MS Clinical Psychopharmacology

[PsyDStar]

Hello All,

Curious about any thoughts about this degree... and if all programs are generally equivalent... many if not most schools offering this degree seem to be in that "marginal" category (professional psyc schools, etc).

Seems like it will be a significant degree in the future, particularly if CA policy changes as was indicated in another thread on this board.

I appreciate any thoughts you share.

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[EL CAPeeeTAN]

Ultimately for any psychologist who wants to be able to prescribe in the states that are moving that direction, he / she will have to have significant training in this area. I believe that as more states allow prescribing privileges that many doctorate level programs will add significant course work in psychopharmacology. I am not familiar with many of the current programs and whether or not they meet the given requirements for New Mexico / Louisiana prescribing privileges. This is a growing area within psychology and I am curious to see how it all plays out. Eventually if the states that I am interested in practicing in allow prescribing privileges for psychologists I will take the required course work necessary to meet the qualifications necessary. I would be careful of pursuing this degree to find out later that it does not meet the requirements needed to become a prescribing psychologist. I think it is too early to know what all of the states are going to require. New Mexico and Louisiana have listed their requirements and I would assume that other states that adopt this legislation will have similiar requirements but we do not know for sure. On the other hand any education in this area would be beneficial to you as a psychologist and understanding your patients medications which they will most likely be on if they have been seen by a psychiatrist or even a primary care physician.

 

[PsyDRxPnow]

Nova Southeastern University, Fort Lauderdale, FL offers a master's degree in psychopharmacology. My thoughts on this matter are that you could never go wrong with a master’s degree that can help you understand medications and how it affects your patient. I personally intent to take the courses necessary to gain this degree. I can only imagine that once my state (Fl) passes RxP then I can just add to the education that I gain from a Masters in psychoparm I can’t see the state's requirement to be that much different then that offered by the different schools that offer that masters.

Education will always pay off!!!!!!!!

 

[PublicHealth]

I can only imagine that once my state (Fl) passes RxP then I can just add to the education that I gain from a Masters in psychoparm I can’t see the state's requirement to be that much different then that offered by the different schools that offer that masters.

You mean IF "your" state (FL) passes RxP legislation. RxP privileges for psychologists will always be an uphill battle, especially when many psychologists are opposed to such legislation. Add to this group the majority of the American Psychiatric Association and American Medical Association, and lawyers drooling over fresh-blood prescribing psychologists, and you have one hell of a battle ahead.

 

[PsyDStar]

You mean IF "your" state (FL) passes RxP legislation. RxP privileges for psychologists will always be an uphill battle, especially when many psychologists are opposed to such legislation. Add to this group the majority of the American Psychiatric Association and American Medical Association, and lawyers drooling over fresh-blood prescribing psychologists, and you have one hell of a battle ahead.

Yes, indeed, AMA influence is so powerful (via lobby, etc) I am amazed that legislation got through in Louisiana and New Mexico... isn't there another state tat psychologists have script priviledges?

Also, does anyone know the nature of psychologist prescription priviledges? For instance, is there mandatory MD approval of all scripts and what kind of limitations are there to the range of meds a psychologist can write?

Thanks for responses.

 

[EL CAPeeeTAN]

Yes, indeed, AMA influence is so powerful (via lobby, etc) I am amazed that legislation got through in Louisiana and New Mexico... isn't there another state tat psychologists have script priviledges?

Also, does anyone know the nature of psychologist prescription priviledges? For instance, is there mandatory MD approval of all scripts and what kind of limitations are there to the range of meds a psychologist can write?

Thanks for responses.

There is lots of discussion on this subject in the Psychiatry forum. The states that have approved the prescribing privileges for psychologists require 2 years of additional schooling in psychopharmacology with a specific curriculum. Then a test is required and the psychologist must pass the test. Then the psychologist is allowed to prescribe a formulary of certain medication specifically psychotropics including benzos, SSRI's etc. The psychologist has to prescribe under the supervision of a MD for 2 years and then the psychologist's prescribing history is reviewed and if it is determined that the prescriptions over the 2 years were appropriate then the psychologist is allowed to prescribe on his / her own without MD supervision. A governing psychology board runs all the reviewing processes throughout the entire prescription training procedures.

 

[PsyDRxPnow]

You mean IF "your" state (FL) passes RxP legislation. RxP privileges for psychologists will always be an uphill battle, especially when many psychologists are opposed to such legislation. Add to this group the majority of the American Psychiatric Association and American Medical Association, and lawyers drooling over fresh-blood prescribing psychologists, and you have one hell of a battle ahead.

Hey where have you been? We have missed your pessimism around here. For those who don’t know Public health he is a born again psych person. He has attempted graduate psychology but got discouraged and jumped ship to psychiatry and he is trying to get as much blood to go along with him to psychiatry. I personally think that he is just trying to justify his jumping ship to psychiatry. Anyhow, the battle is difficult and we will loose many on the way but ultimately, we will revolutionize psychology and gain our objective. Although, the battle is difficult but 2 states have passed RxP (New Mexico and Louisiana) I guess by achieving our agenda in those states it can tell you at least one thing, that the argument for RxP is so convincing and is urgently needed that it is overcoming all kinds of hurdles placed in our way by psychiatrist and all of those who attempt to impede progress.

Good luck with all your endeavors public health!

 

[PublicHealth]

Hey where have you been? We have missed your pessimism around here. For those who don’t know Public health he is a born again psych person. He has attempted graduate psychology but got discouraged and jumped ship to psychiatry and he is trying to get as much blood to go along with him to psychiatry. I personally think that he is just trying to justify his jumping ship to psychiatry. Anyhow, the battle is difficult and we will loose many on the way but ultimately, we will revolutionize psychology and gain our objective. Although, the battle is difficult but 2 states have passed RxP (New Mexico and Louisiana) I guess by achieving our agenda in those states it can tell you at least one thing, that the argument for RxP is so convincing and is urgently needed that it is overcoming all kinds of hurdles placed in our way by psychiatrist and all of those who attempt to impede progress.

Good luck with all your endeavors public health!

The only revolution that psychologist RxP will engender is in malpractice!

 

[PsyDRxPnow]

The only revolution that psychologist RxP will engender is in malpractice!

 

[Allotheria]

The only revolution that psychologist RxP will engender is in malpractice!

Hey PublicHealth,

My degree is in clinical health psych so I've actually taken medical classes. Not the graduate classes who claim to be medical classes, but actual medical classes with med students.

So, I actually agree that psychologists shouldn't prescribe medication without the proper education and supervision. I remember how much trouble I had in pathophysiology but the students worked out a nice trade; the med students tutored us for help in epidemiology.

What do psychiatrists feel would make psychologists competent psychotropic providers? What education and supervision? And don't say an M.D. degree and notice that I said psychotropic medication.

 

[PsyDRxPnow]

Hey PublicHealth,

My degree is in clinical health psych so I’ve actually taken medical classes. Not the graduate classes who claim to be medical classes, but actual medical classes with med students.

So, I actually agree that psychologists shouldn’t prescribe medication without the proper education and supervision. I remember how much trouble I had in pathophysiology but the students worked out a nice trade; the med students tutored us for help in epidemiology.

What do psychiatrists feel would make psychologists competent psychotropic providers? What education and supervision? And don’t say an M.D. degree and notice that I said psychotropic medication.

The issue that psychiatrists are having regarding psychologists prescribing is the fact that it invades their turf. The arguments that they use have no valid basis. The patient’s health is never jeopardized at any point since the psychologists who prescribe exceed the training that is given to all PA’s, NP’s, and most of all general medical practitioners when it comes to psychotropic and expertise on mental illness. Referral to the DOD reports http://www.apa.org/divisions/div55/ACNPrpt.html

 

[Allotheria]

The issue that psychiatrists are having regarding psychologists prescribing is the fact that it invades their turf. The arguments that they use have no valid basis. The patient's health is never jeopardized at any point since the psychologists who prescribe exceed the training that is given to all PA's, NP's, and most of all general medical practitioners when it comes to psychotropic and expertise on mental illness. Referral to the DOD reports http://www.apa.org/divisions/div55/ACNPrpt.html

Yes, I've read (heard them). I understand the psychiatrists position I believe I might feel the same way toward master's level therapists and social workers doing testing.

