Medical Psychologists on path to getting prescribing privileges, AMA/APA oppose

MacGyver

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PsychNOS said:
This makes the role of the "medical psychologist" in LA similar to the role of nurse practioners doesn't it? They have to consult with a physician prior to prescribing medications.

The main argument that the governor gives for passing the bill is to provide greater access to mental health care, especially in rural areas. If this bill doesn't meet that goal, I wonder if other states would very hesitant to create and implement such a law.
1) NPs in most states are NOT required to consult with a doctor for prescriptions. They have independent script rights.

2) New Mexico tried this and it failed miserably. Last time I checked, not a single new psychologist who went thru the program set up shop in a rural area. Apparently, Louisiana didnt do their homework or they would have discovered this. The truth is they didnt care. The governor/legislature wanted votes, and one way to do that is to promise "increased access to health care." This is purely a political move with no thought as to the medical side of things.
 

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dentite001 said:
Here is one more set of arguments from a psychology perspective. Statistically, knowledge itself follows a bell-curve. Psychologists were able to get major bang for their buck at the 400 hours, partly because they are bright, but also because they had no prior knowledge base. More knowledge is going to require increased effort. On the other end of the curve are Psychiatrists, who I'd argue at 8 years have reached such a point of diminishing return, that they are no longer accessible to the public.
The analogy of the surgeon argument was somewhat misguided. The psychiatrist is no longer in primary care. The psychiatrist may follow a medical model, but it is the MEDICINE that actually does the job. As for the psychotherapy, psychologists can do this just as well or better than a psychiatrist.
This is precisely the point when a politician should step in and make an unbiased decision. A compromise between the psychologist who suffers from being a jack of all trades, to the Psychiatrist, who suffers from tunnel vision. The politician has to in essence find the peak of the bell curve.
In my opinion, the best option is for the psychiatric and psychology associations to actively merge first. Psychiatry is seen by most MDs as grey, whereas clinical psychology is seen as one of the most prestigious and competitive areas within academia. If a professional Psymed program was available right out of undergrad, open to anyone with the right psychology and science prereq's, just think of the brilliant talent pool that could be selected and recruited. An aptitude test could be thrown in for good measure.
Having all therapy and medicine given by the same professional would be beneficial. It would eliminate paperwork, and the same person could work with a patient from start to finish. People are not cars. This would allow therapy and medicine to be individually tailored.
Psychiatry is currently too inflexible but psychology is too fluffy. Even at its worst and most ignorant though, who cares if a few people suffer unnoticed health problems because of medical psychologists. What will 5 years off the END of a suicidal teen's life be if they end up killing themselves NOW. Besides, most patients don't stay on the medicine for their entire lives.
I agree with Svas that the psychologists are working to change things. These people are some of the most cut-throat I have ever met. Egos that I'd argue are bigger than MD's. Seriously. Best to work together to find a solution.

Dentite001
Best post in this forum, period. :thumbup: :thumbup: :thumbup: :thumbup: :thumbup: :thumbup: :thumbup:
 

Svas

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MacGyver said:
1) NPs in most states are NOT required to consult with a doctor for prescriptions. They have independent script rights.

2) New Mexico tried this and it failed miserably. Last time I checked, not a single new psychologist who went thru the program set up shop in a rural area. Apparently, Louisiana didnt do their homework or they would have discovered this. The truth is they didnt care. The governor/legislature wanted votes, and one way to do that is to promise "increased access to health care." This is purely a political move with no thought as to the medical side of things.

Come on . . it's okay to actually read about what is going on in New Mexico. The RULE promulgation phase of the psychologist prescribing law was just approved by the oversight committee a few weeks ago. As it is, RIGHT NOW, there are NO psychologists prescribing yet in NM.

After they start prescribing, then it's okay to talk about what "actually happened." What has "actually happened" hasnt' happened yet.

Again, let's use REAL data to make our claims.

S
 
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Anasazi23

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dentite001 said:
....On the other end of the curve are Psychiatrists, who I'd argue at 8 years have reached such a point of diminishing return, that they are no longer accessible to the public.
Where in the world did you get this notion? The majority of psychiatrists are not pure academicians, but also see patients. Just because there may be less of them does not mean they are unaccessible. Does this automatically mean that any state that has a shortage of specialists should hand over prescription privilages/medical procedures to the next-closest allied health care field?

....The psychiatrist may follow a medical model, but it is the MEDICINE that actually does the job. As for the psychotherapy, psychologists can do this just as well or better than a psychiatrist.
I'm constantly hearing about how psychiatrists do not know how to do therapy compared to a psychologist. Has anyone bothered to take a look at virtually any resident 4 year curriculum? Therapy abounds in residency, like it or not, even in biologically-driven programs. Just because many psychiatrists CHOOSE not to do much therapy again does not make the logical arguement that psychologists therefore should prescribe.

This is precisely the point when a politician should step in and make an unbiased decision. A compromise between the psychologist who suffers from being a jack of all trades, to the Psychiatrist, who suffers from tunnel vision. The politician has to in essence find the peak of the bell curve.
THE POLITICIAN? :eek:
This is absurd.
Following this to its logical end, then all medical specialties should be glorified graduate programs taking applicants from both "pools," thereby eliminating professional medicine altogether. Why not make special surgery schools where you just specialize in surgical techniques? How is it different?
--Also, psychiatrists do not have "tunnel vision." They are fully trained physicians who specialize in the diagnosis and treatment of psychiatric disorders. They come from a background of biological and physiological underpinnings, and use that understanding not only to use psychotropic medications, but to carefully delineate effects and interactions of non-psychiatric and psychiatric illness. This is not "tunnel vision."

In my opinion, the best option is for the psychiatric and psychology associations to actively merge first. Psychiatry is seen by most MDs as grey, whereas clinical psychology is seen as one of the most prestigious and competitive areas within academia. If a professional Psymed program was available right out of undergrad, open to anyone with the right psychology and science prereq's, just think of the brilliant talent pool that could be selected and recruited. An aptitude test could be thrown in for good measure.
Then who would treat the concomitant medical problems that these psychiatic patients tend to have? Are you suggesting that this "psymed" program give comprehensive courses in human disease as well? This is called MEDICAL SCHOOL.

I think psychologists tend to have this notion that psychiatric patients are simply depressed/psychotic/bipolar, etc --- and that's it. The psychiatric patient with no comorbid illness or one who is not on any other treatments is rare. Again, they'll find this out the hard way.

Having all therapy and medicine given by the same professional would be beneficial. It would eliminate paperwork, and the same person could work with a patient from start to finish. People are not cars. This would allow therapy and medicine to be individually tailored.
Have you seen conversations from the RxP (prescribing psychologist) listserv? These people make no bones about "taking a piece of the financial pie" from psychiatrists. They are mad that social workers and bachelors level therapists are undercutting their pay. Their profession is on the downswing, and they're panicing. If you think that they will simply keep their current caseload with 5 therapy patients a day and just 'happen to prescribe some antidepressants to help them' is a naive viewpoint.

Psychiatry is currently too inflexible but psychology is too fluffy.
Psychiatrists, in New Mexico, offered to work in collaboration with psychologists, and suggested that the prescription privilages be given only to those psychologists who worked in their touted "underserved areas." Well guess what - the psychologists refused it. They wanted complete autonomy.

Even at its worst and most ignorant though, who cares if a few people suffer unnoticed health problems because of medical psychologists. What will 5 years off the END of a suicidal teen's life be if they end up killing themselves NOW. Besides, most patients don't stay on the medicine for their entire lives.
I'm not quite sure how to respond to this.....

I agree with Svas that the psychologists are working to change things. These people are some of the most cut-throat I have ever met. Egos that I'd argue are bigger than MD's. Seriously. Best to work together to find a solution.
I agree with you here. Except, please understand that the psychologists want no "working together." They want autonomy. Period.

I was thinking last night....child psychiatrists do one to two extra years of fellowship to become competent to treat this patient population, and obtain board certification. Are psychologists now all of a sudden, from their weekend courses, going to treat them as well? This is just getting obscene.
 

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Svas,

What "real data" are you talking about? The DoD study suffers from such massive selection bias that its unusable. As you know, these things are just starting to happen. What data can be available?

Don't think that the psychologists don't have a plan. They will prescribe mostly benign SSRIs for 10 years or so, all the while, gathering data about how safely they prescribe. Then, they'll again introduce legislation in the remaining states citing this data, and will falsely be at a great advantage because the "real data" is seemingly in their favor.
 

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dentite001 said:
Here is one more set of arguments from a psychology perspective. Statistically, knowledge itself follows a bell-curve. Psychologists were able to get major bang for their buck at the 400 hours, partly because they are bright, but also because they had no prior knowledge base. More knowledge is going to require increased effort. On the other end of the curve are Psychiatrists, who I'd argue at 8 years have reached such a point of diminishing return, that they are no longer accessible to the public.
The analogy of the surgeon argument was somewhat misguided. The psychiatrist is no longer in primary care. The psychiatrist may follow a medical model, but it is the MEDICINE that actually does the job. As for the psychotherapy, psychologists can do this just as well or better than a psychiatrist.
This is precisely the point when a politician should step in and make an unbiased decision. A compromise between the psychologist who suffers from being a jack of all trades, to the Psychiatrist, who suffers from tunnel vision. The politician has to in essence find the peak of the bell curve.
In my opinion, the best option is for the psychiatric and psychology associations to actively merge first. Psychiatry is seen by most MDs as grey, whereas clinical psychology is seen as one of the most prestigious and competitive areas within academia. If a professional Psymed program was available right out of undergrad, open to anyone with the right psychology and science prereq's, just think of the brilliant talent pool that could be selected and recruited. An aptitude test could be thrown in for good measure.
Having all therapy and medicine given by the same professional would be beneficial. It would eliminate paperwork, and the same person could work with a patient from start to finish. People are not cars. This would allow therapy and medicine to be individually tailored.
Psychiatry is currently too inflexible but psychology is too fluffy. Even at its worst and most ignorant though, who cares if a few people suffer unnoticed health problems because of medical psychologists. What will 5 years off the END of a suicidal teen's life be if they end up killing themselves NOW. Besides, most patients don't stay on the medicine for their entire lives.
I agree with Svas that the psychologists are working to change things. These people are some of the most cut-throat I have ever met. Egos that I'd argue are bigger than MD's. Seriously. Best to work together to find a solution.

