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

[PublicHealth]

Purpledoc,

Would you recommend that MS programs add training in physical diagnosis and general medicine, perhaps to resemble a PA curriculum (http://info.med.yale.edu/phyassoc/curriculum.html)?

MS in Clinical Psychopharmacology programs seem to have covered pharmacology pretty well (http://www.cps.nova.edu/programs/PostdocMasterPsychopharmC7.html), but maybe they should beef up training in physical diagnosis and general medicine as you suggest, being that "the brain does not exist independent of the body." I do not know that any MSN/APRN or PA programs have embraced the notion of psychologists completing their programs en route to becoming prescribers, though there are quite a few APRN-psychologists out there.

It's not about winning and losing. I'm simply curious to know your thoughts about how existing MS in Clinical Psychopharmacology may be improved (if at all). Of course, if you're altogether opposed to these programs (even though you have never, as Svas pointed out, met a psychologist who graduated from one of the MS in Clinical Psychopharmacology programs), I can understand why you'd want to continue the "psychologists want to be mini-psychiatrists" debate.

Journal worth checking out: http://www.apa.org/journals/pro/currentTOC.html

Interestingly, the lead article by Wallis and Wedding in the August 2004 issue of this journal describes how optometry's battle for prescription privileges provides some important lessons for clinical psychology's quest to prescribe.

---

Members don't see this ad.

 

[Anasazi23]

Purpledoc,

You may have missed my post earlier. I'm interested in your thoughts on the practice of empirical medicine.

JRB

Good new topic. Since it's off topic in this forum, I started a new thread in the psychiatry forum....

 

[purpledoc]

It's not about winning and losing. I'm simply curious to know your thoughts about how existing MS in Clinical Psychopharmacology may be improved (if at all). Of course, if you're altogether opposed to these programs (even though you have never, as Svas pointed out, met a psychologist who graduated from one of the MS in Clinical Psychopharmacology programs), I can understand why you'd want to continue the "psychologists want to be mini-psychiatrists" debate.

So much to write, so little time. First, I'm not sure why everyone assumes I have never met a psychologist who graduated from an MS in Clinical Psychopharmacology program. Second, I'm not sure why that would make any difference. There would be no way for me to know from meeting one or two people what parts of their knowledge they gained from their training, any more than someone meeting me would know anything about what I learned in residency vs. what I learned before then or since then.

And, as often as you incorrectly restate my argument as "psychologists wanting to be psychiatrists," the fact is that I am simply arguing that prescribing is, by its very nature, practicing medicine. It does not matter whether the person "wants" to be practicing medicine or not. An MS degree in clinical psychopharmacology still makes no more sense to me than an MS degree in clinical cardiopharmacology, or clinical oncopharmacology.

So, here's a question in return: Do you support separate MS degrees in all the various medical branches of pharmacology, and allowing graduates to prescribe? And if not, why not?

 

[Svas]

You're right. There's a lot to say & little time to say it.

Your comment about prescribing suggests the bias that all prescribing is the practice of medicine. If we're reductionistic, that's not altogether true. Everone prescribes based upon some knowledge. Parents, teachers, nurses, doctors, etc. OTC meds make everyone capable of this. People take vitamins, tylenol, herbs, etc., and not just because we decide they are safe. In fact, as you know, lots of stuff is used that neither of us would call "safe."

Anyway, there's a LONG list of people who "prescribe" that are not physicians and that we wouldn't describe as trying to "practice medicine."

Let's address the question from another angle:

In your opinion: does a BSN and an MSN in psychiatry make NP's more likely competent to prescribe within the confines of psychiatric medicine than a psychologist with a Ph.D AND and MS in psychopharmacology? If so, why?

Svas

And, as often as you incorrectly restate my argument as "psychologists wanting to be psychiatrists," the fact is that I am simply arguing that prescribing is, by its very nature, practicing medicine. It does not matter whether the person "wants" to be practicing medicine or not. An MS degree in clinical psychopharmacology still makes no more sense to me than an MS degree in clinical cardiopharmacology, or clinical oncopharmacology.

So, here's a question in return: Do you support separate MS degrees in all the various medical branches of pharmacology, and allowing graduates to prescribe? And if not, why not?

 

[PublicHealth]

And, as often as you incorrectly restate my argument as "psychologists wanting to be psychiatrists," the fact is that I am simply arguing that prescribing is, by its very nature, practicing medicine. It does not matter whether the person "wants" to be practicing medicine or not. An MS degree in clinical psychopharmacology still makes no more sense to me than an MS degree in clinical cardiopharmacology, or clinical oncopharmacology.

So, here's a question in return: Do you support separate MS degrees in all the various medical branches of pharmacology, and allowing graduates to prescribe? And if not, why not?

If prescribing is "practicing medicine," then paramedics, optometrists, nurse practitioners, physician assistants, and pharmacists are practicing medicine without a medical license.

Your question regarding MS degrees in separate areas of pharmacology disregards clinical psychological education altogether. Keep in mind that MS in Clinical Psychopharmacology programs require individuals to have completed a PhD/PsyD in clinical psychology and be licensed as a psychologist before matriculating. Clinical psychopharmacologic training at the postdoctoral level is therefore designed to allow psychologists to supplement their training in clinical psychology. Interestingly, Steven Tulkin, PhD, and others have suggested incorporating basic medical and psychopharmacologic training into predoctoral training programs in clinical psychology (see Tulkin & Stock, 2004, A Model for Predoctoral Psychopharmacology Training: Shaping a New Frontier in Clinical Psychology, Professional Psychology: Research and Practice, 35, 151-157). A likely reason for why this has not yet happened to a substantial degree is that "psychological fundamentalists" fear the medicalization of psychology and the profession's concomitantly losing its identity as a behavioral science.

An MS in Clinical Psychopharmacology builds upon the competencies of licensed clinical psychologists. I agree that predoctoral training programs in clinical psychology should incorporate more basic medical and pharmacologic training into their curricula than they currently do, or at least allow clinical psychology graduate students to pursue a concentration that allows them to take graduate courses in these areas in addition to regular degree requirements. Many PhD/PsyD programs are already affiliated with medical schools and pretty much all are located on campuses where graduate courses in pharmacology, physiology, microbiology, etc., are regularly offered. Another possibility would be to have PhD/PsyD programs in clinical psychology join forces with PA or MSN/APRN programs to create combined degree programs. Of course, this would not allow such psychologists to prescribe independently in most states.

Thoughts?

 

[PublicHealth]

In your opinion: does a BSN and an MSN in psychiatry make NP's more likely competent to prescribe within the confines of psychiatric medicine than a psychologist with a Ph.D AND and MS in psychopharmacology? If so, why?

I have been trying to get purpledoc to answer that for the past two weeks!

 

[PublicHealth]

Recommended reading: http://content.apa.org/journals/pro/35/2/164.pdf

P.S. You need access to APA journals to open the link.

