Illinois passes bill allowing psychologists to prescribe medications

[vistaril]

This entire issue of extending pharm to psychologists,etc., is born out of necessity. This is happening in states with significant underserved and rural populations who do not have access to psychiatrists or others mental health services.

Even with the dangers inherent, this will help a lot of patients who have unmet needs for psychopharm management. Eighty five percent of most of medicine is bread and butter. In under served populations this will help a lot of people!

I do not see these bills ever passing in places like new York or Massachusetts or California. Mostly because the surplus of physicians, in general, in these states assures lobbying power to protect their kind, ie psychiatrists.

I do support rx for psychologists, but this is a ridiculous and lame argument. there is absolutely no evidence that psychologists that rx would do so in 'underserved and rural' populations.....

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[Therapist4Chnge]

I do support rx for psychologists, but this is a ridiculous and lame argument. there is absolutely no evidence that psychologists that rx would do so in 'underserved and rural' populations.....

NPs said the same thing....and they didn't move into those areas. I'm not going to say that prescribing psychologists would move out to rural areas, but I do think they would offer more coverage in suburban/urban areas that *still* have a shortage of providers. Maybe having a 3-8+ wk wait could be improved in small/mid-sized cities and surrounding areas?

 

[DynamicDidactic]

This bill has been brought out in the IL govt in the following years;
1999, 2000, 2001, 2002, 2003, 2004, 2005, 2007, 2009, and 2012.
The state AMA has done a good job fighting it.

One argument in favor of RxP is the need for rural prescribers, which is completely unsupported in IL. Psychologists IL - almost none in rural and underrepresented in non-metro areas (Baird, 2007) and there is a weak job demand in rural areas (Jameson, Blank, & Chambless, 2009).

if memory serves me correctly, the majority of psychologists do not support RxP (too lazy to find the citation). the push for RxP has been met with a strong resistance from the field itself. The people/groups that push for RxP are the same ones that have led to the glut of poor students from diploma mills with tremendous debt in a field that does not provide MD salaries (I can provide more details if anyone cares). You will find almost zero support for RxP in traditional, science-orientated programs that provide funding for their students.

Personally, I think RxP will mean the death of clinical psychology as we know it. Similarly, it may lead to a change in psychiatry. There are over 4000 students coming out of graduate school a year. More than half of those students do not receive APA-accredited training, which is considered the minimum level of training.

I think the problem is partially on the medical end. Many MDs have no idea about the difference b/w a doctoral level and a masters level practitioner. Furthermore, GPs prescribe the vast majority of antidepressants, anxiolytics, and stimulants (and way too many antipsychotics and antimania drugs). Plus, the ubiquity of antidepressants and anxiolytics in the general population has made it a prime target for those seeking to cash in.

Finally, managed care is making practice for doctoral level almost worthless.

 

[heyjack70]

The difference between a physician and a psychologist is huge because of residency training and medical school. I learned the drugs in ms1 and ms2; indications, side effects, etc. but it wasn't really until somewhere mid residency, after thousands of hours and hundreds of patients on meds that I started getting comfortable to the point I could manage all the psych meds on my own.

If you want someone to rx ssri's and manage more straightforward cases, why not get someone with actual medical training, PAs and NPs who at least have some sense of scope of practice, side effects of meds, etc. Psychologists are not physicians or mid level healthcare providers. Their pursuit of rx rights is a power grab, with the sole intent of increasing their incomes. They want to practice medicine without getting medical training. Practicing medicine is more complicated than just knowing what medications to use for depression, anxiety, bipolar, etc. if a psychologist wants to prescribe, they should go to PA or NP school. Why is no one suggesting that? PA school is only 26 months; we don't need a modified masters in medication program to give psychologists licenses to practice medicine. We need full medical training to get them ready. I fully support psychologist to PA. What is the deal with this fast track that includes only medication training? Psychologists probably know that PA school Is not easy. It's much easier to take a relaxed masters course with weekends off. Get that 50 year old psychologist on call for a medicine rotation so they can see what delirium looks like. Let them see what happens when a suicidal pt overdoses on lithium and destroys their kidneys or amitriptyline and gets hypoxic brain injury when they go into complete heart block. They need to know that there are serious consequences with these meds. Understanding screening labs is another huge issue. Psychiatry done even average is not simple. It's much more complicated than the psychologists make it out to be.

While we're at it, why don't we train psychologists to treat heart failure exacerbation, or pneumonia. These are simple conditions and they are smart people right. We could save tons of money if the ER doc could admit to a psychologist who has taken a masters course in diagnosis and treatment of these common medical conditions.

