NM or LA psychologist

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Anyone know a psychologist from LA or NM who would be willing to join in discussions on this forum? :) :confused:
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It would be fascinating to have a psychologist from one of these two states engage in our discussions. Unfortunately, there seems to be little interest in adding prescription privileges to our existing skills by many on this forum. It is understandable considering most busy student doctors in psychology are thinking about their next statistics class, dissertation proposal, qualifying exams, orals, interviews, internship, defense, post doc, and God Forbid the EPPP. Then someone asks if you want to do more training in psychopharmacology? I can see why some are put off and feel exhausted. However, many clinicians both pre and post doc soon discover the importance of being familiar with psychopharmacology whether or not they end up prescribing. I have attached a fascinating write up (division 55 web site) by a psychologist who was strongly against RxP for psychologists and then later changed his mind and why.


http://www.division55.org/Readers/Vol3/Vol3No11.htm
 
I am in graduate school in LA and a few of the prescribing psychologists are at my school. Would you like me to ask them to post about their experiences?
 
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edieb said:
I am in graduate school in LA and a few of the prescribing psychologists are at my school. Would you like me to ask them to post about their experiences?
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edie,

How (if at all), has your graduate training in clinical psychology changed as a result of LA psychologists obtaining RxP?
 
Passage of RxP has changed the entire program in innumerable ways, all for the better. Instead of talking at-length about all the differences RxP's passage and implementation has made in my program (Clinical Ph.D.), I will tell you about the 2 main repercussions:

1. Before the program virtually ignored psychopharmacology and neuroanatomy. Post-RxP we are actually taking courses from the APA approved RxP training program. This summer we took neuroanantomy (directly from the Farleigh Dickson APA RxP training module) while last semester we took neuropharmacology and how to take/give a history and physical.

2. Before RxP passed, the majority of the students were apathetic about clinical psych. Now, there is a sense of excitement because of the expanded scope of practice we can provide. Of course, some of this excitement originates in avarice but much of it also originates in benevolence and the desire to help those burned by medicine.

As an aside, many of the patients seeing medical psychologists are those who have been burned (i.e., saw no results or felt uncared for) by social workers (who have inferior training in treatment and assessment), general medicine and psychiatrists (being left on meds forever and told there was no hope except to stay on the meds and tolerate the side effects)

I emailed some of the RxP psychologists who are affiliated with LSU; I should hear from them shortly.
 
Thank you for your post.

You mentioned that you're taking courses from the Farleigh Dickinson psychopharmacology program. Do these credits count toward an MS in Clinical Psychopharmacology or will having a PhD in clinical psychology with these courses completed be sufficient for you to sit for the PEP exam and become a medical psychologist in LA?

You mentioned that many patients seeing medical psychologists have been "burned" by social workers and psychiatrists. How does the clinical approach of medical psychologists differ from that of social workers and psychiatrists? Is it the rigorous training in assessment and psychotherapy, and a more balanced "psychotherapy + psychopharmacotherapy" approach to treatment? Are you aware of any studies that are being done to compare patient satisfaction and outcomes as a function of type of clinician (social worker, psychologist, psychiatrist)? If data from this type of study is favorable for psychologists, it may influence RxP legislation in other States.

Keep this thread going...this is the type of objective information that we need around here.
 
edieb,

Any word from the medical psychologists that you contacted?

Psisci and I would like to keep this thread going!

PH
 
I would also like to keep this thread going. Hopefully we can hear from a prescribing psychologist. While we are waiting, did anyone get a chance to read the article that I attached earlier in the thread? Comments?
 
I e-mailed one of them, and he said he would post. However, when he came on the boards he did not see the Clinical Psychology boards and e-mailed me back about where to post, adding he was uncomfortable posting on a medical board. So where we are now is that I just emailed him again with the direct link to the clinical psych board....
 
edieb said:
I e-mailed one of them, and he said he would post. However, when he came on the boards he did not see the Clinical Psychology boards and e-mailed me back about where to post, adding he was uncomfortable posting on a medical board. So where we are now is that I just emailed him again with the direct link to the clinical psych board....
Click to expand...

:thumbup: :thumbup: :thumbup:
 
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psisci said:
Anyone know a psychologist from LA or NM who would be willing to join in discussions on this forum? :) :confused:
Click to expand...

My roommate in undergrad finished her PhD at UCLA and did an internship in NM. She did her post-doctoral master's in psychopharm and now has full RxPs in NM. I have to tell you, Kristen knows more about psychopharm than many of the psychiatrists I know! I really support psychologists getting full RxPs in all states, providing they complete an appropriate training program.

It just seems that it's a major inconvenience to spend another 2 years after a PhD for an MS in psychopharm. Do you think it would be easier, or more logical, to intergrate pharmacology into the PhD degree itself? In other words, maybe PhD programs should restructure and go to PsyD programs at all schools, making the PsyD the entry-level professional degree. I'm only an MD, so I don't know much about graduate education (MD = professional degree), but it seems to me that clinical psychologists would be better served by receiving professional training in their education program, including biopsych, neuroanatomy, pharmacology, etc.) and less academic training (e.g., less stats, less research, etc.). If you want to be a research psych, then get a PhD; however, if you want to be a practicing psych., get a PsyD. Both would be from the same dept. and same university (preferable to a professional school), but one degree would be for the professional practitioner and the other for the academic researcher.

Am I being too naive? Just my thoughts. Forgive my ignorance if I've made any inaccurate statements.
 
ProZackMI said:
My roommate in undergrad finished her PhD at UCLA and did an internship in NM. She did her post-doctoral master's in psychopharm and now has full RxPs in NM. I have to tell you, Kristen knows more about psychopharm than many of the psychiatrists I know! I really support psychologists getting full RxPs in all states, providing they complete an appropriate training program.