I have more medical training than a lot of clinical psychologists and I don't feel secure prescribing medications. I admit I haven't taken the M.S. in Psychopharmacology program though. I think psychologists have the ability to prescribe, I mean hell if a NP can do it why can't a PhD, with proper training and supervision?

My question is what do psychiatrists feel is adequate training and supervision to be able to prescribe psychotropic medication? Don't say med school.

 

[PsyDRxPnow]

Yes, I've read (heard them). I understand the psychiatrists position I believe I might feel the same way toward master's level therapists and social workers doing testing.

I have more medical training than a lot of clinical psychologists and I don’t feel secure prescribing medications. I admit I haven’t taken the M.S. in Psychopharmacology program though. I think psychologists have the ability to prescribe, I mean hell if a NP can do it why can’t a PhD, with proper training and supervision?

My question is what do psychiatrists feel is adequate training and supervision to be able to prescribe psychotropic medication? Don’t say med school.

You have said it “medical school”. They do not want anyone to prescribe unless that someone has an MD and maybe a DO because from what I understand Louisiana was the last state to allow DO to practice as physician until 2 years ago (took 50 yrs to gain power in all 50 states) but I digress, perhaps if they cared primary for the patient’s safety then they should answer your questions in a realistic and rational way, because the fact of the matter is that you don’t need to go to medical school to prescribe competently.

Their motto is protecting the turf at all cost. This is not a motto or a philosophy that has been working.

 

[Allotheria]

You have said it "medical school". They do not want anyone to prescribe unless that someone has an MD and maybe a DO because from what I understand Louisiana was the last state to allow DO to practice as physician until 2 years ago (took 50 yrs to gain power in all 50 states) but I digress, perhaps if they cared primary for the patient's safety then they should answer your questions in a realistic and rational way, because the fact of the matter is that you don't need to go to medical school to prescribe competently.

Their motto is protecting the turf at all cost. This is not a motto or a philosophy that has been working.

To be honest I applaud "protecting one's turf", I see nothing wrong with that. Psychologists do the same when it comes to testing and therapy. I also see nothing wrong with making more money either, if I can provide my family a higher quality of life - so be it.

I agree, I don't think that the issue with psychologists prescribing is patient safety but more monetary. I believe that if the real issue was indeed safety there would be more discussion on how to make psychologists competent prescribers vs. denying privileges. The deny strategy makes sense in the beginning of a "turf war" but with two states granting privileges and others apparently to follow the focus should move to education/safety vs. prevention. I believe that there is an issue currently with psychologists prescribing because we as a profession do not have the expertise to do so.

I'm really curious to know what educational requirements and supervision psychiatrics feel psychologists need in order to be safe psychotropic med providers. (Short of med school)

 

[PsyDRxPnow]

To be honest I applaud “protecting one’s turf”, I see nothing wrong with that. Psychologists do the same when it comes to testing and therapy. I also see nothing wrong with making more money either, if I can provide my family a higher quality of life - so be it.

I agree, I don’t think that the issue with psychologists prescribing is patient safety but more monetary. I believe that if the real issue was indeed safety there would be more discussion on how to make psychologists competent prescribers vs. denying privileges. The deny strategy makes sense in the beginning of a “turf war” but with two states granting privileges and others apparently to follow the focus should move to education/safety vs. prevention. I believe that there is an issue currently with psychologists prescribing because we as a profession do not have the expertise to do so.

I’m really curious to know what educational requirements and supervision psychiatrics feel psychologists need in order to be safe psychotropic med providers. (Short of med school)

Thank you for hitting the nail right on the head. However you may not be able to get your answer from psychiatrists at the time being due to the fact that they are still in denial. However you will get the answer from other psychologists who are already prescribing and the MD/DOs who are providing them with supervision for the time being. These individuals are open minded and are not defensive or insecure about their turf which makes them more open and sincere in answering your questions.

Good chatting with you

 

[Anasazi23]

The issue that psychiatrists are having regarding psychologists prescribing is the fact that it invades their turf. The arguments that they use have no valid basis. The patient’s health is never jeopardized at any point since the psychologists who prescribe exceed the training that is given to all PA’s, NP’s, and most of all general medical practitioners when it comes to psychotropic and expertise on mental illness. Referral to the DOD reports http://www.apa.org/divisions/div55/ACNPrpt.html

There are empirical studies showing that non-physician practitioners harm and in some cases, kill people when compared with their physician counterparts. I don't have the citations handy...do a search on pubmed for "nurse anesthesists, adverse outcome, physician assistant," and the like.

Don't say the patient's health is never jeopardized. When anyone prescribes a medication, the potential exists, especially in one who is not medically trained, which nurses and PAs are. Nurses and PAs at least have a broad background in disease states, and recognize sick people when they see them. Psychologists have not proven they can. Why should they? They are not trained to do so, are not trained to do so in the weekend master's courses, and don't operate in that capacity.

Please stop referring to the DoD paper if you can't assimilate the full results and make the appropriate extrapolations (or lack thereof). Tell me the only medications they prescribed and to what populations, and with what supervision, and with what exact training. It's quite different from what is currently being offered in non-medically affiliated psychopharm master's institutions across the US. And it's extremely different in light of psychologists' want for a FULL formulary with NO oversight. There is no possible way to explain this other than ego needs. Please answer that question....what possible need does a psychologist have to carry a full formulary with no oversight? I look forward to the response.

As a prescribing psychologist, would you ever prescribe an antibiotic, ever? What about a harmless medication refill for your patient who's out of atenolol? Would you ever prescribe cleocin for your son's acne? Ever? Be honest. If you answer no, I know you're lying.

You have said it “medical school”. They do not want anyone to prescribe unless that someone has an MD and maybe a DO because from what I understand Louisiana was the last state to allow DO to practice as physician until 2 years ago (took 50 yrs to gain power in all 50 states) but I digress, perhaps if they cared primary for the patient’s safety then they should answer your questions in a realistic and rational way, because the fact of the matter is that you don’t need to go to medical school to prescribe competently.

.....Their motto is protecting the turf at all cost. This is not a motto or a philosophy that has been working.

Wrong again. The last state to license DOs was in 1973 in Mississippi.

On what basis do you claim that physician's motto is to "protect turf at all costs," and that it "is not a motto or a philosophy that has been working?" We arguably have the best healthcare available anywhere in the world. We didn't get that way by giving practicing rights to everyone that demanded them. Looks like it's working to me.

you may not be able to get your answer from psychiatrists at the time being due to the fact that they are still in denial. However you will get the answer from other psychologists who are already prescribing and the MD/DOs who are providing them with supervision for the time being. These individuals are open minded and are not defensive or insecure about their turf which makes them more open and sincere in answering your questions.

Or perhaps it's because psychiatrists and residents don't often have the time to sit in front of the computer all day long responding to posts within seconds of them being written. For God's sake. We're out seeing sick patients....not pontificating in group settings about the agenda for the next diversity workshop.

...the fact of the matter is that you don’t need to go to medical school to prescribe competently.

What about ECT? Answer it. What about DM or HTN management? What about emergency psychiatry (please research the medical complexities of it before you answer a blanket "Yes!"). What about addiction psychiatry? Again, look into it. Will you confidently treat the SSRI syndrome you caused in your office or the NMS? You won't learn this in your measly 100 patient practicum, and will be embarrassed and shamed when you're on the phone calling the ambulance or dialing the psychiatrists in the hospital clinic because you don't know what to do, since you didn't do a psychiatry residency, and missed out on 2-3 years of general practical medical training as a medical student.

Want to become truly competent and confident in what you're doing? Want to do it RIGHT? Want to know that you've given the sick patient all the best care that can reasonably be offered by your knowledge base in the best practice of medicine? Go to medical school and stop fooling yourself. Other psychologists have. Talk to them.