Psychologists practicing medicine is absurd.

 

[DynamicDidactic]

Their pursuit of rx rights is a power grab, with the sole intent of increasing their incomes. They want to practice medicine without getting medical training. Practicing medicine is more complicated than just knowing what medications to use for depression, anxiety, bipolar, etc. if a psychologist wants to prescribe, they should go to PA or NP school. Why is no one suggesting that?

just wanting to point out that many psychologists disapprove of RxP. Similarly, those that do not support it are more than happy to support that psychologists use traditional routes to prescribing.

 

[DynamicDidactic]

one more point. I think a lot more can be gained from the continuum of mental health professions working together than a continued leaning on medication-only.

 

[Craigz]

Psychologists practicing medicine is absurd.

Same with GPs giving SSRIs. Turf war, this, that all.

 

[heyjack70]

just wanting to point out that many psychologists disapprove of RxP. Similarly, those that do not support it are more than happy to support that psychologists use traditional routes to practicing medicine.

Fixed. Psychiatrists are not "prescribers" anymore than an outpatient internist or family doc is a prescriber. I order imaging and labs, and yes, even do physical examinations when indicated. Calling it prescribing rights is a clever ruse to make it out to be something much less than it is. It is practicing medicine.

And thank you for your perspective.

 

[DynamicDidactic]

Fixed. Psychiatrists are not "prescribers" anymore than an outpatient internist or family doc is a prescriber. I order imaging and labs, and yes, even do physical examinations when indicated. Calling it prescribing rights is a clever ruse to make it out to be something much less than it is. It is practicing medicine.

And thank you for your perspective.

that is a very good point.

In LA medical psychologists (that is the term used in LA) are actually governed by the state medical association. So, technically speaking a medical psychologist no longer needs to be licensed as a psychologist to practice.

 

[BS81]

that is a very good point.

In LA medical psychologists (that is the term used in LA) are actually governed by the state medical association. So, technically speaking a medical psychologist no longer needs to be licensed as a psychologist to practice.

Which is the way it should be. If they are going to be practicing medicine. Some of these other bills don't call for that oversight, and that is very worrisome.

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[billypilgrim37]

I do med management for the clinic for our psychology PhD program (top 10 psychology dept). None of these kids would have had any problem getting into med school, but they didn't go to med school, because they wanted to be psychologists, not physicians/ psychiatrists/med managers. So, if the well qualified psychologists could have gone to med school but didn't want to, then I worry that the only psychologists who would want to prescribe would be the ones that wouldn't be smart enough to get into med school. It's not the tightest logic, but my PhD students seemed to enjoy it.

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[billypilgrim37]

Scratch that, more like a top 25 instead of top 10 psychology program. They're still all really damn smart!

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[vistaril]

I do med management for the clinic for our psychology PhD program (top 10 psychology dept). None of these kids would have had any problem getting into med school, but they didn't go to med school, because they wanted to be psychologists, not physicians/ psychiatrists/med managers. So, if the well qualified psychologists could have gone to med school but didn't want to, then I worry that the only psychologists who would want to prescribe would be the ones that wouldn't be smart enough to get into med school. It's not the tightest logic, but my PhD students seemed to enjoy it.

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there are a number of leaps in this post that I'm not sure are appropriate....for one just because someone doesn't want to go to medical school or be a physician doesn't mean they would have no interest in prescribing psychotropic medications.

 

[billypilgrim37]

there are a number of leaps in this post that I'm not sure are appropriate...

You certainly are an expert in inappropriate leaps... I kid.

I agree, it's not the best logic, but that doesn't mean it doesn't contain substantial truth. Most psychologists don't want to prescribe, and many would have gone to medical school if that had been their interest. In the future if psychology prescribing was established, I could imagine people taking different paths. But right now, it would consist of people who later decide they want to be able to prescribe and prefer not to work in a collaborative model, or people who couldn't have gone go medical school and now see a way to get privileges through a back door. I don't know which of these two categories would account for more prescribing psychologists.


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[vistaril]

You certainly are an expert in inappropriate leaps... I kid.

I agree, it's not the best logic, but that doesn't mean it doesn't contain substantial truth. Most psychologists don't want to prescribe, and many would have gone to medical school if that had been their interest. In the future if psychology prescribing was established, I could imagine people taking different paths. But right now, it would consist of people who later decide they want to be able to prescribe and prefer not to work in a collaborative model, or people who couldn't have gone go medical school and now see a way to get privileges through a back door. I don't know which of these two categories would account for more prescribing psychologists.


