Illinois passes bill allowing psychologists to prescribe medications

[Therapist4Chnge]

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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.

God forbid you actually look at the proposed language, though I guess it is much easier to just make stuff up. Here is the actual language from the current proposal, not wildly inaccurate declarations of fact....

(3) graduation with a master's degree in clinical
24 psychopharmacology from a regionally accredited
25 institution, the curriculum of which shall include

1 instruction in anatomy and physiology, biochemistry,
2 neurosciences, pharmacology, psychopharmacology, clinical
3 medicine, pathophysiology, and physical and laboratory
4 assessment.

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.

Here is more language from the proposed legislation....

-----------------------------------
24 The certification shall grant
25 prescribing psychologists prescriptive authority to prescribe

1 and dispense those drugs used in the treatment of mental,
2 emotional, and psychological disorders in accordance with
3 applicable State and federal laws.
-----------------------------------
(d) A prescribing psychologist shall maintain an ongoing
3 collaborative relationship with the physician, attending
4 physician, or referring physician who oversees the patient's
5 general medical care to ensure that (1) all necessary medical
6 examinations are conducted, (2) all medical and psychological
7 issues are communicated, (3) no prescribed medications are
8 contraindicated, and (4) all significant changes in the
9 patient's medical or psychological condition are communicated.
10 For the purposes of this Section, "collaborative relationship"
11 means a cooperative working relationship between a prescribing
12 psychologist and a physician, attending physician, or
13 referring physician in the provision of patient care, including
14 diagnosis and cooperation in the management and delivery of
15 physical and mental health care.
-----------------------------------

 

[nitemagi]

God forbid you actually look at the proposed language, though I guess it is much easier to just make stuff up.

T4C, we've discussed this on the RxP sticky, and you've been pretty verbal about the low standards these bills all have. Do you really think this is any different? How is that loose language of oversight and required curriculum do much other than add further Large loopholes? The same or worse that's in the language of the LA and NM laws.

 

[Therapist4Chnge]

T4C, we've discussed this on the RxP sticky, and you've been pretty verbal about the low standards these bills all have. Do you really think this is any different? How is that loose language of oversight and required curriculum do much other than add further Large loopholes? The same or worse that's in the language of the LA and NM laws.

I agree with you and others that the standards as proposed are insufficient, and as written I don't support the legislation. However, I take issue with how many posters are mischaracterizing what is actually written. Infusing misinformation and scare tactics does nothing to actually address the bill.

[It] would only add a few hours to their total in class time"

"[they could] run a viagra mill on the side if they wanted"

"They are looking to do exactly what we do and become the primary mental health provider for patients"

Some of these other bills don't call for [physician] oversight, and that is very worrisome.

Their pursuit of rx rights is a power grab, with the sole intent of increasing their incomes.

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.

...and so on.

 

[heyjack70]

So Psychologist w/ PA or ARNP degree = mid level capable of providing medical care. Or psychologist w/ MD/DO degree + 4 year psych residency = physician capable of providing medical care.

 

[heyjack70]

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.

I agree.

If a family member of mine had a moderate to severe mental illness, I would want a psychiatrist to provide their care. I would guess (who knows if I'm right) that psychologists would try to pass such a patient off to the psychiatrist, too. I mean who wants that liability? From what I've seen, PAs and ARNP try to get these sicker patients off their panels, unless they're in over their heads and completely oblivious.

It seems like Vistaril is taking the perspective that psychologists will be providing medical care for the middle to upper middle class worried well. I could be wrong, but I don't think there is a shortage of psychiatrists for this demographic.

 

[vistaril]

I agree.

If a family member of mine had a moderate to severe mental illness, I would want a psychiatrist to provide their care. I would guess (who knows if I'm right) that psychologists would try to pass such a patient off to the psychiatrist, too. I mean who wants that liability? From what I've seen, PAs and ARNP try to get these sicker patients off their panels, unless they're in over their heads and completely oblivious.