 

[purpledoc]

Your comment about prescribing suggests the bias that all prescribing is the practice of medicine. If we're reductionistic, that's not altogether true. Everone prescribes based upon some knowledge. Parents, teachers, nurses, doctors, etc. OTC meds make everyone capable of this. People take vitamins, tylenol, herbs, etc., and not just because we decide they are safe. In fact, as you know, lots of stuff is used that neither of us would call "safe." Anyway, there's a LONG list of people who "prescribe" that are not physicians and that we wouldn't describe as trying to "practice medicine."

Actually, teachers don't even dare to give an aspirin these days for fear of being sued. And regular nurses in the hospital cannot give any "prn" (as needed) medications, including aspirin or Tylenol, unless a doctor has written an order. The FDA decides which are OTC medications, which are medications that they state are safe to take without a doctor prescribing them. Therefore, taking these or giving these is, by definition, not prescribing.

Let's address the question from another angle:

In your opinion: does a BSN and an MSN in psychiatry make NP's more likely competent to prescribe within the confines of psychiatric medicine than a psychologist with a Ph.D AND and MS in psychopharmacology? If so, why?

I know that you and Public Health would like me to answer this question. However, it's a false choice. An NP will be more competent to medically treat a patient, period. A psychologist will be more competent in diagnosis, period. That is precisely why psychologists should give a diagnosis and refer on to others, just as I do in any area outside psychiatry. I think the "slippery slope" of granting medical privileges to those with graduate degrees and no medical training is very, very dangerous.

As for existing non-MDs (NPs, PAs, etc) practicing medicine, well, this issue has already been decided, and there's nothing really for me to say. I know that this issue will be used by RxP proponents. All I know is that as less and less training is required to practice medicine, the worse off all of our patients are. The solution to shortage areas is to make medical school more affordable, or better repayment plans for those who go to rural areas, not to require less education to prescribe.

Just my two cents, again.

 

[PublicHealth]

An NP will be more competent to medically treat a patient, period. A psychologist will be more competent in diagnosis, period. That is precisely why psychologists should give a diagnosis and refer on to others, just as I do in any area outside psychiatry.

Sure, this may be true now, but let's not forget that medicine and psychology are progressive, ever-changing professions. In fact, I don't know of any healthcare professions that are not seeking to expand, whether it's additional diagnostic or treatment rights, hospital privileges, clinical doctorates, etc. Some attempt to do to stay alive in a healthcare system that is continuously in flux. Many professions have been successful in this regard -- optometrists now prescribe, chiropractors are on the staffs of military and VA hospitals, physical therapists have established a clinical doctorate, etc. In my opinion, the nonphysician healthcare professions will continue to expand, as managed care organizations and hospital administrators realize the cost-effectiveness of hiring nonphysicians who can "do what doctors do." It'll be interesting to see how such practices affect physician salaries.

I think the "slippery slope" of granting medical privileges to those with graduate degrees and no medical training is very, very dangerous.

Again, you're assuming that the level of medical training provided by MS programs in Clinical Psychopharmacology is not sufficient enough to allow psychologists to prescribe. Having never interacted with a psychologist who graduated from one of these programs or seen data regarding the actual prescribing practices of such psychologists, on what grounds are you making this assumption?

 

[Svas]

I know that you and Public Health would like me to answer this question. However, it's a false choice. An NP will be more competent to medically treat a patient, period. A psychologist will be more competent in diagnosis, period. That is precisely why psychologists should give a diagnosis and refer on to others, just as I do in any area outside psychiatry.

If I understand your answer . . . it's "No, psychologists would NOT be competent to prescribe medication even with the training and NP's are."

Right?

Svas

 

[purpledoc]

Sure, this may be true now, but let's not forget that medicine and psychology are progressive, ever-changing professions. In fact, I don't know of any healthcare professions that are not seeking to expand, whether it's additional diagnostic or treatment rights, hospital privileges, clinical doctorates, etc.

I don't believe psychiatrists are seeking to expand...unless I've missed something. All the professions seeking to expand are attempting to do so in order to earn more money, plain and simple. Most are doing it because of the evil managed care system squeezing rates and not because of greed, but that is still the reason for it.

In my opinion, the nonphysician healthcare professions will continue to expand, as managed care organizations and hospital administrators realize the cost-effectiveness of hiring nonphysicians who can "do what doctors do." It'll be interesting to see how such practices affect physician salaries.

Yes, and the non-psychologist therapists will continue to expand, "doing what psychologists do." An army of undertrained therapists doing CBT strictly by the book. If you think that's what psychologists do, then I suppose you'll think that nonphysicians do what physicians do. Cost-effective? Sure -- if you think "effective" means, "saving the MCO and hospital money." If you think "effective" means that the patient actually gets good treatment, well, I wouldn't use for-profit industry guidelines as something to aspire to.

As for physician salaries, they've been going down yearly for quite some time, as medical school costs and debts increase. There is nothing "interesting" about seeing the continued decimation of an entire profession, unless you believe that social evils such as lack of universal health care are "interesting."

Having never interacted with a psychologist who graduated from one of these programs or seen data regarding the actual prescribing practices of such psychologists, on what grounds are you making this assumption?

You have also still not answered my point, which is, what difference would it make with regard to what I have been saying?

 

[PublicHealth]

All the professions seeking to expand are attempting to do so in order to earn more money, plain and simple. Most are doing it because of the evil managed care system squeezing rates and not because of greed, but that is still the reason for it.

Agreed.

Yes, and the non-psychologist therapists will continue to expand, "doing what psychologists do." An army of undertrained therapists doing CBT strictly by the book. If you think that's what psychologists do, then I suppose you'll think that nonphysicians do what physicians do. Cost-effective? Sure -- if you think "effective" means, "saving the MCO and hospital money." If you think "effective" means that the patient actually gets good treatment, well, I wouldn't use for-profit industry guidelines as something to aspire to.

I did not mean "effective" in the sense of the former definition. But refuting outright that psychologists with an MS in Clinical Psychopharmacology will not be able to prescribe effectively according to the latter definition without data is nothing more than conjecture.

You have also still not answered my point, which is, what difference would it make with regard to what I have been saying?

As Svas as suggested above, perhaps it would open your eyes to the actual level of medical and psychopharmacologic knowledge that these individuals possess. Basing your opinions on curriculum outlines and personal bias is not very scientific. Subjective opinions from interviews with MS-trained psychologists isn't either, but it's a start. Bottom line: WE NEED DATA.

 

[purpledoc]

As Svas as suggested above, perhaps it would open your eyes to the actual level of medical and psychopharmacologic knowledge that these individuals possess. Basing your opinions on curriculum outlines and personal bias is not very scientific. Subjective opinions from interviews with MS-trained psychologists isn't either, but it's a start. Bottom line: WE NEED DATA.

Hm. I seem to recall you specifically posting curriculum outline links and suggesting we read them and comment....? At any rate, my point still stands. How many MS-trained psychologists would I need to talk to? One? One from each program? More? And as you said, all of this just to form a subjective opinion?

I do agree with needing data. However, I think the data should not be gathered by throwing MS-trained psychologists out into the community to prescribe and see what happens. You're talking about experimenting on a population -- the mentally ill -- who tend to have less money and fewer resources, sometimes don't know the difference between an MD and a PhD or PsyD, and often have no one else to turn to.