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There is no evidence that prescribing psychologists wouldn't want to work in a collaborative model. In fact, just from browsing the psychology board many of the prescribing psychologists who work in states where it is already established emphasize that they do work in such a model....especially with the pt's primary care physician.
Also, collaborative models have downsides as well in that they can be less efficient in situations where services aren't bundled. There isn't anything efficient about a pt getting therapy from one provider and med mgt from another(two separate bills and sometimes two separate visits) vs having a psychologist provide therapy and rx services. One could easily argue that a model consisting of presribing psychologist + pcp is more efficient than pcp + psychiatrist + therapist of some sort. In fact, I'm not even sure it's something to argue...it's pretty obvious.

 

[billypilgrim37]

I'm sure it's quite obvious to one of such great intellect!

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[DynamicDidactic]

I do med management for the clinic for our psychology PhD program (top 10 psychology dept). None of these kids would have had any problem getting into med school, but they didn't go to med school, because they wanted to be psychologists, not physicians/ psychiatrists/med managers. So, if the well qualified psychologists could have gone to med school but didn't want to, then I worry that the only psychologists who would want to prescribe would be the ones that wouldn't be smart enough to get into med school. It's not the tightest logic, but my PhD students seemed to enjoy it.

I agree with you but I have little empirical data to support it. There was a study that found that PsyDs are more likely to support RxP and PsyD are also more likely to attend unfunded programs, which have lax criteria for admission. And of course, this wouldn't be the case across the board. But, in general, I agree with your hypothesis. I bet there is a correlation between support for RxP and undergrad GPA or GRE scores.

 

[snarfer]

I don't see how psychiatrists have a right to complain about this when some of their brethren are still handing out Xanax as first line treatment for nearly everything that crosses their desks. My personal psychologist wouldn't be interested in prescribing as he tends to not like psychiatric drugs for the most part, but he's a better sounding board for my concerns about medication than someone I see once every 3-6 months for 15 minutes who has to look at a chart to get my name let alone knows which meds I'm on. My psychologist actually has treated people who have withdrawn from benzos (not medically but treated them for the emotional issues that come up with withdrawal) and understands ideas like tapering whereas my psychiatrist puts people on benzos. Someone I can't call or e-mail, and see a few times a year and doesn't really know me can't help the way someone who sees you once a week for an hour can.

I'm not sure if I would want to see a prescribing psychologist--it seems like it might muddy the waters. I think it might hurt the relationship for a variety of reasons. But it would be my hope that a prescribing psychologist would be more judicious than a psychiatrist and use medications adjunctively, but they could end up setting up their schedules the same way psychiatrist do, and then where's the difference?

And yes, I will point out the requisite: there are good, judicious psychiatrists. They're a bit like finding unicorns, though.

I am not against psychologists prescribing if this reduces my case load of seeing abusive, entitled and malingering patients who engage in splitting.

 

[vistaril]

I'm sure it's quite obvious to one of such great intellect!

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seeing as how 3 people providing services(and billing btw) is greater than 2....yes, it is obvious. I don't even need my great intellect to do that math problem

there are many patients I see for med mgt(both within my program and in moonlighting) who see someone else for more regular therapy. They also have a pcp. If I could be eliminated from the mix and their therapist would do their psychotropic meds, then that is obviously a more efficient system that saves money. The catch is that some of these patients see lpcs/lcsws and they would have to be seen by a pcyhologist under this model....still, it's more efficient.

 

[vistaril]

I agree with you but I have little empirical data to support it. There was a study that found that PsyDs are more likely to support RxP and PsyD are also more likely to attend unfunded programs,.

well this would make sense seeing as how PsyDs are more likely to be interested in only clinical matters where as large numbers of psych phds see themselves as researchers first(or at least heavily into research).....I don't know that it speaks to their ability to prescribe.

 

[nitemagi]

seeing as how 3 people providing services(and billing btw) is greater than 2....yes, it is obvious. I don't even need my great intellect to do that math problem

there are many patients I see for med mgt(both within my program and in moonlighting) who see someone else for more regular therapy. They also have a pcp. If I could be eliminated from the mix and their therapist would do their psychotropic meds, then that is obviously a more efficient system that saves money. The catch is that some of these patients see lpcs/lcsws and they would have to be seen by a pcyhologist under this model....still, it's more efficient.

A good generalist psychiatrist that can manage basic primary care issues and do therapy should save even more money, by that logic.