It just seems that it's a major inconvenience to spend another 2 years after a PhD for an MS in psychopharm. Do you think it would be easier, or more logical, to intergrate pharmacology into the PhD degree itself? In other words, maybe PhD programs should restructure and go to PsyD programs at all schools, making the PsyD the entry-level professional degree. I'm only an MD, so I don't know much about graduate education (MD = professional degree), but it seems to me that clinical psychologists would be better served by receiving professional training in their education program, including biopsych, neuroanatomy, pharmacology, etc.) and less academic training (e.g., less stats, less research, etc.). If you want to be a research psych, then get a PhD; however, if you want to be a practicing psych., get a PsyD. Both would be from the same dept. and same university (preferable to a professional school), but one degree would be for the professional practitioner and the other for the academic researcher.

Am I being too naive? Just my thoughts. Forgive my ignorance if I've made any inaccurate statements.
Click to expand...


Another comment...there is no reason why properly trained PhD/PsyD clinical psychologists shouldn't be able to Rx. If dentists, optometrists, and...cringe...Nurse Practitioners can, so should properly trained psychologists. I'm not the only psychiatrist who feels this way. I know many psychologists who don't think it's right, but I think it would enhance the profession and open many doors for you guys. I think it's a good thing. I just hope those of you who do have RxPs don't become like most psychiatrists, many of whom become...useless.
 
Paendrag said:
Your perspective on psychologists is likely skewed. The average GRE score of UCLA clinical psychology students is about 1400. UCLA is a highly competitive program. Contrast psychologists from that program, and other competitive programs, to schools like:

Long List of schools
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No offense, but your GRE, MCAT, LSAT, or GMAT score is just a number. It might be helpful in the competitive process of admissions, but in reality, it's a meaningless number that does not predict whether one has the ability to be a skilled practitioner. I've known exceptional physicians, both psychiatrists and non-psychiatrists, who got their medical degrees from the Medical College of Ohio, Medical College of Wisconsin, Meharry Medical School, and New England College of Osteopathic Medicine. One of the best psychiatrists I know got his MD from Thomas Jefferson Medical School in Penn.

Likewise, some of the biggest *****s I've encountered had MDs or PhDs from Harvard, Yale, Dartmouth, and Princeton. Many of these people were complete wastes of space. I've seen smeared feces with more intelligence than some Harvard or Yale grads.

Where you went to school only impresses some. In the real world, where you went to school shouldn't matter much, assuming, of course, you went to a recognized and accredited school. I have no idea what the psych professional schools are like, but I have worked with some very sharp and skilled PsyDs from lesser known schools and some complete duds who had their PhDs or MDs from top notch Ivy League institutions.

It's not the degree or the school attended that makes one a good psychiatrist/psychologist, but rather, the person who holds the degree. An dingus is still an dingus despite holding a Harvard degree. UCLA might be good, but that was not my point. My friend is a PhD and does a more effective job managing her patients pharmacologically than many psychiatrists. I find that to be impressive. I believe that she is not unique among psychologists, and for that reason, I support RxPs for properly qualified psychologists.
 
ProZackMI said:
No offense, but your GRE, MCAT, LSAT, or GMAT score is just a number. It might be helpful in the competitive process of admissions, but in reality, it's a meaningless number that does not predict whether one has the ability to be a skilled practitioner. I've known exceptional physicians, both psychiatrists and non-psychiatrists, who got their medical degrees from the Medical College of Ohio, Medical College of Wisconsin, Meharry Medical School, and New England College of Osteopathic Medicine. One of the best psychiatrists I know got his MD from Thomas Jefferson Medical School in Penn.

Likewise, some of the biggest *****s I've encountered had MDs or PhDs from Harvard, Yale, Dartmouth, and Princeton. Many of these people were complete wastes of space. I've seen smeared feces with more intelligence than some Harvard or Yale grads.

Where you went to school only impresses some. In the real world, where you went to school shouldn't matter much, assuming, of course, you went to a recognized and accredited school. I have no idea what the psych professional schools are like, but I have worked with some very sharp and skilled PsyDs from lesser known schools and some complete duds who had their PhDs or MDs from top notch Ivy League institutions.

It's not the degree or the school attended that makes one a good psychiatrist/psychologist, but rather, the person who holds the degree. An dingus is still an dingus despite holding a Harvard degree. UCLA might be good, but that was not my point. My friend is a PhD and does a more effective job managing her patients pharmacologically than many psychiatrists. I find that to be impressive. I believe that she is not unique among psychologists, and for that reason, I support RxPs for properly qualified psychologists.
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*applause*

GREAT POINT!! Nice to hear that as a psychiatrist you support the efforts of psychologists to gain Rx rights. You my friend are a great addition to this board!
 
ProZackMI said:
It just seems that it's a major inconvenience to spend another 2 years after a PhD for an MS in psychopharm. Do you think it would be easier, or more logical, to intergrate pharmacology into the PhD degree itself? In other words, maybe PhD programs should restructure and go to PsyD programs at all schools, making the PsyD the entry-level professional degree. I'm only an MD, so I don't know much about graduate education (MD = professional degree), but it seems to me that clinical psychologists would be better served by receiving professional training in their education program, including biopsych, neuroanatomy, pharmacology, etc.) and less academic training (e.g., less stats, less research, etc.). If you want to be a research psych, then get a PhD; however, if you want to be a practicing psych., get a PsyD. Both would be from the same dept. and same university (preferable to a professional school), but one degree would be for the professional practitioner and the other for the academic researcher.

Am I being too naive? Just my thoughts. Forgive my ignorance if I've made any inaccurate statements.
Click to expand...

