Name change of my state's psychiatric association and nurse practitioners

Doctor Bagel

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So my state psychiatry association is having a vote about whether we should change our name from the Oregon Psychiatric Association to the Oregon Psychiatric Physician Association basically as a way to differentiate from (and you know exclude) psychiatric nurse practitioners. Apparently based on a poll of members, 80% wanted this change, and they mentioned that other state psychiatric associations have made similar moves. What do you guys think?

I'm sitting out here voting no after reading a lot of articles in the mainstream media about the conflicts between nurse practitioners and physicians and realizing that we're really losing the public relations battle here (at least from looking at articles in mainstream media sources). We do have more training than nurse practitioners, and I definitely want to protect my income, but I'm thinking measures like these are only going to make us look worse, potentially isolate us and hurt us in the long run.

Do you work with nurse practitioners? Are you worried about facing a decreasing income because of them? What is and should their role be in your work? To complicate things for me, my sister is a psychiatric nurse practitioner, which could lead to some ugly holiday meals. :)
 

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A name change might help since physicians are still viewed as the gold standard. All I can say is use your training to its full extent and patients will know the difference when they walk out of your office. If you conform to substandard practice of seeing patients every 10 minutes it will be increasingly hard for anybody to tell the difference.
 
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MacDonaldTriad

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The APA seems to put 99% of its resources into this battle. I’m not so sure I agree. Are we really that diminished by supervising NPs? A good working relationship with a nurse can provide good care and raise productivity and billing. Similarly, a psychologist prescribing independently doesn’t bother me that much for very different reasons. The first bad outcome will give lawyers a field day and the malpractice coverage will jump to unsustainable levels. Some of us will even make some money testifying as to the inadequacy of their training as the cause of the bad outcome. If I’m wrong, maybe this job is easy and we should let non-MDs use psychotropics. It just seems like the psychiatrists that are taking the Chicken Little stance seem to lack a confidence in the value of our training.
 

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Off on a tangent, please tell your state APA to be a bit more vocal on the psychologist prescriber issue or any other issue for that matter. When this almost became law in Oregon a few years ago, there were several articles where some non-physicians in the mental health field that didn't know what they were talking about were interviewed and supported psychologist prescribing powers. I did not see anyone from the state APA contribute to a debate leading to a very one-sided article making it out as if the mental health field in general support psychologist prescribing.

I wrote letters to some local papers after this came to my knowledge and some even published my responses. I specifically mentioned that many psychologists did not back up prescribing powers, the data on it was from a military study that even recommended it was not valid if used in the community, and that even in the military study, psychologists were showed to be deficient in some areas. I was very much bugged when they told me no one from their state APA was contacting them. Each state branch APA should have a public relations person that should've given responses to these articles within just a few days, and they were telling me that I was one of the only people giving them a psychiatrist's opinion and I wasn't in the state.
 
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vistaril

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So my state psychiatry association is having a vote about whether we should change our name from the Oregon Psychiatric Association to the Oregon Psychiatric Physician Association basically as a way to differentiate from (and you know exclude) psychiatric nurse practitioners. Apparently based on a poll of members, 80% wanted this change, and they mentioned that other state psychiatric associations have made similar moves. What do you guys think?

I'm sitting out here voting no after reading a lot of articles in the mainstream media about the conflicts between nurse practitioners and physicians and realizing that we're really losing the public relations battle here (at least from looking at articles in mainstream media sources). We do have more training than nurse practitioners, and I definitely want to protect my income, but I'm thinking measures like these are only going to make us look worse, potentially isolate us and hurt us in the long run.

Do you work with nurse practitioners? Are you worried about facing a decreasing income because of them? What is and should their role be in your work? To complicate things for me, my sister is a psychiatric nurse practitioner, which could lead to some ugly holiday meals. :)
the problem for psychiatrists going forward is that the number of psych nps in the next 10 years is going to explode. Yes, psych nps don't make nearly as much as crnas, but then again psych nps also have a 10x easier route to becoming psych nps than crnas do. Right now psych nps aren't exerting all that much downward pressure on psych salaries because there just arent enough. But when their numbers explode, you're going to see it more......it's a big concern for psychs. I don't see myself working in mental health 10 years from now, but for people who do I think it's going to be a big issue in terms of salaries.
 
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Doctor Bagel

Doctor Bagel

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Off on a tangent, please tell your state APA to be a bit more vocal on the psychologist prescriber issue or any other issue for that matter. When this almost became law in Oregon a few years ago, there were several articles where some non-physicians in the mental health field that didn't know what they were talking about were interviewed and supported psychologist prescribing powers. I did not see anyone from the state APA contribute to a debate leading to a very one-sided article making it out as if the mental health field in general support psychologist prescribing.