It seems like Vistaril is taking the perspective that psychologists will be providing medical care for the middle to upper middle class worried well. I could be wrong, but I don't think there is a shortage of psychiatrists for this demographic.

there isn't....but so what? psychologist rx'ing isn't a good reason for that phony reason.

it's a good reason because it gives patients more options. It makes things more efficient for patients.

 

[hamstergang]

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.

How is that anywhere close to being clear? Isn't that the whole crux of this debate?

 

[heyjack70]

there isn't....but so what? psychologist rx'ing isn't a good reason for that phony reason.

it's a good reason because it gives patients more options. It makes things more efficient for patients.

What you said isn't a good reason. My reason was good. More efficient? What are you talking about?

 

[vistaril]

What you said isn't a good reason. My reason was good. More efficient? What are you talking about?

see...that's where we disagree- I believe giving patients more options is always a good reason.

And it's more efficient because it would encourage one provider to do meds and therapy.

 

[billypilgrim37]

see...that's where we disagree- I believe giving patients more options is always a good reason.

And it's more efficient because it would encourage one provider to do meds and therapy.

THAT'S IT! I NOW UNDERSTAND!!! Vistaril is what would happen if you crossed Daniel Carlat and Duck Dynasty in a lab experiment! It's so clear now!

 

[heyjack70]

see...that's where we disagree- I believe giving patients more options is always a good reason.

And it's more efficient because it would encourage one provider to do meds and therapy.

And I believe psychologists are unqualified to practice medicine until they go through a PA, ARNP, or MD/DO,training program. So it is an inappropriate option.

We already have 'providers' who can do medical care and psychotherapy. They're called psychiatrists. If you think psychologists aren't going to shift to the standard 'med management' (which I think is really pejorative) model when they realize the earning potential, you're naive. Always follow the money...

So, in my opinion, you're advocating for unqualified medical providers who will add nothing but warm bodies to the ranks of those providing 'med checks'.




I really dislike split treatment. It think it is driven by economics, and not good medical care. But how can we incentivize psychiatrists to do medical tx plus therapy....money! Unfortunately, while medicare is happy to overpay for several spinal steroid injections, or thousands a month for brand name atypical antipsychotics,they don't like paying for combined mental health care. Which I think is dumb.

 

[Therapist4Chnge]

Unfortunately, while medicare is happy to overpay for several spinal steroid injections, or thousands a month for brand name atypical antipsychotics,they don't like paying for combined mental health care. Which I think is dumb.

Some services are paid like we are just printing money...oh wait. Welcome to Modern Healthcare in 'Murica!

 

[roubs]

I think a one positive effect will be increasing availability of services in under served areas, but if declining reimbursement for psychosocial interventions and encroachment into doctoral psychology from MA-level therapists were not happening, there wouldn't be such a huge push.

 

[Leo Aquarius]

Everyone's encroaching into everyone else's territory. Why can't we all get along and do what we are best qualified to do and leave it at that? Actually, psychiatrists aren't trying to encroach into any territory at all... it's all the mid-levels and psychologists who are to blame. Am I wrong?

 

[vistaril]

I think a one positive effect will be increasing availability of services in under served areas, but if declining reimbursement for psychosocial interventions and encroachment into doctoral psychology from MA-level therapists were not happening, there wouldn't be such a huge push.

yep.....

anytime MORE CHOICE is what comes out of something, that's always a good thing imo.

 

[Leo Aquarius]

yep.....

anytime MORE CHOICE is what comes out of something, that's always a good thing imo.

Actually no, not always in medicine. More choice can hurt patients when they can't compare quality of care among the choices and assume they are getting just as good of care as then next option.

Having more choices isn't of benefit unless you can compare among those choices. For the general population, they can't tell you that seeing a family medicine doctor for bipolar disorder is better than seeing a psychiatrist vs seeing a psychologist who can prescribe meds. John Doe will assume that if a psychologist can prescribe me meds, then he or she must be very qualified to do so. Pretty straightforward, right? Not really.