You reek of inexperience and naivete, and clearly have a dearth of knowledge regarding the workings of healthcare in general, and the practice of medicine and psychiatry in particular. If you ever received rx privilages, and moved to a state where it was allowed, and somehow came to practice this way without supervision, I pray for your patients.

 

[Pterion]

I'm with Anasazi. I have a PsyD and several years of practice. My dissertation was basic research. I am now in medical school. I can tell you unequivocally that there is no comparison between what I am learning now and what I learned in grad school. Grad school is NO preparation for clinical pharm. Very few programs have anything approaching a biologically-based clinically-oriented program. Why? That's what med school is for. Grad school is to teach people how to do real research (Advantage: PhD. No comparison) psychological testing (unique to psychology) and specific interventions (Advantage: depends on the school).

Although there are competent, non-MD prescribers, they are unlike psychologists. As Anasazi says, their entire training program is geared toward such work. So to claim that a 2-year master's degree provides you better training than a PA or NP is ridiculous.

Should CT techs be allowed a 2-year course in pharmacology so they can prescribe cardiac glycosides for the cath patients they scanned? After all, they've seen thousands of occluded LAD's, and they care about patient safety a lot more than cardiologists. Would you go to such a practitioner?

Maybe if psychologists spent more time doing what they're trained to do they wouldn't be coveting their neighbor's status.

 

[Anasazi23]

I’m really curious to know what educational requirements and supervision psychiatrics feel psychologists need in order to be safe psychotropic med providers. (Short of med school)

A reasonable question that is asked with much more tact and understanding than the baseless and infantile statements that others make.

The problem from our perspective is this. Psychiatrists are physicians. As such, we have 2+ years of training in basic sciences and clinical medicine (LOTS) of classes, with laboratory equivalents, with classes in physical medicine, diagnostics, countless tests and exams, three part boards, (now) a national diagnostic skills exam, and more. This is followed by two more years of APPLYING this knowledge in all major clinical settings...surgery, medicine, pediatrics, emergency medicine, radiology, family practice, psychiatry, and lots of electives. During these exposures, myriad specialty consult services are worked with and in as electives. As it is, many of these rotations are only 4-12 weeks long. And though a huge amount of information is garnered there, there is still SO much lacking. To not even have that training, and attempt to give out medications, is almost crazy.

Is every minute of all these rotations needed for psychiatry? Obviously not. The same can be said, however, for the practice of cardiology or surgery. Would you like your cardiologist to have taken only the bare minimum classes on weekends in hotels in a watered down setting with no examining board exams (PEP is not independently regulated and can be taken endless times), and no general background of the rest of medicine? Hopefully not - because the truth is that the body is a unit, brain included, and cannot be artifically excluded from the rest of itself.

You have to understand that physicians will see anything less than what we go through as inferior, because as basic medical and residency training goes, even we feel like we don't know enough medicine on any given day. The amount to know is incredible, and requires a formal training to even study properly, while the amount of information on which to stay current is massive.

That's why the term you use "psychotropic med provider" is so limiting, and really short-changes the patient. You can be a psychotropic med provider, and conduct a study showing that you're just as safe, but the reality is that the patients are not getting as good care. This isn't always measured by filling out an adverse effect form and making statistical comparisons. There's a lot more to it. That is why it is so difficult to answer properly your question as to "what is appropriate."

 

[edieb]

I hardly ever post on these threads, but your arguments strike me as missing the point of PhD prescribing. Psychologists, with apt training, are in the best position to prescribe because we HAVE training in research methods. You speak of your training being mostly research as if research is divorced from treatment. However, research training, which med students, NPs, etc., do not receive, is REQUISITE for proper treatment. We are better able to evaluate treatments [multiple baseline treatment would be used in psychologist prescribing (psychotherapy + pharmacotherapy)] and
see if they are efficacious or not. If not deemed effective, we can switch treatment (e.g., add new treatments, et cetera) and keep on assessing. Psychiatrists, with no training in research, are not in a position to effectively prescribe medicine and evaluate if treatments are working. Psychologists have long been encumbered by many (not all) of their psychiatrist counterparts who have no idea how to truly evaluate if treatment is effective or not. Many times psycholgists must work with a patient who is sufferring from so many licit drug induced side effects that they cannot be treated in psychotherapy. Being on some psychoactive drugs precludes treatment with much more efficacious psychotherapy (one big example: exposure therapy with benzodiazapines is not effective). However, we don't control when the patient is on his/her psychoactives and many times can't help them because they are on all these drugs. Much of psychiatry has turned into polypharmacy (i.e., throwing multiple drugs at a patient) and the patient ends up with a terrible quality of life. In addition, many of these psychotropics have horrible side effects, esp. with prolonged use. However, psychiatrists just prescribe and prescribe without treating the root cause. Why should they want their patient's off pills? This prolonged use of meds probably ends up shortening the patient's life span. Thus, many times psychatirst prescribing is a danger to the public health. Why don't we talk about that danger? Psychologists will probably remedy this.

The RxP movement is now a veritable juggernaut. The situation in Tennessee looks exactly the same as it did in Louisiana last year when RxP passed (I am in Louisiana). The train has left the station.

I'm with Anasazi. I have a PsyD and several years of practice. My dissertation was basic research. I am now in medical school. I can tell you unequivocally that there is no comparison between what I am learning now and what I learned in grad school. Grad school is NO preparation for clinical pharm. Very few programs have anything approaching a biologically-based clinically-oriented program. Why? That's what med school is for. Grad school is to teach people how to do real research (Advantage: PhD. No comparison) psychological testing (unique to psychology) and specific interventions (Advantage: depends on the school).

Although there are competent, non-MD prescribers, they are unlike psychologists. As Anasazi says, their entire training program is geared toward such work. So to claim that a 2-year master's degree provides you better training than a PA or NP is ridiculous.

Should CT techs be allowed a 2-year course in pharmacology so they can prescribe cardiac glycosides for the cath patients they scanned? After all, they've seen thousands of occluded LAD's, and they care about patient safety a lot more than cardiologists. Would you go to such a practitioner?

Maybe if psychologists spent more time doing what they're trained to do they wouldn't be coveting their neighbor's status.

 

[50960]

It is really not worth arguing about anymore, as Edieb said the train has left the station.

 

[Anasazi23]

Hi, let me address some of your points....

Psychologists, with apt training, are in the best position to prescribe because we HAVE training in research methods. You speak of your training being mostly research as if research is divorced from treatment.

I never said that....besides, you'd be surprised at the amount of research that many psychiatrists know. Almost all of my fellow residents have published, and many have worked in big research institutions, including NIH. That's just my place. The research that is published in psychiatry journals is often great research. Like psychologists, who are often extremely limited in their research/stats knowledge, not every psychiatrist has to have extensive training in research to evaluate studies or their meanings. It's not incredibly hard to interpret an anova, correlations, t-tests, and the like. The complex studies that psychologists often fabricate are for academic purposes with questionable clinical usefullness.

PsyDs and school psychologists will be eligible to take these classes. How do you justify this?

However, research training, which med students, NPs, etc., do not receive, is REQUISITE for proper treatment. We are better able to evaluate treatments [multiple baseline treatment would be used in psychologist prescribing (psychotherapy + pharmacotherapy)] and see if they are efficacious or not.

It's doesn't take a PhD to understand treatment outcome studies. FYI all medical students take biostatistics, at a minimum, and much more in psychiatry residency. I can't vouch for nurses, but I have seen their journals. You should check them out too. They also do lots of outcome studies dealing with their interventions.

It's again naive to think that every psychologist is going to run around with serial PAIs and rating scales for every medication adjustment they make. It's simply not true.

Psychiatrists, with no training in research, are not in a position to effectively prescribe medicine and evaluate if treatments are working.

I'm not quite sure how to respond to this. It's simply absurd.
Why can't I just say, "psychologists, with no training in formal medicine, are not in a position to effectively prescribe medicine..." Sounds much easier to swallow.

I thought the point of rxp was to serve the underserved, whilst working with the patient's psychiatrist and GP?

