorly. Also, he made psych grad school out to be longer than it really is.

 

[PublicHealth]

I read that post recently and wondered how someone who claims to be a psychiatrist could botch the explanation so poorly. Also, he made psych grad school out to be longer than it really is.

PM him. He's a nice guy.

 

[Solideliquid]

Try attacking the issues posted in the thread, not the people posting them.

I'm not attacking you. The honest truth is as a recent medical graduate I simply am not informed enough to have an opinion, I am not as arrogant as you. After I complete my intern year I feel I will have enough experience to tackle this issue.

IMO, I don't think it matters how many times you have volunteered or how many rotations I have done. As long as you have never worked in a physician capacity you have no experience in the field. It's like saying an OR nurse who has done 1000 assists on the surgical floor can start talking about the field of surgery like you are doing for the field of psychiatry.

Tone down your arrogance.

 

[Psyclops]

Well PH, the hornets nests have been stirred on both sides of the fences it looks like. Although this is a little more civil than usual. And, what else would we talk about on these boards.

Ana, I have to point out, can't resist, that even if the distribution of ologists and iatrists is the same, with thier being more ologists over all, there are more in rural areas, etc.

The MH system in america has big problems, I think most of you would agree with me on that one, right? Access, lack of parity (otherwise know as disparity), closing of state hospitals, the fact that we don't have an adequate diagnostic system in place, etc. the list goes on. Some of these problems, are compounded by many FMGs entering the field as practitioners, the type of FMGs who although medically trained, presumably adequately, lack the cultural and comunication backgrounds to treat disorders that are often psychosocial in nature. My experience has been that this is the case. And I am not disparaging these MDs, I just think another specialty might be better, like surgery, or radiology.

With all of these problems I think iatrists and ologists should be working together to ameliorate the situation. But I find it difficult to form cooperative partnerships when treated with disdain and condescention.

 

[50960]

Well PH, the hornets nests have been stirred on both sides of the fences it looks like. Although this is a little more civil than usual. And, what else would we talk about on these boards.

Ana, I have to point out, can't resist, that even if the distribution of ologists and iatrists is the same, with thier being more ologists over all, there are more in rural areas, etc.

The MH system in america has big problems, I think most of you would agree with me on that one, right? Access, lack of parity (otherwise know as disparity), closing of state hospitals, the fact that we don't have an adequate diagnostic system in place, etc. the list goes on. Some of these problems, are compounded by many FMGs entering the field as practitioners, the type of FMGs who although medically trained, presumably adequately, lack the cultural and comunication backgrounds to treat disorders that are often psychosocial in nature. My experience has been that this is the case. And I am not disparaging these MDs, I just think another specialty might be better, like surgery, or radiology.

With all of these problems I think iatrists and ologists should be working together to ameliorate the situation. But I find it difficult to form cooperative partnerships when treated with disdain and condescention.

The lesson here is "no zealot like a convert"!!! PH annoys you solideliquid because you can't spell solid, and you attack him instead of his ideas.

 

[Psyclops]

With me being the converted zealot?

 

[50960]

With me being the converted zealot?

Um nO? Are you a convert? I was referring to all the ex-psychology school folks here who are now in medical training...to be psychiatrists. Nothing wrong with that, but I take offense when they attack me/you/us for success in the field when they could not, or chose not to be. I feel the need to protect PH because he is one of a few on both forums who is not dogmatic, and has searched to understand what is REALLY happening rather what each individual wants to believe in order to make them feel OK about their choice of careers........

 

[Psyclops]

Gotcha, I agree with you.

 

[Solideliquid]

The lesson here is "no zealot like a convert"!!! PH annoys you solideliquid because you can't spell solid, and you attack him instead of his ideas.

Weren't you the one who told Poety she can't have an informed opinion about the field of psychiatry because she only just graduated med school?

 

[Solideliquid]

PM him. He's a nice guy.

Not if you happen to be an FMG/IMG. He thinks these guys are the spawn of satan.

 

[Solideliquid]

Not to nitpick, but more than 70% of the attendings at Cabrini Medical Center (where Sazi is completing his residency) are FMGs:

\]

Not to nitpick, but a whoel bunch of those attendings/residents graduated from US medical SCHOOLS. So they are NOT FMGs.

What's your point?

 

[50960]

I did not tell Poety anything, but I did state that she is not the most reliable spokesperson on the field of psychiatry being as she has just graduated medical school....in the psychology forum. So??? That has nothing to do with you attacking PH..

 

[Solideliquid]

I did not tell Poety anything, but I did state that she is not the most reliable spokesperson on the field of psychiatry being as she has just graduated medical school....in the psychology forum. So??? That has nothing to do with you attacking PH..

I didn't attack him, I respect his opinion.

I was reiterating YOUR point. And pointing out a grammatical or spelling mistake is pretty rude. The e is sort of like the i in iPOD. And certain old english texts spell it as such anyways.

 

[Psyclops]

I always thought it was because you were from a French speaking country, and then you got cut off for the last e.