You want data? Have some people with psychiatric problems VOLUNTEER to be part of a study where they are randomly assigned to be seen by MS-trained psychologists and given prescriptions exactly as the MS-trained psychologist recommends, signed by an MD observing "partner" who never talks with the patient or the therapist, or assigned to a control group seen by psychiatrists and also given prescriptions signed by a separate MD "partner." (The "observing" part -- ideally behind a one-way mirror, of course -- is needed so that the MD can write the prescription without being accused of malpractice.) I didn't see any of the advocates of RxP propose that kind of study. I wonder why not? Doesn't a simple double-blind study seem like the minimum thing that should be done before trying out an untested treatment on human beings?

 

[PublicHealth]

Hm. I seem to recall you specifically posting curriculum outline links and suggesting we read them and comment....?

What's wrong with that? I was simply curious to know your opinion regarding this training and which subjects may need to be added. I think someone else initially posted the curriculum outline to point out how they thought it was deficient and that it provided a rather cursory review of basic medical knowledge.

At any rate, my point still stands. How many MS-trained psychologists would I need to talk to? One? One from each program? More? And as you said, all of this just to form a subjective opinion?

Enough to get a better sense of their level of training.

I do agree with needing data. However, I think the data should not be gathered by throwing MS-trained psychologists out into the community to prescribe and see what happens. You're talking about experimenting on a population -- the mentally ill -- who tend to have less money and fewer resources, sometimes don't know the difference between an MD and a PhD or PsyD, and often have no one else to turn to.

You want data? Have some people with psychiatric problems VOLUNTEER to be part of a study where they are randomly assigned to be seen by MS-trained psychologists and given prescriptions exactly as the MS-trained psychologist recommends, signed by an MD observing "partner" who never talks with the patient or the therapist, or assigned to a control group seen by psychiatrists and also given prescriptions signed by a separate MD "partner." (The "observing" part -- ideally behind a one-way mirror, of course -- is needed so that the MD can write the prescription without being accused of malpractice.) I didn't see any of the advocates of RxP propose that kind of study. I wonder why not? Doesn't a simple double-blind study seem like the minimum thing that should be done before trying out an untested treatment on human beings?

Have you read the New Mexico report? It's not a RCT as you describe, but pretty darn close. I would imagine that we'll see quite a few research reports once psychologists start prescribing in NM.

http://www.nmpsych.org/report_hb_170.htm

 

[prominence]

this is the greatest thread ever in the history of SDN.

 

[Anasazi23]

Have you read the New Mexico report? It's not a RCT as you describe, but pretty darn close. I would imagine that we'll see quite a few research reports once psychologists start prescribing in NM.

http://www.nmpsych.org/report_hb_170.htm

I'm not really sure how this is close to an unbiased controlled research trial. It's pretty much "on the fly" experimentation on real patients, with almost too many flaws in the implemented design to mention individually. Interestingly, this report also mentions that the majority of the medications prescribed by the DoD team were SSRIs. This is disturbing, since the natural inclination for psychologists will be to expand into territory (disease and withdrawal states, to name just two) that they are ill-equipped to handle.

From that same report:

"These are the empirically based conclusions from the 6-year DoD-PDP. Unfortunately, the Committee?s majority recommendations essentially ignore the empirically based guidance provided by the DoD-PDP experience, and give far too much weight to the guidelines promoted by the American Psychological Association (APA).

Unlike the DoD-PCP guidelines, the APA guidelines are much more a matter of professional and personal opinion than empirical fact. As well, one must consider the degree to which the APA guidelines are shaped by political and economic goals. To summarize, we have extensive data and carefully formulated conclusions from the DoD-PDP; we have no data on the competence or safety of graduates of a program designed according to APA guidelines.

Furthermore, I am struck by the degree to which the profession of psychiatry has been excluded from the development of national guidelines and standards for the training and evaluation of prescribing psychologists. Psychiatrists are currently the largest national source of psychopharmacologic expertise, and the majority of clinical wisdom regarding psychotropic medication use comes from psychiatrists. As with the exclusion of the DoD-PDP data, the exclusion of this wealth of expertise and experience is worrisome, and raises questions about possible political and economic motivations. Specific examples are discussed below; at present I simply note that little if any psychiatric input went into the APA recommendations or the proposed national qualifying examination for prescribing psychologists (the PEP).

Also noteworthy by their absence from the majority recommendations are certified nurse practitioners, clinical nurse specialists, physician?s assistants, and other non-doctoral prescribing professionals. While prescribing psychologist advocates (and Committee deliberations) often cited these professions as models of alternative (i.e., non-physician) training of psychotropic medication prescribers, these same professions have been excluded as supervisors, admitting committee members, or complaint committee members, or peer reviewers in the majority regulations. Why were they included earlier when doing so furthered the goals of prescribing psychologist advocates, only to be excluded from the final majority recommendations?

Finally, I note that the Committee?s majority recommendations allow prescribing psychologists to be trained by a very few, variably-credentialed individuals; clinically supervised by even fewer individuals; and educated in a very limited variety of settings, while seeing a worrisomely limited number and diversity of patients over a short period of time, all potentially outside of an accredited academic institution. The majority recommendations essentially describe an apprenticeship teaching model, with educators and supervisors functioning outside of accredited and monitored academic institutions, with severely limited assurance of patient safety and educational quality, and with questionable and potentially conflicting relationships among students, educators, and certifying entities. This model was discredited over a century ago (Abraham Flexner, Report on Medical Education, Carnegie Foundation Bulletin No. 4, 1910), and rightly so. Since 1910, modern clinical education has been based in accredited and monitored academic institutions, with education and supervision provided by a varied, credentialed faculty over an extended period of time to students in residence, and with independent, dispassionate external authority to certify, monitor, and license both educational institutions and clinical caregivers. How can we now support a return to a model of clinical education that was discredited almost a century ago? "

I don't recall any of this being mentioned in the much more lax LA bill. There's a lot more where this came from. I encourage everyone to read the problematic points posed Dr. Bailey. It's not as easy as rxp psychologists wish it to be. Scarily, the LA bill has even much less restriction as it stands.

Insightful application and mention of the Flexner report, by the way.

 

[Svas]

Furthermore, I am struck by the degree to which the profession of psychiatry has been excluded from the development of national guidelines and standards for the training and evaluation of prescribing psychologists.

You must be kidding. Go back and take a look at this. Psychologists who have been interested in psychopharmacology have been asking for our support and guidance for decades. Because of turf related issues, we've been telling them to go away.

If upon request we had said anything other than "forget it unless you go back through medical school," I have little question that we would have been directly responsible for how these laws/rules would have been implemented. Instead, however, we psychiatrists were shortsighted and didn't realize that psychologists were smart enough to move around us. And they are.

All is not lost, however. We could still offer.

Svas

 

[Anasazi23]

You must be kidding. Go back and take a look at this. Psychologists who have been interested in psychopharmacology have been asking for our support and guidance for decades. Because of turf related issues, we've been telling them to go away.

If upon request we had said anything other than "forget it unless you go back through medical school," I have little question that we would have been directly responsible for how these laws/rules would have been implemented. Instead, however, we psychiatrists were shortsighted and didn't realize that psychologists were smart enough to move around us. And they are.