Dentite001
QUOTE=dentite001] ?The analogy of the surgeon argument was somewhat misguided. The psychiatrist is no longer in primary care. The psychiatrist may follow a medical model, but it is the MEDICINE that actually does the job.?
Who said psychiatrists are providing primary care? And I don't understand about the issue of "medicine doing the job".
?As for the psychotherapy, psychologists can do this just as well or better than a psychiatrist. ?
Exactly, they are cheap and they are trained to do so. No doubts about that and that's why they should stick w/ it. If they want to prescribe medicines, please do the extra 8 years of MD and post-MD training.
?This is precisely the point when a politician should step in and make an unbiased decision. A compromise between the psychologist who suffers from being a jack of all trades, to the Psychiatrist, who suffers from tunnel vision. The politician has to in essence find the peak of the bell curve. ?
Interesting. Since when politicians are taking the place of FDA and other regulatory bodies?
?In my opinion, the best option is for the psychiatric and psychology associations to actively merge first.?
It happened to certain extent in 50s and 60s as an effort to demedicalize the specialty-thank you, it didn't work and as MDs we are not going back on the same route. We talk of more neurosciences these days than neurologists.
?Psychiatry is seen by most MDs as grey, ?
What's the source of that info? For the last several yrs match rate for USMGs have been going up and that reflects an active interest in the field.
?whereas clinical psychology is seen as one of the most prestigious and competitive areas within academia. If a professional Psymed program was available right out of undergrad, open to anyone with the right psychology and science prereq's, just think of the brilliant talent pool that could be selected and recruited. An aptitude test could be thrown in for good measure. ?
Doing a 8 yr training(MD and residency) will serve the same purpose.
Having all therapy and medicine given by the same professional would be beneficial. ?It would eliminate paperwork, and the same person could work with a patient from start to finish. People are not cars. This would allow therapy and medicine to be individually tailored. ?
No doubt about it. Unfortunately 3rd party payment does not reimburse psychtx done by a psychiatrist, it's way cheaper if done by a therapist. That's why it's going to stay this way unless some radical change happens in health-care delivery system.
?Psychiatry is currently too inflexible but psychology is too fluffy. Even at its worst and most ignorant though, who cares if a few people suffer unnoticed health problems because of medical psychologists.
What will 5 years off the END of a suicidal teen's life be if they end up killing themselves NOW. ?
Really? Are you sure to practice w/ this attitude sometime in future? Good luck.
?Besides, most patients don't stay on the medicine for their entire lives.?
I differ-schizophrenia, bipolar d/o and some pts w/ depressive d/o and anxiety d/o do need lifetime tx. And I am not bringing up the other psych conditions associated w/ gen med conditions/developmental d/o blah blah blah.
The issue is all about pt safety, not the question of having bigger ego.
 

Svas

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"I never lie. I willfully engage in a campaign of misinformation."
--Fox Mulder


Frankly, Anasazi23, the moto at the end of each of your letters reflects a very real truth in politics. That is everyone rationalizes for their own ends (or to save it). Psychiatrist and psychologists, Democrats and Republicans . . . the list goes on forever.

I have spent the last two years carefully looking at the data. I don't think that there is data to suggest either selection bias (although I do think that the military and the psychologists were careful to select competent candidates - because they didn't want to hurt anyone) or that the psychologists trained will do poorly. Moreover, since there was SO much scrutiny of the DoD program (before and after), why wasn't the selection bias you discussed pointed out early? In fact, if the selection bias was so severe, why has the DoD opted to continue to train psychologists to prescribe. Both the Air Force and Navy are picking up new psychologist who are being trained, or who have already been trained. Why did the psychiatric residents LIKE working with the prescribing psychologists. Why did the psychiatric residents experience the psychologist as better at teaching than their medical school professors when it came to discussing psychopathology? It seems that the powers that be in the military would have balked when this "selection bias" was apparent. The data appear to the contrary.

I do think that there is an active selection process occuring. Those psychologists that are bright enough to get through the science program inherently required to get a degree in psychopharm will step forward. If the person cannot get through, they'll fail or not try at all. So, sure, a selection process is present (but it probably doesn't rise to a bias.

BTW, did you read the DoD findings?

Talk about bias . . . look at McGyver's comments. This writer is talking about how psychologists didn't start prescribing in rural areas any more than the psychiatrists . . . without admitting that the first psychologist-written prescription has not been produced there. Moreover, when we talk about bias, why didn't MyGyver (or you) comment that as a result of the rural-urban problem, psychiatrists by the hoards started moving to the rural areas? We can't just point our fingers at psychologists and say "see, they're no better than us." We have to work to solve the problem if we want to improve our credibility.
 

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I am not sure of this but how many of these medical psychologists will treat their own spouse/children/family if anyone of them happens to be suffering from mental d/o w/o consulting w/ a psychiatrist?
What do you guys think?
For myself, I am seriously thinking of making a career in becoming a plaintiff expert witness if this trend continues. :rolleyes:
 

Svas

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Subject: [PP] Re: M2M: Louisiana joins New Mexico-prescribing by psychologists



On Sat, 8 May 2004, Ivan Goldberg wrote that is now "close to impossible

to stop" extension of psychologist prescribing to other states and perhaps

to disciplines beyond psychology.



All the intense lobbying and publicity that money can buy will not put the

cat back in the bag and will only demean the profession of psychiatry as

self-serving.



There are two strategies for making the best of the situation.



One is to eliminate all prescribing restrictions and make everything

over-the-counter. There are good arguments for this, but it won't happen,

as there are good counter-arguments (no pun intended).



The other strategy is to help the courts go after incompetent prescribers

in a way that will inhibit anyone who ventures into that territory without

the adequate preparation that only medical training can provide.



Specifically, the APA should generate and make available resources for the

"plaintiff's bar" that would facilitate successful civil actions in tort

against prescribers who harmed patients (or "clients") by virtue of not

really knowing what they were doing. While this might ensnare some hapless

psychiatrists who are not up to snuff, it hopefully would have far more

influence on practitioners who will be at a disadvantage on the witness

stand when they have to disclose that their education in

psychopharmacology lacked all sorts of components that are standard in the

training of physicians and the specialization of psychiatrists.



This line of attack relies more on "science" (the idea that we know more

than psychologists and that letting them prescribe makes little sense)

than on "conscience" (the idea that politicians ought to protect their

constituents rather than deliver them to the wolves).



The APA should create documents that would be useful in court, both for

plaintiffs' attorneys and for psychiatric experts in demonstrating that a

given defendant prescriber overstepped his or her competency, was

unprepared to take a necessary medical perspective, was unable to

understand and integrate relevant data before putting a patient at risk by

starting (or continuing) a course of psychopharmacologic treatment, etc.



This would be a more dignified, effective and feasible course of action

than would trying, as Ivan Goldberg wrote, to "stop the tidel wave" of

prescribing by non-medical providers.



No drug $$ No drug stock. One nerf-brain from I forget which pharma at

the APA meeting.


Myron


Myron L. Pulier, MD

Clin Assoc Prof Psychiatry, UMDNJ-NJ Medical School
 

Anasazi23

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Svas,

Of course I read the DoD findings....I'm not impressed that the psychologists, working in collaboration with physicians, not treating patients with comorbid medical conditions, not treating geriatric patients, not treating children, etc. etc., did an acceptable job.

Look more closely at how the psychologists chosen for this study were recruited. No selection bias? Hardly.

While I agree with you that this process is entirely politically/financially motivated by both sides of the fence, this does not preclude the points made by the MD you quoted above. Like I said in another post, there is no "working together" with these psychologists....for them it's autonomy or bust. Nobody has refuted the more complicated vignettes I mentioned in other posts, I think for a reason. Nobody, including the legislators, completely thought them through.

Psychiatrists by the hoardes are moving to the rural areas? You don't speak lightly in your other posts, so I'm sure that you saw data somewhere for you to say this. I'd be interested in hearing some of the numbers. Frankly, this would surprise me. Which brings me to another point. If the Louisana legislators are concerned about the lack of psychiatrists in their area...have they thought about the ramifications later on? In other words, I myself know for sure (not that I had the desire - although I hear it's lovely) that I will never practice in Louisana now....and I'm also sure that other psychiatrists will get fed up with the price underfixing by psychologists and perhaps move out-of-state. What then? The state where psychologists are prescribing through primary care docs with a dearth of psychiatrists? This does not sound like a solution to the problem. The care would be then substandard, with LESS psychiatrists to treat the patients. Any thoughts?
 

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Anasazi23 said:
Svas,
Look more closely at how the psychologists chosen for this study were recruited. No selection bias? Hardly.
?
I think that it's important to differentiate selection "bias" from criterion-based selection which is intended for success. I think this selection cluster was utterly conscious and done so that the military could assess the potential for training psychologists AND protect their consumers. They did that.

I've already addressed the other selection issues - we could call it intellectual or vocational selection (natural by another name).

I think that it is our responsibility to demonstrate the numbers the reflect that psychologists will not safely prescribe. Asking psychologists to prove that they will or will not prescribe safely is silly . . . *until they prescribe*. They have a base of psychologists who can & have apparently done so admirably. Where are the adverse events??? Now we'll have clusters of psychologist in two states (and counting - trust me on that one) & we'll get new data.

BTW, you can BET that psychologists are researching OUR adverse event counts. They are neither egotistical or stupid. (By the way, the number of psychologists who are also attorneys are staggering.) Their practice directorate is run by psychologist/attorney types. So before we start done the road of looking and challenging their adverse events . . . we should make sure that our own houses are not made of glass - - - and they are.