 

[slickster032]

I just matched in Psychiatry, I am currently an MSIV. Honestly, I don't see a lot of problems with this. There will always be a very important role for psychiatrists in acute inpatient/emergency management, care for the psychiatrically or medically complex patients such as those with active psychosis, active suicidality, treatment resistent depression, terminal schizophrenia, conversion disorder, the geriatric depressed patient with HTN, diabetes, CHF, multiple CVAs, etc. I think having psychologists managing less acute, less complex psychiatric /medical patients (obviously not the psychologically complex which psychologists would actually be better at I think) and consulting psychiatrists appropriately when needed is really not a big deal. I think that would actually give psychiatrists more time to deal with the more medically/psychiatrically complex patients who require somebody with more extensive medical and inpatient training. Ultimately, however, the key is collaboration, talking more, consulting each other more. We do our patients a disservice when we do not work together!

 

[vistaril]

Actually no, not always in medicine. More choice can hurt patients when they can't compare quality of care among the choices and assume they are getting just as good of care as then next option.

Having more choices isn't of benefit unless you can compare among those choices. For the general population, they can't tell you that seeing a family medicine doctor for bipolar disorder is better than seeing a psychiatrist vs seeing a psychologist who can prescribe meds. John Doe will assume that if a psychologist can prescribe me meds, then he or she must be very qualified to do so. Pretty straightforward, right? Not really.

I'm not as pessimistic as you towards the 'general population'.....I tend to put trust in people to make their own decisions to some degree.

 

[nitemagi]

I think a one positive effect will be increasing availability of services in under served areas, but if declining reimbursement for psychosocial interventions and encroachment into doctoral psychology from MA-level therapists were not happening, there wouldn't be such a huge push.

There's not a whole lot of evidence that RxP leads to increased availability in underserved areas, especially since most psychologists are in urban areas.

In addition, the millions of dollars used to create a program like this, leading to only something like 16 providers in NM, for example, could be spent a lot more effectively to just recruit a couple of extra psychiatrists with higher salary to these rural areas.

 

[Therapist4Chnge]

Everyone's encroaching into everyone else's territory. Why can't we all get along and do what we are best qualified to do and leave it at that? Actually, psychiatrists aren't trying to encroach into any territory at all... it's all the mid-levels and psychologists who are to blame. Am I wrong?

Yes...neuropsych testing.
"I can just use a computer program."
"I can do medicolegal evals using neuropsych assessments"
Etc.

 

[Therapist4Chnge]

I think having psychologists managing less acute, less complex psychiatric /medical patients (obviously not the psychologically complex which psychologists would actually be better at I think) and consulting psychiatrists appropriately when needed is really not a big deal. I think that would actually give psychiatrists more time to deal with the more medically/psychiatrically complex patients who require somebody with more extensive medical and inpatient training.

...I can see how a psychiatrist wouldn't want to only see complex cases, but I think the net effect would allow more pts to be seen and sooner.

 

[sunlioness]

Before we get up in arms to protect our turf, I think we need to seriously look at how well we are serving our turf. And the answer on where I sit is not well at all. And not because we suck. There just aren't enough of us. I get all these emails from the APA and the IL state medical society about OMG we need to stop the midlevels and psychologists from ruining medicine, killing people,and stealing our jobs, but meanwhile I work at a place where it takes 4 months for a patient to get an initial appointment and I can't even get my established patients in crisis in before 6 weeks. It's bad. If midlevels and psychologists can help with this, I say let them and let's devote our efforts to fixing the access problem.

My main concern with psychologists prescribing is that it will change the field of psychology. Psychologists are the therapists and assessors par excellence. I would hate for them to lose that because of the demand for medication.

 

[notdeadyet]

Yes...neuropsych testing.
"I can just use a computer program."
"I can do medicolegal evals using neuropsych assessments"
Etc.

Are psychiatrists really pushing for doing neuropsych testing?

In my experience, psychiatry is more than happy to leave this to the psychologists. It's just not our field of expertise and I don't know anyone that wants it to be. It's too easy to consult neuropsychology to do these tests and incorporate it into our decision-making process. These reports and results are used in psychiatry-delivered evaluations, but they are meant to be. No test is meant to be standalone; by definition it's just a tool.

If psychiatrists are trying to get into the neuropsychology testing development/administration field, that's just silly.

