Illinois passes bill allowing psychologists to prescribe medications

[F0nzie]

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Assuming that RxP becomes ubiquitous throughout the nation in the next couple of decades, how badly will it affect the income potential of psychiatrists? I know that no one can predict the future, but is this something to seriously consider when weighing the pros and cons of this specialty?

The same thing that happened to psychotherapy reimbursements when we discovered the biochemistry of mental illness and let everyone else offer psychotherapy?

 

[Therapist4Chnge]

Hard to say. According to the bill, RxP gets unlimited prescribing abilities as I understand it. What would keep them from treating diabetes, strep throat, or any other condition?

Scope of practice...which from what I read earlier is defined in the legislation.

Your bedside manner?

Well played sir!



vistaril (to his credit) provides a less rosy view of psychiatry, which I think is often needed. There can only be so many threads/posts that say: "Ok...so I can make $300k/yr, cash only, and work 3 days a week, right?" before someone needs to burst the bubble. I welcome his posts....albeit partly bc I love all of the visceral responses from other posters.

It's after 5pm...time to go for a joy ride. Peace out SDN.

 

[BS81]

We'll just have to start doing pain fellowships.

 

[vistaril]

Scope of practice...which from what I read earlier is defined in the legislation.



Well played sir!



vistaril (to his credit) provides a less rosy view of psychiatry, which I think is often needed. There can only be so many threads/posts that say: "Ok...so I can make $300k/yr, cash only, and work 3 days a week, right?" before someone needs to burst the bubble. I welcome his posts....albeit partly bc I love all of the visceral responses from other posters.

It's after 5pm...time to go for a joy ride. Peace out SDN.

The funny thing is that most people I know inside and out of medicine think I am a huge cheerleader for psychiatry....I guess it all depends one the perspective.

 

[Leo Aquarius]

Ok Vistrail, now's your chance to defend your cheerleading reputation. What do you really think of psychiatry and psychiatrists? I'm not holding my breath here.

 

[billypilgrim37]

The funny thing is that most people I know inside and out of medicine think I am a huge cheerleader for psychiatry....I guess it all depends one the perspective.

It's rarely what you say. It's usually how you say it. And it's very cumulative. You post at a higher clip than anybody else here. You've been much better behaved for quite awhile, but you were a pretty unbearable poster for a while, and on any given thread, other things you have said color everything you say now. Then there was the lying about where you were (among other things). You do say lots of reasonable and true things, but your overconfidence about it all makes what you say ineffective, and if anything, counterproductive. Most of us are on here because we want to be helpful and we like hearing ourselves talk (an anonymous psychiatry board screens narcissism in like crazy!). Sometimes it's totally unclear why you're here. If you're trying to be helpful, you've done enough to undermine yourself and just stir people up. You've sparred with pretty much everybody.

You say plenty of stuff that isn't much different than what michaelrack and splik and even I would say. Yet the rest of us don't cause so many fights about it. It is rarely what you say.

 

[MacDonaldTriad]

This has gone a long way away from psychologists writing meds.
In terms of our angry disaffected poster, I agree with what has been said, but style aside, he has some points. I would like to think we can tolerate some controversy. That is what make this interesting and keeps me reading after all.
I know a lot of you have tremendous debt, but my gosh, you will be comfortable enough. Just because you are miserable now doesn't mean things will not be better and manageable financially. Most of us have made good decisions about life and we will do better than most (maybe with a few exceptions I don't think will post).
Psychiatry is great. I see very few people in it with regret and it isn't a field that people are running from because of lack of pay.

 

[vistaril]

It's rarely what you say. It's usually how you say it. And it's very cumulative. You post at a higher clip than anybody else here. You've been much better behaved for quite awhile, but you were a pretty unbearable poster for a while, and on any given thread, other things you have said color everything you say now. Then there was the lying about where you were (among other things). You do say lots of reasonable and true things, but your overconfidence about it all makes what you say ineffective, and if anything, counterproductive. Most of us are on here because we want to be helpful and we like hearing ourselves talk (an anonymous psychiatry board screens narcissism in like crazy!). Sometimes it's totally unclear why you're here. If you're trying to be helpful, you've done enough to undermine yourself and just stir people up. You've sparred with pretty much everybody.

