How Will Psychologists Practicing Medicine Affect Psychiatry?

[Solideliquid]

Care to comment on the article posted above?

There are IMG/FMGs in evey specialty of medicine. Sooner or later you will start thinking about the specialty you wish to enter. At the same time, you will need to evaluate your chances of getting into said specialty. You may ask your friends for input. What you will discover is that each specialty is at some point in time more popular/competitive than at other times.

The point is at this time psych is deemed non-competitive for the most part, even though it pays more then IM, peds and FP in general. IMGs typically try for the less competitive specialties due to many reasons most just want to get into residency.

If you looked at this years match process you see OB/GYN has had a massive turn around at least this year. GS is also on the rise with only 1 cat spot in the scramble (has that ever happened?!). Psych filled 95% before scramble though I do not know the composition of AMGs (in the past it has been 65%).

I do not see the relevance of IMGs in the field of psychiatry with regard to RxP for psychologists. Are IMGs bad? Do they compromise patient care? Medicine did not start in the US, in fact it started before there was a US, and this country was built on the efforts of IMGrants.

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[Solideliquid]

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

I strongly suspect the average medical student/resident doesn't give a damn about this issue.

 

[PublicHealth]

I strongly suspect the average medical student/resident doesn't give a damn about this issue.

Well then I guess I'm an outlier!

 

[Psyclops]

A couple of things come to mind from the previous posts. Ana, makes a good point about market forces. I know that in terms of the personal interests and salary, the fewer people entering your field the better for you. I know many in the field of psychology get frustrated by the enormous classes graduating from for profit professional schools (usually with PsyDs). This is a frustration to those in university based programs who have had to go through rigorous entrance requirements.

Which brings me to my next point. SL, there are two types of FMG/IMGs as I see it. (but granted I don't know much about this not being in med school). There are those who grew up in another country, another culture, and went to med school in their country of origin, then moved to the US. I've always been weary of this type of psychiatrist (or any type of mental health provider for that matter) because so much of psychiatric disorders/diagnosis has cultural issues or underpinings. The other type would be those who grew up in american culture, went to the carabean or whatever to get their degree for whatever reason, and then returned. They wouldn't have the cultural deficincies as I see it. As to whether or not they are as good? Thats the kind of stuff you would know about not me.

 

[PublicHealth]

A couple of things come to mind from the previous posts. Ana, makes a good point about market forces. I know that in terms of the personal interests and salary, the fewer people entering your field the better for you. I know many in the field of psychology get frustrated by the enormous classes graduating from for profit professional schools (usually with PsyDs). This is a frustration to those in university based programs who have had to go through rigorous entrance requirements.

Which brings me to my next point. SL, there are two types of FMG/IMGs as I see it. (but granted I don't know much about this not being in med school). There are those who grew up in another country, another culture, and went to med school in their country of origin, then moved to the US. I've always been weary of this type of psychiatrist (or any type of mental health provider for that matter) because so much of psychiatric disorders/diagnosis has cultural issues or underpinings. The other type would be those who grew up in american culture, went to the carabean or whatever to get their degree for whatever reason, and then returned. They wouldn't have the cultural deficincies as I see it. As to whether or not they are as good? Thats the kind of stuff you would know about not me.

Not to mention that many FMGs chose psychiatry, neurology, and other less competitive residency because it's their ONLY OPTION TO BECOMING A DOC IN THE US. I personally know three FMG psychiatrists who entered this specialty solely because they would not be able to compete for the more competitive residencies in which they already accumulated years of postresidency experience -- two were formerly surgeons in Brazil, and another was formerly a dermatologist in the Ukraine.

 

[Anasazi23]

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."

One wouldn't play the stocks in the same manner in which you interpret this data. Admittedly, the psychiatry folks have possibly mininterpreted the data as well.

Do you sell a stock when it plateaus for one day? Trends are what we're looking at. If interest continues to "plateau" or fall in the next five years, then you get concerned. If I remember correctly, this is all in the context of an increasing amount of psych residency spots. Which would make this interpretation even more ridiculous.

Like I said in the other thread with that link...and I like quoting myself:
"Looks like radiology, urology, dermatology, internal medicine, neurosurgery, and PGY-II anesthesia filled spots leveled off or dropped too!"

I wonder if the dermatology newsletter has voiced the impending doom of their profession since they filled less spots this year.

This "sky is falling" stuff is too much.

PH, if you choose radiology, I'm going to harass you about telerads being farmed to India to get back at you.