Psychologists have long been encumbered by many (not all) of their psychiatrist counterparts who have no idea how to truly evaluate if treatment is effective or not.

It's called structured clinical interview. We are trained for years to evaluate symptom patterns, use rating scales when we want, and make adjustments based on our interaction with the patients and collateral family/friend information. Again, I'm surprised that one can even make this statement.

Many times psycholgists must work with a patient who is sufferring from so many licit drug induced side effects that they cannot be treated in psychotherapy. Being on some psychoactive drugs precludes treatment with much more efficacious psychotherapy (one big example: exposure therapy with benzodiazapines is not effective). However, we don't control when the patient is on his/her psychoactives and many times can't help them because they are on all these drugs. Much of psychiatry has turned into polypharmacy (i.e., throwing multiple drugs at a patient) and the patient ends up with a terrible quality of life. In addition, many of these psychotropics have horrible side effects, esp. with prolonged use. However, psychiatrists just prescribe and prescribe without treating the root cause. Why should they want their patient's off pills?

This is a tired cliche used by psychologists that do not understand clinical medicine. "psychiatry is the big evil empire that forces your kids to take mind altering chemical substances." It's much more sophisticated. If you've never worked in an outpatient or inpatient psychiatry clinic, you wouldn't know the amount of happiness brought to these patients by the reduction of their symptoms, or the return to baseline functioning so that they can resume their lives. We're always receiving cards and calls thanking us for helping them or their sick family members.

This prolonged use of meds probably ends up shortening the patient's life span. Thus, many times psychatirst prescribing is a danger to the public health. Why don't we talk about that danger? Psychologists will probably remedy this.

This is just insane. Psychologists with no medical training to the rescue!!!!

The RxP movement is now a veritable juggernaut. The situation in Tennessee looks exactly the same as it did in Louisiana last year when RxP passed (I am in Louisiana). The train has left the station.

It doesn't matter to me if psychologists are prescribing in every state in the union. You'll never convince me that the quality of care is as good.

 

[PsyDRxPnow]

A reasonable question that is asked with much more tact and understanding than the baseless and infantile statements that others make.

The problem from our perspective is this. Psychiatrists are physicians. As such, we have 2+ years of training in basic sciences and clinical medicine (LOTS) of classes, with laboratory equivalents, with classes in physical medicine, diagnostics, countless tests and exams, three part boards, (now) a national diagnostic skills exam, and more. This is followed by two more years of APPLYING this knowledge in all major clinical settings...surgery, medicine, pediatrics, emergency medicine, radiology, family practice, psychiatry, and lots of electives. During these exposures, myriad specialty consult services are worked with and in as electives. As it is, many of these rotations are only 4-12 weeks long. And though a huge amount of information is garnered there, there is still SO much lacking. To not even have that training, and attempt to give out medications, is almost crazy.

Is every minute of all these rotations needed for psychiatry? Obviously not. The same can be said, however, for the practice of cardiology or surgery. Would you like your cardiologist to have taken only the bare minimum classes on weekends in hotels in a watered down setting with no examining board exams (PEP is not independently regulated and can be taken endless times), and no general background of the rest of medicine? Hopefully not - because the truth is that the body is a unit, brain included, and cannot be artifically excluded from the rest of itself.

You have to understand that physicians will see anything less than what we go through as inferior, because as basic medical and residency training goes, even we feel like we don't know enough medicine on any given day. The amount to know is incredible, and requires a formal training to even study properly, while the amount of information on which to stay current is massive.

That's why the term you use "psychotropic med provider" is so limiting, and really short-changes the patient. You can be a psychotropic med provider, and conduct a study showing that you're just as safe, but the reality is that the patients are not getting as good care. This isn't always measured by filling out an adverse effect form and making statistical comparisons. There's a lot more to it. That is why it is so difficult to answer properly your question as to "what is appropriate."

I must admit that I did not research the DO’s and Louisiana issue since I gained the information from an ER DO.

The time that you have spent on this forum is equivalent to the time that I spend chatting with another member. So don’t be a hypocrite!

In regards to your posts they come across angry and I don’t care for it because life is to short. Also, MD’s probably used the same rational and arguments that you make now towards DOs and it seems like they eventually won full privileges that MD possess.

No matter, having these arguments or not will not have any significant difference on the outcome of RxP. I will just continue to do what I do in life and await my state to grant psychologists with appropriate training to prescribe.

 

[Anasazi23]

While I agree that psychologists should not be prescribing medications, I think psychiatry overreaches their role. Most psychiatrists I have worked with and read reports by have been poor diagnosticians. They are consistently the worst of the medical specialties in diagnosis. It is truly breathtaking. I think it is because of a fly by the seat of the pants mentality, the complete reliance on clinical judgement in 15 - 30 minute, Henry Ford like snippets of patient contact. The polypharmacy problem the other fellow brought up is real. Psychiatrists are prone to fad prescriptions and diagnoses. It's annoying. I would never send a relative or friend to a psychiatrist. I would send them to a psychologist and coordinate with a real doctor (neurologist).

Poor diagnosticians how? Because the results of your PAI printout didn't match what the psychiatrist diagnosed on the 5 axes? What super education occurs in psychology, which traditionally sees a much narrower range of psychiatric diagnoses, that allow them to make "better" diagnoses than psychiatrists? The truth is that psychiatrists don't treat DSMs, they treat people and their symptoms. If you want to argue over paranoid personality vs. schizophrenia paranoid type vs. schizoid vs bipolar with psychotic features, etc, that's fine. But to make blanket statements like this are nuts. You'd be very surprised at the complexities of what our psychiatrists do with medications, why they do it, how they do it, and the research they cite to back it up. Don't assume that because you never heard of or don't understand a medication regimin that it's bad treatment.

I admitted another overdose suicide attempt last night while on call. The kid had been seeing a psychologist who never referred him to a psychiatrist. Do I blame the psychologist? Not really. These things happen. While I do see completely inappropriate and very dangerous things that psychologists have done, I don't make blanket statements about their ineptitude, knowing that there are good and bad.

The polypharmacy issue is another that is a tired cliche constantly cited. What would you do as a psychiatry attending with a chronic pt. who has been on your ward 4 times in the last 6 months, you've known for 9 years, who has had poor response to every neuroleptic or other psychotropic? The truth is that polypharmacy is not the ideal, but WORKS in CERTAIN situations. Again, it seems like people are enjoying throwing rocks from their ivory tower without understanding pharmacology, symptom profiles, chronic psychiatric patients, and the full importance of relevant psychiatric research. Psychiatrists have been doing this a long time, and have developed augmentation strategies that work, for various reasons. And the truth is that psychologists, by nature of the training, don't know better. Just because you don't like the 20 of Zyprexa combined with the haldol and risperdal doesn't mean it's not right. While I don't have the energy to go into that particular cocktail justification such as that right now, there are often good reasons. I do this all the time myself and have success.

Send them to a neurologist for psych management? While the fields are related and every psychiatrist, much to your surprised, is boarded in neurology, thinking neurologists know more psychopharm than psychiatry demonstrates a lack of medical understanding of the two fields. I'm constantly correcting the neuro residents I work with and the neuro attendings on the subtleties of dosages and strategies, as they do with me in eg. management of seizure disorders.

I imagine you'd be very surprised at what you didn't know if you sat through one of our rounds.

 

[Allotheria]

I'm with Anasazi. I have a PsyD and several years of practice. My dissertation was basic research. I am now in medical school. I can tell you unequivocally that there is no comparison between what I am learning now and what I learned in grad school. Grad school is NO preparation for clinical pharm. Very few programs have anything approaching a biologically-based clinically-oriented program. Why? That's what med school is for. Grad school is to teach people how to do real research (Advantage: PhD. No comparison) psychological testing (unique to psychology) and specific interventions (Advantage: depends on the school).