Hi ProZackMI,

WOW!!!
I really enjoyed your post's balanced view on RxP, i.e., psychologists who are properly trained can be ethical and effective psychopharmacotherapist.
BTW, I'm a psychologist (completing my pre-med reqs) and intending to be a psychiatrist but very much in favor of psychology's embrace of somatic therapies to compliment psychosocial ones.

I also agree with your analysis of how psychology needs to evolve in order to fully become a significant participant in healthcare, i.e., PsyD for practitioners and PhD (or PsyD, PhD akin to the MD, PhD) for academicians as well as the restructuring of the pre-doc training so that biomedical sciences become much more prevalent and there is no need for a post-doc MS in psychopharm.

Below I have included a previous post of mine with some added ideas. I'm interested in your feedback.

I agree with both points wholeheartedly and it is my hope that as medicine (and psychiatry) continue to advance scientifically that psychology is able to keep apace. In this regard I have a question: Should psychology follow in the podiatry model, i.e., a graduate education analogous to medical school with a basic science curriculum and clinical clerkships, the awarding of the PhD/PsyD prior to residency, and specialized residencies in mental health, health, neuro, forensic, and medical (RxP) psych?
I know that this is may appear as an exercise in futile fantasizing but psychology has shown a capacity to adapt through the past 50 years and I'm just wondering if anyone else in this forum has considered the possibility of such an evolution.
Despite my decision to pursue med school I still very much appreciate the humanistic values present in psychology and hope that psychology as such increasingly informs healthcare.
Peace. :)

P.S. I also enjoyed your lack of prejudice regarding both the PsyD degree and educational/training program. :cool:
 
ProZackMI said:
My roommate in undergrad finished her PhD at UCLA and did an internship in NM. She did her post-doctoral master's in psychopharm and now has full RxPs in NM. I have to tell you, Kristen knows more about psychopharm than many of the psychiatrists I know! I really support psychologists getting full RxPs in all states, providing they complete an appropriate training program.

It just seems that it's a major inconvenience to spend another 2 years after a PhD for an MS in psychopharm. Do you think it would be easier, or more logical, to intergrate pharmacology into the PhD degree itself? In other words, maybe PhD programs should restructure and go to PsyD programs at all schools, making the PsyD the entry-level professional degree. I'm only an MD, so I don't know much about graduate education (MD = professional degree), but it seems to me that clinical psychologists would be better served by receiving professional training in their education program, including biopsych, neuroanatomy, pharmacology, etc.) and less academic training (e.g., less stats, less research, etc.). If you want to be a research psych, then get a PhD; however, if you want to be a practicing psych., get a PsyD. Both would be from the same dept. and same university (preferable to a professional school), but one degree would be for the professional practitioner and the other for the academic researcher.

Am I being too naive? Just my thoughts. Forgive my ignorance if I've made any inaccurate statements.
Click to expand...

This is one of the best posts I've read in a while. Thank you.
 
Paendrag said:
Training wise, I think UCLA is more likely to provide depth of knowledge in pharmacologically related areas because of the nature of the faculty and the presence of the neuropsychiatric institute.
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Wrong. Scroll down to course listing for clinical psychology: http://www.psych.ucla.edu/Grads/handbook2004/MajorAreaCourseRequirements.pdf You must be in a PsyD program, otherwise you would have done the research to find this out on your own (sorry, couldn't resist! :p)
 
sasevan said:
Hi ProZackMI,

WOW!!!
I really enjoyed your post's balanced view on RxP, i.e., psychologists who are properly trained can be ethical and effective psychopharmacotherapist.
BTW, I'm a psychologist (completing my pre-med reqs) and intending to be a psychiatrist but very much in favor of psychology's embrace of somatic therapies to compliment psychosocial ones.

I also agree with your analysis of how psychology needs to evolve in order to fully become a significant participant in healthcare, i.e., PsyD for practitioners and PhD (or PsyD, PhD akin to the MD, PhD) for academicians as well as the restructuring of the pre-doc training so that biomedical sciences become much more prevalent and there is no need for a post-doc MS in psychopharm.

Below I have included a previous post of mine with some added ideas. I'm interested in your feedback.

I agree with both points wholeheartedly and it is my hope that as medicine (and psychiatry) continue to advance scientifically that psychology is able to keep apace. In this regard I have a question: Should psychology follow in the podiatry model, i.e., a graduate education analogous to medical school with a basic science curriculum and clinical clerkships, the awarding of the PhD/PsyD prior to residency, and specialized residencies in mental health, health, neuro, forensic, and medical (RxP) psych?
I know that this is may appear as an exercise in futile fantasizing but psychology has shown a capacity to adapt through the past 50 years and I'm just wondering if anyone else in this forum has considered the possibility of such an evolution.
Despite my decision to pursue med school I still very much appreciate the humanistic values present in psychology and hope that psychology as such increasingly informs healthcare.
Peace. :)

P.S. I also enjoyed your lack of prejudice regarding both the PsyD degree and educational/training program. :cool:
Click to expand...


Hey, thanks for the positive comments. I think your previous post is par with my earlier post. Among the clinical health professions, clinical psychology is the odd man out. Historically, all professions, but primarily the health professions, were undergraduate programs. In the UK and countries subscribing to the British educational model, medicine, law, dentistry, pharmacy, etc., are all undergraduate professional programs (e.g., MBBS, LLB, BDS, etc.). In the US, professional programs moved up to the professional doctorate degree (MD, JD, DDS, DPM, DVM) because of the scope and breadth of the subject matter, the need for an undergraduate degree before professional studies, and the complexities of obtaining licensure.

What you see now is an educational change in many professions. Today, even physical therapists and audiologists are upgrading their professional degrees from master's degrees to professional doctorates (DPT and AuD). Pharmacy did this a while back (e.g., 5-year BS to a Doctor of Pharmacy or PharmD that is earned post BS). The professions that are transitioning into professional doctorate programs, and even many of the more established professional programs, are seeking to enhance their scope of practice powers in most states.