 

[PublicHealth]

Admittedly, the psychiatry folks have possibly mininterpreted the data as well.

Yeah, Sid always f*cks it up. What the hell does he know anyway?

http://pn.psychiatryonline.org/cgi/content/full/40/23/27-c
http://www.appi.org/book.cfm?id=8938

PH, if you choose radiology, I'm going to harass you about telerads being farmed to India to get back at you.

Not if I do interventional rads!

 

[Solideliquid]

Not to mention that many FMGs chose psychiatry, neurology, and other less competitive residency because it's their ONLY OPTION TO BECOMING A DOC IN THE US. I personally know three FMG psychiatrists who entered this specialty solely because they would not be able to compete for the more competitive residencies in which they already accumulated years of postresidency experience -- two were formerly surgeons in Brazil, and another was formerly a dermatologist in the Ukraine.

Well you still have Peds, FM, and in some cases IM programs that are less competitive than psych. Also thats not to say that there are USMGs who have low board scores and find themselves in this position as well.

 

[Anasazi23]

Yeah, Sid always f*cks it up. What the hell does he know anyway?

http://pn.psychiatryonline.org/cgi/content/full/40/23/27-c
http://www.appi.org/book.cfm?id=8938

By these above quotes, are you asserting that his interpretation of a one year leveling of spots means overall U.S. interest in psychiatry has stopped?

Not if I do interventional rads!

You better rock step II in a year, and have already rocked step I.


I didn't. I suck at those tests. Thankfully, my chosen specialty didn't require super-competitive board scores to be competitive. Though, I saw a couple of scary folks heading for surgery. I hope I don't end up under their knife.

 

[Poety]

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'm just going to add to this that the psychologists I worked with did nothing at all for the patient but TEST THEM AND SUBMIT THEM TO THEIR STUDIES THAT THEY GOT GRANTS FOR (some equalling in excess of 1 million) but I guess that was to maintain his BENZ that he was driving. PH don't act like only psychiatrists make money. If you ONLY KNEW where half that grant money went (not to MENTION his vacations in Hawaii, etc while he expected ME to have written the whole damn paper when it was HIS work I jumped IN on.)

Theres a lot in academia you may not know PH but its dirty dirty work.

 

[Poety]

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?



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.

All of these are cush jobs and all are compensated pretty damn well, you can't attack Sazi for money if these are your choices

 

[PublicHealth]

All of these are cush jobs and all are compensated pretty damn well, you can't attack Sazi for money if these are your choices

I want to help you pay off your loans.

 

[PublicHealth]

I'm just going to add to this that the psychologists I worked with did nothing at all for the patient but TEST THEM AND SUBMIT THEM TO THEIR STUDIES THAT THEY GOT GRANTS FOR (some equalling in excess of 1 million) but I guess that was to maintain his BENZ that he was driving. PH don't act like only psychiatrists make money. If you ONLY KNEW where half that grant money went (not to MENTION his vacations in Hawaii, etc while he expected ME to have written the whole damn paper when it was HIS work I jumped IN on.)

Theres a lot in academia you may not know PH but its dirty dirty work.

Who and where was this? Federal dollars used for personal expenses?

Sazi tells me that psychologists make $60K/year.

 

[Poety]

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?

Howd all this Cabrini talk get in here anyway? Am I missing something?

 

[Poety]

Who and where was this? Federal dollars used for personal expenses?

Sazi tells me that psychologists make $60K/year.

Shyeah right, and I'll just say somewhere in New Jersey he's driving a freaking Mercedes (CHAMPAGNE PINK AT THAT) and slams the hell outta psychiatrists while he does nothing all day but talk crap, write grants, and pay for his 500K house and go on vacation - meanwhile he has his psyD students doing ALL THE TESTING, writing ALL THE PAPERS, and the few MD's that come through there realize its a joke and LEAVE.

So don't tell me its all the MD's looking for the mula, theres a fair share of this in academia/psychologist PHD land too ----- and one other thing, you'd never know this but I had NO IDEA how bitter psychologists were toward psychiatrists until I WORKED WITH ONE EVERY DAY - thats when the truth came out and its an ugly ugly "touchy feely" all you want reality.

 

[50960]

What took you so long Poety??

 

[Poety]

I want to help you pay off your loans.

OK - please DO i need money, and I'm not happy with the compensation I've been seeing as of late - I'm feeling betrayed dammit.