S
 

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This is a public health policy matter. The quality of public health care has been on the decline for quite a while, in spite of increasing costs, increased technology, increased array of pharmacological tx. options, etc.
http://www.rand.org/news/press.04/05.04.html

Psychiatric care, and especially child psychiatry is at the level of public health care emergency at this time, IMHO. By APA's own statement, the "mental health care delivery system is in shambles" http://www.psych.org/news_room/press_releases/visionreport040303.pdf

Physicians and their professional associations have absolutely no political "clout" re. public health care policy matters. Some argue that a "national health care system" might provide some solutions. Doubtful, especially re. chronic diseases, including severe, persistent psychiatric disorders, developmental disabilities, etc. Look at the NHS in the UK.

What is the answer? I don't know. But I am worried, just like many of my colleagues. I have not heard so far any satisfactory answers/solutions from my mentors, nor my peers, nor my professional association, nor from the NIH. What are we to do as physicians? Do we even have the responsibility to do anything, at a national level, and, even if we do, how can we regain some of the "control" over such public health policy matters?

I am hopeful that maybe the younger generation will have some answers.
 

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I am a psychiatry resident and I am very concerned. I think that I will ultimately leave psychiatry and obtain a residency in another specialty. This is very sad. I don't see how giving psychologist prescription writing ability is helping mental health. Psychologist will follow the money trail and will abandon psychotherapy soon enough. I gurantee you they will not go to rural areas any more than psychiatrist. How does this help? Soon there will be no one to perform psychotherapy. I am insulted that psychologist have obtained prescription writing capabilities. All physicians that have done a residency know that a PhD degree in psychology is far inferior to a medical education and residency when it comes to making medical decisions. Don't we as physicians make enough mistakes as it is, why do we need to make it worse by letting psychologist act as psychiatrist. I just don't understand this decision. It is very sad, just as psychiatry residency applications were rising and the profession was experiencing a fantastic rebound. I predict that the number of psychiatry residents will now decrease rapidly, again I don't see how this helps mental health care. Soon enough all psychiatry residencies will be filled with FMG's. Psychiatry will once again become the field of Muhammed, Muhammed, and Muhammed. My heart tells me it's wrong to grant psychologist this extra autonomy. My brain tells me it is extremely dangerous and that innocent patients will end up dead. It is sad to see one of the greatest fields of medicine dummed down in this manner.
 
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thethrill said:
All physicians that have done a residency know that a PhD degree in psychology is far inferior to a medical education and residency when it comes to making medical decisions. Don't we as physicians make enough mistakes as it is, why do we need to make it worse by letting psychologist act as psychiatrist. I just don't understand this decision.
Even our young residents are infected.

Psychologists are different than psychiatrists. Their thinking or abilities are not inferior with regard to making decisions about patients mental-health oriented medical care. They've been doing it for years. Psychiatrists see only a tiny fraction of mental health patients. The frequency with which psychologists see patients outstrips psychiatry. Psychologists have been recommending medication to FP's/IM/Pediatricians for decades and apparently they've been successful enough to establish strong relationships with those docs. We're not "letting" them do anything. They are doing what they are doing BECAUSE PSYCHIATRY stopped paying attention to critical social and emotional responsibilities that it had.

Psychologists have been complaining about psychiatrists and their lack of understanding of human relationship/development/cognition/dynamics for years. FP's, Pediatricians, etc., have complained about psychiatry for an equal number of years, particularly as we stopped being careful about writing to them and involving them in the care of their patients. While psychiatry was protecting its turf regarding admitting privileges (how silly was that?), psychologists were responding by developing methods to prove that their competence was being overlooked. By refusing to allow psychologists to function autonomously with their patients, psychiatry allowed itself to be protrayed as collectively acting AGAINST what was in the best interest of the patient/consumer.

Psychiatry succumbed to the power of Mangled Care and when we were threatened with "start a med in 24 hours or don't get paid" duirng hospitalization, we did as we were told so that we and the hospital could be paid. We paved the way for the "evidence" that treatment could begin IMMEDIATELY, rather than allowing enough time to go by so that we could get to know the patient through interactions, psych testings, and group exposure. Instead, we began to push meds and patted ourselves on the back for how good we had become at diagnosing/treating so quickly. We ignored effect size data with these meds and we often made decisions without sufficient medical information about patients because it couldn't be collected quickly enough to satisfy MCO's. If COLLECTIVELY we had taken a stand for what we knew was right, *I think* some of this could have been avoided. We're seen as pill pushers, complicated by the social image of our still using bolts of electricity to people's heads (whether ECT is effective or not is far beside the point and, BTW, I *DON'T think that psychologists will lobby for ECT use, but will leave that to psychiatrists for reasons that are obviously related to stigma).

Finally, the field of psychology has not blended with medicine. Those obtaining 2 year post-doc psychopharm degrees are getting them AFTER the've completed graduate school and 2 year post-docs in whatever field of specialty. They're not going to medical school because they think the medical model is wrong. Frankly, it's pretty easy to persuade the public that the medical model is wrong, particularly in the wake of publicity about AD's, Ritalin, etc. Haven't you attended to the explosion of alternative medicine clinics EVERYWHERE? Until the 1990's, psychiatrists were thought to be in a competitive race with dentists over which profession had the highest suicide rate. (I don't know who is winning anymore and yes, I know that the suicide by profession data is pretty weak.) So, psychology has proposed a new model. One that bases prescriptive authoriy upon KNOWING the patient and continuting to provide psychotherapy. And, wisely, they've built this success around the intelligent mantra of "the authority to prescribe is also the authority to NOT prescribe."

So, my suggestion is that you resist leaving psychiatry. Rather, stay here and help psychiatry to change. If psychiatry remains as it is, it will only move toward becoming obsolete. Psychiatry needs some fresh perspective because it's being killed off by old guard who incorrectly read the environment.
 

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first excuse my many misspellings in the last post, I did not proof read. I think that your altruistic thinking is refreshing but misguided. Psychiatrist used to do mainly psychotherapy but insurance companies and the government now dictate the length of office visits and hospital stays. Psychotherapy is now allocated to much less expensive psychologist. Psychologist will soon feel the pressure to see as many patients as possible for med rechecks. Soon someone else will step in to do the psychotherapy perhaps a psychonurse practitioner. The skills psychologist learned as psychotherapist sadly will soon fall by the wayside. But congratulations, psychologist will save the government a lot of money in the short run. It is definitely a slippery slope. Honestly I can't afford with my $180,000 debt and family to gamble on my career. I definitely feel a sense of doom and gloom for psychiatrist and mental health patients.
 

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Svas said:
So, my suggestion is that you resist leaving psychiatry. Rather, stay here and help psychiatry to change. If psychiatry remains as it is, it will only move toward becoming obsolete. Psychiatry needs some fresh perspective because it's being killed off by old guard who incorrectly read the environment.
I am curious, Svas, do you have any specific solutions for "helping psychiatry to change"? And when you say "Psychiatry", do you refer to the discipline/specialty in general, to Academia, to organized associations, etc.? Who exactly would be in "charge" of this changing? And, even in the broadest general sense, in what specialty have you seen that physicians have any "power" to "change anything"?

I fear you come from the perception that somehow there was a sort of "old guard collusion" that "led to the destruction of the field". Well, IMHO, this is an utterly simplistic/naive perception, and definitely does not take into account even the most basic knowledge about the history and/or the definition of the field, nor the social/historical circumstances that have shaped its evolution.

I didn't mean to beat up on you specifically. Actually, I don't even know whether you are a psych. resident or what background of knowledge you come from. So don't feel bad about this. We are all here to learn and exchange information. Young doctors in training, IMHO, especially are probably thirsty for meaningful information, not just opinions. Although, of course, this board is very good for venting and support as well. We just have to be able sometimes to differentiate between information and propaganda. This can be sometimes hard to do in this medium of communication. :)
 

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PsychMD said:
Young doctors in training, IMHO, especially are probably thirsty for meaningful information, not just opinions. Although, of course, this board is very good for venting and support as well. We just have to be able sometimes to differentiate between information and propaganda. This can be sometimes hard to do in this medium of communication. :)
For what it's worth: http://www.defensehealth.net/reports/GAOHEHS9998.pdf
 

mdblue

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Again, the same issue. :confused:
It's not about being more smart/effecient/intelligent when we are talking about psychologist's scripting power. It means you are compromising the patient care. It's as simple as that.
Everyone needs more $-there's no problem w/ that, however you can't make more $ in putting others in danger. That's precisely what's happening here. I am asking all of you here the same question again- how many of these so-called "medical psychologists" do you think will treat their spouse/kids/family w/o taking them to a psychiatrist first? I mean a full clinical eval and proper MSE, not those "over-the-phone" BS. One of my attending used to call it as "the mom test"-rather simplistic but very effective in medical-decision making. :)
We have seen earlier a lot of stuffs being passed around as alternative medicine. Li at one point of time used to be claimed as the panacea of all ills. The consumer/client makes the ultimate decision about whether they will see a psychiatrist and a medical psychoologist or an alternative practitioner for that matter. But we have to make sure that there's no harm intended in the process and the acceptable risk should not be more than the current medical model. This basic regulation is absent in this scenaro-that's why I am concerned.
BTW, the lawsuits against Ritalin has been thrown out- because it's one of the most effective med in psychiatry. However, diagnosing ADHD is another matter. As it was mentioned before most of the cases are seen by the non-psych PCP/therapist who lack the specialized training for whom diagnosing a psych pt mean only checking those DSM criterias and using a NOS code(I must admit often it's for insurance reasons). :rolleyes:
The basic medical model is being questioned here and we have to deal w/ this squarely NOW. This may not be the best system, but at least it's working and we are ensuring pt safety and the in-built checks are auditing the negative consequences. People who don't have a clue about medicine/ MD curriculum/post-MD training are questioning the medical model which is really intriguing and dangerous for the future generations to come.
 