 

[Bluemirage]

It infuriates me when I see this happen to our profession. Alot of you probably remember me posting a few years ago when Oregon was thinking about allowing their psychologists to do the same thing. What is the point of working hard to get into medical school, enduring 4 years of actual medical school and then busting your butt to get through residency only to have psychologists go through a 2 year online course to do exactly what you do? If they are willing to pass Step 1, 2 and 3 as part of the requirement for RX rights then I think the argument can be made for them to legitimately prescribe (similar to the process DDS/MD's go through to become oral surgeons). Otherwise they are bypassing the educational requirements to legitimately and safely prescribe medications through legislation.

 

[Leo Aquarius]

But the people who do know our training, and that we are physicians, will value our (psychiatrists) knowledge more than anyone else's when it comes to prescribing mental illness meds. I'd rather see a psychiatrist for schizophrenia management than a psychologist.

 

[DynamicDidactic]

well this would make sense seeing as how PsyDs are more likely to be interested in only clinical matters where as large numbers of psych phds see themselves as researchers first(or at least heavily into research).....I don't know that it speaks to their ability to prescribe.

being interested in clinical matters and being competent are two separate issues. Our best (indirect) metrics of clinical ability (i.e., EPPP pass rates and internship match) favor PhD programs. However, these are correlational findings and thus limiting. PhD psychologists are less likely to support RxP.

Again, taking some leaps here with inferences, better clinicians with less debt are less likely to support RxP.

I am going to quote someone from the Psychology forum to address the other point.

[there is a] common misconception that one should go to a psy.d program so that they can receive "a focus on clinical training"...as if Ph.D programs just throw you to the wolves and hope you come out a clinician... or some other such nonsense

PhD programs emphasize science and research within clinical treatment, which is akin to the emphasis when attaining a doctorate in medicine. As opposed to lets say a doctorate in naturopathic medicine

 

[Bluemirage]

But the people who do know our training, and that we are physicians, will value our (psychiatrists) knowledge more than anyone else's when it comes to prescribing mental illness meds. I'd rather see a psychiatrist for schizophrenia management than a psychologist.

I agree with you but unfortunately the general public already has a hard time knowing the different between a psychiatrist and a psychologist. Make no mistake about it. They are not lobbying for these rights in order to play the role of the "mid-level" provider and have us "supervise them." They are looking to do exactly what we do and become the primary mental health provider for patients. Having a group of non-physicians that have not passed USMLE Step 1, 2 and 3 do this is not healthy for the profession or for the patients we care for.

 

[vistaril]

being interested in clinical matters and being competent are two separate issues. Our best (indirect) metrics of clinical ability (i.e., EPPP pass rates and internship match) favor PhD programs. However, these are correlational findings and thus limiting. PhD psychologists are less likely to support RxP.

Again, taking some leaps here with inferences, better clinicians with less debt are less likely to support RxP.

I am going to quote someone from the Psychology forum to address the other point.



PhD programs emphasize science and research within clinical treatment, which is akin to the emphasis when attaining a doctorate in medicine. As opposed to lets say a doctorate in naturopathic medicine

Im not all that interesting in a psyD vs phd comparison because...because I just don't care either way. I will say that I plan on referring to lots of psyD's and lots of phds, and I plan on *not* referring to lots of psyD's and phds. I really do not value one over the other.

And if individual psyD's or phds dont want to prescribe...well...they dont have to get the additional training and do so. Just like how I don't plan on getting certified to do ECT and doing so.

 

[vistaril]

A good generalist psychiatrist that can manage basic primary care issues and do therapy should save even more money, by that logic.

but not that many psychiatrists will do CBT for example weekly with a pt and bill it to insurance....so yes in theory their could be just one mh provider but you can't force psychiatrists to do something. The fact that most psychiatrists can't/don't/won't do CBT and bill to insurance is one reason this is so appealing in the first place.

 

[vistaril]

I agree with you but unfortunately the general public already has a hard time knowing the different between a psychiatrist and a psychologist. Make no mistake about it. They are not lobbying for these rights in order to play the role of the "mid-level" provider and have us "supervise them." They are looking to do exactly what we do and become the primary mental health provider for patients.

ummm thats sort of the problem that creates this opening...in many/most cases psychiatrists are not willing to be the primary mental health provider in any real sense. They are all too often interested in quick med checks and sending the patient somewhere else for the real work......

the prescribing psychologists are saying 'hey, I'll do the therapy and the meds'......to me that is appealing.