 

[Poety]

What took you so long Poety??

yeah, I was stuck in the molester thread

 

[PublicHealth]

I'm not happy with the compensation I've been seeing as of late - I'm feeling betrayed dammit.

Oh? What are you seeing?

 

[PublicHealth]

Shyeah right, and I'll just say somewhere in New Jersey he's driving a freaking Mercedes (CHAMPAGNE PINK AT THAT) and slams the hell outta psychiatrists while he does nothing all day but talk crap, write grants, and pay for his 500K house and go on vacation - meanwhile he has his psyD students doing ALL THE TESTING, writing ALL THE PAPERS, and the few MD's that come through there realize its a joke and LEAVE.

So don't tell me its all the MD's looking for the mula, theres a fair share of this in academia/psychologist PHD land too ----- and one other thing, you'd never know this but I had NO IDEA how bitter psychologists were toward psychiatrists until I WORKED WITH ONE EVERY DAY - thats when the truth came out and its an ugly ugly "touchy feely" all you want reality.

Was this at UMDNJ? Feel free to PM me if you don't want to post openly. I'm just curious to know who you're talking about.

 

[Poety]

Oh? What are you seeing?

I already showed you in the other thread. PD 80K Chair 140K, starting out at 70K, I'm not happy one bit dammit. And if I don't get my 150K outta residency someone driving a mercedes is gunna get hurt

 

[50960]

It is frustrating to me that people here have personal experiences that are negative with either psych, and then go on to believe that all ____'s are this way. I work my a$$ off in medical clinics daily seeing MANY pts in a day. I make OK $, and YES I do it to make a living not because I am do-gooder. YES, I do medication consults, and have for years. NO I do not know all I psychiatrist does, and probably never will. We are all smarter, and should be more professional than this....even on a internet forum!!

 

[Poety]

It is frustrating to me that people here have personal experiences that are negative with either psych, and then go on to believe that all ____'s are this way. I work my a$$ off in medical clinics daily seeing MANY pts in a day. I make OK $, and YES I do it to make a living not because I am do-gooder. YES, I do medication consults, and have for years. NO I do not know all I psychiatrist does, and probably never will. We are all smarter, and should be more professional than this....even on a internet forum!!

I didn't start it HE started it <reverts to childhood brattiness> you can't make me stop unless HE stops first

 

[Solideliquid]

I already showed you in the other thread. PD 80K Chair 140K, starting out at 70K, I'm not happy one bit dammit. And if I don't get my 150K outta residency someone driving a mercedes is gunna get hurt

Chillax. Those are rates you see in academia land. Private practice and hospital inpatient/out are starting 150K out of residency.

 

[Psyclops]

It is frustrating to me that people here have personal experiences that are negative with either psych, and then go on to believe that all ____'s are this way.

I want to second this. At the same time, it's difficult not to base your opinions on your own experience. I for one feel that my experience working with psychiatrists has been more positive than negative. But I have seen a few areas that I think the field could improve on. And I have ways I think psychology could improve as well. I think the internet is a great way to air these greavances. Of course there is a respectful and a disrespectful way to do it. And Ns of 1 aren't the best.

 

[Poety]

Chillax. Those are rates you see in academia land. Private practice and hospital inpatient/out are starting 150K out of residency.

Are you gunna patent "chillax" cuz I want some of that

 

[PublicHealth]

I already showed you in the other thread. PD 80K Chair 140K, starting out at 70K, I'm not happy one bit dammit. And if I don't get my 150K outta residency someone driving a mercedes is gunna get hurt

That blows. Where is this?

 

[Anasazi23]

YES, I do medication consults, and have for years. NO I do not know all I psychiatrist does, and probably never will. We are all smarter, and should be more professional than this....even on a internet forum!!

Wow, a major Freudian slip big guy.

Couldn't resist. I know you hate the 'psychiatry envy' stuff.

All in fun, bud.

 

[50960]

Good one....and I is nowhere near A on a keyboard!!!

 

[50960]

PS. I need some chillax...

 

[PublicHealth]

PS. I need some chillax...

You're a medical psychologist ... order some up!

 

[PublicHealth]

Interesting anecdote about an FMG psychiatrist on page 2, first column: http://www.critpsynet.freeuk.com/apr03resnick.pdf

 

[Solideliquid]

Interesting anecdote about an FMG psychiatrist on page 2, first column: http://www.critpsynet.freeuk.com/apr03resnick.pdf

Not really. Let me tell you what IS interesting though...the PS3 IS COMING NOVEMBER 17th!!!!! For a modest $499, or $599 for the bigger HD model!