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I agree, dr blue...definitely this is systems issue...and it IS NOT just applicable to Psychiatric care. Basically, as of now, in our health-care system, the demand for health-care services is overwhelmingly larger than what the current resources are available to provide. What drives this current imbalance, I wonder? Multiple factors, I assume (included, but not limited to economical ones). The other issue is: as Physicians...do we even have any SAY or any practical influence re. Public Health policy problem-solving? We are just part of the tip of the iceberg and bob up when there's a crisis, we feel the crisis on our backs, on a daily basis, etc. But what power do we have? We are not even organized in any meaningful way. Even our professional organizations have no "clout" whatsoever. Medicine, in general, although we may HATE this idea, has lost much of the prestige and power and respectability that were imbued into it around the time of the end of the 19-th century/beginning of the 20-th century, actually co-inciding with the advances in sanitation/science/tx. methods/public health, etc.
Where are we now? Academic medicine is now completely subsumed to Pharma...that's where the money comes from. Pharma's objective is: to create new markets for making money. Pharma's influence has altered any ethical notions re. health-care research/teaching, etc. It's already gone BEYOND any acceptable bounds. Socially too..people are basically desperate to get access to health-care services. Psychiatric care has always been rare/expensive/inefficient. Pharma "proposed" the model that "we can easily cure lots of diseases by lots of PILLS"...yeah, right! Just look at our public health stats...ABYSMAL...especially for our rich and powerful nation. :scared:

But, OTOH...would "national health care bring any relief"...or even more conflict/inequities/maldistribution?, etc. Just think, from the perspective of a current med student, saddled with $ 200 K in debt...how are you going to tell that person to go do public health work for a moderate wage, also burdened with a potentially onerous and dysfunctional "National Health Service scheme" responsibilities, etc. What about LIABILITY? What about ETHICAL responsibilities? :confused:

National "solutions" (including using physician-extenders, under-qualified personnel, etc.) will maybe bring some short-term relief re. demand...but then..we will have a de facto 2 tiered health-care system: one for the rich and one for the poor, further fueling maldistribution, inequities, etc. It's a freaking downward spiral, wherever you look at it from! :eek:

What's a DOCTOR to do, I wonder? I was hoping to hear some youthful enthusiasm here, among young trainees. I do not mean to discourage anyone or to bring anyone's spirits down. But Medicine is a VERY tough, lonely, self-sacrificing, arduous road. That's how it is.

Hope I didn't put you all to :sleep:
 

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The "medical model" was mentioned above. Nurse practitioners are trained in the "nursing model" and are able to prescribe drugs. How are these models different?
 

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To Svas and others like you:

You inspire me with your personal and professional wisdom and your scientific reasoning.

You are the kind of physician that I admire and aspire to become:
a good PHYSICIAN not a medical fundamentalist.

I am completing my psychology residency and beginning pre-med with the intention of entering med school in a couple of years and eventually completing a psychiatry residency.

I am doing this because I am committed to the biopsychosocial model of healthcare and want to be a mental health provider who is able to fully integrate the biological and behavioral dimensions in patient assessment and intervention. I also rather do this in the next 10 years than wait to do in the next 20 or 30. I agree with you that RxP for psychologists is coming but it will probably take a few decades, as evidenced by how long it has taken other healthcare practitioners to gain RxP, e.g. NP.

However, I do totally support RxP for psychologists and believe that post-doc training in psychopharmacology (using the APA/DoD formula) will result in medical psychologists who will be able to function effectively and safely as both psychotherapists and psychopharmacotherapists. If I was willing to move to NM or LA or if RxP came to FL that is what I would do.

In the mean time I intend to personally live up to the challege of two great psychiatrists, George Engel and Lawrence Kubie. I also intend to continue to support professional psychology's evolution in the Engel/Kubie paradigm and challenge professional psychiatry's reactionary attachment to the medical fundamentalist paradigm.

Engel's biopsychosocial model and Kubie's "medical psychology" model (it was he who in 1954 proposed that new discipline which was meant to integrate psychiatry, psychology, psychoanalysis, and social work and which resulted in the establishment of a Doctor of Mental Health degree in 1973 at UC Berkeley and San Francisco but which ended being abolished in 1986 in part due to the opposition of med fundas to any RxP for any non-physicians) has been slowly but progressively inspiring psychology to enter into the healthcare field not only as academicians and researchers but as clinicians, resulting in the establishment of the PsyD degree for those most trained to be practitoners while retaining the PhD degree for those most trained to be scientists.

Of course, it's not just psychologists who have embraced the biopsychosocial model. Despite the opposition of med fundas, NPs and others are gaining a seat at the multi-disciplinary treatment team table, including RxP. Today NPs have RxP in all 50 states, including independent and full formulary practice in 11 states and DC.

Interestingly enough, there is NO evidence that patients are being harmed by getting prescription meds, including controlled substances, from non-physicians in those 12 jurisdictions where NPs don't have supervision from MD/DOs. By the way, some of those NPs are PhD/PsyDs who have undertaken post-doc training in nursing. :rolleyes:

Also interestingly enough, there is NO evidence that patients are being harmed by DoD psychologists, all of whom prescribe independently in the military and some of whom actually supervise the prescribing of psychiatry residents in the armed forces. :rolleyes:

Imagine that!!! People being judged on their knowledge and skill and not on whether their doctorate in medicine is allopathic, osteopathic, behavioral, etc. :eek:

Med fundas are bound to go the way of other ideologues who demand special privileges without evidence as to why they alone should be accorded them.

They remind me of the male chauvinists who wanted to deny women the right to vote, the white supremacists who wanted segregation/apartheid, religious bigots who wanted their beliefs to be the official state ones, etc.

Ultimately, it is those who demand privilges for themselves that must DEMONSTRATE why their proposed discrimination should be enshrined in law.

Why should 4 years of med school and 4 years of psychiatry residency be the ONLY way for a clinician to be able legally to prescribe psych meds???

The evidence DOES NOT DEMONSTRATE that the current psychiatrist model is the only one (note the NP model and the DoD psychologist model) nor the best one. LET'S STOP THIS UNFAIR DISCRIMINATION...NOW!!! :mad:

Many MD/DOs already have and the LA RxP model may well further enhance collaboration between non-psychiatrists physicians and psychologists. A collaboration that may well result in patients receiving comprehensive and compassionate physical and mental healthcare; even if it does not involve hubris consumed psychiatrists asking in vain why others do not see their superiority.

Like you said, the train is coming. As a soon to be psychologist I'm glad for psychology as a future psychiatrist I'm concerned for psychiatry. Hopefully we'll all be on the train. :luck:

Again, to you Svas and others like you I say: THANKS.

To my future psychiatrist colleagues I say:

We can all be good physicians without being medical fundamentalists. :)
 

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*Sigh*

Forensic psychiatry looks more and more like the wave of future...

Psychologists wanting to be psychiatrists. Optometrists wanting to be ophthalmologists. Nurse Anesthetists wanting to be independent Anesthesiologists. NPs wanting to be family docs, or junior cardiologists, or whatever.

I wonder if anyone ever realizes the importance of a comprehensive medical education anymore.

It looks like psychiatrists are going to have to find specializations in order to survive financially. What we do need to formulate in 20 years if and when a national trend towards "medical psychology" materializes is what the role of the psychiatrist is and what the role of the clinical psychologist is. Can both function together similar to optometrists and ophthalmologists? Where is the line drawn between the responsibilities of the M.D. and the Ph.D.? Should we open more spots in medical schools nationwide, or create medical schools in rural areas in order to better serve the public, rather than inventing a new degree?

What does provide some hope for the future of psychiatry is that many psychiatrists do currently make a living doing psychotherapy even though there are clinical psychologists and social workers that do it also. Plenty of patients to go around, although reimbursement rates will go down even further unless clinical psychologists increase their fees (which I assume they will if they get prescription rights).

The lawyers and pharmaceutical companies are going to be living large if this medical psychology thing ever comes to fruition.
 

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Psychologists wanting to be psychiatrists.
I don't know how to help you with this in anyway other than I have done, PsychNOS.

Again, psychologists DO NOT want to be psychiatrists. This appears to be the only way you can understand the material - but I'm not sure why?

(Frankly, I'd be overjoyed if psychiatrists were really psychiatrists again.)

S
 
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Unfortunately, and I hate to say this as an entering psychiatry resident, the field of psychiatry is doomed for failure unless the potential of billable procedures comes to fruition. Even that will be fleeting, as I'm SURE they will lobby to perform those procedures as well to the "underserved," and so that they can "more comprehensively provide for the mentally suffering."

Sasavan argues that prescribing power should be based on knowledge, not "medical fundamentalism." That being said, all pharmacists should prescribe. All PhDs imaging procedures should clinically read MRIs, all teachers who take a weekend course for two years should prescribe Ritalin. All uberdextrious people good with their hands should take courses and perform surgeries, all chiropractors should perform laminectomies. All optometrists should perform corneal transplants, etc, etc.

The psychology prescribing train may be coming, but their train in general is derailing. I left the profession for a reason...they are in massive overproduction (so much so that the Amer. Psychological Assn. is limiting the amount of PhDs they're now producing), their salaries are plummeting, and their image is declining. Medicare will no longer pay $85 for a 40 minute therapy session...not when they can pay a psychiatric social worker half that, or even better (like is coming in NJ), a bachelor's level psychologist. Again, the psychologists on the RxP listserv make no bones about it. They want a piece of the psychiatry money pie, and will relentless pursue it until they obtain it, whilst inevitably dragging the profession into the financial sewers with it.

I hate to use a sports analogy, but this is our game to lose. When you're the champ going into a fight, people expect you to win....and if you do, you're simply defending. If you lose in an upset, there's an uproar and you've been dethroned. Another: Every team loves to beat the Yankees...they are perennial winners, and all other teams hate them. When they win, it's expected. When they lose, the other teams celebrate to no end.

Psychiatry is ours to lose. Psychiatry is at the pinnacle of the mental health model and psychiatrists are the most comprehensively trained to manage all aspects of psychiatric care. To that there is no argument. To constantly defend means inevitable defeat. Yet, working "with them" is something they have refused (NM psychologists rejected a modified bill to have them prescribe in rural areas only). What solution can there be to this? Psychiatrists are busy taking care of patients. Psychologists are largely academic in comparison and have nothing but time to lobby, promote, and propose legislation to advance their profession out of the traditional boundaries. Things look dire for a great and noble profession with a unique perspective on the human condition.
 