 

[vistaril]

But the people who do know our training, and that we are physicians, will value our (psychiatrists) knowledge more than anyone else's when it comes to prescribing mental illness meds. I'd rather see a psychiatrist for schizophrenia management than a psychologist.

yeah, and psychologists wouldn't be seeing these patients....for one they probably arent good therapy candidates(at least therapy where a doctoral level practitioner is needed)....

and when you get out of residency you will be shocked at the number of psychiatrists who aren't all that comfortable(or good at) medmgt for the smi population. If you work in outpt pp for 15 years and never see SMI patients(as some psychs do), you lose that skill....

 

[Bluemirage]

ummm thats sort of the problem that creates this opening...in many/most cases psychiatrists are not willing to be the primary mental health provider in any real sense. They are all too often interested in quick med checks and sending the patient somewhere else for the real work......

the prescribing psychologists are saying 'hey, I'll do the therapy and the meds'......to me that is appealing.

Hey that's fine but my point is they should go through the standard that we went through in order to get these rights. As I said before, I can be supportive of their wish to RX if they pass USMLE step 1,2 and 3. We had to do it, the dental surgeons had to do it, they should have to do it. If they can come up with some type of curriculum during their post-psychology training that prepares them to pass the USMLE then they can legitimately claim that they are properly trained to competently and safely prescribe. I think the general public will agree also. I think the medical boards that currently oversees their license to prescribe should enforce this.

 

[nitemagi]

but not that many psychiatrists will do CBT for example weekly with a pt and bill it to insurance....so yes in theory their could be just one mh provider but you can't force psychiatrists to do something. The fact that most psychiatrists can't/don't/won't do CBT and bill to insurance is one reason this is so appealing in the first place.

You're not forcing psychologists to prescribe either. You're opening a loophole and then incentivizing.

If psychiatrists were paid WELL to be their own mental health "home" and manage all 3 (meds, therapy, and basic related medical conditions), then more would do it.

Vist, why don't you be a proponent of something that benefits your own specialty (though I continue to doubt you're actually a psychiatrist, as you've failed to answer repeated requests to even verify that you're a physician), rather than talking up the doom and gloom and how "obvious" everyone else has it better than us. Pretty sad that you're still trolling on here so much and so often, trying to antagonize every single pro-psychiatry poster (even multiple in the same thread) while under the guise that you're a psychiatrist.

 

[vistaril]

You're not forcing psychologists to prescribe either. You're opening a loophole and then incentivizing.

If psychiatrists were paid WELL to be their own mental health "home" and manage all 3 (meds, therapy, and basic related medical conditions), then more would do it.

Vist, why don't you be a proponent of something that benefits your own specialty (though I continue to doubt you're actually a psychiatrist, as you've failed to answer repeated requests to even verify that you're a physician), rather than talking up the doom and gloom and how "obvious" everyone else has it better than us. Pretty sad that you're still trolling on here so much and so often, trying to antagonize every single pro-psychiatry poster (even multiple in the same thread) while under the guise that you're a psychiatrist.

First, I am somewhat offended by the idea that I am trolling. In fact I've ignored a few posters here myself who I feel don't offer anything. I always stay on topic and do a good deal to generate discussion imo. I'm not particularly interested in being mr popular, and I accept that.

Second, iirc you are a fairly recent grad(I graduate in a couple months myself) and I do think highly of you for offering therapy in addition to med mgt.

Third, you're muddling what I believe/think and what I hope happens. I hope psychologists don't get prescribing rights in large numbers. I hope psych nps don't explode over the next decade. Neither of those things would be good for us psychiatrists in terms of our earning potential(and especially earning floor). But in terms of what I think will happen and what I think is best for mental health care overall, well...that's a different story. I think psychologists with some additional training should be allowed to prescribe psychotropics if they want to. I think psych nps in many settings are very cost effective and a good idea. That doesn't mean I want these things to happen.

 

[vistaril]

Hey that's fine but my point is they should go through the standard that we went through in order to get these rights. As I said before, I can be supportive of their wish to RX if they pass USMLE step 1,2 and 3. We had to do it, the dental surgeons had to do it, they should have to do it. If they can come up with some type of curriculum during their post-psychology training that prepares them to pass the USMLE then they can legitimately claim that they are properly trained to competently and safely prescribe. I think the general public will agree also. I think the medical boards that currently oversees their license to prescribe should enforce this.

this is bizarre....plenty of psych nps practice independently/prescribe independently and they didnt pass usmle steps either. Optometrists prescribe optho meds and they don't pass usmles.....

 

[billypilgrim37]

I'm not sure why PCP+prescribing therapist is better than prescribing Pcp+therapist. If the argument is that you just need someone to do half-assed prescription writing and they aren't sick enough to see a psychiatrist, then I'm not sure why shifting the burden from the PCP to someone with an online "psychopharm" degree is a good idea or saves anything.