 

[AcronymAllergy]

There's not a whole lot of evidence that RxP leads to increased availability in underserved areas, especially since most psychologists are in urban areas.

In addition, the millions of dollars used to create a program like this, leading to only something like 16 providers in NM, for example, could be spent a lot more effectively to just recruit a couple of extra psychiatrists with higher salary to these rural areas.

I guess it depends on what you consider an underserved area, as pretty much all of Louisiana could likely be considered as such.

As for the disparity between the number of MPs in LA vs. NM, I believe a big part of that was/is due to differences in the ways individuals are approved to prescribe. I don't recall the specifics, but inter-profession politics may have come into play at some point.

 

[AcronymAllergy]

Before we get up in arms to protect our turf, I think we need to seriously look at how well we are serving our turf. And the answer on where I sit is not well at all. And not because we suck. There just aren't enough of us. I get all these emails from the APA and the IL state medical society about OMG we need to stop the midlevels and psychologists from ruining medicine, killing people,and stealing our jobs, but meanwhile I work at a place where it takes 4 months for a patient to get an initial appointment and I can't even get my established patients in crisis in before 6 weeks. It's bad. If midlevels and psychologists can help with this, I say let them and let's devote our efforts to fixing the access problem.

My main concern with psychologists prescribing is that it will change the field of psychology. Psychologists are the therapists and assessors par excellence. I would hate for them to lose that because of the demand for medication.

Many psychologists would agree with you re: changing the practice and overall identity of the field.

 

[vistaril]

Before we get up in arms to protect our turf, I think we need to seriously look at how well we are serving our turf. And the answer on where I sit is not well at all. And not because we suck. There just aren't enough of us. I get all these emails from the APA and the IL state medical society about OMG we need to stop the midlevels and psychologists from ruining medicine, killing people,and stealing our jobs, but meanwhile I work at a place where it takes 4 months for a patient to get an initial appointment and I can't even get my established patients in crisis in before 6 weeks. It's bad. If midlevels and psychologists can help with this, I say let them and let's devote our efforts to fixing the access problem.
.

Bingo...and the reality is we create part of that access problem imo. There are a lot of psychiatrists who hang onto stable outpatients forever because they are...well...stable and easy and quick. If they were sent back to pcp to write prescription, that would free up more spots for the patients who are actually in crisis and need to be seen....*in* crisis...not later when they may not even need to be seen anymore.

I don't think the issue is so much that there is such a massive need for our services that we can't accomodate that need, although I would some would disagree with that. I think the allocation of our time and resources is just very poor.

 

[Therapist4Chnge]

Are psychiatrists really pushing for doing neuropsych testing?

I have seen it most frequently in a forensic setting (e.g. TBI & committing a crime or seeking compensation). I have seen it also attempted by neurologists (directly marketed to by software companies...e.g. Concussion eval).

 

[Armadillos]

Many psychologists would agree with you re: changing the practice and overall identity of the field.

This is the part that seems weird/impractical to me. Prescribing medication has never been a focus of psychologists, while medical doctors have been prescribing meds for awhile. It seems weird to have one field expand completely outside of current (and historical) focus of its training, instead of just expanding the field that historically practices in this way.

While there apparently is a shortage of psychiatrists to prescribe meds in some areas, I would assume there is also a shortage of psychologists in those same areas, so if you give incentive for psychologists to do other things than what they are currently doing, then its probably going to be even harder for a patient to get an appointment with a good psychologist for therapy or assessment.

I mean if you want to do anything besides increase the number of psychiatrists, maybe they should just add more psychiatric training to FM/IM residency, because realistically those are the only health professionals you know are going to be available in every rural area so would seem to target the problem most directly.

 

[dl2dp2]

Bingo...and the reality is we create part of that access problem imo. There are a lot of psychiatrists who hang onto stable outpatients forever because they are...well...stable and easy and quick. If they were sent back to pcp to write prescription, that would free up more spots for the patients who are actually in crisis and need to be seen....*in* crisis...not later when they may not even need to be seen anymore.