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I am wondering if people realize that this very essential "debate" about the "Medical model" of health-care delivery VS. "Other models...(?)" is not currently going on re. Psychiatry only, but also re. the most fundamental specialty of Medicine, Internal Medicine, and other specialties as well.

And is this even a core "debate" within our profession, or is it mere propaganda? And what is driving it? I don't know, but I sure would like to find out. I also realize that I do not even know even the most basic definitions: what IS this "medical model"? what are the "other" models? Again, not just re. Psychiatry, but about health-care delivery in general.
 

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Svas:

I guess my statement should read "psychologists want the same practicing privileges as psychiatrists."

All of your arguments have been based on semantics and philosophy rather than what will actually be done in practice. Fine, people don't go to medical school because they don't believe in the "medical model." But, these very same people are willing to attain the rights and responsibilities that have traditionally been given to physicians. They want to attain prescription rights and attain autonomy. They want to be the ones to be directly working with pediatricians and family docs. What I don't understand is that if psychologists don't want to be part of the medical model, why are they so willing to inject themselves into it?

Explain to me how a psychologist with a presciption pad will be different than a psychiatrist with a prescription pad IN PRACTICE. More psychotherapy? More time spent with patients? A different philosophical approach? That will disappear when the realities of managed care and medical economics come into play.

I don't understand why the current mental health care model doesn't work. I've seen practices where clinical psychologists and psychiatrists work side by side, with psychologists handling the bulk of therapy and psychiatrists handling the bulk of medication management. Both types of professionals are involved in the care of the patient. Must we be so willing to explore breaking down these distinctions? For what reason? To provide greater access to mental health care? There have been multiple postings on why this is not the primary reason that clinical psychologists are seeking prescription rights.
 

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PsychNOS said:
Should we open more spots in medical schools nationwide, or create medical schools in rural areas in order to better serve the public, rather than inventing a new degree?

The lawyers and pharmaceutical companies are going to be living large if this medical psychology thing ever comes to fruition.
There are branch DO schools popping up all over the US. Interestingly, most are located in or near so-called "rural, underserved areas." Maybe creating a psychiatry specialization track (with increased training in psychotherapy, pharmacotherapy, and research) for aspiring psychiatrists in these programs would help increase the number of physicians pursuing careers in psychiatry? If successful, these programs would produce enough psychiatrists to serve patients in otherwise underserved regions of the country, thereby eliminating the need to "medical psychologists."

In response to your second point, I wonder if any pharmaceutical companies are supporting psychologists' gaining prescription rights. They seem to love "expanding the market" in terms of medicalizing social problems, so something like this would in all likelihood be fully endorsed.
 

mdblue

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Let's give scripting rights to MSWs and any college grad for that matter, if knowledge and personal skill matters most. Who cares if we move backward wrt pt-care. :(
Also people who talk about failure of the medical model are the successors of the potent antipsychiatry movement of the 60s,70s and 80s. For those who are interested please see this http://www.antipsychiatry.org/

sasevan said:
To Svas and others like you:

You inspire me with your personal and professional wisdom and your scientific reasoning.

You are the kind of physician that I admire and aspire to become:
a good PHYSICIAN not a medical fundamentalist.

I am completing my psychology residency and beginning pre-med with the intention of entering med school in a couple of years and eventually completing a psychiatry residency.

I am doing this because I am committed to the biopsychosocial model of healthcare and want to be a mental health provider who is able to fully integrate the biological and behavioral dimensions in patient assessment and intervention. I also rather do this in the next 10 years than wait to do in the next 20 or 30. I agree with you that RxP for psychologists is coming but it will probably take a few decades, as evidenced by how long it has taken other healthcare practitioners to gain RxP, e.g. NP.

However, I do totally support RxP for psychologists and believe that post-doc training in psychopharmacology (using the APA/DoD formula) will result in medical psychologists who will be able to function effectively and safely as both psychotherapists and psychopharmacotherapists. If I was willing to move to NM or LA or if RxP came to FL that is what I would do.

In the mean time I intend to personally live up to the challege of two great psychiatrists, George Engel and Lawrence Kubie. I also intend to continue to support professional psychology's evolution in the Engel/Kubie paradigm and challenge professional psychiatry's reactionary attachment to the medical fundamentalist paradigm.

Engel's biopsychosocial model and Kubie's "medical psychology" model (it was he who in 1954 proposed that new discipline which was meant to integrate psychiatry, psychology, psychoanalysis, and social work and which resulted in the establishment of a Doctor of Mental Health degree in 1973 at UC Berkeley and San Francisco but which ended being abolished in 1986 in part due to the opposition of med fundas to any RxP for any non-physicians) has been slowly but progressively inspiring psychology to enter into the healthcare field not only as academicians and researchers but as clinicians, resulting in the establishment of the PsyD degree for those most trained to be practitoners while retaining the PhD degree for those most trained to be scientists.

Of course, it's not just psychologists who have embraced the biopsychosocial model. Despite the opposition of med fundas, NPs and others are gaining a seat at the multi-disciplinary treatment team table, including RxP. Today NPs have RxP in all 50 states, including independent and full formulary practice in 11 states and DC.

Interestingly enough, there is NO evidence that patients are being harmed by getting prescription meds, including controlled substances, from non-physicians in those 12 jurisdictions where NPs don't have supervision from MD/DOs. By the way, some of those NPs are PhD/PsyDs who have undertaken post-doc training in nursing. :rolleyes:

Also interestingly enough, there is NO evidence that patients are being harmed by DoD psychologists, all of whom prescribe independently in the military and some of whom actually supervise the prescribing of psychiatry residents in the armed forces. :rolleyes:

Imagine that!!! People being judged on their knowledge and skill and not on whether their doctorate in medicine is allopathic, osteopathic, behavioral, etc. :eek:

Med fundas are bound to go the way of other ideologues who demand special privileges without evidence as to why they alone should be accorded them.

They remind me of the male chauvinists who wanted to deny women the right to vote, the white supremacists who wanted segregation/apartheid, religious bigots who wanted their beliefs to be the official state ones, etc.

Ultimately, it is those who demand privilges for themselves that must DEMONSTRATE why their proposed discrimination should be enshrined in law.

Why should 4 years of med school and 4 years of psychiatry residency be the ONLY way for a clinician to be able legally to prescribe psych meds???

The evidence DOES NOT DEMONSTRATE that the current psychiatrist model is the only one (note the NP model and the DoD psychologist model) nor the best one. LET'S STOP THIS UNFAIR DISCRIMINATION...NOW!!! :mad:

Many MD/DOs already have and the LA RxP model may well further enhance collaboration between non-psychiatrists physicians and psychologists. A collaboration that may well result in patients receiving comprehensive and compassionate physical and mental healthcare; even if it does not involve hubris consumed psychiatrists asking in vain why others do not see their superiority.

Like you said, the train is coming. As a soon to be psychologist I'm glad for psychology as a future psychiatrist I'm concerned for psychiatry. Hopefully we'll all be on the train. :luck:

Again, to you Svas and others like you I say: THANKS.

To my future psychiatrist colleagues I say:

We can all be good physicians without being medical fundamentalists. :)
 

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Are you actually comparing psychologists who want this additional training and who want to care for mentally ill patients more effectively to the folks who came up with the Antipsychiatry Coalition???

BTW, how much training SHOULD NP's have gotten before they were able to prescribe meds as they do now?

S
 

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i wonder if svas will be as cocky when he/she kills their first pt by missing an underlying disease or medication interaction. you can not separate biology of the brain and the rest of the body.

i am a msw and will be starting med school in august. social workers are also begining to grumble about prescription rights (and as a profession we populate rural areas much more than psychologists). i am totally against this idea. even with this "advanced" traning in psychopharm, etc. how will anyone who has not had basic science such as chemistry, organic, and biology understand the "advanced" psychopharm. you may scoff, but dosing does require a certian amount of chemistry (as does learning drugs and how they work in the body etc).

i think many people hear psychologists state "we are scientists and doctors", but this is only true for behavior and not basic physical and biological science (for the most part). testing one's IQ etc does not instill confidence in me that one understands the science behind medicine. and please don't say that a basic understanding of how drugs work through their chemistry and how a body is effected by this chemisrty is not important. it is.

the idea that psychologists are at least equal to NP's PA's is silly. they are different professions with different treatment goals! stop using loaded words such as "equal", etc. psychologists are not oppressed due to some inherent, inate intelligence only they have and all the other health care dont. both NP's and PA's have to take basic science such as chemistry, biology, and then their graduate courses that builds on the basics. also, they rotate through all different aspects of medicine while in school. again the idea to separate the brain from the rest of the body is a bad idea and is ultimately deadly.

i do not understand why psychologists as a profession does not tout more of the important role they play as part of the team and the great work they do with testing and therapy? when did this become unimportant? is this not the basis of psychology? is that not why you went to become a psychologist rather than medical school?

each profession is unique and brings its strenghts (and weaknesses) to pt care. i have no problem with any profession gaining prescriptive rights, but do it responsibly. understand what needs to be learned before you take a person's life in your hand. and to those who feel SSRI's can be dispensed like candy, three letters NMS.
 

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MSWPHYSICIAN -

1) I am already a physician & have been licensed for 17 years.

2) I am also a professor - and have been teaching for 15 of those years.

3) Before getting my degree in medicine, I had an undergrad in psychology/biology and a Ph.D. in Chemistry. I have found that the practice of medicine (in a practical sense) to be profoundly more challenging than the study of medicine in school (or residency). It is certainly rewarding & I love what I do. In fact, I really couldn't do anything else.

4) Two of my sons have Ph.D.'s in psychology (one is a clinical psychologist and the other is a neuropsychologist). My daughter is an MSW and is getting a Ph.D. in epidemiology. My youngest, another son, is in his 3rd year of medical school (he hangs out here & is responsible for my finding this board). My wife is a physician (OB/GYN). My father was a physician (gp) and my mother was a vetrinarian. I also have a hunting dog. I'm very familiar with all of their training.