All is not lost, however. We could still offer.

Svas

I'm not really sure how true this is, Svas. While the past is indeed in the passt, psychiatrists DID offer to shape legislation during the creation of the LA bill, and even as a last ditch effort offered to provide more consideration from psychiatry's side if certain obligations were met (prescribing in underserved areas, from a limited formulary, etc). They rejected it all and naturally, sought out the most independence they could garner.

 

[Svas]

I'm not really sure how true this is, Svas. While the past is indeed in the passt, psychiatrists DID offer to shape legislation during the creation of the LA bill, and even as a last ditch effort offered to provide more consideration from psychiatry's side if certain obligations were met (prescribing in underserved areas, from a limited formulary, etc). They rejected it all and naturally, sought out the most independence they could garner.

I appreciate your not being certain. In this case, I am. My position had been sought on this issue 14 years ago & I also strongly opposed it out of hand.

Psychology's psychopharm law in Lousiana allows for continued physician oversight. The formulary is limited and they can't prescribe any med without verifying the script with the patient's physician first (and they have to document that they did this). I think this is overly restrictive & could defeat the law's intent. While I am absolutely in favor of formulary restrictions, I am not in favor of their needing to get a physician's okay for every drug initiation and change. Ultimately I believe this will be a waste of time and effort.

Anyway, I not surprised that psychologists sought more independence with regard to this issue. You'll remember that we're the same group that suggested that psychologists should not have the right to do psychotherapy. We fought them on the basis that their training was insufficient to protect patients from harm. NOW, we are incredulously presenting the EXACT same argument with regard to medication, while simultaneously stating that psychologists should just continue to do what they are best at - testing and PSYCHOTHERAPY.

We've fought psychologist's independence on every conceiveable front. Our fall-back position is and has always been that they should go back to medical school if they want to:___________. In fact, we're using that exact argument with oral surgeon's now. The position rises to the level of the ridiculous when used against people with such thorough training.

Again, we could offer meaningful assistance in their training and legislation & thus sculpt the outcome. Or we can continue what we're doing now - and look silly. I am simply in favor of the former as I think it is in the consumer's and both profession's best interests.

Svas

 

[purpledoc]

Again, we could offer meaningful assistance in their training and legislation & thus sculpt the outcome. Or we can continue what we're doing now - and look silly. I am simply in favor of the former as I think it is in the consumer's and both profession's best interests.

You may be right, but what will happen is that psychologists will still "break free" of the legislative restrictions at some point. So, is it better to take the chance on warning about the problems to come -- e.g., that psychologists won't provide any more treatment in rural areas than psychiatrists -- and potentially having our predictions come true, which might[]/u] influence other states' legislatures not to enact similar laws, or is it better to give in now, help with developing the laws, and "sculpt the outcome" temporarily?

Unfortunately, we can't fight the process and aid the process at the same time. I want to err on the side of protecting patients by limiting the practice of medicine to those who get medical training and not graduate school training, and I'll probably lose in the end, but I'll go down fighting. People said the same thing about the doctors who fought managed care -- it's a lost cause, just give in to the inevitable -- but those of us still fighting are finally beginning to see the tide of public opinion (slowly) turning in our direction now that people have seen the results. If RxP happens and patients do fine, so be it. There won't be any tide to turn, I'll stop fighting, and life will go on. The worst thing that happens in all this is that I'm wrong, and I was being overprotective. But until then, I have to argue for what I believe in, even if it's a lost cause.

 

[PublicHealth]

Unfortunately, we can't fight the process and aid the process at the same time. I want to err on the side of protecting patients by limiting the practice of medicine to those who get medical training and not graduate school training, and I'll probably lose in the end, but I'll go down fighting.

How do you define "medical training?" In your opinion, is PA, MSN/APRN, OD, and DPM considered "medical training?"

People said the same thing about the doctors who fought managed care -- it's a lost cause, just give in to the inevitable -- but those of us still fighting are finally beginning to see the tide of public opinion (slowly) turning in our direction now that people have seen the results. If RxP happens and patients do fine, so be it. There won't be any tide to turn, I'll stop fighting, and life will go on. The worst thing that happens in all this is that I'm wrong, and I was being overprotective. But until then, I have to argue for what I believe in, even if it's a lost cause.

Well put. Thank you for your honesty. Guess we'll just have to wait for outcomes from psychologist RxP efforts in NM and LA. In the meantime, put your gloves back on and let's debate this a bit more!

 

[Anasazi23]

Psychology's psychopharm law in Lousiana allows for continued physician oversight. The formulary is limited and they can't prescribe any med without verifying the script with the patient's physician first (and they have to document that they did this). I think this is overly restrictive & could defeat the law's intent. While I am absolutely in favor of formulary restrictions, I am not in favor of their needing to get a physician's okay for every drug initiation and change. Ultimately I believe this will be a waste of time and effort.

Why would you be not in favor of their getting physician's okay for drug initiation and change? How is this any different at that point than practicing medicine independently? Not even PAs or nurse practitioners can do this in most states. How is it that a non-medical provider, with no univeristy-based medical training can be allowed more independance? No continued oversight on lab results, ordering, and interpretation? This sounds dangerous to allow people to do this who are not physicians.

Unfortunately, you're wrong on the limited formulary aspect. The only medication that they can NOT prescribe is narcotics. Again, psychiatrists did attempt at limiting a formulary in this bill, which was dismissed outright by psychologists who lobbied more effectively.

I agree with purpledoc. You cannot both fight against a principle and look to shape its outcome at the same time. To make the argument that because decades ago, psychiatrists fought against psychologists performing psychotherapy does not allow them the free pass to now be unencumbered in their fight for a much larger increase in scope of practice.

Again, we could offer meaningful assistance in their training and legislation & thus sculpt the outcome. Or we can continue what we're doing now - and look silly. I am simply in favor of the former as I think it is in the consumer's and both profession's best interests.

Svas

It's not really that silly. The APA has successfully fought again multiple states' psychologists' prescribing bills. But as you know, bad news travels fast, so we are often unaware of these defeated pieces of legislation. Quite a few other states' legislators found the issue serious enough to strike down the bills. That says at least something, no? Do search on Psychiatric News' website and you'll see that these bills have been defeated multiple times.

 

[PublicHealth]

The APA has successfully fought again multiple states' psychologists' prescribing bills. But as you know, bad news travels fast, so we are often unaware of these defeated pieces of legislation. Quite a few other states' legislators found the issue serious enough to strike down the bills. That says at least something, no? Do search on Psychiatric News' website and you'll see that these bills have been defeated multiple times.

In my opinion, the American Psychiatric Association would be better served in trying to attract medical students to psychiatry instead of fighting the psychologist RxP efforts. Of course, they will undoubtedly continue to do both.

Psychologists are using the access to care argument to push the legislative process in their favor. Legislators look at the data regarding the state of psychiatric care in their respective State and are likely not too pleased with what's been going on. Psychologists chime in with their access to care argument, adding that there are X number of psychologists in that State who have already completed postdoctoral Master's training in clinical psychopharmacology! Education before legislation and access to care. Optometry successfully used this argument to gain prescription privileges for diagnostic and therapeutic purposes in all 50 states. The AMA, while successful in stalling optometry's efforts a bit, was ultimately unsuccessful in preventing them from obtaining prescription privileges. I have a feeling that the same will happen in clinical psychology.