Optometrists an Rx diagnositic and therapeutic ocular medications in all states. They are seeking surgical training program in Oklahoma.

Podiatrists are seeking full physician status in most states and seek expansion of their scope of practice to include the entire lower extremity rather than just below the ankle.

Pharmacists with clinical doctorates and 1-3 year residencies are seeking RxPs in some states and, in fact, in many states have clinical assessment (physical exam) training and can even perform medical testing.

Audiologists want a clinical doctorate (AuD) and want to be considered equal to optometrists; they will seek RxPs for otological treatment.

PTs are moving toward the DPT degree and want to become primary care providers.

Many of these professions are changing their curricula to include more pharmacology, medical assessment, medical history taking, clinical lab interpretations, etc.

Due to managed health care, these changes very well may occur and those professions may change how we look at and practice medicine.

In contrast, however, clinical psych started off as a purely academic field of study based on biological and social science theories. It morphed into a "profession" after WWII. Clinical psych has always been a graduate level field of study (either MA or PhD). If clinical psych wants to compete with other the other professions, and wants to expand its scope of practice, it will have to change from an academic-research PhD model (Boulder?) to the PsyD (Vale?) model. However, the PsyD is still an academic doctorate based on what I've seen (i.e., large research component, stats, dissertation, defense). A clinical psychologist, IMO, does not need stats, research classes, or to create a dissertation. If you're going to practice, then you need the basic skills to be an effective practitioner. If you're going to work beyond traditional psychotherapy, you need training in pharmacology, neuroanatomy, clinical lab interpretation, physical assessment, etc.

Part 2 is coming:
 
My suggestion:

1. Create dual doctoral programs within clinical psychology departments at universities: one track is for practitioners (PsyD) and one for researchers (PhD).

2. To get into the PsyD, you need the Clinical Psychology Admission Test (CPAT). A BA/BS in any discipline with appropriate pre-reqs (some bio, some chem, many psych and soc classes, etc.). You need a high GPA: 3.0+.

3. The PsyD track is a 4 year post bachelor's program. The first two years include training in the biomedical sciences just medical, dental, pharmacy, vet, podiatry, and other professional programs. The PsyD students learn anatomy and physiology, neuroanatomy, pharmacology, physical assessments, clincial lab interpretation, medical history taking, and other basic medical sciences. The last two years focus on psychometric assessments, counseling and interviewing techniques, theory, and the other classes you guys take in grad school. Maybe one or two research classes. No thesis. No dissertation. No committees. No oral defense.

4. You complete the PsyD degree in four years. You graduate. You then do a 1-4 year residency, depending on your area of interest.

General Practice: 2 years
Community Counseling: 1 year?
Neuropsych: 4 years
Pediatric/Adoloscent: 3-4?
Forensic/Criminal: 3?

5. The PsyD will have then complete a comprehensive licensing exam, like the USLME or Bar Exam. If the PsyD passes, he/she can practice. He/she will have full RxPs and full hospital admitting privileges. In fact, they will have "physician" status like many dentists (oral-maxofacial surgeons), podiatrists, and even optometrists have.

The new PsyD will provide comprehensive mental health treatment to everyone. No need for therapist and psychiatrist teams. No need for subservience under foreign and domestic psychiatrists who are often ignorant pill pushers (and I'm guilty of this!).

Of course, this new PsyD program would attract different types of students. Psychology will move from an academic profession to a clinical profession. It will change, but I believe the change is necessary.

If you guys don't do this, then I fear the MSWs will. I have read a few articles discussing proposals to change the MSW training to a four year doctoral program (DSW) that includes pharmacology and medical assessment. If clincial psychology doesn't evolve, others like counseling and social work might seek to displace or replace you. I doubt this will happen, but look at what's going on in physical therapy and audiology. It could happen.
 
:D
sasevan said:
Hi ProZackMI,

WOW!!!
I really enjoyed your post's balanced view on RxP, i.e., psychologists who are properly trained can be ethical and effective psychopharmacotherapist.
BTW, I'm a psychologist (completing my pre-med reqs) and intending to be a psychiatrist but very much in favor of psychology's embrace of somatic therapies to compliment psychosocial ones.

I also agree with your analysis of how psychology needs to evolve in order to fully become a significant participant in healthcare, i.e., PsyD for practitioners and PhD (or PsyD, PhD akin to the MD, PhD) for academicians as well as the restructuring of the pre-doc training so that biomedical sciences become much more prevalent and there is no need for a post-doc MS in psychopharm.

Below I have included a previous post of mine with some added ideas. I'm interested in your feedback.

I agree with both points wholeheartedly and it is my hope that as medicine (and psychiatry) continue to advance scientifically that psychology is able to keep apace. In this regard I have a question: Should psychology follow in the podiatry model, i.e., a graduate education analogous to medical school with a basic science curriculum and clinical clerkships, the awarding of the PhD/PsyD prior to residency, and specialized residencies in mental health, health, neuro, forensic, and medical (RxP) psych?
I know that this is may appear as an exercise in futile fantasizing but psychology has shown a capacity to adapt through the past 50 years and I'm just wondering if anyone else in this forum has considered the possibility of such an evolution.
Despite my decision to pursue med school I still very much appreciate the humanistic values present in psychology and hope that psychology as such increasingly informs healthcare.
Peace. :)

P.S. I also enjoyed your lack of prejudice regarding both the PsyD degree and educational/training program. :cool:
Click to expand...