5) Congratulations on starting med school. School will be a challenge for you and will probably surprise you.

6) I happen to believe that, in general, clinical psychologists and neuropsychologists are very bright and capable. Yes, I'm biased, but I have also spent time with a large number of them and find psychologists to be uniformly curious and competent abstract thinkers. My daughter, a very bright woman, but did not obtain anywhere near the training that my sons did during her MSW program. Apples and oranges. I have little question that psychologists can be taught to prescribe within a limited, but reasonable formulary in a safe fashion. Given my background, I'm pretty sure I can do better than guess.

7) Physicians have been learning via killing patients for years. It's not glorious, but it's true. Anyone that tells you otherwise is lying to you. That's one of the reasons why we have M/M boards. Hopefully you won't, but you will probably kill someone too. Every doctor either does or gets very close. Some even kill several & it's a byproduct of their specialties, their carelessness, or bad luck. A psychologist WILL kill someone sooner or later. But that won't make them unique in this business and frankly, they will be able to defend themselve by pointing directly to the frequency and method with which we kill people. It doesn't make it a good or right thing; it just is.

There's a lot of rhetoric on this board & very little data. You will learn that there's still a lot of mystery in medicine and a lot of science. I don't think I'd change that, since the mysteries are what keep me interested and willing to stretch both my imagination and creativity. I don't find it of any value to thwart the intellectual investment of interested and bright professional colleagues anymore than it would be of value to thwart yours. I know this doesn't make me popular here but we must all move in the direction of our convictions. Good luck with yours.

S
 

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You know, I still think that some of us are maybe concerned about this "dumbing-down" in a general sense, not as applicable to individual persons who may be quite experienced/intelligent/competent, etc. I don't want to dilute the discussion here by over-generalizing, but, remember, how the initial PA contingent came from former military medics who had years of clinical hands-on experience. Now PA's are churned aout of some programs, with as little as 2 years of clinical rotations and only 4 years of post-highschool or even post GED overall education...and then work side by side with residency trained ER docs, fellowship trained cardiologists or neurologists, functioning as de facto "specialists" in the real world. Anyone has or will have the experience of sending a patient for a specialty CONSULT (implying that one needs some expert knowledge input) and gets in return a boiler-plate exam done by a PA "specialist", who is the only "expert" who has actually seen the patient, and is essentially useless as a consultant, except maybe in some procedural cases.
OTOH, it is pretty clear that high quality expertise IS expensive and definitely we do not have the resources to provide high-quality medical care at a "mass"/national level.
At this time actually the most underserved patient population in Psychiatry is actually the sickest patient population...the ones with complex and multiple medical-neurological-psychiatric co-morbidities, the community clinic patient population. As of NOW, many of these patients do not even have a permanent primary care MD, and may only go seek medical care if urged/referred by the ONLY MD they ever get the chance to see, which is often the Psychiatrist, who identifies certain medical unadressed problems in that setting ON A DAILY BASIS as a matter of fact, by virtue of their training. Well, if the psychologists want to gain rx'ing privileges with the "altruistic" scope of serving underserved patient populations, will they go out into the community clinic world then? And what job are they able to do there, I wonder. This is not about who gets to rx. Prozac.
 

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I'll be a PGY-1 this year and can't imagine what kind of impact this will have on my future after completing residency. I should have just skipped medical school to take a weekend pharmacolgy course. Who needs the Medicine, Surgery, Neurology, Pediatrics, Caridiology etc. after all? I mean, people are just walking brains detached from the rest of their bodies, right? No need to do EKG's, Physical Diagnosis, Labs when the brain functions independently of everything else. It saddens me, but there is nothing else in medicine I want to do, so if I have to change careers, I think I'll go to law school. Then, I'll specialize in mal-practice cases against psychologists who practice medicine without a medical degree. :thumbup: :thumbup: I'd have a regular cottage industry and would then be able to pay off my 200,000 in student loans, support a family, and buy a house before I'm 80. :idea: BTW, Does anybody wonder how much the premiums would be for a psychologist to get mal-practice insurance? :confused: Anyway, the only winners in this wave of the future will be lawyers and psychologists and the losers will be patients and physicians. I might as well be one of the winners! :laugh:
 
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mswphysician

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thank you svas for your comments. i do not agree with the majority of your points, but i respect them. the issue still remains of basic core knowledge. no matter one's intelligence level, you have to understand basics before you can move on to the advanced courses. i have no doubt in my mind that many if not most psychologists are equally as intelligent as physicians, NP's, PA's and MSW's. again a degree does not define a person. there are many dumb people in ALL the fields. this, however, does not mean they (psychologists) can simply pick-up advanced chemisrty and pharmocology and understand it well enough to prescribe. my point remains that doing a statistical thesis on behavior, trends, etc is not physical or biological science and does not offer any insight into these complex courses. i imagine that medical school was easy for you with a phd in chemistry. but again, this is a physical science which medicine strives to understand and use clinically.

i do not disrespect phd in any field. i have several phd psychologist friends who are totally opposed to this trend for the same reasons i have articulated. if psychologists want prescription rights, why is the accrediting body for psychology colleges not requiring a change in curriculum?

i think it is great for your sons who are psychologists. i think with such a strong medical family they are above the bell curve when it comes to discussing medical issues.

thank you for your words of encouragement on starting medical school, and i hope i kill as few pts as possible! :laugh: :smuggrin:
 

mdblue

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Svas said:
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DocBlue

Are you actually comparing psychologists who want this additional training and who want to care for mentally ill patients more effectively to the folks who came up with the Antipsychiatry Coalition???

BTW, how much training SHOULD NP's have gotten before they were able to prescribe meds as they do now?

S
When you start demedicalizing the specialty, that's a possibility.I do consider providing psych w/ scripting power as a first step in that direction. Hopefully call for reforming the specialty will not be hijacked by these so-called antipsychiatrists. :(
BTW your postings are very interesting and thought provoking. :thumbup:
 

sasevan

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Reasons to Grant Prescriptive Authority to Appropriately Trained Psychologists:

1. There is a critical need for appropriate and effective psychoactive medication, but access to this type of care is limited and decreasing.

20% of all Americans suffer from mental illness at any given time.
Studies show that a combination of talk therapy and drug therapy is often the most effective treatment.
Medical students in psychiatric residencies decreased 12% between 1988 and 1994. Interest in psychiatric residencies among medical students in the United States has decreased to the point that about half of the residency slots are being filled by graduates from medical schools in other countries.
The majority of all psychotropic medications are prescribed by non-psychiatric health care providers who have limited exposure to diagnosing mental illnesses.
In the United States there are at least 444 counties that have no psychiatrists but do have psychologists . :)

2. Psychologists are highly trained specialists in mental health who can and are being trained to prescribe psychoactive medications.

Psychologists have an average of seven years of doctoral training in the diagnosis, assessment and treatment of mental and emotional disorders.
Psychologists interested in obtaining prescriptive authority receive specialized post-doctoral training.
Psychologists all over the United States are already seeking postdoctoral training in psychopharmacology.
Psychologists in many professional settings are already collaborating with physicians on patients medication issues.
Ten military psychologists have been trained to prescribe, and an independent study of this group shows them to be safe and effective prescribers .
Most states have granted other non-physician providers, such as dentists, podiatrists, physician-assistants, nurse practitioners, and pharmacists, some degree of prescriptive authority, and many prescribe independently. :)

3. Prescriptive authority for psychologists increases continuity of care.

It is time consuming for patients to see multiple health care providers for the same problem. Prescribing psychologists, because of their mental health expertise, will be able to provide patients with assessment, diagnosis, and therapy, as well as psychotropics and medication management.
Psychologists trained to prescribe will provide integrated psychological and pharmacological care. :)
 

sasevan

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Prescription Privileges for Psychologists:
Frequently Asked Questions (FAQs)
by Practice Organization staff

Q: Must all psychologists prescribe?

A: No. Only those licensed, doctoral psychologists willing to seek post-doctoral training in psychopharmacology, pass a national exam, and meet other state criteria will be eligible to prescribe. Moreover, prescriptive authority would not extend to the many psychologists whose professional focus is research, teaching, consulting or other areas of psychology that do not involve seeing patients.

Q: If psychologists want to prescribe, shouldn?t they go to medical school?

A: No. Many Non-physician health care providers prescribe without going to medical school, although they are trained in other profession-appropriate institutions. Psychologists who want to prescribe must seek extensive, post-doctoral training in psychopharmacology. Recommended training is a minimum 300 hours of didactic training and a supervised 100 patient practicum, beyond the doctoral training in mental health already received.


Q: If there are so many prescribing professions why do we need another one? Isn?t there already a problem with over-medication?

A: While the numbers of prescribing heath care providers specially trained in mental health are decreasing, the number of psychotropic medications being prescribed are increasing significantly. The majority of all psychotropic medications are prescribed by health care providers with little to no training in the diagnosis and treatment of mental illness. The knowledge of psychotropic medications will allow psychologists not only to prescribe, but also to eliminate, reduce or correct medication because of their expertise in mental health and their ability to balance medications with psychotherapy.

Q: If a psychologist doesn?t go to medical school, how can he or she detect a physical illness that looks like mental illness?

A: Psychologists are the health care professionals with the greatest amount of training in the assessment and diagnosis of mental illness. Psychologists are already trained, as part of the practice of psychology, to identify which health care issues are outside the individual psychologist?s scope of competence and refer those patients to a more appropriate health care provider. Although prescribing psychologists will have an expanded area of expertise, they will continue to refer patients who should be seen by another health care provider.


Q: If psychologists and physicians are already working together, why do psychologists want to be able to write prescriptions themselves?

A: Studies show that a combination of talk therapy and pharmacotherapy is the most effective treatment for some mental illnesses. Many consumers seeking a combination of talk therapy and pharmacotherapy must see multiple healthcare providers for the same condition, resulting in added costs to the consumer. Prescribing psychologists will be able to provide this integrated therapy resulting in more efficient and more effective care.