 

[Anasazi23]

Good points....assuming we've beat this topic to death, the question I wonder is this: For those in LA and NM who will eventually prescirbe as psychologists, is it worth it? Svas makes good points about the hassle involved in psychology prescribers, and I noticed the same thing myself. To have to spend half your day on the phone convincing a physician about why and how you want to prescribe a medication seems counterproductive to me. I know that some bills may eventually allow for independent prescribing, but what a pain in the ass and some would say, humiliating way to get there. Is all this hassle and work worth being able to prescribe some zoloft, since it is generally agreed that psychologists will not/should not be handling cases much more complicated that this?

 

[50960]

Whew that was painful to read!!! The whole thread. The bottom line is really nobody agrees that psychologists should be prescribing. However, many feel feel that psychologists can be trained to do so via PA, NP or MS (psychopharm/medical psych) programs and the appropriate residency training. I personally would rather an appropriately trained psychologist prescribe psychotropics than a generic PA, FNP or family doc. Regardless of all the anger, and holier than thou arguments this will happen nationally as it did for nurses etc.., because HMO's want to save $ and drug companies want more prescribers. I have always said the best benefit psychologists can look forward to if they train to prescribe is the privilege to remove inappropriate meds people are on rather than write for a bunch of new meds.

 

[PublicHealth]

I have always said the best benefit psychologists can look forward to if they train to prescribe is the privilege to remove inappropriate meds people are on rather than write for a bunch of new meds.

Great to have you aboard. You make a great point. Dr. Morgan Sammons and others have discussed this in considerable depth as the "psychological model of prescribing." The basic idea is to have clinical psychology doctoral programs continue to train students exclusively in psychosocial interventions, and to have psychologists interested in prescribing pursue postdoctoral training in clinical psychopharmacology. This was probably set up to appease all the dinosaur psychologists who oppose any kind of change in their beloved profession, but it'll be interesting to see how it affects prescribing patterns. Optometry dealt with the same kind of young vs. old tensions and ultimately attained RxP. I imagine the same will happen in clinical psychology.

 

[Svas]

Unfortunately, you're wrong on the limited formulary aspect. The only medication that they can NOT prescribe is narcotics. Again, psychiatrists did attempt at limiting a formulary in this bill, which was dismissed outright by psychologists who lobbied more effectively.

Anyone got a copy of the law. I was pretty certain of the limited formulary issue & would like to read this again.

Thanks!

Svas

 

[purpledoc]

Great to have you aboard. You make a great point. Dr. Morgan Sammons and others have discussed this in considerable depth as the "psychological model of prescribing." The basic idea is to have clinical psychology doctoral programs continue to train students exclusively in psychosocial interventions, and to have psychologists interested in prescribing pursue postdoctoral training in clinical psychopharmacology. This was probably set up to appease all the dinosaur psychologists who oppose any kind of change in their beloved profession, but it'll be interesting to see how it affects prescribing patterns.

Ah, the idealism of youth... Not in terms of age, but in terms of being new to the privilege of prescribing. There will be no difference in prescribing patterns. Psychiatrists who prefer psychotherapy try to develop practices with little complex psychopharmacology. Those who prefer psychopharmacology do little complex psychotherapy. And a few of us try to do both in equal amounts. Psychologists will be the same way. There will be those more or less comfortable with psychotherapy -- certainly not all psychologists love psychotherapy, anymore than all psychiatrists love psychopharmacology -- and in the end, the supposed difference in prescribing patterns between psychologists and psychiatrists will not be a difference at all.

I can't tell you how many idealistic medical students I met who thought they would have an entirely different attitude about prescribing or doing procedures than existing physicians, and then realized that although they could be nicer to patients than older physicians, good medicine is good medicine. The fact is that holistic medicine approaches actually have been proven in studies to be less effective than evidence-based medicine. "Evidence-based" won't change depending on the degree of the practitioner.

I may be cynical, but all the social psychology studies will back me up. Once you gain a privilege that others don't have, you begin to act like other members of the privileged group. Anyone remember Animal Farm? In the end -- in simple cases without medical issues -- psychologists will prescribe exactly like psychiatrists.

 

[JRB]

The fact is that holistic medicine approaches actually have been proven in studies to be less effective than evidence-based medicine. "Evidence-based" won't change depending on the degree of the practitioner.

How does the practice of holistic medicine relate to physicians "being nice to patients" or to psychology prescribing patterns and effectiveness?


Curious,
JRB

 

[purpledoc]

How does the practice of holistic medicine relate to physicians "being nice to patients" or to psychology prescribing patterns and effectiveness?


Curious,
JRB

Sorry, I wasn't really clear. I just meant that those medical students who are interested in a more holistic approach to treating patients generally find that they were naive and had made many assumptions about the desirability of this and why many existing physicians weren't using this approach. As a result, though these medical students may have ended up being nicer and more communicative with their patients, their basic decision-making process is fundamentally no different than existing physicians.

I see this as similar to psychologists who believe that psychiatrists are "overprescribing" and say that they will have a more holistic approach to prescribing. I believe that when they start prescribing, they will end up prescribing in the same patterns that psychiatrists do.

Hope that makes a little more sense.

 

[50960]

Sorry, I wasn't really clear. I just meant that those medical students who are interested in a more holistic approach to treating patients generally find that they were naive and had made many assumptions about the desirability of this and why many existing physicians weren't using this approach. As a result, though these medical students may have ended up being nicer and more communicative with their patients, their basic decision-making process is fundamentally no different than existing physicians.

I see this as similar to psychologists who believe that psychiatrists are "overprescribing" and say that they will have a more holistic approach to prescribing. I believe that when they start prescribing, they will end up prescribing in the same patterns that psychiatrists do.

Hope that makes a little more sense.

I do not see, or hear others saying that psychiatrists are overprescribing, but rather that others (family docs, peds, GP's) are overprescribing psychiatric medications...

 

[Svas]

I see this as similar to psychologists who believe that psychiatrists are "overprescribing" and say that they will have a more holistic approach to prescribing. I believe that when they start prescribing, they will end up prescribing in the same patterns that psychiatrists do.

Hope that makes a little more sense.

I think that you've grossly misinsterpreted the psychologists' position. I understand that they aren't concerned with what psychiatry is or isn't doing. What they are saying is that they are better trained to understand mental health conditions than NP's and FP's . . . and that with psychopharm training, they will do a MUCH better job of medicating mental health patients than NP's and FP's.

I think they are right.

Svas

 

[purpledoc]

I think that you've grossly misinsterpreted the psychologists' position. I understand that they aren't concerned with what psychiatry is or isn't doing.

I do not see, or hear others saying that psychiatrists are overprescribing, but rather that others (family docs, peds, GP's) are overprescribing psychiatric medications...