You say plenty of stuff that isn't much different than what michaelrack and splik and even I would say. Yet the rest of us don't cause so many fights about it. It is rarely what you say.

eh...I'm just not all that interested in being 'productive' or 'effective'. I don't even know how such things would be measured on such a forum(?). I like to come in here, read about psych happenings, and run my mouth on matters related to our field. It's entertainment. If someone gains something from my comments, great, but that's not the expectation. It's all good.....

 

[billypilgrim37]

eh...I'm just not all that interested in being 'productive' or 'effective'. I don't even know how such things would be measured on such a forum(?). I like to come in here, read about psych happenings, and run my mouth on matters related to our field. It's entertainment. If someone gains something from my comments, great, but that's not the expectation. It's all good.....

Well, that's the most honest you've probably ever been. Interestingly, you nearly defined yourself as a troll.

A lot of us remember being on this forum as med students and getting a lot of helpful advice. Some of us stick around to hopefully be a part of that. As ridiculous as it may sound to you, people make all kinds of decisions based on what they read here. Especially folks who don't have good academic advising at their home psychiatry departments.

 

[nitemagi]

eh...I'm just not all that interested in being 'productive' or 'effective'. I don't even know how such things would be measured on such a forum(?). I like to come in here, read about psych happenings, and run my mouth on matters related to our field. It's entertainment. If someone gains something from my comments, great, but that's not the expectation. It's all good.....

Per urban dictionary:

1. Troll

One who posts a deliberately provocative message to a newsgroup or message board with the intention of causing maximum disruption and argument

 

[digitlnoize]

. Especially folks who don't have good academic advising at their home psychiatry departments.

Or don't HAVE home psychiatry departments...

 

[slickster032]

So can we get back on topic?

 

[Merovinge]

They pushed the vote back till Wednesday when many of the psychiatrists would be busy at APA (although I have no idea if that was planned or not). Weill know very shortly if this is going to happen...

 

[slickster032]

http://www.ilga.gov/legislation/BillStatus.asp?DocNum=2187&GAID=12&DocTypeID=SB&SessionID=85&GA=98

This suggests it is still in committee with hearing on May 21 with deadline for final action on May 24. It was assigned to the Executive Committee whatever that does. Sounds like it might die there?

 

[slickster032]

They pushed the vote back till Wednesday when many of the psychiatrists would be busy at APA (although I have no idea if that was planned or not). Weill know very shortly if this is going to happen...

Do you mean committee or full house? Do you have a source?

 

[Therapist4Chnge]

Do you mean committee or full house? Do you have a source?

On the state website it said it is now in the Executive Committee, earmarked for review on May 21st. They review it and then they can vote a number of different ways, "yes, yes w. revisions, no, etc.". They report back by the deadline, which in this case is May 24th. If they support it (outright or w. revisions), then it can go up for a vote. If not....it will not move forward, as proposed. There is a process to re-do and re-submit, but that gets more technical as things can vary by state. With it being Illinois (aka Chicago + stragglers) they probably just vote in favor of the highest bidder.

It's been quite a few years since I've been involved w. lobbying, so take the above w a grain of salt, but that is how I remember it to proceed.

 

[slickster032]

On the state website it said it is now in the Executive Committee, earmarked for review on May 21st. They review it and then they can vote a number of different ways, "yes, yes w. revisions, no, etc.". They report back by the deadline, which in this case is May 24th. If they support it (outright or w. revisions), then it can go up for a vote. If not....it will not move forward, as proposed. There is a process to re-do and re-submit, but that gets more technical.

It's been quite a few years since I've been involved w. lobbying, so take the above w a grain of salt, but that is how I remember it to proceed.