I don't think the issue is so much that there is such a massive need for our services that we can't accomodate that need, although I would some would disagree with that. I think the allocation of our time and resources is just very poor.

This isn't necessarily the issue. There's a lack of cause and effect involved in this. I.e. the cause of lack of access is due to lack of provider's interest, but it's not due to a lack of provider. Psychologists are not really very interested in provide therapy for patients in crisis either, and when they do, they get paid very little. While there is a shortage for medication management, there's a real shortage for EVIDENCE BASED therapy for patients who need therapy, even though there is a huge oversupply of therapists.

The bottom line is even if psychologists had RX, they still wouldn't want to treat an undesirable population and it doesn't solve the access issue. Meanwhile, it may, as you said, hurt the bottom line for psychiatrists because now they are competing with the same pool of desirable patients. For something like APA/AMA, which is essentially a lobbying group, I don't see any reason why they wouldn't advocate for a position that's in the professional interest of the members. Now, APA also has an patient advocacy role, which may or may not conflict with the professional advocacy role, but clearly this is not at stake or else NAMI and pure patient advocacy groups would push for RxP. Right now it's a small lobby of RxP groups that are advocating fro RxP, with clearly their own agenda.

The situation isn't that simple. For instance, if we really want to solve the access problem, we can train RxPs but only limit their practice to a few access needy areas. But clearly that defeats the purpose of the law, which is to train RxPs to make MD salaries. Everyone has an implicit stake in this game.

Again, as you are not very optimistic about biological psychiatry we are gonna have to agree to disagree, but as biological psychiatry expands, the practice of psychiatry is becoming more and more medical, and it'll eventually become a special thing where it's just very clear that it's not possible to do something like RxP. That's really the ultimate solution to this problem. But before that happens we'll just have APA/AMA fight on our behave.

 

[sunlioness]

Bingo...and the reality is we create part of that access problem imo. There are a lot of psychiatrists who hang onto stable outpatients forever because they are...well...stable and easy and quick. If they were sent back to pcp to write prescription, that would free up more spots for the patients who are actually in crisis and need to be seen....*in* crisis...not later when they may not even need to be seen anymore.

I don't think the issue is so much that there is such a massive need for our services that we can't accomodate that need, although I would some would disagree with that. I think the allocation of our time and resources is just very poor.

There's some truth to that and I think part of the solution is better education for PCPs. I get a lot of referrals from PCPs who "aren't comfortable" writing a patient's psych meds even if they've been stable on them for years. If it's something like lithium, I get that. But within th last week, I've had a PCP who wasn't comfortable with 300mg of Wellbutrin and another who freaked out because their patient was on 300mg of Effexor XR and told her that she either needed to drop down to 225mg or see a psychiatrist. This is someone who'd been doing fine on the 300mg dose for years. It's very frustrating. And then there are the patients who decide they don't like their doctor anymore and want to switch to someone else in the practice and by and large we let them even though it takes an assessment slot away from someone else. Lots of things like that that we could be doing much better. But fundamentally, I still think it boils down to there not being enough of us and short of fixing that, there's only so much tweaking you can do. I think it's a systemic problem that ultimately is going to have to be solved at the public policy level. So it's frustrating to me to see all the griping at that level being about what midlevels and psychologists are allowed to do instead of grappling with the fundamental problem of access.

And yeah, access to psychotherapy here is just as bad. So shifting the focus of the therapy providers to providing medication wouldn't really solve anything. We need more therapists too.

 

[Esquire]

.

 

[AcronymAllergy]

This is the part that seems weird/impractical to me. Prescribing medication has never been a focus of psychologists, while medical doctors have been prescribing meds for awhile. It seems weird to have one field expand completely outside of current (and historical) focus of its training, instead of just expanding the field that historically practices in this way.

While there apparently is a shortage of psychiatrists to prescribe meds in some areas, I would assume there is also a shortage of psychologists in those same areas, so if you give incentive for psychologists to do other things than what they are currently doing, then its probably going to be even harder for a patient to get an appointment with a good psychologist for therapy or assessment.