Saseven,

Since you're a psychologist, you know it's hard to resist dispensing advice. Psychiatrists are no different. So, please forgive me for getting all preachy, but I feel the need to give some advice to you. Sorry to shout, but: DON'T GO TO MEDICAL SCHOOL!!!!!!!!!!!!!!! :D

If you have your PhD and are licensed, then stay where you are. If you want to enhance your knowledge of the medical sciences, you might want to consider getting a post-doc master's in pharmacology or a degree as a physician assistant. If you have a master's degree in psychology, then I suggest you consider the myriad of other health care professions out there and give them all some thought. If you want to provide mental health services to patients, then go into a PsyD or PhD program and get fully licensed.

Medical school is four long years of pure hell. A psychiatric residency that follows is another 4-5 years of hell. I don't know how old you are, but do you really want to do that? And, if yes, to what end? Do you know what my job consists of on a day-to-day basis? I spend about 10-15 minutes per patient. I sometimes do a cursorary physical exam. I ask some questions about their health status, compliance with medication, and improvement/worsening of sx's. I then write some Rx's and send them on their way to the MSW or MA psychologists. Once in a while, I do rounds at a local hospital. The patients there are often court-mandated involuntaries or often DA and A or other polysub abusers mixed in with a few suicidal MDDs or BADs.

I don't do therapy. I find that my work rarely helps anyone get better. True, many cases of depression are endogenous and can be treated with SSRIs or TCAs, but even with those folks, how many get "better"? I've seen more progress with good psychotherapy (and sorry, but you won't get good psychotherapy from most MSWs or MA-level psychologists) combined with medication.

So, what I'm saying is, psychiatry is a dying profession. Most medical students look down on psychiatry and very few enter it as a speciality. Why do you think there are so many foreign medical grads going into psychiatry? It's a well-paying job, but it's unlike other medical specialties.

While I was still a resident, I started going to law school. I finished my JD in May and will be sitting for the February bar exam. My plan is to leave medicine and go into law full-time. If that doesn't work out, I will go back to internal medicine and abandon psychiatry. I would never encourage anyone to pursue psychiatry. Please think about your decision and give some consideration to staying where you are or enhancing your skills by becoming a PA and psychologist or something like that.

Sorry to preach. Best of luck!
Zack
 
ProZackMI said:
:D

Saseven,

Since you're a psychologist, you know it's hard to resist dispensing advice. Psychiatrists are no different. So, please forgive me for getting all preachy, but I feel the need to give some advice to you. Sorry to shout, but: DON'T GO TO MEDICAL SCHOOL!!!!!!!!!!!!!!! :D

Sorry to preach. Best of luck!
Zack
Click to expand...

LOL :D
I appreciate your advise; I believe we're both ultimately coming from the same direction, i.e., how can mental health patients be better served.

For me, after a year of reflection and research, the answer was to pursue psychiatry. I definitely considered the time, energy, and expense that this pursuit would entail but where I completed my psychology internship I had the opportunity to meet 3 psychologists-psychiatrists (including the Chair of the Dept of Psychiatry and Beh Sciences) and was convinced that the process, though very arduous, is manageable. As a result, I began my pre-med reqs during my psychology fellowship and am now completing them with an April MCAT still awaiting me. BTW, I'm a PsyD and I'm licensed.

Though I disagree that psychiatry is a dying specialization, I do agree that often times it is practiced in a less than life enriching way, either for the patient or the provider, e.g., 10 minute med checks. However, I believe that while neither the current practice models of psychology (rarely meds) or psychiatry (regularly meds) is fully functional, that psychiatry offers a greater potential for flexibility in assessment and treatment, i.e., a psychologist cannot in most States choose to compliment psychotherapy with psychopharmacotherapy but a psychiatrist can certainly do the inverse. I'm aware that many psych MD/DO may be hampered from doing this for economic reasons but psych PhD/PsyD are hampered by legal reasons, which I consider more difficult to surmount.

Additionally, I want to be able to provide psychopharmacotherapy to the gamut of psych patients and I don't believe that med psychologists in the future will ultimately function as pharmacotherapists beyond outpatient services. And psych NP and PA while having RxP don't have independent and full formulary practices.

Actually, I believe that psychologists getting RxP will not only revitalize psychology by making it a full participating member in the biopsychosocial model but that it will do the same for psychiatry. If medical psychologists insist on exercising RxP as envisioned, i.e., no 10 min med check but med mgm in the midst of the 50 min therapy session then psychiatrist will perhaps be able to insist on doing the same and managed healthcare will not be able to continue to coerce psychiatrists into only doing pharmacotherapy and referring out for psychotherapy. I mean, if the two doctoral level mental health professions insist on this model where else can an HMO send patients for psych assessment and treatment?

So, I am going to be a psychologist-psychiatrist. And I like for you to do the same. An MD, JD, PsyD may just be what the APA needs to implement the type of program you presented. :D

Peace.

P.S. This program is AWESOME!!! :thumbup:

1. Create dual doctoral programs within clinical psychology departments at universities: one track is for practitioners (PsyD) and one for researchers (PhD).

2. To get into the PsyD, you need the Clinical Psychology Admission Test (CPAT). A BA/BS in any discipline with appropriate pre-reqs (some bio, some chem, many psych and soc classes, etc.). You need a high GPA: 3.0+.

3. The PsyD track is a 4 year post bachelor's program. The first two years include training in the biomedical sciences just medical, dental, pharmacy, vet, podiatry, and other professional programs. The PsyD students learn anatomy and physiology, neuroanatomy, pharmacology, physical assessments, clincial lab interpretation, medical history taking, and other basic medical sciences. The last two years focus on psychometric assessments, counseling and interviewing techniques, theory, and the other classes you guys take in grad school. Maybe one or two research classes. No thesis. No dissertation. No committees. No oral defense.

4. You complete the PsyD degree in four years. You graduate. You then do a 1-4 year residency, depending on your area of interest.