Pterion,

I disagree with both you and Anasazi, psychologists can become competent psychotropic providers. I do agree that grad school is no preparation for med school. My medical classes were some of the hardest I have ever taken. Overall though, I think that it depends on your program. Mine was clinical health psych which is still a minority in the psych field, but perhaps that should be the basis of psychologists as medication providers - half grad and half med?

A reasonable question that is asked with much more tact and understanding than the baseless and infantile statements that others make.

The problem from our perspective is this. Psychiatrists are physicians. As such, we have 2+ years of training in basic sciences and clinical medicine (LOTS) of classes, with laboratory equivalents, with classes in physical medicine, diagnostics, countless tests and exams, three part boards, (now) a national diagnostic skills exam, and more. This is followed by two more years of APPLYING this knowledge in all major clinical settings...surgery, medicine, pediatrics, emergency medicine, radiology, family practice, psychiatry, and lots of electives. During these exposures, myriad specialty consult services are worked with and in as electives. As it is, many of these rotations are only 4-12 weeks long. And though a huge amount of information is garnered there, there is still SO much lacking. To not even have that training, and attempt to give out medications, is almost crazy.

Is every minute of all these rotations needed for psychiatry? Obviously not. The same can be said, however, for the practice of cardiology or surgery. Would you like your cardiologist to have taken only the bare minimum classes on weekends in hotels in a watered down setting with no examining board exams (PEP is not independently regulated and can be taken endless times), and no general background of the rest of medicine? Hopefully not - because the truth is that the body is a unit, brain included, and cannot be artifically excluded from the rest of itself.

You have to understand that physicians will see anything less than what we go through as inferior, because as basic medical and residency training goes, even we feel like we don't know enough medicine on any given day. The amount to know is incredible, and requires a formal training to even study properly, while the amount of information on which to stay current is massive.

That's why the term you use "psychotropic med provider" is so limiting, and really short-changes the patient. You can be a psychotropic med provider, and conduct a study showing that you're just as safe, but the reality is that the patients are not getting as good care. This isn't always measured by filling out an adverse effect form and making statistical comparisons. There's a lot more to it. That is why it is so difficult to answer properly your question as to "what is appropriate."

Anasazi, again I disagree with this comment. I don't believe psychologists need to go to med school. I do believe they need more than a weekend pharmacology masters though. I also disagree that patients wouldn't get as good quality of care. Every psychiatrist that I know refers out for everything outside the scope of psych and refuses to write scripts for anything other than psychotropics. Why would psychologists be different? If a psychologist has the proper training and education I believe they could be competent providers, and I don't mind being viewed as a mid-level provider.

You're right though defining the proper training is difficult. I think that a post doc degree might be sufficient. For example you have to meet the educational criteria for the program (Epidemiology, Fundamentals of the disease process, etc.) then you work full time in an inpatient unit under the supervision of a psychiatrist prescribing 40-60hrs a week; while working on the Pharm masters degree – total supervision time 2yrs. Just a thought

 

[Pterion]

Pterion,

I disagree with both you and Anasazi, psychologists can become competent psychotropic providers. I do agree that grad school is no preparation for med school. My medical classes were some of the hardest I have ever taken. Overall though, I think that it depends on your program. Mine was clinical health psych which is still a minority in the psych field, but perhaps that should be the basis of psychologists as medication providers - half grad and half med?

I should clarify. Sure, psychologists could become competent psychopharmacologists. I didn't intend to indict all members of the profession. Given the appropriate amount of training, anyone could. The argument, as you point out, centers around what constitutes "appropriate" or "sufficient".

As for the referring out that you cite in your response to Anasazi, I'm not sure that's the problem. Its knowing when to refer out that a 2-yr MA isn't likely to supply thoroughly.

Example: While working for an inpatient psych unit, a colleague of mine did an intake on a fellow who was clearly psychotic. Classic signs, straight out of the IV-TR. He was sent to the locked ward b/c of his periodic violent displays, but at the time of intake was pretty passive and disoriented. The psychiatrist - a man whose inidvidual competence I still question - noticed immediately in the chart that the patient's urine output was almost zero. He was referred to medical for treatment of kidney failure. That treatment resolved the psychiatric symptoms fully. Where else will the psychologists get that kind of background if not in a 4-yr medical program? The decision tree of differentials is potentially mind-boggling.

Your training sounds unusually thorough in the medical sciences, so my apologies if I'm preaching to the chior on this point.

 

[Allotheria]

I should clarify. Sure, psychologists could become competent psychopharmacologists. I didn't intend to indict all members of the profession. Given the appropriate amount of training, anyone could. The argument, as you point out, centers around what constitutes "appropriate" or "sufficient".

As for the referring out that you cite in your response to Anasazi, I'm not sure that's the problem. Its knowing when to refer out that a 2-yr MA isn't likely to supply thoroughly.

Example: While working for an inpatient psych unit, a colleague of mine did an intake on a fellow who was clearly psychotic. Classic signs, straight out of the IV-TR. He was sent to the locked ward b/c of his periodic violent displays, but at the time of intake was pretty passive and disoriented. The psychiatrist - a man whose inidvidual competence I still question - noticed immediately in the chart that the patient's urine output was almost zero. He was referred to medical for treatment of kidney failure. That treatment resolved the psychiatric symptoms fully. Where else will the psychologists get that kind of background if not in a 4-yr medical program? The decision tree of differentials is potentially mind-boggling.

Your training sounds unusually thorough in the medical sciences, so my apologies if I'm preaching to the chior on this point.

Would a NP actually pick up on the kidney failure or an ND? Don't get me wrong I completely agree with you. That's why psychologists should have supervision. I think that most do not have the training, but what about other mid-level practitioners? Don't get me wrong I never think that psychologists will ever be on the same medical level as an MD (but really who is), just as an M.D. will never be on the same research level as a PhD. I believe "referring out" should be one the most stressed ideas in the M.S. Pharmacology program. Psychologists have no business seeing a health psych client without the client having been through a thorough screening, ex. Cardiac patients.

I am for psychologists gaining prescription privileges, but only if it can be done safely. Privileges have been passed in two states and looks like it's going to pass in a few more. I don't want this thread to turn into another trite psychologists vs. psychologists turf war. There's far to many of those already.

What I really want to know is what it would take to make psychologists competent psychotropic providers.

My previous post:

For example you have to meet the educational criteria for the program (Epidemiology, Fundamentals of the disease process, etc.) then you work full time in an inpatient unit under the supervision of a psychiatrist prescribing 40-60hrs a week; while working on the Pharm masters degree – total supervision time 2yrs. Just a thought

 

[psychgeek]

Come on people. As usual, this forum had degenerated into ridiculous hyperbole. It is insane to suggest that psychologists will become equal to or better at prescribing psychotropic medication than psychiatrists after a two-year masters. However, it is equally asinine to suggest the research training afforded psychiatrists is anywhere near equivalent to that provided to Ph.D. psychologists. Anasazi, if you really are working with psychologists who are making comprehensive diagnoses on the basis of an automated PAI, then stop listening to them (they obviously suck). Since I have never seen any student or psychologist attempt to submit a PAI (or MMPI or RIAP) printout in place of an integrated report, I doubt that this is the case. I actually suspect that you have little idea what goes into writing an integrated report and a poor understanding of why 5 axes Dx are far less reliable than the results of psychometrically sound assessment instruments. By the same token, I sincerely hope Paendrag would not look for a neurologist to help a family member manage his or her medication for schizophrenia. Psychiatrists are real doctors, and some of them are not only talented, but coordinate well with psychologists (not that you would suspect this from this board).

Psychiatrist, psychologists, and GPs all generally agree that managing depression though sporadic visits to a family doctor is bad medicine. Despite such agreement 19 of 20 prescriptions for SSRIs are written by a GP. Rx privileges for psychologists is one possible way to change this state of affairs. I don’t think anyone (including most practicing psychologists) think it is an ideal solution. Regardless, Rx privileges will not lead to psychologists prescribing to inpatients, there won’t be a rash of cases of misdiagnosed kidney failure, and psychologists will (if anything) be more likely to appropriately refer given their comprehensive understanding of mental health and circumscribed medical training.