I mean if you want to do anything besides increase the number of psychiatrists, maybe they should just add more psychiatric training to FM/IM residency, because realistically those are the only health professionals you know are going to be available in every rural area so would seem to target the problem most directly.

This could be true in some areas, although in general, there seems to be an oversupply of psychologists getting churned out. However, related to other posters mentioning the shortage of therapists practicing evidence-based interventions (with which I definitely agree), while there's a potential glut of psychologists in some areas, there very well could be a shortage of well-trained psychologists. We (psychologists) as a field really need to work on reducing the variability and raising the minimum bar of our admissions and training programs, particularly with respect to free-standing professional schools.

In actuality, I'm nearly positive there are many, many psychologists who'd love to make a living primarily as clinicians providing only evidence-based therapy. Unfortunately, the reimbursement situation for therapy in general is such that this is becoming more and more difficult to do. I'd be all for insurance companies clamping on non-evidence-based therapies if this meant that they'd pay more (and less often fight paying) for EBTs.

 

[notdeadyet]

As someone considering psychiatry, NP's and prescribing psychologists are the biggest turnoffs to me considering the field.

Keep in mind that there is little-to-no actual data or data-based forecasts that is showing any substantial threat to the field from prescribing psychologists, NPs, PAs, or the rest. The fear is most prevalent on sites like SDN. Most fields in medicine has this subset of folks that are always worrying about encroachment.

• There are primary care internists and family practice folks that worry about NPs and PAs
• There are radiologists worried about nighthawks
• There are anesthesiologists worried about CRNAs
• There are OB-GYNs worried about midwives
• Etc., etc., etc.

In fact, even those with no real encroachment have their gripes. Pathologists have less opportunities for jobs. Many surgeons are seeing declining salaries. Hang around different doctor lounges or read some of the other forums.

The fact is that medicine as a whole is just not the true gravy train it once was and is likely never to be again. That's just the economics of the situation and it's likely to continue to head that direction (incidentally, it's also true of law, business, and all sort of fields). And the cold hard reality is that medicine has gone from being a top 3% income bracket profession to being a top 4% income bracket job.

If you love what you do, even if you're only in the top 6% income bracket, you'll likely be quite content. If slumming in those waters is too hard a reality for folks to accept, well...

 

[slickster032]

As someone considering psychiatry, NP's and prescribing psychologists are the biggest turnoffs to me considering the field. I'm sure more folks feel the same, and will be scared away from psych, and it would lead to more shortages. More shortages give more ammo to the vested parties who are pushing for expanded scope of practice for non-physicians. But there's no real shortage, just a shortage of willingness to pay psych more.

The academics I've spoken to feel that in the future psychs will be taking care of complex inpatients while the NP's deal with outpatients (read: eaiser, profitable patients). But not everyone wants to spend their career dealing with admins and doing inpatient work, or filling their clinic with all difficult patients. One of the appealing things about psych is the ability to open up a private practice, but the expansion of NP's and prescribing therapists will limit that.

If psych becomes more inpatient based, there's nothing to stop hospitals from hiring NP's to do that work too. If CRNAs can push drugs in the OR, then surely an MBA will figure out he can utilize NPs on the psych wards too and pocket a bonus. What's to stop what's happening to new anesthesiologists from happening to new psychs?

Well to be honest, why should we get paid to do something that requires the basic medical knowledge of an NP or a trained psychologist? Why should an otherwise healthy person with mild depression have to see a psychiatrist for a low dose anti-depressant when he/she could see someone with adequate enough training to do the same thing for much cheaper? Obviously, I can't envision a psychologist or NP managing medication cocktails for patients suffering from schizoaffective disorder - bipolar type, ruling out capacity after diagnosing a delusional disorder secondary to a general medical condition, realizing the medicine ER incorrectly sent a patient with a brain bleed to the psych ER because of psychosis, or independently managing the borderline patient in the ER on his/her 10th suicide attempt, in addition to our roles as teachers, consultants and managers. It's not that we are smarter than them, but it's what we are trained to do. I think it is a waste of very expensive training for us not to want to delegate some of this work.

 

[LiamNeesons]

In some countries all medications are over-the-counter.