General Practice: 2 years
Community Counseling: 1 year?
Neuropsych: 4 years
Pediatric/Adoloscent: 3-4?
Forensic/Criminal: 3?

5. The PsyD will have then complete a comprehensive licensing exam, like the USLME or Bar Exam. If the PsyD passes, he/she can practice. He/she will have full RxPs and full hospital admitting privileges. In fact, they will have "physician" status like many dentists (oral-maxofacial surgeons), podiatrists, and even optometrists have.

 
sasevan said:
LOL :D
I appreciate your advise; I believe we're both ultimately coming from the same direction, i.e., how can mental health patients be better served.

For me, after a year of reflection and research, the answer was to pursue psychiatry. I definitely considered the time, energy, and expense that this pursuit would entail but where I completed my psychology internship I had the opportunity to meet 3 psychologists-psychiatrists (including the Chair of the Dept of Psychiatry and Beh Sciences) and was convinced that the process, though very arduous, is manageable. As a result, I began my pre-med reqs during my psychology fellowship and am now completing them with an April MCAT still awaiting me. BTW, I'm a PsyD and I'm licensed.

Though I disagree that psychiatry is a dying specialization, I do agree that often times it is practiced in a less than life enriching way, either for the patient or the provider, e.g., 10 minute med checks. However, I believe that while neither the current practice models of psychology (rarely meds) or psychiatry (regularly meds) is fully functional, that psychiatry offers a greater potential for flexibility in assessment and treatment, i.e., a psychologist cannot in most States choose to compliment psychotherapy with psychopharmacotherapy but a psychiatrist can certainly do the inverse. I'm aware that many psych MD/DO may be hampered from doing this for economic reasons but psych PhD/PsyD are hampered by legal reasons, which I consider more difficult to surmount.

Additionally, I want to be able to provide psychopharmacotherapy to the gamut of psych patients and I don't believe that med psychologists in the future will ultimately function as pharmacotherapists beyond outpatient services. And psych NP and PA while having RxP don't have independent and full formulary practices.

Actually, I believe that psychologists getting RxP will not only revitalize psychology by making it a full participating member in the biopsychosocial model but that it will do the same for psychiatry. If medical psychologists insist on exercising RxP as envisioned, i.e., no 10 min med check but med mgm in the midst of the 50 min therapy session then psychiatrist will perhaps be able to insist on doing the same and managed healthcare will not be able to continue to coerce psychiatrists into only doing pharmacotherapy and referring out for psychotherapy. I mean, if the two doctoral level mental health professions insist on this model where else can an HMO send patients for psych assessment and treatment?

So, I am going to be a psychologist-psychiatrist. And I like for you to do the same. An MD, JD, PsyD may just be what the APA needs to implement the type of program you presented. :D

Peace.

P.S. This program is AWESOME!!! :thumbup:

Hey, I think if you have patience, money, and ability to do it, go for it. You might be surprised, though, when you start thinking about specializing in pediatrics, internal medicine, or dermatology! Just because you have a PsyD doesn't mean you have to settle for psychiatry. Once you get your MD, you have many options available to you.

Good luck! :)

BTW, I'm going to be 35 this fall. I'm way too old to start another degree. I just hope I can pass the bar exam in February. My brain is damn near fried. No way I could handle a PsyD or PhD. Besides, most PhD programs are full-time, like medical school, and so are most PsyD programs. The closest PsyD progam to me is in Chicago. There are none in Michigan that I know. There are plenty of PhD progams in clinical psychology, but I can't afford it. I would have to give up my job and study full time another 4-5 years, plus do a dissertation.

Sorry to the PhDs out there, but I don't feel a PhD is an appropriate degree for practitioners/clinicians; it's way too research-intensive and academic for my tastes. Besides, what would a PsyD or PhD get me? At best, a solid foundation in psychotherapy, but I could pick that up in a master's program perhaps, or through training at a behavioral or psychoanalysis institute.

:)
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Paendrag said:
By switching to that kind of model, you'll basically create more psychiatrists. The model that you don't like, i.e. 15 minutes and a pill, will define psychology if prescription priviledges are widespread. They will not be immune to the forces in play (the pharmaceutical and insurance companies).

Psychologists currently out number psychiatrists almost 3:1. I don't think widespread prescription drug priv. for psychologists would help psychiatry, it would replace it.


The strength of clinical psychology is assessment. It always has been. It's how the field started. Psychotherapy is fine, but it is not a doctoral level skill. If psychologists want to do psychotherapy as their primary time expenditure, they should expect pay on par with social work. There's nothing wrong with that, except that Psy.D. grads average > 60K in debt upon graduation which is difficult to overcome on $35,000 a year.

I don't think that the Vail model is an academic model. Yes, many programs require a dissertation, some don't, but that can still be a minimal project (e.g., retrospective paper, analysis of an existing data set, theoretical paper). The research training is minimal. In short, the Vail model already does what you want it to do, minus the psychopharm.

Currently I think the time expenditure for vail vs. boulder goes like this:

Vail = 3-4 years coursework/practica, 1 year internship, 1-2 year post doc depending on specialty (e.g., neuropsych is 2 years).

Boulder = 4-5 years coursework/practica/research, 1 year internship, 1-2 year postdoc depending on specialty

I think the future of psychology is specialization and I think the way towards peace and prosperity is yielding more power to the boards. Neuropsychology, for example, already has an extensive board option (ABPP-Cn). This is where psychology needs to develop. Unfortunately, this is an arduous task. There is substantial disagreement on training requirements. In neuropsychology, there are two boards because of this, one with strict requirements (ABPP-Cn) and one with loose, weak requirements.