I wrote letters to some local papers after this came to my knowledge and some even published my responses. I specifically mentioned that many psychologists did not back up prescribing powers, the data on it was from a military study that even recommended it was not valid if used in the community, and that even in the military study, psychologists were showed to be deficient in some areas. I was very much bugged when they told me no one from their state APA was contacting them. Each state branch APA should have a public relations person that should've given responses to these articles within just a few days, and they were telling me that I was one of the only people giving them a psychiatrist's opinion and I wasn't in the state.
I wasn't in Oregon when that whole thing went down, so I don't know how the discussion looked. I don't think it's the best organization at finding ways to reach and appeal to the public, and I'm not really seeing that changing in the near future. At least they've generally done a good job at alienating me, and I'm a psychiatrist and have directly benefitted from them (they pay my APA fees and pay for our resident retreat). We can't just sit back and assume that people are going to think we have more skills because we trained more -- that course has failed so far. We need people in our field who are articulate, personable and able to make a pitch about our importance that resonates with non-physicians.
 
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Whopper, the same thing happened in Illinois. The state medical society pounced as well as me (I do not belong to the state medical society) and many other physicians and psychologists against psychologists prescribing. The Tribune came out against it, and it didn't even get heard in the house. SDN and other sites like this really help coordinate the effort!
 

whopper

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While I was in the NJ-APA, if something like that happened, I would've recommended that the senior APA members make themselves available to every single news outlet to provide information for the public's digestion.

Whatever one's opinion on psychologist prescribing, the newspapers were giving a very one-sided and ill-informed message to the public, citing a military study justified psychologist prescribing in the community despite that specific freaking study citing it didn't apply to the community. None of those reporters even bothered to look up the original military study so when I contacted those papers, I gave them a link, and underlined where it specifically stated it was not applicable to the community, some of them even noted where it said in the article that it was not applicable to the community in a follow-up article.

Had I not done that I don't think those papers would've published that data. To hear that no one in that state's APA contacted those papers IMHO possibly suggests poor leadership in that area at the time.

While I'm on this soapbox, many of you should use your state APAs. They could be a very good resource and they may benefit from your activity with them.
 
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While I was in the NJ-APA, if something like that happened, I would've recommended that the senior APA members make themselves available to every single news outlet to provide information for the public's digestion.

Whatever one's opinion on psychologist prescribing, the newspapers were giving a very one-sided and ill-informed message to the public, citing a military study justified psychologist prescribing in the community despite that specific freaking study citing it didn't apply to the community. None of those reporters even bothered to look up the original military study so when I contacted those papers, I gave them a link, and underlined where it specifically stated it was not applicable to the community, some of them even noted where it said in the article that it was not applicable to the community in a follow-up article.

Had I not done that I don't think those papers would've published that data. To hear that no one in that state's APA contacted those papers IMHO possibly suggests poor leadership in that area at the time.

While I'm on this soapbox, many of you should use your state APAs. They could be a very good resource and they may benefit from your activity with them.
Can you post that article or link please?
 

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Why don't they change it to the Oregon Psychiatrists' Association or Oregon Association of Psychiatrists? It sounds less pretentious if you leave out the word "physician." And "Oregon Psychiatrists' Association" wouldn't even require a change in the abbreviation... it's only a difference of a couple of letters, so they might not even have to change the logo too much.
 
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heyjack70

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The APA seems to put 99% of its resources into this battle. I’m not so sure I agree. Are we really that diminished by supervising NPs? A good working relationship with a nurse can provide good care and raise productivity and billing. Similarly, a psychologist prescribing independently doesn’t bother me that much for very different reasons. The first bad outcome will give lawyers a field day and the malpractice coverage will jump to unsustainable levels. Some of us will even make some money testifying as to the inadequacy of their training as the cause of the bad outcome. If I’m wrong, maybe this job is easy and we should let non-MDs use psychotropics. It just seems like the psychiatrists that are taking the Chicken Little stance seem to lack a confidence in the value of our training.
The problem is that NPs in several states, especially out west (including Oregon), are allowed by law to practice without supervision. I think East Coasters forget this.
 

shan564

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The problem is that NPs in several states, especially out west (including Oregon), are allowed by law to practice without supervision. I think East Coasters forget this.
Yeah, I admitted a patient to medicine recently whose PCP was an NP. The patient had presented with painless jaundice, nausea/vomiting, bilirubinuria, and 20-30 lbs of unintentional weight loss, and the PCP started her on ciprofloxacin because of the dark urine, even though she had no other symptoms suggestive of a UTI. She didn't even do a UA. She sent her home and followed her up in 2 months. When she hadn't improved, she referred her to a hepatologist, who immediately called us and admitted her directly. The lady didn't end up having pancreatic cancer, but if she had (like everybody thought she did - including my attending and the hepatologist who admitted her), her prognosis would have been massively altered by the unnecessary delay in treatment.
 

whopper

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Can you post that article or link please?
This happened years ago so I couldn't find every single paper I saw back then but I did find one where they mentioned me. When this stuff was going on, I saw some articles where I felt the presentation was very one-sided. I wrote a letter to the editor for some of those publications.

http://www.thelundreport.org/resource/psychologists_win_prescribing_rights
Here's where they mentioned me..