 

[st2205]

Couldn't a lot of the access problems be solved by making available a few SSRIs OTC along with Abilify and Seroquel? That could put a huge dent into access problems.

 

[vistaril]

Couldn't a lot of the access problems be solved by making available a few SSRIs OTC along with Abilify and Seroquel? That could put a huge dent into access problems.

there is already a medication that is pretty much as good as ssri's(with generally fewer side effects) otc- it's called st johns wort

 

[F0nzie]

There's not a whole lot of evidence that RxP leads to increased availability in underserved areas, especially since most psychologists are in urban areas.

In addition, the millions of dollars used to create a program like this, leading to only something like 16 providers in NM, for example, could be spent a lot more effectively to just recruit a couple of extra psychiatrists with higher salary to these rural areas.

I agree with your first point, Psych NPs that can practice independently are already opening up private practices (cash and insurance) in wealthy urban areas, not in underserved areas. There is no reason to think Rx psychologists would take a different approach.

I also agree with your second point. You could offer a starting salary of let's say $280k and I guarantee psychiatrists will move to NM just to take that job. It's only a 60k bump in salary vs. hiring an NP less qualified for the job for 140k

 

[Excitotox]

Couldn't a lot of the access problems be solved by making available a few SSRIs OTC along with Abilify and Seroquel? That could put a huge dent into access problems.

Good God, I hope you're joking. Please tell me you're joking.

 

[vistaril]

I agree with your first point, Psych NPs that can practice independently are already opening up private practices (cash and insurance) in wealthy urban areas, not in underserved areas. There is no reason to think Rx psychologists would take a different approach.

I also agree with your second point. You could offer a starting salary of let's say $280k and I guarantee psychiatrists will move to NM just to take that job. It's only a 60k bump in salary vs. hiring an NP less qualified for the job for 140k

but that's looking at it wrong...it's a 60k bump in salary but a 120k in salary difference between another option(hiring the psych np for 140)

 

[F0nzie]

This thread reminds me of the time I was admitted to the hospital by a nurse practitioner that was specialized in internal medicine. A part of me wanted to complain about not getting a doctor, and another part of me wanted to stay quiet so as to not come across as a narcissist. I just kept my mouth shut.

 

[nancysinatra]

And while they're at it why not just create an ultra fast track and let high school graduates take a weekend workshop to memorize the DSM. If they pass, they can sign up for the psychotropic medication retreat. I'll bring the soda and crackers.

In some places, this is called "residency."

 

[nancysinatra]

This thread reminds me of the time I was admitted to the hospital by a nurse practitioner that was specialized in internal medicine. A part of me wanted to complain about not getting a doctor, and another part of me wanted to stay quiet so as to not come across as a narcissist. I just kept my mouth shut.

It's far more narcissistic to worry about how you'll come across in a situation like that than it would be to simply complain. You're entitled to worry about your health, especially when you're in the hospital. In fact, that's quite normal. If it weren't, no one would go to hospitals. And it's normal to expect a doctor in a hospital.

 

[benjee]

Well to be honest, why should we get paid to do something that requires the basic medical knowledge of an NP or a trained psychologist? Why should an otherwise healthy person with mild depression have to see a psychiatrist for a low dose anti-depressant when he/she could see someone with adequate enough training to do the same thing for much cheaper? Obviously, I can't envision a psychologist or NP managing medication cocktails for patients suffering from schizoaffective disorder - bipolar type, ruling out capacity after diagnosing a delusional disorder secondary to a general medical condition, realizing the medicine ER incorrectly sent a patient with a brain bleed to the psych ER because of psychosis, or independently managing the borderline patient in the ER on his/her 10th suicide attempt, in addition to our roles as teachers, consultants and managers. It's not that we are smarter than them, but it's what we are trained to do. I think it is a waste of very expensive training for us not to want to delegate some of this work.

The main problem is nobody can 100% absolutley sure that this is simple mild depression forever/for life and if those mid levels, psychocologists are competent, they should be able to manage anything like what a MD does. They should not cherry pick the easy ones and dump all the complicated ones to MDs and this is unethical/discriminative even in their own fields. yes, I don't agree non-mds restrict themselves to certain population in terms of practicing medicine once they are granted with privileges of quasi medicine practice.