Sas,

I agree with prozack about the med school thing. 8 more years of school/training after doing a psy.d. is alot. Plus, the debt load will be incredible. That's a ton of school just to add prescription and admitting rights to your reportoire. I believe Pscisi is already doing exactly what you want to do. Why not respecialize in psychology and do something more lucrative?
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You make some valid points. That's the danger of restructuring clinical psych into a more medicalized profession. I don't know, but I really think it's something more professional schools should consider. Such competition might reform psychiatry.
 
Paendrag said:
In an assessment driven field, the Boulder model makes more sense in my opinion. For psychotherapy, I agree with you, it's overkill. Get an MSW. For assessment though, the Boulder model provides greater depth of knowledge, especially in the current realities of the training models. I think being a scientist-practitioner is an excellent way to approach complex diagnostic problems.
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Right. But then you're limited with respect to treatment. Psychotherapy is helpful in most cases, but pharmacotherapy is often useful as a primary or adjunctive treatment. Referrals to psychiatrists take time -- time during which a patient may be depressed, anxious, etc -- and talk therapy just doesn't do anything for these patients. It is unethical to keep a severely mentally ill person in talk therapy without considering pharmacotherapy or referral to a physician. I won't even get into child psychiatrists. A colleague of mine is in a clinical psychology PhD program and had a client with severe depression and anxiety. The waiting time to see a child psychiatrist was EIGHT MONTHS! I believe it's even worse in some states. Why have the ability to thoroughly assess and diagnose psychopathology when you cannot thoroughly treat it?

The scientist-practitioner idea has to go. There are no such animals! If they exist, there are very few of them, and they're not doing exceptionally well in both areas. This problem is analogous to MD-PhDs. Perhaps this is why clinical psychology PhD programs take so damn long to complete. And then people graduate from these programs, take research jobs to pay the bills, and ultimately never use their psychotherapy skills which they spent three or more years acquiring!

Bottom line: Clinical psychology training programs need to be restructured to capitalize on the strengths of the profession, add training or at least a track that offers "hard sciences," and ultimately produce practitioners who are NEEDED and SOUGHT AFTER in behavioral healthcare, not just some adjunctive tools that are relied upon for assessments.
 
My impression is that some of the most influential and powerful people within the American Psychological Association are members of division 55 (American Society for the Advancement of Pharmacotherapy). Consequently, as these determined and influential psychologists continue to advance RxP in order to provide better patient care, we will see more changes in both pre and post doctoral training. While it will be important to add some new course work to pre doctoral training (neuroscience, anatomy, pathophysiology and physical assessment), I am not convinced radical course work change would be beneficial. It is critical that we are trained first as psychologists. The sub specialty training should come after graduate school, or psychology may simply attract pill pushers. Besides, not every psychologist wants to prescribe, just like not every psychologist wants to do pediatric neuropsych testing all day. Interestingly, there are discussions about the emerging professional identity of the prescribing psychologist. In the DOD program, the psychologists were found to be a very different type of prescribing provider than their MD counterparts. This is because of our training, a biopsychosocial model. An outdated, reductionistic, medical model is not ideal. In mental health, the medical model has failed patients, why would we want to learn that model? I hope our training in psychology will forever positively influence our case conceptualization and patient care. Our goal is not to be junior psychiatrists, this approach would not benefit our profession or our patients.
 
PsychEval said:
My impression is that some of the most influential and powerful people within the American Psychological Association are members of division 55 (American Society for the Advancement of Pharmacotherapy). Consequently, as these determined and influential psychologists continue to advance RxP in order to provide better patient care, we will see more changes in both pre and post doctoral training. While it will be important to add some new course work to pre doctoral training (neuroscience, anatomy, pathophysiology and physical assessment), I am not convinced radical course work change would be beneficial. It is critical that we are trained first as psychologists. The sub specialty training should come after graduate school, or psychology may simply attract pill pushers. Besides, not every psychologist wants to prescribe, just like not every psychologist wants to do pediatric neuropsych testing all day. Interestingly, there are discussions about the emerging professional identity of the prescribing psychologist. In the DOD program, the psychologists were found to be a very different type of prescribing provider than their MD counterparts. This is because of our training, a biopsychosocial model. An outdated, reductionistic, medical model is not ideal. In mental health, the medical model has failed patients, why would we want to learn that model? I hope our training in psychology will forever positively influence our case conceptualization and patient care. Our goal is not to be junior psychiatrists, this approach would not benefit our profession or our patients.
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Well put. I think a concentration or track in "medical psychology" in existing doctoral programs in clinical psychology is the way to go. Screw the MS in clinical psychopharmacology. Clinical psych students who are interested in RxP should have their own track that includes training in the basic sciences, behavioral sciences, and practicum, externship, and internship training in biopsychosocial assessment and treatment of psychopathology, with a focus on both psychotherapeutic and pharmacotherapeutic interventions. This type of clinician is what behavioral healthcare needs, as clinical psychologists assess and do talk therapy and psychiatrists prescribe psychotropics. It's one or the other. Empirical data are clear that pharmacotherapy and psychotherapy together are the most efficacious approach to treating most major psychiatric disorders. But then there is currently no training model that trains clinicians to be proficient at both types of interventions! Is "medical psychology" the answer? I'm itching to see the data out of NM and LA.
 
I hate to intrude on the psychology forum parade, but...Have you guys ever picked up a psychiatry journal?

PsychEval, you sound like some sort of unsophisticated public statement sounding board spewing nonsensical propaganda about psychiatry. I know you're smarter than this from your other posts. You are not a psychiatrist. Please don't begin to assume that we've "all failed our patients." These statements are just asinine and come from no first hand knowledge.

Go ahead...tell me that I've never helped a patient, and that I've "failed them all" because I'm a psychiatrist. Ludicrous.