Interesting. What if no action is taken by May 24? And what will happen if there is no vote taken in the full house by the end of the legislative year? Would the bill die?

Thanks for the perspective!

 

[Therapist4Chnge]

Again...take all of this with a grain of salt because there are quirks with each state and sometimes there are some arcane procedures and lesser known maneuvers to manipulate the process. There are also well known maneuvers, even after McCain-Fiengold (aka the Bipartisan Campaign Reform Act of 2002). I did some lobbying prior to the implementation of the BCRA, so I could just walk in with a check and have an audience of my choosing prior to important votes...ya know...the 'Murican Way! You can tell I'm not jaded with the process. .

Here are the IL House Rules. Be warned they are wordy and boring...welcome to the gov't. The committee options are as follows:

22. Committee Procedure.
(a) A committee may consider any legislative measure referred to it, except as provided in subsection (b), and may make with respect to that legislative measure one of the following reports to the House or to the parent committee, as appropriate:
(1) that the bill "do pass";
(2) that the bill "do not pass";
(3) that the bill "do pass as amended";
(4) that the bill "do not pass as amended";
(5) that the resolution "be adopted";
(6) that the resolution "be not adopted";
(7) that the resolution "be adopted as amended";
(8) that the resolution "be not adopted as amended";
(9) that the floor amendment, joint action motion, conference committee report, or motion to table a committee amendment referred by the Rules Committee "be adopted";
(10)that the floor amendment, joint action motion, conference committee report, or motion to table a committee amendment referred by the Rules Committee "be not adopted";
(11) that the Executive Order "be disapproved";
(12) that the Executive Order "be not disapproved";
(13) "without recommendation"; or
(14) "tabled".

If the proposed legislation makes it out of committee, then it goes back to the House, which then goes through a number of steps involving a reading of the bill, open debate, public comment, questions for the committee, etc. The bill needs to be read 3 times prior to any full membership vote (to ensure things don't get added in without fair notice of the reps and public....allegedly). This is all well and good, but there are a bunch of things that can be done to stall, change, kill, etc. proposed legislation.

As for taking action by the deadline....I believe something needs to be done about the legislation, which can include extended it to the next meetings/session, tabling it, sending it back to the committee w. questions/clarifications, withdrawing it (done by the Sponsor), etc. I'm sure I'm forgetting about a dozen things...but hopefully that helps.

It really takes a ton of effort to get ANYTHING through bc of all of the horse-trading that goes on behind closed door. I'll be watching this closely, but there are still quite a few hoops that need to be jumped through before this legislation sniffs the Governor's desk for a signature.

 

[nitemagi]

Sorry all.

http://alert.psychiatricnews.org/20...PsychiatricNewsAlert+(Psychiatric+News+Alert)

 

[OldPsychDoc]

Sorry all.

http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1668022

Were you meaning to post This Link instead?

 

[nitemagi]

were you meaning to post this link instead?

yes! edited post.

 

[OldPsychDoc]

yes! edited post.

<sigh> 272 posts...and all for naught. :cry:

 

[kumar28]

woohoo! Good job IPS and APA to squash this ridiculous bill!!!!

 

[Leo Aquarius]

Yeee Haww~!

 

[Leo Aquarius]

Hey Psychologists, stop treading on places you have no business treading. Stop trying to be physicians, and stop trying to take our jobs.

 

[slickster032]

Hey Psychologists, stop treading on places you have no business treading. Stop trying to be physicians, and stop trying to take our jobs.

Your post reminded me of this: https://www.youtube.com/watch?v=768h3Tz4Qik

On a serious note: I feel this turf warfare is of little benefit. How about a discussion on how best to collaborate, improve outcomes, etc? So little mutual respect and civility on this forum.

 

[vistaril]

Hey Psychologists, stop treading on places you have no business treading. Stop trying to be physicians, and stop trying to take our jobs.

psych nps are 20x the threat psychologists are

 

[st2205]

psych nps are 20x the threat psychologists are

From a financial point of view, yes.