Well, I can't help but feel that it's a little disingenuous. It's rather like Bush saying that he's not responsible for the Kerry attack ads. "Officially," psychologists are not criticizing psychiatrists. "Unofficially," they are implying it left and right, and fully utilizing the public's view of psychiatrists as evil, greedy, or incompetent drug pushers to their advantage. It makes sense politically -- who wants to be seen as criticizing someone's nice primary care practitioner or pediatrician? -- but that's what's happening. I have yet to hear a single RxP proponent officially say in front of a state legislature that they think GPs are overprescribing (though I'll be happy to read anything someone else has to the contrary). Yet the argument that psychologists will "know when not to prescribe," or "stop inappropriately prescribed medications" is obviously perceived by any layperson as a criticism of psychiatrists, not other physicians.

Peace,
Purpledoc

P.S. Darn it, I can't believe I'm still posting on this thread. Anyone remember "Analysis terminable and interminable"....? I'm willing to throw up the white flag and go back to talking about the Red Sox if everyone else is....... I'll even let y'all have the last word.

 

[50960]

You may be right purpledoc, and that is too bad really. Both psychs should be working together and not divisively if at all possible. However, most info I see and hear on RxP makes a point that most psychotropics are prescribed by GP's etc..., who do not have the Dx training needed to do this appropriately..although well intentioned. Another point I wish to make has to do with the arguments used for and against RxP that cite amount of hard science coursework. My wife is a PhD biochemist, and has taken,taught and practiced more biochem, genetics, molecular bio, etc.. than myself, and RxP provider, pharmacist or physician. However, to make that a case for her to prescribe is not valid. I know this because we discuss this stuff. I talk serotonin receptors, she comes back with histology stuff, intracellular degredation blah blah...., but has no clue what citalopram does, how to Dx depression, how to dose, titrate etc.. This clinical skill is not taught in hard science.
I 100% believe any prescriber should have a good bio-scientific bases, but to make that the benchmark for good prescribing is off the mark.
Speaking of Redsox purple, have you ever read "If I never get back" by Darryl Brock? If not and you are a sox, or baseball fan I recommend it highly.

 

[Svas]

Well, I can't help but feel that it's a little disingenuous. It's rather like Bush saying that he's not responsible for the Kerry attack ads. "Officially," psychologists are not criticizing psychiatrists. "Unofficially," they are implying it left and right, and fully utilizing the public's view of psychiatrists as evil, greedy, or incompetent drug pushers to their advantage.

P.S. Darn it, I can't believe I'm still posting on this thread. Anyone remember "Analysis terminable and interminable"....? I'm willing to throw up the white flag and go back to talking about the Red Sox if everyone else is....... I'll even let y'all have the last word.

1) I think that their complaint about psychiatry is that we are blocking psychologists from precribing for reasons other than what we're suggesting. They are beginning to cry that we're improperly selecting them to prohibit & not going after other non-MD/DO prescribers that are likely LESS well trained in mental health medicine. Their position, in this matter, holds water.

2) I am only able to discuss the Dodgers. It's a religious thing.

Svas

 

[50960]

Watchout for the Padres, and for my beloved Giants!!!!!

cheers

 

[PublicHealth]

Any new developments with respect to RxP for psychologists? Last I checked, Florida was gearing up for the next legislative session -- that is, once Hurricane Frances is done. Anyone else have anything to share?

 

[PsychMD]

http://www.nepsy.com/leading/0406_ne_prescrip.html

 

[PublicHealth]

The latest from NM: http://www.apa.org/releases/NMtestimony.html

 

[SeaviewMD]

Also from NM.

http://releases.usnewswire.com/GetRelease.asp?id=36434

 

[Janusdog]

I have extensive training in neurodevelopmental disabilities and a specialty in health psychology.

What that means is that I can spot autism from a mile away and help individuals maximize the quality of their life if they have chronic pain. I can help them with treatment adherence and recommend rehabilitation programs.

I would never, never, never, say that, even with the developed training, I would be qualified to prescribe.

Prescribing is not why I went to school. If I wanted to prescribe I would have gone to med school. I have the brains, the ability to focus, the dedication. That's just not what I wanted to do.

I'm very irritated that our profession has been hijacked this way. I was recently floating about and a drug rep, who was setting up a lunch for FP residents (I teach in a residency), came up to me to ask if I could sign for her samples. I said no, I'm a psychologist. She whispered in my ear that she didn't understand why psychologists can't prescribe. I shot her a look of death and told her that I could give her eighty reasons why, was she interested in hearing them? She said no and slunk off.

Her comment told me all I wanted to know about where we would be going if we truly did this.

Also keep in mind that the membership of our APA is not at all unified in this. The APA tends to block presentations by people who are opposed to the idea, thereby presenting to the membership the image that we are all on the same page about this. We're not. http://www.quackwatch.org/07PoliticalActivities/rxp2.html

All I see this Quixotic quest doing is ruining our relationships with psychiatrists.

So, please keep in mind that you are fighting a segment of us, not all of us.

 

[edieb]

Psychiatry's arguments against RxP are akin to psyciatry's arguments agains psychologists gaining other privileges: "If psychology is granted _______ (hospital privileges, the right to do psychotherapy, et cetera), people will die." As victories for psychology have come swifty (2 states:2 years), it is patent that legislators are seeing through this argument.




As an aside, I really enjoyed the part of your post where you remark on the look of "death" you gave that unsuspecting, undeserving drug representative. With a temper like that, I hope to God that parents don't leave you alone in rooms with their children...

I have extensive training in neurodevelopmental disabilities and a specialty in health psychology.

What that means is that I can spot autism from a mile away and help individuals maximize the quality of their life if they have chronic pain. I can help them with treatment adherence and recommend rehabilitation programs.

I would never, never, never, say that, even with the developed training, I would be qualified to prescribe.

Prescribing is not why I went to school. If I wanted to prescribe I would have gone to med school. I have the brains, the ability to focus, the dedication. That's just not what I wanted to do.

I'm very irritated that our profession has been hijacked this way. I was recently floating about and a drug rep, who was setting up a lunch for FP residents (I teach in a residency), came up to me to ask if I could sign for her samples. I said no, I'm a psychologist. She whispered in my ear that she didn't understand why psychologists can't prescribe. I shot her a look of death and told her that I could give her eighty reasons why, was she interested in hearing them? She said no and slunk off.

Her comment told me all I wanted to know about where we would be going if we truly did this.

Also keep in mind that the membership of our APA is not at all unified in this. The APA tends to block presentations by people who are opposed to the idea, thereby presenting to the membership the image that we are all on the same page about this. We're not. http://www.quackwatch.org/07PoliticalActivities/rxp2.html

All I see this Quixotic quest doing is ruining our relationships with psychiatrists.

So, please keep in mind that you are fighting a segment of us, not all of us.

 

[Janusdog]

As an aside, I really enjoyed the part of your post where you remark on the look of "death" you gave that unsuspecting, undeserving drug representative. With a temper like that, I hope to God that parents don't leave you alone in rooms with their children...

Hm. I'm sorry you can't see the difference between a drug rep who is clearly out for the interests of a corporation and being in a room with a child. And of course it has to do with my personality, not circumstances or responding to an issue I believe in passionately.

Just because 'x' is allowed, does not mean 'y' should be.