Let me save you the effort...

"Pcps don't want to do this and they are bad at it even though it is so simple that i laugh at people who disagree... lol. They want a specialist to do it, and they would rather the psychologist who knows them the best and sees them every week and to do it. Our job is simple and you could train some preadolescent member of your family to do 85% of what we do. And our job is just like a psychologist, except we get paid better and don't do anything worthwhile and just generally lap up taxpayer money, but I'm sure glad I get to do it because I'm going to make a lot of money (but not as much as anybody else here thinks they are going to make) still even though I went to medical school and hated the idea of doing any other specialty... lol."

You have trained me well, master vistaril.


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[Therapist4Chnge]

Hey that's fine but my point is they should go through the standard that we went through in order to get these rights. As I said before, I can be supportive of their wish to RX if they pass USMLE step 1,2 and 3. We had to do it, the dental surgeons had to do it, they should have to do it. If they can come up with some type of curriculum during their post-psychology training that prepares them to pass the USMLE then they can legitimately claim that they are properly trained to competently and safely prescribe. I think the general public will agree also. I think the medical boards that currently oversees their license to prescribe should enforce this.

...since that is what was required for PAs and NPs to prescribe. Oh wait....different standards. I see what you did there.

 

[vistaril]

I'm not sure why PCP+prescribing therapist is better than prescribing Pcp+therapist.

because the content of the session is much more likely to be relevant to the pt's psychopharm needs in the former.

Imagine you just had a session with one of your patients....my guess is(depending on the therapy) you may already know what you would want to do with that pt's meds without asking any more questions. And if not, with a few tweaks and extra questions here and there you could assess the pt from a pharm standpoint as well.

 

[F0nzie]

"Pcps don't want to do this and they are bad at it even though it is so simple that i laugh at people who disagree... lol. They want a specialist to do it, and they would rather the psychologist who knows them the best and sees them every week and to do it. Our job is simple and you could train some preadolescent member of your family to do 85% of what we do. And our job is just like a psychologist, except we get paid better and don't do anything worthwhile and just generally lap up taxpayer money, but I'm sure glad I get to do it because I'm going to make a lot of money (but not as much as anybody else here thinks they are going to make) still even though I went to medical school and hated the idea of doing any other specialty... lol."

This is the most sense you've made in a while BP

 

[nitemagi]

First, I am somewhat offended by the idea that I am trolling. In fact I've ignored a few posters here myself who I feel don't offer anything. I always stay on topic and do a good deal to generate discussion imo. I'm not particularly interested in being mr popular, and I accept that.

Second, iirc you are a fairly recent grad(I graduate in a couple months myself) and I do think highly of you for offering therapy in addition to med mgt.

Third, you're muddling what I believe/think and what I hope happens. I hope psychologists don't get prescribing rights in large numbers. I hope psych nps don't explode over the next decade. Neither of those things would be good for us psychiatrists in terms of our earning potential(and especially earning floor). But in terms of what I think will happen and what I think is best for mental health care overall, well...that's a different story. I think psychologists with some additional training should be allowed to prescribe psychotropics if they want to. I think psych nps in many settings are very cost effective and a good idea. That doesn't mean I want these things to happen.

You can be offended. That's your right. I call out trolling because unlike most others who have gone on to get verified as physicians on SDN, you have not, even though others continue to question and doubt your credentials. Not that you have to answer the challenge, but then I don't have to take seriously your claims about yourself, either.

I do appreciate the distinction between what you wish would happen, and what you think will happen. A distinction which more of your posts should elucidate.

Unlike many other physicians, I don't see the state or even trend of medicine as inevitable. If we want something we are in a reasonable position of strength to carve out a niche that serves us well. We have ended up in this corner from following the carrot dangled by others (insurance companies, etc). With not that much creativity and clear thinking we can easily move our specialty closer to what we wish it to be. There just need to be more entrepreneurialism in the industry.

For example, I now work with two ends of the SES. I wanted to do therapy, and be challenged. I work with the homeless doing "street medicine" in those with medical probs, substance dependency, and psychiatric illnesses. It's really challenging, and I get the freedom to do therapy a lot of the time (including brief therapies, etc). I steered this work towards therapy because it needed a therapy minded psychiatrist, and I'm never bored.

Then I do private practice with cash paying patients who can afford my fees.