 

[digitlnoize]

From a financial point of view, yes.

Not if they're working for you.

 

[vistaril]

Not if they're working for you.

lol....the trend is such that most don't now, and in 5-10 years almost none will. Psych np's love to work in salaried positions at cmh centers and VAs...part of the private practice equation varies based on the state, but as more years pass(especially as healthcare legislation hits) psych nps in pp won't be working for psychiatrists for the most part.

Also, even if you do have a pp with psych nps....is that really the type of psychiatry you want to practice? The only thing worse than the psychiatrist doing 5 minute med checks is their freaking nurse practitioner doing 5 minute med checks(and thats what they are trained to do)......

 

[hamstergang]

psych nps are 20x the threat psychologists are

So? What does that have to do with this thread? This thread is about psychologists trying to get prescribing rights, which many think is a bad thing, so they expressed that here. That you view psych NPs as a bigger 'threat' is not useful unless you're just trying to pick fights and disagree with people.

 

[vistaril]

So? What does that have to do with this thread? This thread is about psychologists trying to get prescribing rights, which many think is a bad thing, so they expressed that here. That you view psych NPs as a bigger 'threat' is not useful unless you're just trying to pick fights and disagree with people.

sheeesh talk about trying to pick fights...

and when the topic is one group of practitioners possibly gaining more rights that overlap with ours it is most certainly reasonable to make a quick comment comparing that group to another in terms of infringement potential. Even taking a very narrow view of what constitutes 'on topic', that would still easily qualify.

 

[st2205]

Encroachment and standard of care are two separate issues.

 

[AnnoyedByFreud]

psych nps are 20x the threat psychologists are

I really don't think you have to worry. Psych is just as unpopular for NPs as it is for physicians

 

[vistaril]

Encroachment and standard of care are two separate issues.

and in this very long thread, many different posters have made dozens of posts on each. Thus either of those is certainly appropriate in the context of this thread.

 

[hamstergang]

and when the topic is one group of practitioners possibly gaining more rights that overlap with ours it is most certainly reasonable to make a quick comment comparing that group to another in terms of infringement potential.

But what's your point? That we shouldn't be discussing the psychologists, or we shouldn't be worried because the NPs are a bigger threat? Otherwise it just seems like a non sequitur.

 

[vistaril]

But what's your point? That we shouldn't be discussing the psychologists, or we shouldn't be worried because the NPs are a bigger threat? Otherwise it just seems like a non sequitur.

that defeating one psychologist bill(for now) in one state just isn't that big a deal because another group's encroachment is much more problematic

 

[billypilgrim37]

Giving people who don't have medical training (that masters is a joke) the option to prescribe is very different than giving people with less medical training than us the option to prescribe. That's our point. That's why you're being hit here, because throughout the thread you have been oblivious to this distinction. I get it, you think psychologists could prescribe safely and increase access to care. And we say that's bull****. And that was settled 100 posts ago. So it goes.

When you go to a bar and your buddy hooks up with the cute brunette, the next day you don't tell him that it didn't matter because he didn't hook up with her hot blonde friend. But that's how you constantly act about psychiatry. Oh, you're not "diminishing" the cute brunette, you're just pointing out that she's not the hot blonde, constantly. Don't be shocked when you don't get invited to the wedding.

 

[Heist]

Anyone see these in the Tribune?
http://www.chicagotribune.com/news/...celettersbriefs-20130518,0,92089.story?page=2

This is not the only state to not accept this legislation.
And it is a good thing Grover didn't testify.

 

[F0nzie]

psych nps are 20x the threat psychologists are

I recently applied to a job that offered me a craptastic salary. There was a full-time and a half-time position available for a psychiatrist OR psych NP. I turned them down and they hired 2 NPs within a month: One for 140k and 70k respectively.

Word.