Just for the record, I am ambivalent about Rx privileges for psychologists. Most people who suffer from mental illness are being done a great disservice by the mental health service system as it now exists. I like that Rx privileges could help to provide them with more appropriate treatment, but I am also concerned that the fundamental focus of psychology could shift as a result of emphasizing medication.

 

[50960]

Well said.

 

[Pterion]

Come on people. As usual, this forum had degenerated into ridiculous hyperbole. It is insane to suggest that psychologists will become equal to or better at prescribing psychotropic medication than psychiatrists after a two-year masters. However, it is equally asinine to suggest the research training afforded psychiatrists is anywhere near equivalent to that provided to Ph.D. psychologists.

So far, so good.

Psychiatrist, psychologists, and GPs all generally agree that managing depression though sporadic visits to a family doctor is bad medicine. Despite such agreement 19 of 20 prescriptions for SSRIs are written by a GP.

I agree that this is a state of affairs that needs to change. But that's a problem with primary care physicians (There are virtually no GP's anymore, they are either Family Practitioners or Internists now) and their lack of knowledge or willingness regarding referral to psychiatry.

Rx privileges for psychologists is one possible way to change this state of affairs.

True. In what direction remains to be seen.

I don’t think anyone (including most practicing psychologists) think it is an ideal solution.

Sometimes I wonder.

Regardless, Rx privileges will not lead to psychologists prescribing to inpatients, there won’t be a rash of cases of misdiagnosed kidney failure, and psychologists will (if anything) be more likely to appropriately refer given their comprehensive understanding of mental health and circumscribed medical training.

Gibberish. There is no way to predict the efficacy or competence of a professional population in a duty that is new. Earnest desire and good intentions do not imbue one with immunity from ignorance due to inadequate training. That is why, at the very least, the Louisiana and New Mexico experiences should be thoroughly evaluated both formatively and summative to answer all these questions instead of charging headlong into such a significant professional shift. They should NOT be evaluated by state psychology associations, the APA (or the APA), any pharmaceutical company or possibly even by psychologists at all.

...I am also concerned that the fundamental focus of psychology could shift as a result of emphasizing medication.

I could not agree more. What happened to professional pride? Since there are so many useful and important contributions psychologists can already make, why is there so much more focus on gaining new privileges rather than emphasizing what they can do now? As you implied, it seems like the ultimate in thorough mental health care is a collaboration between the biomedical, the biopsychological and the sociopsychological experts. Mental health is far too complex for anyone to cogently argue that a single profession can provide for all.

 

[50960]

What happened to professional pride? Nothing. I am quite proud of my ability to treat depression with CBT etc.. However, how proud would I be if I did so to the exclusion of a medication when called for? Psychopharmacology has changed MH Tx drastically, and that is the impetus behind all of these discussions regarding RxP...simple fact. Money is also part of it, but psychologists wouldn't be pushing so hard for this if all we had were mellaril, TCA's, and phenobarb; the world has changed.
The bigger issue here is not prescribing, but having some baseline of medical training for all psychologists; this is not happening. If I were a patient I would be much more worried about going to see joe-blo psychologist, who likely has no basic medical or science training, than seeing a psychologist (prescriber or not) who has 2.5+ years of postdoctoral education in science and clinical medicine. Many people visit psychologists as a primary mental health provider, and many psychologist don't even have a shot of recognizing when an acute migraine may be a stroke/CVA rather than somaticizing some repressed memory.
I would love to see medicine push for a minimum of 1 year science/c-med training for all licensed psychologists, and to support RxP in a way that would ensure all prescribers have the education and supervision needed.

 

[Allotheria]

The bigger issue here is not prescribing, but having some baseline of medical training for all psychologists; this is not happening. If I were a patient I would be much more worried about going to see joe-blo psychologist, who likely has no basic medical or science training, than seeing a psychologist (prescriber or not) who has 2.5+ years of postdoctoral education in science and clinical medicine. Many people visit psychologists as a primary mental health provider, and many psychologist don't even have a shot of recognizing when an acute migraine may be a stroke/CVA rather than somaticizing some repressed memory.
I would love to see medicine push for a minimum of 1 year science/c-med training for all licensed psychologists, and to support RxP in a way that would ensure all prescribers have the education and supervision needed.

Ok, now we're getting to what I actually wanted to discuss.

What will it take to make psychologists safe psychotropic providers?

I'm thinking maybe a post-doc (that has minimum requirements for acceptance such as epidemiology, fundamentals of the disease process, etc.) under supervision for 2 years at 40-60hrs a week plus the Pharm M.S. What do you think?

 

[Pterion]

Ok, now we're getting to what I actually wanted to discuss.

What will it take to make psychologists safe psychotropic providers?

I’m thinking maybe a post-doc (that has minimum requirements for acceptance such as epidemiology, fundamentals of the disease process, etc.) under supervision for 2 years at 40-60hrs a week plus the Pharm M.S. What do you think?

I don't know if we can create a good answer. Epidemiology is important, yes, but frankly not widely used in clinical medicine. It's not ignored-but it is about as prevalent a forethought in medicine as population distributions of DSM diagnoses are for psychologists. Sure, include it, but it should be part of clinical psychology training anyway.

The rest gets sticky. It could be argued that learning "fundamentals" of the disease process would require understanding the fundamentals of the "well state". In other words, a class in pathology wouldn't be very meaningful without the prereq's of anatomy, physiology and histology. Then the discussion quickly degenerates into "you have just described medical school, so there's your answer". So it should be interesting to hear ideas on the "minimum requirements" to be adequately educated regarding prescription. I think your 2yr idea is probably good, assuming the focus is pharmacotherapy and not interrupted with psychotherapy. Then you're in the ballpark of prescription supervision time for psychiatrists. (Puts on asbestos undies)

I am concerned by the Cartesian separation implied in many "RxP" supporters. Despite psychology's strong scientific support for the elimination of such a construct, the refusal to face concern for collateral/comorbid/iatrogenic medical issues is simply frightening. One cannot muck with one system (supratentorial chemistry) and not affect all other systems.

If a major criticism of psychiatry/boost to PP is that psychiatrists don't consistently address collateral medical issues, isn't the parsimonious solution to hold them to a higher standard rather than introduce a lower standard so that even more people can do it?

 

[Allotheria]

I don't know if we can create a good answer. Epidemiology is important, yes, but frankly not widely used in clinical medicine. It's not ignored-but it is about as prevalent a forethought in medicine as population distributions of DSM diagnoses are for psychologists. Sure, include it, but it should be part of clinical psychology training anyway.

The rest gets sticky. It could be argued that learning "fundamentals" of the disease process would require understanding the fundamentals of the "well state". In other words, a class in pathology wouldn't be very meaningful without the prereq's of anatomy, physiology and histology. Then the discussion quickly degenerates into "you have just described medical school, so there's your answer". So it should be interesting to hear ideas on the "minimum requirements" to be adequately educated regarding prescription. I think your 2yr idea is probably good, assuming the focus is pharmacotherapy and not interrupted with psychotherapy. Then you're in the ballpark of prescription supervision time for psychiatrists. (Puts on asbestos undies)

I am concerned by the Cartesian separation implied in many "RxP" supporters. Despite psychology's strong scientific support for the elimination of such a construct, the refusal to face concern for collateral/comorbid/iatrogenic medical issues is simply frightening. One cannot muck with one system (supratentorial chemistry) and not affect all other systems.

If a major criticism of psychiatry/boost to PP is that psychiatrists don't consistently address collateral medical issues, isn't the parsimonious solution to hold them to a higher standard rather than introduce a lower standard so that even more people can do it?

Ahh… this is more like it.

Ok, I was just using Epidemiology and Fundamentals as an example. They were just some of the classes I had to take at the Med. School and just popped into my head. Other classes that were more relevant are physiology, anatomy, neurophysiology etc. I apologize for any confusion.

I believe that most psychologists do not get this level of training that is why I'm concerned at us getting prescription privileges. I don't think the classes you mentioned describe med school but actually a clinical health psychology program, which apparently few outside of psychology know exist but that's a rant for another post.