 

[slickster032]

The main problem is nobody can 100% absolutley sure that this is simple mild depression forever/for life and if those mid levels, psychocologists are competent, they should be able to manage anything like what a MD does. They should not cherry pick the easy ones and dump all the complicated ones to MDs and this is unethical/discriminative even in their own fields. yes, I don't agree non-mds restrict themselves to certain population in terms of practicing medicine once they are granted with privileges of quasi medicine practice.

Well, I am sure that just as most other professionals who when presented with something they are unsure of will consult appropriately, especially under liability of malpractice. I work with a lot of NPs and they have all been very quick to consult appropriately when the complexities of the case reach the limits of their training. At the end of the day, allowing psychologists and NPs to do some of the work of medication management is good for patients.

 

[Merovinge]

God forbid you actually look at the proposed language, though I guess it is much easier to just make stuff up. Here is the actual language from the current proposal, not wildly inaccurate declarations of fact....

Here is more language from the proposed legislation....

As I do live in Illinois and have been involved in different parts of investigation of language, this has been what I have found. As you quote the language is quite vague on what drugs are allowed. Because things like antihypertensives have good evidence for psychiatric treatment (the A2 agonists), the language is specifically intended to be more inclusive. Not only are some patients on SSRIs also given Viagra, but some people argue that folks with ED have mood disorder related to lack of sex and prescribe Viagra; accordingly, as I mentioned, RxPs could do a Viagra mill as they wanted under the proposed law.

Additionally, the course descriptions are fine to be listed, but youll note no actual in-class requirements listed. The current model for next year already has a setup with reduction in other areas of training to make sure the grad student's can finish in the same amount of time with some extra time for online courses needing to be done over nights/weekends. It's just like the PA's adding 3 months of school to get a Doctorate (PhD). It's specifically designed to give advanced degrees/privileges at single digit percents of comparable time/learning because people want what their neighboors have and PAs and PhDs spend lots of time around MDs.

 

[toothless rufus]

This infuriates me. Ok so we need to overturn psychologist Rx in all states, and close the doors on the midlevels, and make these permanent immutable STFU changes. Actually for all of medicine. And get rid of CRNA's and all the rest everywhere in every specialty. Shortage? Too bad. Open more medical schools. And let supply and demand drive our compensation through the roof.

Physician only please. Being a doctor is supposed to provide a great salary and lifestyle, and treating patients should require medical school plus residency and should be the only allowable option. Midlevels were a very bad idea. MAybe not originally, but they continue to mewl and to push their scope of practice and cheap bastards would rather hire them than physicians.

Isn't anything sacred? Don't people want the best care possible to be the minimum standard? I should not be wondering if I should be regretting this path. I should be rejoicing in soon being substantially reimbursed for as long as I choose to work.

Yay!

Glad that's all solved.

 

[michaelrack]

. Shortage? Too bad. Open more medical schools. .

Opening more residency programs is the key to fixing any shortages.

 

[benjee]

Well, I am sure that just as most other professionals who when presented with something they are unsure of will consult appropriately, especially under liability of malpractice. I work with a lot of NPs and they have all been very quick to consult appropriately when the complexities of the case reach the limits of their training. At the end of the day, allowing psychologists and NPs to do some of the work of medication management is good for patients.

That means it's ok to let a pharmacy. tech to assume the job of a pharmacist.

 

[slickster032]

That means it's ok to let a pharmacy. tech to assume the job of a pharmacist.

Your analogy about pharmacy techs assuming the role of pharmacists is closer to MAs being able to write scripts in our world. Nurse practitioners are not simple ancillary staff with little training or experience; they are highly trained clinicians (albeit not as much doctors), as would be PhD psychologists with advanced training in psychotropic pharmacology. As we gain further understanding of the complexities of the mind and as advancements in psychopharmacology continue, I have no doubt there will always be more than enough work for psychiatrists even if psychologists gain the ability to prescribe.