 

[Heist]

I recently applied to a job that offered me a craptastic salary. There was a full-time and a half-time position available for a psychiatrist OR psych NP. I turned them down and they hired 2 NPs within a month: One for 140k and 70k respectively.

Word.

That prolly deserves its own thread..
And some psychiatrist is "collaborating" with those NPs...Ie, taking the liability for them.

 

[vistaril]

I recently applied to a job that offered me a craptastic salary. There was a full-time and a half-time position available for a psychiatrist OR psych NP. I turned them down and they hired 2 NPs within a month: One for 140k and 70k respectively.

Word.

yep....and that trend is only going to get worse.

As for the craptastic salary, I bet it was a bit higher than the 140k the full time np(which is a bit high for them) got right?

 

[vistaril]

That prolly deserves its own thread..
And some psychiatrist is "collaborating" with those NPs...Ie, taking the liability for them.

maybe...maybe not. In many(most?) areas psychiatrists and NPs work together and there is no collaboration or liability. The psych np has their patients and the psychiatrist has their patients.

 

[F0nzie]

That prolly deserves its own thread..
And some psychiatrist is "collaborating" with those NPs...Ie, taking the liability for them.

No they aren't. They have their own liability and they manage their own teams.

 

[F0nzie]

yep....and that trend is only going to get worse.

As for the craptastic salary, I bet it was a bit higher than the 140k the full time np(which is a bit high for them) got right?

NPs get reimbursed at 85% of the physician rate. Do the math.

 

[Heist]

Depends on the state. In Wisconsin and Illinois they need a collaboration agreement. This means they have their own liability. But if the crap hits the fan, the collaborating physician is on the hook too.

 

[vistaril]

NPs get reimbursed at 85% of the physician rate. Do the math.

yeah, that's about what I figured.

I am not sure what the issue is though. You get paid to see patients and bill. If being a psychiatrist rather than an NP provided a skill set and training base that enables you to see more pts and see them faster, then that is going to result in more billings and more pay. If it doesn't, then you shouldn't get paid more. We already have something a built in advantage with the small cut in reimbursement for identical billing codes they get.

 

[vistaril]

Depends on the state. In Wisconsin and Illinois they need a collaboration agreement. This means they have their own liability. But if the crap hits the fan, the collaborating physician is on the hook too.

seeing as how those two states have serious long term financial problems, wouldn't be surprised if they get rid of that required collaboration bit eventually.....it's pretty clear that in agency and public funded outpt mental health settings(which includes cmhcs who mostly survice on medicare/medicaid bundled billing), the trend is going to be increasing autonomy of psych nps and msws...in many that is already the case, but it's only going to increase.

The days of psychiatrists getting paid 200k to be one of a few staff outpt psychiatrists at cmhcs are gradually winding down....Changes in medicare/medicaid bundling(which is going to happen eventually) for these facilities will really accelerate the process.

 

[Heist]

seeing as how those two states have serious long term financial problems, wouldn't be surprised if they get rid of that required collaboration bit eventually.....it's pretty clear that in agency and public funded outpt mental health settings(which includes cmhcs who mostly survice on medicare/medicaid bundled billing), the trend is going to be increasing autonomy of psych nps and msws...in many that is already the case, but it's only going to increase.

The days of psychiatrists getting paid 200k to be one of a few staff outpt psychiatrists at cmhcs are gradually winding down....Changes in medicare/medicaid bundling(which is going to happen eventually) for these facilities will really accelerate the process.

Not serious enough to let psychologists prescribe....
And many states have financial issues..really bad ones...

 

[vistaril]

Not serious enough to let psychologists prescribe....
And many states have financial issues..really bad ones...

cmhcs would much prefer psych nps to rx'ing psychologists...it's not even close. psychologists wouldnt be efficient at all in most cases.

10 years from now, the vast majority of prescribing encounters with a pt at cmhcs will be with psych nps and not psychiatrists. The number of psychiatrists needed statewide at cmhcs will decrease a good bit.