 

[Solideliquid]

I always thought it was because you were from a French speaking country, and then you got cut off for the last e.

Wee wee! Nah I originated a little more east on the map.

 

[Anasazi23]

PH, as has happened to you before, you're way wrong with your inappropriately placed post on the residency attending graduation. The internet is often not a reliable source for fluid information.

Most of the people were adjunct faculty who have teaching appointments. Which, as you might know, are not full-time faculty. I've never heard of 2/3 of those people, and many of them are neurologists. The program chair, psychiatry PD, and 2/3 inpatient attendings, the C/L attending, the outpatient head, and assistant PD are all US born and trained. So you're basically wrong. The person from whom I learn most of my pharmacology is Russian born. I dare you to challenge this person on their knowledge because they are an FMG.

A few of the "FMGs" would school you and any psychologist 6 ways to Sunday on various therapy techniques including psychoanalysis, family therapy, and CBT, and speak better English than I do.

Not trying to be rude. But that was way off.

 

[PublicHealth]

PH, as has happened to you before, you're way wrong with your inappropriately placed post on the residency attending graduation. The internet is often not a reliable source for fluid information.

Most of the people were adjunct faculty who have teaching appointments. Which, as you might know, are not full-time faculty. I've never heard of 2/3 of those people, and many of them are neurologists. The program chair, psychiatry PD, and 2/3 inpatient attendings, the C/L attending, the outpatient head, and assistant PD are all US born and trained. So you're basically wrong. The person from whom I learn most of my pharmacology is Russian born. I dare you to challenge this person on their knowledge because they are an FMG.

A few of the "FMGs" would school you and any psychologist 6 ways to Sunday on various therapy techniques including psychoanalysis, family therapy, and CBT, and speak better English than I do.

Not trying to be rude. But that was way off.

Your taking down the list that showed that more than 70% of the psychiatrists listed on the CABRINI MEDICAL CENTER website are FMGs is analogous to psychiatrists bullying efforts to derail psychologist RxP. If they don't like it, they take it down. And then they resort to personal attacks. The issue on the table is the percentage of FMGs in psychiatry, not my or psychologists' knowledge of psychotherapy! You know well that I've been incredibly well trained in psychopharmacology and psychotherapy in my two years at NYCOM. Puhlease.

Can you post a list of the psychiatry attendings at Cabrini?

 

[Solideliquid]

Why is the percentage of FMGs in psychiatry an issue? 25% of today's physicians are FMGs. In fact I think (although I haven't seen any numbers) that the field with the largest percentage of FMGs is not psychiatry.

It's unfortunate that SOME FMGs in psych have some culture or language barriers but this is not a systemic problem in the field, it is a problem that can be found in ALL fields of medicine.

I think psychologists adding this "issue" to the slew of problems in the field today are running the risk of being seen as racist by the public, this could backfire on you guys in a big way. Better think of a new issue to bring up in the myriad line of excuses for RxP. Why don't you just admit the real primary reason...$?

Afterthought: Oh and speaking of leveling personal attacks, I don't know what could be MORE personal than pointing out someone's ethnicity as a negative.

 

[Solideliquid]

. . . and why don't you just admit the real primary reason you oppose it. . . . .$?

I don't think the minority of ologists going for RxP is going to impact my earnings in a significant way. I think the Gov and taxes are going to do that just fine!

 

[Solideliquid]

ahh. . .so you hate liberals too.

Lets get back to the OP shall we?

Rush is my hero.

 

[Anasazi23]

Your taking down the list that showed that more than 70% of the psychiatrists listed on the CABRINI MEDICAL CENTER website are FMGs is analogous to psychiatrists bullying efforts to derail psychologist RxP. If they don't like it, they take it down. And then they resort to personal attacks. The issue on the table is the percentage of FMGs in psychiatry, not my or psychologists' knowledge of psychotherapy! You know well that I've been incredibly well trained in psychopharmacology and psychotherapy in my two years at NYCOM. Puhlease.

Can you post a list of the psychiatry attendings at Cabrini?

I'll say it again because you didn't get it the first time....many of these don't teach regularly, and some are neurologists, and the majority of the current department isn't on that list - which just happen to be American grads.

What I don't like, and wouldn't do to you, is put personal information regarding my situation on the internet. It's rude.

The issue is NOT the amount of fmg's in psychiatry. That's another issue that psychology uses in warped reasoning as to why they should be able to prescribe. It's a separate issue that's unrelated. Want to not deal with FMGs? Go to Mt. Sinai, which apparently you neglected to post as part of my training where, incidentally, I spend a year of my time.

How are you going to feel when a FMG psychiatrist slams you for not knowing psychopharm?

WHile some fmgs have a language problem, so do other doctors, and so do foreign trained psychologists. I know them, and have met them. Again, no discussion on this - it's not in their agenda.

FMG does not equal piss-poor English speaking. To assume otherwise is just stupid.