 

[Anasazi23]

Interesting anecdote about an FMG psychiatrist on page 2, first column: http://www.critpsynet.freeuk.com/apr03resnick.pdf

I know plenty of psychologists that wouldn't pick up that 40's jazz lingo.

A stuffy academic psychologist be immune to this error because........


The Psychologist, April 2003
Enough said.

 

[pschmom1]

What the heck, it has been 3 days and there's 4 pages. What the heck? Is this on the psychology forum also? Why is the psychiatry forum always having to defend ourselves to the psychology people? No animosity b/c I love both but really? I will say this even though I will regret it and I love everyone, but, I think psychology people envy psychiatry and want to be them in a way, if not, they wouldn't constantly argue here on this forum. Can't we all just get along Ok, now please don't freak out on me.

 

[Doc Samson]

What the heck, it has been 3 days and there's 4 pages. What the heck? Is this on the psychology forum also? Why is the psychiatry forum always having to defend ourselves to the psychology people? No animosity b/c I love both but really? I will say this even though I will regret it and I love everyone, but, I think psychology people envy psychiatry and want to be them in a way, if not, they wouldn't constantly argue here on this forum. Can't we all just get along Ok, now please don't freak out on me.

Amen! Enough of this crap. Again, let's limit discussions of psychologist prescribing to the psychology forum.

 

[Poety]

Amen! Enough of this crap. Again, let's limit discussions of psychologist prescribing to the psychology forum.

I agree, but someone needs to talk to PH about bringing this stuff up on here like 100 times a day - I think he enjoys rattling everyone up. I mean, in all reality, PH knows how the psychs feel about it, its been brought up over and over, and its like Sazi's moticon, its beating a dead horse at this point.

If no one responds to these threads, they'll go away.

 

[Poety]

Not really. Let me tell you what IS interesting though...the PS3 IS COMING NOVEMBER 17th!!!!! For a modest $499, or $599 for the bigger HD model!

Are you getting it Solid? Not worth the money in my eyes. I'm still stuck on "Discworld"

 

[PublicHealth]

Amen! Enough of this crap. Again, let's limit discussions of psychologist prescribing to the psychology forum.

When the President of the American Psychiatric Association writes an editorial on psychologist prescribing in Psychiatric News, a publication of the American Psychiatric Association, the issue is clearly relevant to psychiatry. As a medical student interested in psychiatry, I think this is an important issue that we should discuss. If you're not interested in discussing, you can explore other threads, there are plenty of them. Ignoring the problem will not make it go away. Psychiatry and psychology are both discussants at the table.

Or, as Sharfstein puts it, "as I have traveled around the country, many psychiatrists have expressed deep concern about whether the addition of psychologists in the marketplace for prescribing antidepressant, mood-stabilizing, antipsychotic, and antianxiety agents will radically alter the prospects for the practice of psychiatry. Psychiatrists who have spent thousands of hours in medical school and residency training now see psychologists with less than 5 percent of this training treading on their hard-earned licensure and economic entitlements. In recent years with the struggle over reimbursement that psychiatrists have had with managed care, this is an insult added to injury in terms of psychiatric identity and a potential threat to our livelihood."

 

[Psyclops]

I agree with PH on this one. It seems relevant to both ology and iatry. If you don't like the topic don't reply or even read the thread. I personally like reading both forums because tehy both have threads which pertain to my interests and professional curiosity. I feel I can learn from both. I get tired of the same arguments myself, and wish we spent more time discussing useful topics to both fields. For either ology or iatry to think they exist to the exclusioin of the other is just plain stupid. I've heard ologists say, "Frankly I can't tell the difference if my patients are on meds or not, so I don't pay attention to it", and I've seen similar comments from psychiatrists about therapy and the contributions of psychologits. I shake my head every time and think you guys are idiots. When int comes to RxP people tend not to play nice, I realize it's a charged issue. But for the most part I enjoy other discussions that pertain to both fields regardless of the side of the fence they generally lie on. Ultimately, ology and iatry fall under the larger rubric of MH treatment. So everyone should just get over themselves. For me, I plan on staying on this high horse and joining discussion on both boards (notice I resisted the urge to say contribute).

 

[Solideliquid]

Are you getting it Solid? Not worth the money in my eyes. I'm still stuck on "Discworld"

Heck yes I'm getting this!

 

[Anasazi23]

Heck yes I'm getting this!

Should I get this or the 360?