 

[sasevan]

Hi Janusdog,

I apologize in advance if what I write sounds sarcastic or condenscending; I have made an honest attempt to review, reflect on, and edit, to the best of my ability, what I have written.

I am sincerely interested in your response.

I have extensive training in neurodevelopmental disabilities and a specialty in health psychology.

What that means is that I can spot autism from a mile away and help individuals maximize the quality of their life if they have chronic pain. I can help them with treatment adherence and recommend rehabilitation programs.

I would never, never, never, say that, even with the developed training, I would be qualified to prescribe.

Neither does the APA; that's why clinical psychologists who would like to specialize in medical psychology will need to complete a post-doc masters program (including practicum) in psychopharmacology.

Prescribing is not why I went to school. If I wanted to prescribe I would have gone to med school. I have the brains, the ability to focus, the dedication. That's just not what I wanted to do.

Do you believe that if dentists, podiatrists, optometrists, and nurse practitioners want to prescribe that they too should go to med school?

I'm very irritated that our profession has been hijacked this way.

Do you believe that our profession was earlier hijacked when it expanded its scope of practice from teaching/research to mental health diagnosing, assessment and treatment?

I was recently floating about and a drug rep, who was setting up a lunch for FP residents (I teach in a residency), came up to me to ask if I could sign for her samples. I said no, I'm a psychologist. She whispered in my ear that she didn't understand why psychologists can't prescribe. I shot her a look of death and told her that I could give her eighty reasons why, was she interested in hearing them? She said no and slunk off.

I'm interested in hearing your eighty reasons. Would you please articulate them?

Her comment told me all I wanted to know about where we would be going if we truly did this.

Where do you believe that is?

Also keep in mind that the membership of our APA is not at all unified in this. The APA tends to block presentations by people who are opposed to the idea, thereby presenting to the membership the image that we are all on the same page about this. We're not. http://www.quackwatch.org/07PoliticalActivities/rxp2.html

When was the last time you attended an APA convention/RxP workshop? From my experience in Toronto and from what my friends tell me about their's in Honolulu, the APA continues to promote discussion of all RxP issues, even the appropriatness of the goal itself. Do you believe that the other ApA does the same regarding their position.

All I see this Quixotic quest doing is ruining our relationships with psychiatrists.

Quixotic??? Do you believe it was futile to tilt at the windmills of NM and LA?
Will it ruin it or ultimately improve it by promoting increased equality akin to women and men, minorities and the majority; or should we just stay in our place?

So, please keep in mind that you are fighting a segment of us, not all of us.

Of course; just like not all psychiatrists are opposed to psychologists gaining RxP.

 

[PsychMD]

Re. "Of course; just like not all psychiatrists are opposed to psychologists gaining RxP".

Would you mind offering some supporting evidence for this? I don't mean to be rude or "inflame", but you've "aroused" my curiosity.

 

[Janusdog]

Neither does the APA; that's why clinical psychologists who would like to specialize in medical psychology will need to complete a post-doc masters program (including practicum) in psychopharmacology.

Not enough. Sorry, but it's not enough. Read the link I posted, which is a very well thought out argument as to how it will be very difficult to translate the DoD program into a workable and affordable solution.

Do you believe that if dentists, podiatrists, optometrists, and nurse practitioners want to prescribe that they too should go to med school?

We are none of these people. Do we do surgery or medical procedures? Have you done a Pap smear lately? How about remove an impacted wisdom tooth? If I wanted to be those people I would have gone to those respective schools. Why do people keep arguing that if these people can do it, so can we? I don't hear enough should we and keep hearing could we?

Do you believe that our profession was earlier hijacked when it expanded its scope of practice from teaching/research to mental health diagnosing, assessment and treatment?

In my opinion, that was an evolution. I suppose you could say this is an evolution too, but I'll say that then we will no longer be psychologists in the classic sense. Eventually you cross the line. Even if the change has barely been noticible for some time, one day it's no longer the original species; think domestic dog/wolf. That's fine by some people, but it's too far of a stretch for me.

I'm interested in hearing your eighty reasons. Would you please articulate them?

Too busy at present to say it eloquently and coherently. Again, the link I posted does a good job.

Where do you believe that is?

Just another target market for drug companies, and we would have very little ability to think critically about it because living with that kind of pressure will initially be new for us. I could almost see this drug rep salivate when she told me she thought psychologists should be able to prescribe. Just...ick.

When was the last time you attended an APA convention/RxP workshop? From my experience in Toronto and from what my friends tell me about their's in Honolulu, the APA continues to promote discussion of all RxP issues, even the appropriatness of the goal itself. Do you believe that the other ApA does the same regarding their position.

I don't belong to the APA anymore, beginning this year. All I see from them is throwing my money at this issue and other bizarre, self-destructive causes. I belonged for nearly 10 years, and last year I got a bill for over $400 for the year. $400 is how much my California license costs. I'm not a rich woman (in fact, I have trouble living on my salary), because they've done a bad job advocating for why people should actually PAY us.

Part of that $400 was this 'advocacy' fund, and I disagree with a lot of their advocacy goals, including trying to get laws overturned that protect psychologists from other disciplines that want our pie. (This is a discussion in itself, but it pertains to allowing 'technicians' to administer psych tests.) I think we should quit taking on psychiatrists and start worrying more about the fact -- yes, fact -- that the public doesn't know the difference between us and social workers. Ads I see advertise for "psychologist or social worker." Either. Where's the APA in doing their BASIC job, which is to tell the public who we are and that we should get paid?

Worry about social workers now teaching psych assessment in their schools and pushing to test. I wanted my advocacy money put towards those issues. Not confused, identity-seeking machinations.

Quixotic??? Do you believe it was futile to tilt at the windmills of NM and LA?
Will it ruin it or ultimately improve it by promoting increased equality akin to women and men, minorities and the majority; or should we just stay in our place?

What?

If you're saying that we're helping underserved populations by prescribing I can tell you that I don't know many psychiatrists who want my population -- Medicaid or no funding. Do you really think we will take that on? I'm skeptical. Educational debt is a growing problem for us and I can't see too many people devoting their life to serving the underserved when they are in debt.

If you're saying RxP is a basic human rights issue...sorry, don't see it; in fact, where I sit, evoking those images minimizes the struggles of those groups.

Of course; just like not all psychiatrists are opposed to psychologists gaining RxP.

It doesn't matter to me whether "their" ApA is on my side and fair and balanced or not. Of course they're not. And please keep in mind that we expect these people to train us -- see again the models in existence. Who would train people who want to supplant them? I suppose you might get a few altruistic individuals, but from a business standpoint it makes no sense and I don't blame psychiatrists for not liking this idea.

Bottom line: We've screwed ourselves in the last 20 years, and RxP is like putting a bow on it.

 

[sasevan]

Re. "Of course; just like not all psychiatrists are opposed to psychologists gaining RxP".

Would you mind offering some supporting evidence for this? I don't mean to be rude or "inflame", but you've "aroused" my curiosity.

Sure, just review this very thread for all of Svas' views.

 

[sasevan]

Thanks for responding. I appreciate your perspective even while I disagree with it.