When I interviewed for jobs, I mentioned my interest and I am MORE respected because I don't limit my work to only meds, and because I ask to do some therapy when possible in my work. Other therapists respect you more. There is no reason this can't be the trend throughout out field. We just have to take ownership over this.

All this being subsumed into neurology, or ceding our work to prescribing psychologists will only happen if we let it. Ask for and do what you love, and don't buy into this BS that "because they'll only pay us to do med visits" that that's the limit of our work. If you accept their definition of what we do, you're looking at it wrong. Find some ownership again over your work.

 

[vistaril]

You can be offended. That's your right. I call out trolling because unlike most others who have gone on to get verified as physicians on SDN, you have not, even though others continue to question and doubt your credentials. Not that you have to answer the challenge, but then I don't have to take seriously your claims about yourself, either.

I do appreciate the distinction between what you wish would happen, and what you think will happen. A distinction which more of your posts should elucidate.

Unlike many other physicians, I don't see the state or even trend of medicine as inevitable. If we want something we are in a reasonable position of strength to carve out a niche that serves us well. We have ended up in this corner from following the carrot dangled by others (insurance companies, etc). With not that much creativity and clear thinking we can easily move our specialty closer to what we wish it to be. There just need to be more entrepreneurialism in the industry.

For example, I now work with two ends of the SES. I wanted to do therapy, and be challenged. I work with the homeless doing "street medicine" in those with medical probs, substance dependency, and psychiatric illnesses. It's really challenging, and I get the freedom to do therapy a lot of the time (including brief therapies, etc). I steered this work towards therapy because it needed a therapy minded psychiatrist, and I'm never bored.

Then I do private practice with cash paying patients who can afford my fees.

When I interviewed for jobs, I mentioned my interest and I am MORE respected because I don't limit my work to only meds, and because I ask to do some therapy when possible in my work. Other therapists respect you more. There is no reason this can't be the trend throughout out field. We just have to take ownership over this.

All this being subsumed into neurology, or ceding our work to prescribing psychologists will only happen if we let it. Ask for and do what you love, and don't buy into this BS that "because they'll only pay us to do med visits" that that's the limit of our work. If you accept their definition of what we do, you're looking at it wrong. Find some ownership again over your work.

Im curious...what's the funding for this 'street medicine'? Is it basically just ACT with loose housing standards? Is it bundled?

And I agree of course you will be more respected if you have additional skills....isn't everyone? The problem for many people is getting paid to do it....

 

[F0nzie]

Unlike many other physicians, I don't see the state or even trend of medicine as inevitable. If we want something we are in a reasonable position of strength to carve out a niche that serves us well. We have ended up in this corner from following the carrot dangled by others (insurance companies, etc). With not that much creativity and clear thinking we can easily move our specialty closer to what we wish it to be. There just need to be more entrepreneurialism in the industry.

I agree with the entrepreneurship. We need a non-complacent attitude to make things happen. Good to see you back on these message boards Nitemagi.

 

[billypilgrim37]

because the content of the session is much more likely to be relevant to the pt's psychopharm needs in the former.

Imagine you just had a session with one of your patients....my guess is(depending on the therapy) you may already know what you would want to do with that pt's meds without asking any more questions. And if not, with a few tweaks and extra questions here and there you could assess the pt from a pharm standpoint as well.

Give me credit, if this is all you had left, then I did a pretty good job covering the bases!

I'm not saying it wouldn't be nice if psychologists could prescribe for their patients in some ways. But I would still argue that the value of having someone with a primary medical background taking care of the medications is a better idea than having someone without a medical background doing it. We trade off one thing for another. I would also argue that we're talking about a very different patient population than what I see, which is people who are sick enough that the expertise of their PCP has been overwhelmed. If the PCP is overwhelmed, I would be surprised if a psychologist with an online psychopharm degree is going to have substantially greater facility with psychiatric medications than a PCP who by necessity has to do a fair amount of psychiatric medication management. I would not be shocked if you could show that a psychologist could be trained to prescribe with similar facility as a PCP.

Ideally, if a psychologist wants to prescribe, I think they should pursue a PA program and receive "supervision" (albeit loosely) with a physician, even a primary care doc. A PA program is two years just like these online psychopharm degrees, and PA programs have track records of producing safe prescribers. Even better, make a special PA track for psychologists who want to prescribe! A much better idea than an online psychopharm degree without comparable supervision to any established route to prescription privileges. Given the fact that their is ALREADY a perfectly legitimate and validated route for a psychologist to become a prescriber in two years without passing a single new law, we have to question whether the impetus for change has anything to do with increasing access to anything.