I like my x-box a lot better than my PS II, but that's for power/graphics reasons. The PS III is technically gonna be stronger than the 360, but I like the x-box games better overall.

I need my KOTOR, damnit.

 

[Poety]

Heck yes I'm getting this!

Yer nuts - go ahead, blow your loan money on games, Im blowing mine on thuja giant trees

 

[Solideliquid]

Should I get this or the 360?


I like my x-box a lot better than my PS II, but that's for power/graphics reasons. The PS III is technically gonna be stronger than the 360, but I like the x-box games better overall.

I need my KOTOR, damnit.

Weeeeell...of course getting a PS3 at LAUNCH is going to cost a pretty penny and by then the X360 may have a price reduction. I am getting BOTH.

I need to play Halo 3 and Metal Gear Solid 4. Need to. Enjoy watering those trees Poety. I guess that's like a video game...

 

[Anasazi23]

Weeeeell...of course getting a PS3 at LAUNCH is going to cost a pretty penny and by then the X360 may have a price reduction. I am getting BOTH.

I need to play Halo 3 and Metal Gear Solid 4. Need to. Enjoy watering those trees Poety. I guess that's like a video game...

I play a lot of Battlefront online.

What's your x-box tag?
Mine's Anasazi 23, naturally.

 

[Anasazi23]

I feel I can learn from both. I get tired of the same arguments myself, and wish we spent more time discussing useful topics to both fields.

What do you learn from the psychiatry forum?

I'm not being facetious...

 

[Solideliquid]

I play a lot of Battlefront online.

What's your x-box tag?
Mine's Anasazi 23, naturally.

LOL....

Mine's Dirdy D.

 

[Poety]

LOL....

Mine's Dirdy D.

You Dirty boy you

Everyone around here needs to CHILLAX - drink some beers, smoke some...



























cigars or something

Sun is out, i'm heading outdoors!

 

[Psyclops]

What do you learn from the psychiatry forum?

I'm not being facetious...

I like the discussions about the various meds. Be it TCAs and hypo, or mirtazapine, etc. Biological bases of behavior are interesting to me, or the way drugs can affect behavior is interesting. Not my primary interest but an interest none the less. Contrary to the popular belief that psycholigsts don't get any or only minimal bio training, in my MS program I've taken both Biological Psychology and Psychopharmacology. Granted just two courses, but 25% of my MS courses. I haven't yet started my PhD program. It gave me enough to follow the tca hypo thread.

As I've mentioned before I've worked in psych hospitals for a few years. I enjoy hearing about the considerations that go into the pharm choices that are made.

The psychiatry forum is often more practice based than the ology forum which is often very getting into school based, sometimes, not always.

I enjoy getting different perspectives. I enjoy discussions (arguements?), and even the RxP doesn't get me bent out of shape like it does some.

I also find it interesting to hear about your guys' training, since at some point I will be working side by side with a psychiatrist (grad school has one in house) even if I don't primarily do practice. And, I think it's important to understand someone's training to understand why they make the decisions they do.

I would encourage more of the ology students to come over here more often if I knew it wouldn't piss you guys off.

Also, the more you challenge your own assumptions the better you will be at defending them in the future. Unless of course you change your mind.

Currently, my feeling about RxP is that psycholgists shoud be allowed to pursue them, and get them if they want to. But I don't think they should want to. Which may make very little sense I know.

 

[Kulak Bondiced]

I think that the underlying problem might be that mental health is not taken that seriously in this country. This underlying factor leads to (most importantly) reduced reimbursement rates for psychiatrists – low salary - which leads to a dwindling population of psychiatrists, leading to scant access to psychiatric care, leading to GP’s flippantly prescribing psychiatric medications, making psychologists believe that it is no big deal to prescribe psychotropic drugs. Allowing people without medical degrees to prescribe psychotropic medicine continues this deleterious attitude toward mental health.

Psychologists merely rationalize their desire for prescription rights by highlighting the profound need for quality mental health care and claim that all they want to do is help the people. All along, they know that (maybe they repress it) they need to increase their salary because the financial rewards for providing mental health care are not that good for a psychologist either.

Bottom line, if anyone wants to practice medicine, they should go to medical school. We should not degrade mental health care any further by allowing non-medical doctors the power to prescribe psychotropic medicine. On the contrary, to solve this problem, our nation needs to pay psychiatrists more money for the work they do. This would defiantly make psychiatry more attractive (increase supply of docs) and, in the same manner, make society see mental health as a more serious issue (because the more you pay for something – the more it is worth).