I think you can have some psychotherapy components in the 2 year post doc, but the majority 80%+ needs to be pharmacotherapy under supervision. Overall, I believe that through grad school and pharm training/supervision psychologists can become comprehensive mental health providers.

I agree that the collateral/comorbid/iatrogenic medical issues are indeed frightening. Indeed when you "muck" with one system you are going to affect others. That's why I'm a little worried about just a M.S. in pharmacology.

Yes, every psychiatrist I know refers out and that's what the residents are trained to do. If its medical it's not you appears to be the motto. I agree with your comment on introducing higher standards, but we have to realistic. That's not going to happen. Status quo is for a reason…. Since psychologists have prescription privileges (and more on the way) we should focus on making them competent providers and then "muck" with the system.

How's this for a program:

*Basic understanding of physiology, anatomy, neurophysiology, pharmacology, etc. as prerequisites for the post-doc.
*Post-Doc 2 years of pharmacology training under the supervision of a psychiatrist in an inpatient or hospital setting.
*During the post-doc year psychologists also have to obtain the M.S. in psychopharmacology.

 

[50960]

I think we need to review what courses are involved in this so called MS in psychopharm. We have biochem, neurochem, neurophys, neuroanatomy, 8 mos clinical medicine/pathophys, 1 year pharmacology, special populations (kids, old folks, pharm-genetics), chemical dependence, physical assessment, applied pharmacotherapuetics. All this adds up to a 40 semester unit MS degree, and takes 2.5 years to complete.
I think the clinical med part could be expanded to 1 full year, and I also think there needs to be a more organized supervision/practical training requirement that is part of the degree itself.

 

[PublicHealth]

I think we need to review what courses are involved in this so called MS in psychopharm. We have biochem, neurochem, neurophys, neuroanatomy, 8 mos clinical medicine/pathophys, 1 year pharmacology, special populations (kids, old folks, pharm-genetics), chemical dependence, physical assessment, applied pharmacotherapuetics. All this adds up to a 40 semester unit MS degree, and takes 2.5 years to complete.
I think the clinical med part could be expanded to 1 full year, and I also think there needs to be a more organized supervision/practical training requirement that is part of the degree itself.

OK, let me get this straight: PhD/PsyD in clinical psychology takes 5-7 years, clinical psychology internship takes 1 year, and post-doctoral specialization fellowship (neuro, health) takes 1-2 years. Then you need 5-years of licensed practice as a psychologist, a 2-year MS in clinical psychopharmacology, and then a 2-year provisional/supervised RxP period, only to be able to prescribe in two states in the U.S.? That's 16-19 years of training to obtain woefully inadequate training in basic medicine and psychopharmacology and a conditional RxP certificate!

Compare this to 4 years of medical school, 4 years of psychiatry residency, and RxP in all 50 U.S. states, better money and career stability, and better overall care for your patients.

I understand that the above scenario does not apply to practicing psychologists.

 

[50960]

It needs some work... Also, I am a practicing psychologist.

 

[PublicHealth]

It needs some work... Also, I am a practicing psychologist.

What do you recommend?

Also, would you mind sharing your impressions of modern clinical psychology? What is your day-to-day life like? What kind of patients do you see? What kinds of interventions do you employ?

 

[50960]

I posted above what I recommend. I think all psychologist should have 1 solid year of medical and science training in their doctorate program. This could easily be done at most univ's who have med schools or advanced nursing programs if we cut all the PC coursework, and made it CME (via the board). Then any psychologist who wished to prescribe could pursue such a training, and it should include all the courses I mentioned before, as well as a clinical rotation component to get the degree/cert. After that 2 years of practice (prescribing) would be supervised by an MD/DO, before one could get a DEA. I also believe in a limited formulary.
Not all psychologists would do such a thing. I think the current Alliant MS is good, but needs an applied component. I am much more worried that noone is moving to catch psychology curriculum up with the times!
Do you want me to ramble on the board about me experience or privately? I have worked in a GP's medical office for 3 years and we collaboratively provide medication management to our patients. It is a great model, and even if I could prescribe tomorrow I probably wouldn't do it much as I have the MD there on site.

 

[Allotheria]

I think we need to review what courses are involved in this so called MS in psychopharm. We have biochem, neurochem, neurophys, neuroanatomy, 8 mos clinical medicine/pathophys, 1 year pharmacology, special populations (kids, old folks, pharm-genetics), chemical dependence, physical assessment, applied pharmacotherapuetics. All this adds up to a 40 semester unit MS degree, and takes 2.5 years to complete.
I think the clinical med part could be expanded to 1 full year, and I also think there needs to be a more organized supervision/practical training requirement that is part of the degree itself.

Good idea!

Health psychologists normally have neurochem, neurophys, nuroanatomy, pathophys, psychopharm, epidemiology, fundamentals of disease process, etc. Perhaps a health background should be a prerequisite, almost like premed to give them a solid foundation.

Ok, I looked up the psychopharm degree. Here are the classes:

Neuroanatomy/Neuropathology, Neurophysiology, Neurochemistry, Introduction to Organic Chemistry and Biochemistry, Pathophysiology, General Pharmacology, Clinical Psychopharmacology, Developmental Psychopharmacology, Chemical Dependency and Pain Management, Introduction to Physical Assessment and Laboratory Exams, Professional, Ethical, and Legal Issues, Psychotherapy/Pharmacotherapy Interactions, Computer-Based Practice Aids, Pharmacoepidemiology, Practicum I: Psychopharmacology, Practicum II: Psychopharmacology.

All of these sound pretty good except for, Practicum I, II and Introduction to Physical Assessment and Laboratory Exams. I would like to see more than just total 200hrs practicum and 50 patient practicum. I would like to see it as a more stringent post-doc. 1 full year (2 preferred of supervision 2000-4000 hrs.) I would also like to see more than an introduction into physical assessment with all the complexities I don't think an introductory class will cut it, maybe the intro with another advanced assessment class in addition to the supervision….

My recommendation…

*Health/Science background
*M.S. Psychopharm
*2 year supervised post-doc, can be completed after first year of psychopharm (during 2nd year). (Plan on no life)

 

[Allotheria]

I posted above what I recommend. I think all psychologist should have 1 solid year of medical and science training in their doctorate program. This could easily be done at most univ's who have med schools or advanced nursing programs if we cut all the PC coursework, and made it CME (via the board). Then any psychologist who wished to prescribe could pursue such a training, and it should include all the courses I mentioned before, as well as a clinical rotation component to get the degree/cert. After that 2 years of practice (prescribing) would be supervised by an MD/DO, before one could get a DEA.

Bingo!
That's one of the reasons why I attended the PhD program that I did. Solid training at the medical school in addition to training in psychology. I really think that psychopharm Privileges should move from clinical psychology to health psychology, or at least a specialization in health psychology.

 

[50960]

I agree!!

 

[Allotheria]

I agree!!

LOL, to which statement?

 

[PublicHealth]

I am much more worried that noone is moving to catch psychology curriculum up with the times!

So why isn't the APA working on restructuring existing curricula at clinical psychology programs? Are the dinosaurs resisting a more progressive, up-to-date curriculum that focuses on combined pharmacotherapeutic and psychotherapeutic interventions in order to remain true to their professional roots? What steps would you recommend at the PRE-doctoral level that would prepare psychologists to prescribe psychotropic medications and how would you go about implementing them?

Seems to me that a fundamental restructuring is in order -- even if "medical psychology" is a concentration track within existing clinical psychology programs. Many of my friends who attend such programs have no interest whatsoever in psychotropic meds. It's the neuro- and health psychology folks who typically have an interesting in psychopharmacology. Why not create a more rigorous, basic science-based curriculum for these folks?

PH

 

[Allotheria]

So why isn't the APA working on restructuring existing curricula at clinical psychology programs? Are the dinosaurs resisting a more progressive, up-to-date curriculum that focuses on combined pharmacotherapeutic and psychotherapeutic interventions in order to remain true to their professional roots? What steps would you recommend at the PRE-doctoral level that would prepare psychologists to prescribe psychotropic medications and how would you go about implementing them?