 

[nitemagi]

Im curious...what's the funding for this 'street medicine'? Is it basically just ACT with loose housing standards? Is it bundled?

Kinda ACT + medical care (we have a PCP and PA) with focus on getting the housed and treating the barriers (medical, mental health) to housing.

Paid by prop 63 (pilot program)

 

[billypilgrim37]

I call out trolling because unlike most others who have gone on to get verified as physicians on SDN, you have not, even though others continue to question and doubt your credentials.

I will personally vouch for Vistaril that he is in fact an MD and a psychiatry resident. He has told many fibs, some of which he has corrected, some of which he has not.

I will also offer in his defense that he can have a sense of humor about himself, and I'm convinced that if I knew him in real life I might actually like him.

That doesn't mean I agree with him or find his overconfidence becoming on an anonymous board. In person, there might be a little bit more of a twinkle in his eye. Or he might be a total wiener. I don't know.

 

[nitemagi]

I will personally vouch for Vistaril that he is in fact an MD and a psychiatry resident. He has told many fibs, some of which he has corrected, some of which he has not.

I will also offer in his defense that he can have a sense of humor about himself, and I'm convinced that if I knew him in real life I might actually like him.

That doesn't mean I agree with him or find his overconfidence becoming on an anonymous board. In person, there might be a little bit more of a twinkle in his eye.

BP, you I take at your word. Fair enough.

 

[vistaril]

Ideally, if a psychologist wants to prescribe, I think they should pursue a PA program and receive "supervision" (albeit loosely) with a physician, even a primary care doc. A PA program is two years just like these online psychopharm degrees, and PA programs have track records of producing safe prescribers. Even better, make a special PA track for psychologists who want to prescribe! A much better idea than an online psychopharm degree without comparable supervision to any established route to prescription privileges. Given the fact that their is ALREADY a perfectly legitimate and validated route for a psychologist to become a prescriber in two years without passing a single new law, we have to question whether the impetus for change has anything to do with increasing access to anything.

You can't seriously compare the entirety of PA school(2.5 fairly intensive years covering all of medicine) to specific psychopharm advanced coursework for psychologists?
PA school is a full time(and then some in some cases) job for 2.5 years.....Im assuming these psychologists that do the psychology prescribing route pursue the extra coursework in their spare time.

 

[billypilgrim37]

You can't seriously compare the entirety of PA school(2.5 fairly intensive years covering all of medicine) to specific psychopharm advanced coursework for psychologists?

You're right, I can't! The PA route is so much more legitimate I can't even compare it.

Programs around here are only two years, not 2.5. I taught a chunk of their behavioral health class.

 

[Merovinge]

You can't seriously compare the entirety of PA school(2.5 fairly intensive years covering all of medicine) to specific psychopharm advanced coursework for psychologists?
PA school is a full time(and then some in some cases) job for 2.5 years.....Im assuming these psychologists that do the psychology prescribing route pursue the extra coursework in their spare time.

They do, and that's his point. PA school would be rigorous training and obviously next to no psychologists are also becoming PA's to prescribe. The Illinois legislation provides for a much much easier pathway. I believe it would only add a few hours to their total in class time (less than 20), no longer to finish the training, and some extra online coursework to do in their spare time. It's night school for prescribing drugs. This is why many MDs, not just psychiatrists, are aghast at the proposal.

Also, It's full reign for all drugs, not just psychotropics (I am not sure about restrictions with regarded to scheduled meds, I will admit). These folks could do therapy for free to help the undeserved and run a viagra mill on the side if they wanted to finance it, although I am sure none would be so cavalier early on.

 

[DynamicDidactic]

well this would make sense seeing as how PsyDs are more likely to be interested in only clinical matters where as large numbers of psych phds see themselves as researchers first(or at least heavily into research).....I don't know that it speaks to their ability to prescribe.

oh, I see who I am dealing with. There is always one on each forum.

 

[vistaril]

They do, and that's his point. PA school would be rigorous training and obviously next to no psychologists are also becoming PA's to prescribe. .

and my point was that such rigorous training isn't needed......I guess it's debatable what degree of training is needed to do what, but clearly the standard should not be anything close to going to PA school just to prescribe psychotropic meds.

Also most psychologists would have to spend well over a year just getting ready to apply to PA school...

 

[billypilgrim37]

and my point was that such rigorous training isn't needed......I guess it's debatable what degree of training is needed to do what, but clearly the standard should not be anything close to going to PA school just to prescribe psychotropic meds.

Okay, and we're going to disagree with you. I think that's that. Let us all move along.