Q: Are there psychologists already prescribing?

A: Yes. Psychologists trained by the Department of Defense to prescribe have been prescribing safely and effectively for several years. These prescribing psychologists are among the most highly scrutinized health care professionals ? independent studies have shown that these psychologists are safe prescribers.

Q: If there were a need for prescribing psychologists wouldn?t consumers be requesting this service?

A: Not necessarily. There is still a stigma attached to mental illness, or the perception of mental illness, which discourages patients and consumers from advocating for themselves. Accordingly, psychologists must often advocate on behalf of their patients and mental health care consumers as a whole. In addition, many consumers may not even realize that such a service could be an option.
 

Anasazi23

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[cut majority of grossly and disturbingly generalized assumptions from this "practice organization staff"]



sasevan said:
Prescription Privileges for Psychologists:
Frequently Asked Questions (FAQs)
by Practice Organization staff.....

Q: If a psychologist doesn?t go to medical school, how can he or she detect a physical illness that looks like mental illness?

A: Psychologists are the health care professionals with the greatest amount of training in the assessment and diagnosis of mental illness. Psychologists are already trained, as part of the practice of psychology, to identify which health care issues are outside the individual psychologist?s scope of competence and refer those patients to a more appropriate health care provider. Although prescribing psychologists will have an expanded area of expertise, they will continue to refer patients who should be seen by another health care provider.
As a person who completed a Master's degree en route to a clinical neuropsycology Ph.D., I can tell you that this is no less than a joke. While many neuropsychologists clearly have some understanding of overall human physiology and disease processes related to the CNS, to state that disease or subclinical conditions manifesting as disease states will be easily recognized by non-physician psychologists is just plain wrong.

It is interesting how the answers to the above questions follow classic propaganda rhetorical techniques - deflect an irrefutable question with an unrelated fact, and buster the argument with straw-man logic to confuse the reader and assume truth.

Very sad indeed.
 

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Anasazi23 said:
As a person who completed a Master's degree en route to a clinical neuropsycology Ph.D., I can tell you that this is no less than a joke. While many neuropsychologists clearly have some understanding of overall human physiology and disease processes related to the CNS, to state that disease or subclinical conditions manifesting as disease states will be easily recognized by non-physician psychologists is just plain wrong.
This reiterates an ongoing concern that I have about my fellow physicians with regard to psychology. Anasazi, I appreciate that you completed a master's degree and no one should take that from you. That's not the same,however, as completing your doctorate, post-doc, etc. I know that you know that, so this set of facts isn't part of our disagreement. However, having the master's degree doesn't make you a neuropsychologist and it doesn't entitle you to know the scope of training that psychologists/neuropsychologists receive.

You are, of course, making the same argument about psychology and medicine. Because psychologists haven't been through medical school, they don't know what they don't know." They don't know how deficient they are with regard to their psychopharm training. Correct?

We'd have to say the same thing about psychiatrists. Because they have not gone through the Ph.D's training . . . nor have we gone through their post-doctoral training, we really don't know what kind of training they are getting. Until we check it out carefully, we're also just engaging in baseless rhetoric.

If we're going to complain, let's complain with real data. I keep calling for this & people continue to suggest that I'm ignoring what they are telling me. So, perhaps someone should talk down to my level and give me the numbers.

S
 

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It appears that we agree to disagree on what constitutes medical scope of practice in general, and what amounts to the practice of clinical psychiatry (at least in part) in particular.

While I did not complete the Ph.D. in clinical neuropsychology, I did complete two years, whilst (almost - it's a longer more boring story) completing the dissertation. As far as not knowing what the training entails because I didn't complete another year of assessment and therapy...well - what can I say.

It's akin to the third year medical student doing a medicine rotation and at that same time, a fourth year student also doing a medicine rotation...it's basically more of the same stuff. Hopefully, you have an increased knowledge base with that extra year of training, but the work is basically the same.

Your statements bring up a good point to me personally. A major reason I left the field was exactly because of what I just alluded to - the repetitiveness was simply killing me.

As I worked in my post bac premed program, I continued to work half time in a neuropsychology private practice and functioned basically on the same level as the other Ph.D. clinicians. I have no data to support this. You'll just have to take my word on it. Rethinking my opinions due to your callings made me reiterate what I had originally thought - in many cases of practicing, there is really no (and how could there be) significant knowledge gained in physical disease not related to the CNS...even more so when one is not employed in a hospital setting.

It is true that you keep asking for numbers - Nobody would like to see them more than I. However, this is a discussion board, not a research symposium. By definition, therefore, there is a lot of talking, with oftentimes little supporting data. I get the feeling that you may be holding out on us, Svas. Do you have any supporting data of your own? Perhaps we should collaborate on a joint project to obtain some. There is no doubt the American Psychiatric Association certainly needs it.
 

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I was on call Monday night and 4 0f the 8 people I admitted to the hospital had a psych disorder, 3 of the 4 were medically related. These patients had 1) malignant mets to the brain, 2) Hypothyroidism (patient had been seeing a psychologist for 6 monthes for depression and suicidial ideations before seeing her PCP who sent her straight to the hospital) 3) Hyponatremia. I am feed up with psychologist saying they can safely prescribe psychotropics. I am not afraid to say that psychologist as a whole are not as intelligent as medical doctors and are not even close to as well prepared to take care of psychiatric patients. Applying to and getting accepted to medical school is phenomenally difficult and passing medical school is another feat in and of itself. Psychiatry is not easy. I feel as if SVAS thinks psychiatry is easy. Psychiatry is easy if your differential is short and you don't know what to ask. If you are well read and have a broad differential psychiatry is extremely difficult because you are constantly teasing out subtle psychologic and neurologic deficits. a psychiatrist needs to be as much a neurologist as much as a psychiatrist. Psychologist prescribing psychotropics is wrong, plain and simple. Psychologist prescribing psychotropics will kill patients. There is a reasong physicians feel uncomfortable prescribing psychotropics medications, because they are dangerous. The arguement that psychologist should prescribe because they spend more time doing psychotherapy is flawed in the worst kind of way. Good psychiatrist do spend time a lot of time with their patients. As soon as psychologist start prescribng their time spent with patients with decrease enormously. If psychologist start to prescribe they will be under the governments rule and then psychologist will also be be doing a little psychotherapy and a lot of med rechecks. The fact of the matter is that psychologist prescribing med's is the dumbing down of medicine, it is much, much, much easier to become a PhD psychologist. Psychologist are probably deeply affended but the truth sometimes hurts. Just because you want to become a doctor doesn't mean you should be a doctor. There are standards for a reason. This is medicine and people die, I hate talking about this with psychologist because for the most part they have not spent the night in the hospital or done an ICU rotation. I have done 3 ICU rotations and 3 months of internal medicine. I have seen many people die. I mean dead, done, bye-bye. I have had the good luck and fortune of never killing a patient, but I have seen many gifted physician kill patients. Psychologist prescribing medications is dangerous. Prescribing Psychologist will kill many more patients than prescribing psychiatrist. They simply don't have the training or intelligence. The answer to helping the mentally ill is to recruit more medical students into the wonder field of psychiatry and this is starting to happen if one looks at the trends. There are much less FMG's entering psychiatry over the past 4 years and many more US medical student applications to psychiatry. This is bound to change this year secondary to the bill that was passed in Louisiana. Medical Students feel the government is handing mental health over to less expensive and cheaper psychologist. Psychologist going to rural areas is a joke. These areas are rural for a reason and physicians don't go to rural areas for a reason. I don't blame psychologist for not going to rural areas. You need to see a certain amount of patients to make a living as a psychiatrist or a psychologist. I don't care if your a psychiatrist or a psychologist if you only see 5-10 patients a day you and your family will starve. I hope this is a wake up call for all psychiatrist, we have felt for so long that this was such a ridiculous concept that it could never possibly happen. Well it finally has. It is now time to fight for the integrity of the mental health field and for the mental health patients.
 

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Wow . . . I don't know where to start with this one. In fact, I'm nearly speechless.
 

mswphysician

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i agree psychologists should not prescribe, but i think it is incorrect to state they are not as intelligent as physicians. lets face it, there are dumb physicians as well as psychologists. a profession does not define a person or their intelligence. this does not mean psychologists should prescribe, for they should not. see my previous posts for my reasoning.
 

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Why is everyone so politically correct. Fine psychologist and physicians are both intelligent that is easy to agree with. But, as a whole physicians are more intelligent than psychologist. Also, let's face facts. Psychologist getting the right to prescribe is purely a political move in Louisiana that was fasted tracked through the political process by some wealthy psychologists and politically motivated politicians. This decision was opposed by every faction of psychiatric medicine accept psychologist mainly because the bill is very poorly written and gives psychologist far too much autonomy far too quickly with far to little oversight. I am a physician and I have volunteered many, many hours to needy and less fortunate people and have won many awards for volunteering. I graduated near the top of my medical school class and had the choice of many residencies and choose psychiatry because I truly love helping people and there is such a great need in psychiatry. I will never be wealthy physician because I spend too much time doing charity work. That being said, I have worked with many psychologist and respect what they do greatly but they have not earned the priviledge and honor of treating medically ill patients. Psychologists play and key and pivotal role in the mental health care field. They are extremely important and their role can not be replaced. Who fills their role when they start prescribing. I also firmly believe that only the top 5-10% of psychologist would be able to survive medical school. Psychologist are not medical doctors nor "medical psychologist". I firmly oppose this trend of psychologist, PA's, nurse practitioners, optometrists, etc... from gaining more and more rights in medicine. Instead we should be focused on recurrenting more of the best and brightest into medicine and raising the current standards of medicine. Not dumbing it down. SVAS I doubt you are a physician, if you are a psychiatrist I feel you would be more concerned with recruiting great medical students into psychiatry and you would be very concerned with psychologist prescribing powerful psychotropics. The bill in Louisiana will do nothing short of scare great medical students away from psychiatry. I was speechless and the other psych residents in my program where also speechless when they heard of the bill in Louisiana passing in the speed and fashion in which it was. This bill is shady at best. There was no discussion or thorough thought process. I as well as many other great psychiatrist in training will rapidly be leaving the field of psychiatry, how does that help the mental health field. SVAS if you are truly a psychiatrist that supports psychologist, how do you envision the future of psychiatry?
 