Opponents contend they have no problem giving prescribing authority as long as psychologists receive proper training. It’s not about turf, but patient safety, according to Dr. James Cho.
“Several of the antidepressants such as the monoamine oxidase-inhibitors could be easily fatal if taken with the wrong foods,” according to Cho. “Lithium is known to be very toxic and can exacerbate several medical conditions, and several of the antipsychotics such as Clozapine require frequent blood test monitoring. All the antipsychotics by the standard of care require that lab tests be done to monitor possible metabolic side effects that could lead to metabolic syndrome, and worse, possibly diabetes, a heart attack, or stroke.”
Editor’s Note
In our previous article on this topic, we referenced a 15-year precedent with the Department of Defense in training psychologists to safely prescribe medications. Several astute readers took issue with this comparison.
Dr. James Cho provided a link to a study about the DOD program and an independent review of the study by the National Association of Mental Illness. He said military psychologists had more limited prescribing authority compared to what the Oregon bill grants.
“The psychologists in the military study had more limitations in their ability to prescribe, and the study, while not even applicable to the public by the military's admission was considered cost-ineffective,” Cho wrote.
“The citizens of Oregon deserve that an actual study be done that emulates the parameters of the proposed bill before they allow it to become a reality,” Cho continued. “To do otherwise would be to put patients through an untested medical process that could yield negative outcomes including death.”
I have given my identify on the forum before, but I choose to be low-profile for the most part. Here's my name again. Hey, by the way, I got another publication coming out but I don't remember when....

The original article, that I read years ago from this publication only presented pro-psychologist prescribing data, so I wrote the editor a letter. By the time the above article came about, at least in this publication, they did utilize some opinions from the Oregon Psychiatric Association, but I will add one from a lobbyist that didn't get to the heart of the matter. That the so of-often cited military study, hailed as if it's "proof" that psychologist prescribing can work doesn't even apply to the community by the military's own admission. If any shmuck actually took the time to read it, you'd see it in black and white. So often the psychologist prescribing crowd cites it, obviously not having even read the report (or ignoring the lack of applicability to the community) and so often do psychiatrists fight back not having read it either.

When I sent my response to the editor, I pointed exactly where in the military study it mentioned this.
 
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Thanks. One of the things I mentioned was the stimulant medications as psychologists I have met think patients need to be on them. I wrote about the risk of sudden death and the fact it is category 2. Vital signs and labs an EKG's are not monitored by people not trained in the medical model either. I have a patient who was started on stimulants by a PCP, and an EKG had been done by him. I ordered a more recent EKG and made sure the patient followed up with an Echo and stress test due to abnormalities.
 
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Yeah, I admitted a patient to medicine recently whose PCP was an NP. The patient had presented with painless jaundice, nausea/vomiting, bilirubinuria, and 20-30 lbs of unintentional weight loss, and the PCP started her on ciprofloxacin because of the dark urine, even though she had no other symptoms suggestive of a UTI. She didn't even do a UA. She sent her home and followed her up in 2 months. When she hadn't improved, she referred her to a hepatologist, who immediately called us and admitted her directly. The lady didn't end up having pancreatic cancer, but if she had (like everybody thought she did - including my attending and the hepatologist who admitted her), her prognosis would have been massively altered by the unnecessary delay in treatment.
We will always be there to save them. That is what the system is based on.
 
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Whopper, in Illinois the psychologists were trying to shift all medical management to the IM and FP physicians who would be "supervising" them, aka taking the hit if anything went wrong. The psychologists I know just wanted to give out stims and benzos to everyone anyway. They are not familiar with the complications from those medications but it wouldn't be on them anyway if something happened...
 

whopper

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When these psychologist-prescribing things happen, I've noticed a little turf war brews between our professions. Most psychologists I know don't want to prescribe. In fact I don't know one psychologist that wants this power and I know several.

I don't have much problem with a psychologist working with a patient, and them calling an M.D. or D.O., telling them their opinions and then kicking the tires so to speak on what meds to try given they do have insight on psychopharmacology, just as much as I occasionally ask one of my psychologist mentors if he should do an MMPI after I've presented a very odd case to him where I believe the test may give me the missing data I need. As we all know, however, psychopharmacology is only that. It doesn't take into account the entire medical picture of the patient.