Seems to me that a fundamental restructuring is in order -- even if "medical psychology" is a concentration track within existing clinical psychology programs. Many of my friends who attend such programs have no interest whatsoever in psychotropic meds. It's the neuro- and health psychology folks who typically have an interesting in psychopharmacology. Why not create a more rigorous, basic science-based curriculum for these folks?

PH

I agree, while I'm not familiar with neuropsych programs some clinical health programs are already designed the way you mentioned. I just believe it depends on the school and if they're affiliated with a medical school or not. Overall, some schools are moving this way and that's why it's so important for incoming doctoral candidates to research the schools that they're applying to.

I think this or something close should be the pre-doctoral track for psychopharm.

 

[Anasazi23]

Many of my friends who attend such programs have no interest whatsoever in psychotropic meds. It's the neuro- and health psychology folks who typically have an interesting in psychopharmacology. Why not create a more rigorous, basic science-based curriculum for these folks?

PH

Public is exactly right. Many, perhaps most psychology graduate students are not in the market to become junior or mini-psychiatrists. They like psychological theory, and its implementation. If they were so interested in such, then they definately should just go to med school.

Health psychologists normally have neurochem, neurophys, nuroanatomy, pathophys, psychopharm, epidemiology, fundamentals of disease process, etc. Perhaps a health background should be a prerequisite, almost like premed to give them a solid foundation.

Ok, I looked up the psychopharm degree. Here are the classes:

Neuroanatomy/Neuropathology, Neurophysiology, Neurochemistry, Introduction to Organic Chemistry and Biochemistry, Pathophysiology, General Pharmacology, Clinical Psychopharmacology, Developmental Psychopharmacology, Chemical Dependency and Pain Management, Introduction to Physical Assessment and Laboratory Exams, Professional, Ethical, and Legal Issues, Psychotherapy/Pharmacotherapy Interactions, Computer-Based Practice Aids, Pharmacoepidemiology, Practicum I: Psychopharmacology, Practicum II: Psychopharmacology.

All of these sound pretty good except for, Practicum I, II and Introduction to Physical Assessment and Laboratory Exams. I would like to see more than just total 200hrs practicum and 50 patient practicum. I would like to see it as a more stringent post-doc. 1 full year (2 preferred of supervision 2000-4000 hrs.) I would also like to see more than an introduction into physical assessment with all the complexities I don’t think an introductory class will cut it, maybe the intro with another advanced assessment class in addition to the supervision….

I worry for the fact that the class, "fundamentals of disease process" will cover the entirety of nephrology, cardiology, gastroenterology, obstetrics, gynecology, pathology, infectious disease, molecular biology and genetics, immunology, anatomy, internal medicine, pediatrics, and surgery.

I would like to see more than just total 200hrs practicum and 50 patient practicum. I would like to see it as a more stringent post-doc. 1 full year (2 preferred of supervision 2000-4000 hrs.) I would also like to see more than an introduction into physical assessment with all the complexities I don’t think an introductory class will cut it, maybe the intro with another advanced assessment class in addition to the supervision….

Ever hear the phrase, "a little bit of knowledge is dangerous?" I fear for the psychologist that puts a stethescope up to someone's chest and makes the determination that they're hemodynamically stable.

 

[Anasazi23]

Anasazi, if you really are working with psychologists who are making comprehensive diagnoses on the basis of an automated PAI, then stop listening to them (they obviously suck). Since I have never seen any student or psychologist attempt to submit a PAI (or MMPI or RIAP) printout in place of an integrated report, I doubt that this is the case. I actually suspect that you have little idea what goes into writing an integrated report and a poor understanding of why 5 axes Dx are far less reliable than the results of psychometrically sound assessment instruments.

The psychologists I work with employ a Rorschach (non-exner scoring...just sort of fly by the seat of your freudian pants scoring system), a Draw-a-person, and Draw-a-tree-then-tree-in-a-storm-then-tree-after-the-storm tests............for every patient regardless of referral question.

I have seen many practicing psychologists and psychology graduate students employ PAI printouts as part or whole assesments. I saw it in California, New York, North Carolina and New Jersey. I watched and did the the "integrated report" process for 3 years...and determined I had to get out. It just wasn't for me. I don't at all mean this as a slight. Even the better, more comprehensive integrative report writing...it just wasn't for me. Other people are better suited to do it.

About the 5 axes being bad, etc. Again, we're not out to take 2 weeks of tests to determine exactly what mental schema the patient is employing and slaving over the validity scales to see how the patient manipulated the test (after all, they do answer the questions however they want). I understand the validity scales of most major psychiatric assessment tools. We look for symptom clusters, and do our best to reduce them. If our initial impressions change with additional information, like in all branches of medicine, we redraw our differential and alter our treatment. The same EXACT thing happens in psychology. That's why even short-term goal oriented therapy can go on for weeks and months. Information given to you changes, regardless of the form - and you must adapt accordingly.

 

[50960]

Ever hear the phrase, "knowing enough to know what you don't know"?

 

[Allotheria]

Ever hear the phrase, "a little bit of knowledge is dangerous?" I fear for the psychologist that puts a stethescope up to someone's chest and makes the determination that they're hemodynamically stable.

True, but no knowledge is even more dangerous... the day I see a psychologist with a sthethescope rather than referring out is the day... well the day something nasty happens.

 

[Anasazi23]

True, but no knowledge is even more dangerous... the day I see a psychologist with a sthethescope rather than referring out is the day... well the day something nasty happens.

Here's a game...can you find the MD or DO in this brochure? Look closely, there's only one!
http://www.alliant.edu/download/2004/pubs/CA_RxP_Brochure0704.pdf

They teach psychologists to use a stethoscope in the "Physical Assessment" class according to a link I don't have time to find.

I think the point of the above axiom is that if you know nothing, you theoretically are scared and refer out. If you know a little, you may have the idea that you can handle it because you read about it somewhere before. That's why it's MORE dangerous to have a little knowledge than none at all.

I'm glad that there's no way to fail the course. They allow you to remediate until you pass. *phew* wouldn't want to waste people's hard-earned money.

P.S.

The course are in-place are HMP (History and Medical Physical Examination). We learn how-to give physical examinations (using a stethoscope, et cetera). Pathophysiology, Neuorchemistry, and Clinical Pharmacology I and II are also in-place. The courses are to-be offered Fall 05 in a pre-doctoral sequence and are tuition free and optional (I guess the APA wants to train as many clinicans to prescribe as possible; offering free courses definitely works!)

 

[Allotheria]

Here's a game...can you find the MD or DO in this brochure? Look closely, there's only one!
http://www.alliant.edu/download/2004/pubs/CA_RxP_Brochure0704.pdf

They teach psychologists to use a stethoscope in the "Physical Assessment" class according to a link I don't have time to find.

I think the point of the above axiom is that if you know nothing, you theoretically are scared and refer out. If you know a little, you may have the idea that you can handle it because you read about it somewhere before. That's why it's MORE dangerous to have a little knowledge than none at all.

I'm glad that there's no way to fail the course. They allow you to remediate until you pass. *phew* wouldn't want to waste people's hard-earned money.

P.S.

Your axiom just highlights the need for the M.S. program to stress referring out. Psychologists should not be doing physical assessments, bottom line. What I meant by a little knowledge is better (I would normally agree with you by the way) is that they'll hopefully be able to recognize when they do need to refer vs. being oblivious to the situation.

Yep, it took awhile to find the M.D., although I was surprised to see two Pharm.D's. If you could find the link for the psychologists using a stethoscope post it or PM me. I would really like to read that, although it'll probably cause a blood vessel to burst in my forehead. I'm actually really worried about psychologists prescribing, and I don't want this to turn into another psychologists vs. psychiatrists post.

Psychologists are prescribing so what can we do to make them safe providers? Psychologists' attending med school apparently is not an option since they're stressing the M.S. How can the M.S. program be structured to make psychologists competent mid-level providers?