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thethrill said:
Why is everyone so politically correct. Fine psychologist and physicians are both intelligent that is easy to agree with. But, as a whole physicians are more intelligent than psychologist. Also, let's face facts. Psychologist getting the right to prescribe is purely a political move in Louisiana that was fasted tracked through the political process by some wealthy psychologists and politically motivated politicians. This decision was opposed by every faction of psychiatric medicine accept psychologist mainly because the bill is very poorly written and gives psychologist far too much autonomy far too quickly with far to little oversight. I am a physician and I have volunteered many, many hours to needy and less fortunate people and have won many awards for volunteering. I graduated near the top of my medical school class and had the choice of many residencies and choose psychiatry because I truly love helping people and there is such a great need in psychiatry. I will never be wealthy physician because I spend too much time doing charity work. That being said, I have worked with many psychologist and respect what they do greatly but they have not earned the priviledge and honor of treating medically ill patients. Psychologists play and key and pivotal role in the mental health care field. They are extremely important and their role can not be replaced. Who fills their role when they start prescribing. I also firmly believe that only the top 5-10% of psychologist would be able to survive medical school. Psychologist are not medical doctors nor "medical psychologist". I firmly oppose this trend of psychologist, PA's, nurse practitioners, optometrists, etc... from gaining more and more rights in medicine. Instead we should be focused on recurrenting more of the best and brightest into medicine and raising the current standards of medicine. Not dumbing it down. SVAS I doubt you are a physician, if you are a psychiatrist I feel you would be more concerned with recruiting great medical students into psychiatry and you would be very concerned with psychologist prescribing powerful psychotropics. The bill in Louisiana will do nothing short of scare great medical students away from psychiatry. I was speechless and the other psych residents in my program where also speechless when they heard of the bill in Louisiana passing in the speed and fashion in which it was. This bill is shady at best. There was no discussion or thorough thought process. I as well as many other great psychiatrist in training will rapidly be leaving the field of psychiatry, how does that help the mental health field. SVAS if you are truly a psychiatrist that supports psychologist, how do you envision the future of psychiatry?
:laugh: :laugh: :laugh:

Thanks for demonstrating so convincingly that the "dumbing down" of medicine has nothing to do with psychologists, PAs, NPs, optometrists, etc but rather with medical fundamentalists. Again, thanks for the laugh.

:laugh: :laugh: :laugh:
 

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thethrill's post is a remarkable push-me pull-you. You remember the beast of the kids stories who wanted to go in two different directions at once?

Thethrill's world here is all about superiority; psychologists are "dumber" than MDs. FMGs (infering from the context in which they're mentioned in the post) also inferior to US allopaths. (and fair enough, IMGs are in gerenal smaller currency come residency time-but not always). But note that in the doctoring world of stereotypes, psychiatrists are viewed often as the one's who couldnt hack it as "real doctors". But its ok! We can still feel superior! the thrill turns this one around by mentioning all that we know about the real complexity of the field. So we like the superiorty notion a lot, but when we are on the wrong end of that stick we just turn it around to show you how the other guy really just got that one wrong. Whew. Sounds more like a politician than a doctor.

Yes I agree psychologists, who dont study medicine in general and neuro in particulary shouldn't perscribe. And psychiatry is an amazing field. But anyone still looking at the world in terms of who they're better than really hasn't made it too far out of adolesence, emotionally. And I'm sure a good psychiatrist would have something to say about that.
 

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thethrill,
Out of curiosity, what evidence do you have in the infintie inferiority of non-MD professions, aside from your evident god complex. By the way, with approx. a 3.8-4.0 gpa and standardized test scores above the 90th percentile, the top 5-10% of psychologists could definitely survive medical school. That is, of course, assuming that past grades are an accurate predictor of future accomplishment. You claim the inferiority of psychologists exists due to their lack of general medical knowledge, yet I'll bet you can't manually calculate a univariate analysis of variance. Knowledge is gained through training and has no bearing on intelligence. Now as far as prescription rights are concerned, at the moment I wouldn't advocate prescription rights for psychologists, however I am not aware of what educational requirements psychologists would have to complete. Anyone can be trained to do anything and I am confident that psychologists would be responsible and skilled prescribers with the proper training. The question is what the training should entail and if it would then be to the benefit of psychologists to undergo this training rather than leaving the system as is. As far as the need to recruit mre intelligent people into psychiatry, perhaps if the environment were not so malignant it would be easier. And I'm not just speaking of your rather obtuse assumptions,but the pre-med and medical environment in general is very stressful and much of it is not necessary. Well that's about it from me for right now. :)
 

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Svas said:
Wow . . . I don't know where to start with this one. In fact, I'm nearly speechless.
Svas, and other "pro-Svas-ers": there IS a very clear-cut and simple path towards training psychologists to prescribe psychotropic medications. It is called "Medical School". Then, if they are that concerned about rapidly relocating to the underserved areas and giving care to underserved populations, they can MAYBE have an abbreviated residency training, but it MUST include a full internship covering rotations in Neurology, Internal Medicine, and Pediatrics, PLUS rotations in Inpatient Psychiatry and Consultation-Liaison Psychiatry. So, this MINIMALLY necessary training would cover approximately 6 years...all of them filled with information and practical clinical experience which IS NOT currently covered in any type of psychology program. How do you propose to fit all this NECESSARY knowledge in a brief "psychopharm. training program"? Or maybe you want to argue that much of this knowledge is NOT necessary for a competent psychiatrist?! Are you sure you want to argue this, as a physician?

Svas, you said you have 3 children in college...I can easily understand now where YOU are coming from: you worry, as a parent (as WE ALL DO) about their professional future and their well-being, especially in this current time of economical/professional turmoil, health-care crisis, etc. Maybe indeed, the era of "traditional" Medicine is nearing its end. Maybe not quite yet. Who knows? I have a daughter in college too. I worry everyday about her future and what career she'll have and whether she will EVER even be self-sufficient. BTW, she's not touching the health-care field, nor any other "academic"/liberal arts fields with a 10-foot pole! (She grew up around too much BS/bitching and moaning from doctors and teachers and psychologists surrounding her as she was growing up!) So she's going into...guess what? Public Relations! Still trying to get some mastery over the cacophony of opposing arguments that were surrounding her while growing up!

Svas, since you are one of the more "mature" members of this forum, wouldn't it behoove you to TEACH and MENTOR younger colleagues in a dispassionate manner, by good example, rather than disparaging younger colleagues who are posting here? Examine where YOU are coming from. Are you coming from a personal perspective (just trying to find a forum for your ideas to be heard), or a mentoring perspective (you just like to teach others), or are you genuinely concerned re. public health in our country and are discussing certain topics of general interest for the benefit of our junior colleagues?

Maybe thethrill was overly passionate, maybe he over-generalized re. certain aspects of his argument. It is fairly easy to see, however, that his "passion" (or what the SDN moderator called "emotionality") is actually coming from his concern for patients' well-being, and patient safety, and...also maybe physiologically from a little sleep deprivation (he was just coming off call, remember?!).

YES, IMHO, psychotropics ARE indeed very dangerous substances, in spite of the pretty ads from Pharma.
 

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Svas said:
You are, of course, making the same argument about psychology and medicine. Because psychologists haven't been through medical school, they don't know what they don't know." They don't know how deficient they are with regard to their psychopharm training. Correct?

S
I find this statement, while simple, to be effectively powerful. I think that perhaps this may be the key issue to which many of us had been alluding, but did so in a much more drawn-out manner.

How will this be brought up in a psychopharm training course? I tried to put myself in the psychologists' shoes, thinking about how to effectively create a psychopharm program that would address all the potential pitfalls of missed comorbid conditions, masquerading illnesses, etc. If that were not hard enough, then to propose training that would allow one to competently and confidently prescribe medications to these same patients.

Not surprisingly, the web of "what if's" and "well if you're going to address this, you'll have to address that" syndrome and the cornucopia of subtle physiological processes made me feel that this undertaking is simply too large to address in a training program. Even if it were possible from a classroom standpoint, what about clinical practicums in which the psychologist would learn how to recognize these medical conditions?

In sum, I feel that the statement "they don't know what they don't know" has great relevance and just could be a driving force behind future studies which will examine adverse patient reactions, delayed treatments, and even deaths in the scientific literature. However, it will be a long and unfortunate wait for said data.
 

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Anasazi23 said:
Not surprisingly, the web of "what if's" and "well if you're going to address this, you'll have to address that" syndrome and the cornucopia of subtle physiological processes made me feel that this undertaking is simply too large to address in a training program. Even if it were possible from a classroom standpoint, what about clinical practicums in which the psychologist would learn how to recognize these medical conditions?
This is along the lines of the type of program I described in earlier posts. Combine the best of both worlds -- medical psychiatry and clinical psychology. Create an integrative curriculum with training in all aspects of medicine and psychology relevant to psychiatric practice. This includes research. With the dizzying array of psychotropic medications, empirically-based psychotherapies, and emerging procedures to treat psychiatric disorders (e.g., rTMS), I'm surprised such programs are not already in operation!

I know of several people (including myself) who would love to enter such a program. In fact, most of these people are torn between medical school/psychiatry and graduate school/clinical psychology. To my knowledge, there is not a single MD/PhD program that allows you to pursue a PhD in clinical psychology. You have to complete the degrees independently, or take a PhD in a "hard science." Of course, there are extra courses that need to be taken toward the clinical psychology PhD that would take additional time to complete, as opposed to the overlap in basic science coursework found in traditional MD/PhD programs.

Why not create a rigorous program that allows students who have an interest in psychopharmacology, psychotherapy, and psychiatric/psychologic research to pursue an advanced degree that would allow them to function as comprehensive behavioral healthcare providers, and if so inclined, researchers?
 
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