 

[PublicHealth]

Clearly, there's a supply problem. Here is Dr. Nyapati Rao's take on it http://www.ncbi.nlm.nih.gov/entrez/..._uids=14754850&query_hl=8&itool=pubmed_docsum

USMGs were trained mainly in medical school programs while IMGs were trained mainly in large nonmedical school programs. By the year 2000, IMGs constituted 100% of the residencies in 11 training programs. This is in contrast to 1992, when no training programs were comprised entirely of IMGs. These findings underscore the fact that psychiatry residency programs developed substantial dependence on IMGs for filling residency classes during the 1990s.

Concerns have already been expressed that the physician surplus that was forecast earlier has failed to materialize, and there may soon be a shortage of specialists (43,44). Similarly, some reports suggest a net replacement deficit of practicing psychiatrists of more than 100 per year (45). This deficit has occurred before the full impact of the recent downsizing efforts will be felt. It is also important to note that these developments are occurring against a backdrop of the expansion of the nonphysician mental health workforce, including psychologists, nurse practitioners, and social workers (46), and this may not be a good sign for the continued viability of our discipline.

In conclusion, psychiatry-training programs have been both downsized and reduced. This will inevitably result in fewer psychiatrists entering the field in the future, perhaps worsening both the shortage and maldistribution of psychiatrists. Presently, the number of USMGs entering the field is increasing, but if their past specialty preference patterns are any indication, psychiatry will not be able to depend on them as a guaranteed supply of future practitioners. Although psychiatry turned to IMGs to fill positions by default in the past, it may not be able to maintain an adequate supply of them in the future. The field will have to decide whether it can afford any more residency downsizing in light of emerging evidence of a shortage of psychiatrists. If the answer is negative, the current downsizing and reduction in training programs must cease. Simultaneously, the field must demand that the restrictive immigration and examination policies be eased in order to expand the pool of IMGs, while redoubling its recent successful efforts to make psychiatry more attractive to USMGs. In the final analysis, the field is better served by having an adequate number of competent psychiatrists, regardless of their medical school of origin, than to have its role usurped by other disciplines due to lack of sufficient numbers of practitioners.

 

[Solideliquid]

I'll say it again because you didn't get it the first time....many of these don't teach regularly, and some are neurologists, and the majority of the current department isn't on that list - which just happen to be American grads.

What I don't like, and wouldn't do to you, is put personal information regarding my situation on the internet. It's rude.


FMG does not equal piss-poor English speaking. To assume otherwise is just stupid.

For them it's OK, but when it comes from the big bad MDs you have psisci and company jumping up and down about personal attacks.

 

[Anasazi23]

PH, when dermatology and ophthalmology limit their numbers, they have demand for residency spots and higher incomes and guaranteed future.

When medical markets are saturated (Family practice, peds), salaries dip, and shortages begin to develop (happening now in FP).

There are market forces here. Overall over the past number of years, the trend for psychiatry is increased residency spots and increasing numbers going into the specialty.

 

[PublicHealth]

For them it's OK, but when it comes from the big bad MDs you have psisci and company jumping up and down about personal attacks.

I was using Cabrini as an example, and according to Sazi, I am wrong in thinking that Cabrini psychiatrists are mostly FMGs. I stand corrected. At the very least, let's try to make this a substantive discussion. Psychologist RxP is an issue that psychologists and psychiatrists will have to grapple with for years to come. As stated in Sharfstein's article, psychologists prescribing will not impact psychiatrists' practice. The situation is analogous to ophthalmologists and optometrists. Ophthalmology fought optometry's obtaining prescriptive authority for more than a decade. Now that optometrists may prescribe, has it affected ophthalmologists' practice and financial security?

Care to comment on the article posted above?

 

[PublicHealth]

PH, when dermatology and ophthalmology limit their numbers, they have demand for residency spots and higher incomes and guaranteed future.

There are two sides to this issue -- physicians and patients. Sure, the demand for residency spots, incomes, and guaranteed futures may be secured when "market forces" have their way. But at what expense to the public who has to wait weeks to months for a proper psychiatric evaluation?

Some "propaganda" that I all-too-often cite around here: http://pn.psychiatryonline.org/cgi/content/full/41/8/1-a

"The figures for psychiatry represent a leveling off of U. S. medical student interest in psychiatry after a steady, albeit slow, increase in the previous five years."

"Psychiatrist Sidney Weissman, M.D., who has maintained an active interest in workforce and training issues for many years and is the Area 4 trustee on APA's Board of Trustees, suggested that psychiatry's steady climb in interest among medical students in the past decade may have reached a plateau. He said that without vigilance on the part of psychiatric educators, numbers could begin to fall again—as they had done in the late 1980s—as students gravitate toward high-paying specialties such as anesthesiology and radiology."

"And he reiterated the dependence of the American health care system on international medical graduates (IMGs), with one-fifth of all residency slots and one-third of all psychiatry slots being filled by IMGs."

I strongly suspect that psychologists getting RxP will further decrease the number of USMGs entering psychiatry residencies.