Not enough. Sorry, but it's not enough. Read the link I posted, which is a very well thought out argument as to how it will be very difficult to translate the DoD program into a workable and affordable solution.

I've read numerous critiques of the non-generalizability of the DoD project but I have not been convinced by these as I have personally met with graduates of that program who continue to prescribe effectively and efficiently and who advocate for the current APA sample program (based on the DoD one).

We are none of these people. Do we do surgery or medical procedures? Have you done a Pap smear lately? How about remove an impacted wisdom tooth? If I wanted to be those people I would have gone to those respective schools. Why do people keep arguing that if these people can do it, so can we? I don't hear enough should we and keep hearing could we?

I have not done a Pap Smear...ever...LOL...and I don't know any dentists or podiatrists who have either nor do I know any optometrists or nurse practitioners who have removed impacted wisdom teeth. I do know dentists, etc. who prescribe in their respective areas. Med psychs are not requesting gynecological or orthodontic privileges just RxP in order to have one more tool in the treatment of psychological disorders.

In my opinion, that was an evolution. I suppose you could say this is an evolution too, but I'll say that then we will no longer be psychologists in the classic sense. Eventually you cross the line. Even if the change has barely been noticible for some time, one day it's no longer the original species; think domestic dog/wolf. That's fine by some people, but it's too far of a stretch for me.

I believe that RxP is an evolution for psychology and I one that I wholeheartedly welcome, though, I believe, that med psych will never represent the whole of clinical psych but rather a sub-specialization such as neuropsych or forensic psych.

Too busy at present to say it eloquently and coherently. Again, the link I posted does a good job.

OK.

Just another target market for drug companies, and we would have very little ability to think critically about it because living with that kind of pressure will initially be new for us. I could almost see this drug rep salivate when she told me she thought psychologists should be able to prescribe. Just...ick.

Here too I wholeheartedly disagree. I believe that our extensive training in research methodology will actually bring a more critical review to pharmaceuticals claims about their products. Once we can prescribe we will have an ethical obligation to do so consistent with scientific principles such as empirical evidence of efficacy. We will be ethically bound to scrutinize the purpoted evidence for the use of psychotropics in the manner currently in practice. It may turn out that med psych will result in a decrease or at least a more judicious use of psychotropics at least by the current primary prescribers of psychotropics, i.e., primary care physicians.

I don't belong to the APA anymore, beginning this year. All I see from them is throwing my money at this issue and other bizarre, self-destructive causes. I belonged for nearly 10 years, and last year I got a bill for over $400 for the year. $400 is how much my California license costs. I'm not a rich woman (in fact, I have trouble living on my salary), because they've done a bad job advocating for why people should actually PAY us.

Part of that $400 was this 'advocacy' fund, and I disagree with a lot of their advocacy goals, including trying to get laws overturned that protect psychologists from other disciplines that want our pie. (This is a discussion in itself, but it pertains to allowing 'technicians' to administer psych tests.) I think we should quit taking on psychiatrists and start worrying more about the fact -- yes, fact -- that the public doesn't know the difference between us and social workers. Ads I see advertise for "psychologist or social worker." Either. Where's the APA in doing their BASIC job, which is to tell the public who we are and that we should get paid?

Worry about social workers now teaching psych assessment in their schools and pushing to test. I wanted my advocacy money put towards those issues. Not confused, identity-seeking machinations.

I'm sorry that you feel disenfranchised from the APA; I hope that you've had a better experience with the CA chapter.

I'm not at all worried about MSW gaining assessment privileges. If they are able to demonstrate that they will receive added training and practicum and can pass appropriate examination in order to administer/interpret psych tests than why not? I believe that as scientists we need to advocate for empirically based positions; rather than artificial disciplinary turf I prefer competent providers whether MD/DO, PhD/PsyD, MSW, MSN, etc. I would prefer a competent psychotherapist whether he/she is a psychiatrist, a social worker, or a psychologist; same for psychopharmacotherapist, psychometrician, etc.

What?

If you're saying that we're helping underserved populations by prescribing I can tell you that I don't know many psychiatrists who want my population -- Medicaid or no funding. Do you really think we will take that on? I'm skeptical. Educational debt is a growing problem for us and I can't see too many people devoting their life to serving the underserved when they are in debt.

Given the large demand (underserved rural and inner city populations) and limited resources (psychiatrists) we have the current crisis in mental health treatment. With more prescribers (med psychs) who are mental health providers the discrepancy can be expected to at least decrease.

If you're saying RxP is a basic human rights issue...sorry, don't see it; in fact, where I sit, evoking those images minimizes the struggles of those groups.

I believe that self-actualization and self-determination are basic human rights. Currently, competent, efficacious, and ethical med psychs are unable to exercise RxP outside the armed forces. This is not because there's any empirical evidence that demonstrates that they cannot do so but because of political constraints that up until now has privileged physicians and marginalized other providers. I'm sorry that you don't see the parallels with other segments of society that have/continue to enjoy politically sponsored privileges while other groups are told not to seek equality.

It doesn't matter to me whether "their" ApA is on my side and fair and balanced or not. Of course they're not. And please keep in mind that we expect these people to train us -- see again the models in existence. Who would train people who want to supplant them? I suppose you might get a few altruistic individuals, but from a business standpoint it makes no sense and I don't blame psychiatrists for not liking this idea.

I also believe that some psychiatrists (and other physicians) will be willing to collaborate with psychologists in this endeavor. In fact, at NSU's post-doc psychopharm program there are staff psychiatrists training/supervising med psychologists already.

Bottom line: We've screwed ourselves in the last 20 years, and RxP is like putting a bow on it.

Again, I disagree, but I thank you for sharing your perspective. Peace.

P.S. Thanks for your defense of PsyDs in the Cl Psych Forum.

 

[PublicHealth]

Thanks for responding. I appreciate your perspective even while I disagree with it.
I believe that RxP is an evolution for psychology and I one that I wholeheartedly welcome, though, I believe, that med psych will never represent the whole of clinical psych but rather a sub-specialization such as neuropsych or forensic psych.
I also believe that some psychiatrists (and other physicians) will be willing to collaborate with psychologists in this endeavor. In fact, at NSU's post-doc psychopharm program there are staff psychiatrists training/supervising med psychologists already.
I've read numerous critiques of the non-generalizability of the DoD project but I have not been convinced by these as I have personally met with graduates of that program who continue to prescribe effectively and efficiently and who advocate for the current APA sample program (based on the DoD one).
I have not done a Pap Smear...ever...LOL...and I don't know any dentists or podiatrists who have either nor do I know any optometrists or nurse practitioners who have removed impacted wisdom teeth. I do know dentists, etc. who prescribe in their respective areas. Med psychs are not requesting gynecological or orthodontic privileges just RxP in order to have one more tool in the treatment of psychological disorders.

sasevan,

Are you still planning to apply to med school? How are the pre-reqs going?

PH

 

[sasevan]

sasevan,

Are you still planning to apply to med school? How are the pre-reqs going?

PH

Still planning on being a psychopharmacotherapist in FL. Everything will depend on when FL approves RxP. What about you; are you at NYCOM? If so, what is your impression so far? NYCOM is my first choice outside FL.