By the way, again not to sound elitist, but psychiatry residency *gasp* trains you in multiple forms of psychotherapy, and will begin to be formally tested as an additional competency for ACGME accredidation. Residencies have informally done this for decades. If you bother to look over psychiatry residency rotations, you'll always find one year dedicated to outpatient therapy. This may or may not include pharmacotherapy. You receive additional coursework during this time, and are supervised by a psychiatrist - in my residency supurb therapists, analysists, DBT experts, and the like. What's so wrong with this? If psychiatrists choose to do psychopharm, let them. It's not your problem. Many choose to do this, and you know what? Many have not! Do you have a statistically validated way of determining how many patients were able to return to their jobs after bipolar or psychotic episodes, from a "psychopharmacologist?" I don't either, but take my word from it. I see it every single day. They're providing a type of service that may not be perfect, but prevents a hell of a lot of people from a worsening condition that they wouldn't otherwise have time to see if they saw them for 5 hours every week and engaged in endless testing and therapy. That may also seem hard to believe to you....not every psych patient needs or wants intensive therapy. You'll learn this.

Have you ever looked at a psychiatry residency curriculum? Here's a typical curriculum. I suggest you read it. This "mindless pill pusher" mantra is getting real old, and only demonstrates a pretty sad ignorance of an entire medical specialty. If it weren't so pathetic, it would be laughable that psychologists, who legally still can't prescribe anywhere as of yet, already know more about psychiatry than psychiatrists in their own warped view. Unbelievable and incredibly arrogant. It is psychiatrists that have come up with the dosing strategies that you hope to understand, it's psychiatrists that have done much of the pharmacological research on how to improve drug effects and decrease interactions. It is primarily psychiatrists that come up with the DSM that psychologists use every day and claim that their testing can nail so completely. It's the psychiatry journals that you'll read during your rxp program that provides you with a fraction of the medical knowledge you need to approach patients comprehensively in the office. It (should be) psychiatrists that you'll approach and ask to mentor you through the rxp training. It will be them that tell you what you're doing wrong and why the orders as you'll like to write them will seriously hurt someone or their family.

This kind of talk makes you look very dissatisfied and mean-spirited. I have a feeling you don't know how much you don't know.

Go ahead and flame away. I'll do my best not to respond and just bow out at this point, seems it seems like educating about psychiatry is fruitless at this point. I really should stay out of the psychogy forum...it's lately filled with so much propaganda, mininformed opinions, bashing, and hatred. I only keep coming back to read these posts because it's like a morbid fascination akin to watching a train wreck. God forbid I come to the forum at this point to ask about recommendations for good therapy books or the like. I'd get flamed out of the place.
 
Sorry...can't resist to respond.
I agree with you in many ways, but you are like a religious convert, you overstate in the other direction. I've published in psychiatry journals, you?
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You betcha...both psychology and psychiatry journals. Your point is that I'm a mindless idiot incapable of research? Or, the clearly faulty assumption that I believe no psychologist can contribute to psychiatric research? I never made that statement.



Paendrag said:
Not adequate, surfacey, and weak on theory.
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How the hell do you know this? Where's your data? Why are the same classes taught in psychology institutions wonderful and anything taught in psychiatry residency crappy? Why are wise, analytically or classically trained teaching psychiatrists uniformly worse than psychologists? Classically trained psychiatrists aren't as rare as you think. Most residency programs have them.


Exaggeration in the other direction.
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It was for effect. 5 hours is not an unreasonable time to test someone. I know psychologists don't do this every day to the same person.

True, most would like a little pill to make it all go away and it is alluring for the psych patient to be told it's not their fault, it's a chemical imbalance. That doesn't make it the healthy option.
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Again, you have no data that this isn't the "healthy option." Most studies show the combination to be the best. There are other studies showing the superiority of therapy, and I remember reading a study showing psychopharm to be as effective as therapy and meds combined. This is a politically correct feel-good statement that isn't always feasible.

But, unfortunately, it's often quite accurate. Just because residencies offer a richer training ground than that does not mean that psychiatrists take advantage of it. There's nothing wrong with being a "mindless pill pusher." It's an important job.
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Wrong. These are required classes that you must attend.

. . . and psychologists, and neuroscientists.
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Right, but mostly psychiatrists. Don't exaggerate in the other direction.

The DSM sucks ass. I never use it. Congrats.
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It isn't perfect by any stretch, I agree. But it does save us a hell of a lot of time, doesn't it?
It's a work in progress.
Psychologists constantly preach that they are superior at diagnosis. Diagnosis based on what standard? ...the DSM.

Everytime this issue comes up, there is misinformed bashing from both sides.

I, btw, realize my "mindless pill pusher" comments are unfair. I know, work with, and respect many psychiatrists. We can both pull negative stereotypes out of the air and fling them around. It's somewhat cathartic.
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Yes, but there's a difference between cathartic and uninformed rambling that borders on dangerousness for patients who could be potentially be reading this board. The thing is, the bashing seems to be one sided. Where in the psychiatry forum are psychiatry residents bashing psychologists? I don't see it in general. Why does it appear to be the other way around in lots of threads?
 
This is awesome!! Anasazi, FYI psychologists can prescribe in 2 states legally. The rest is open to argument!!

:cool:
 
Yes, yes....

Sorry my last post was a little heated. Perhaps you're the bigger person for not responding likewise - minor sarcastic remarks aside.

I'll make a few points in non-quote format. It's just too easy to pick apart individual sentences. Sheesh, this is now completely off-topic. I apologize to the OP:

1. Psychiatry classes (not universally - like psychology grad) are surprisingly in-depth and often last for weeks to months. They are hour long and taught by experienced faculty, require readings, assignments, and often require a demonstration of competence. I'm not sure how that is worse than psychology grad school. I, like you, am not enamored by psychoanalysis. However, in one of our therapy classes, we are taught by a long-standing graduate of the Psychoanalytic Institute. We have lots of readings, and take tests. If one were into that type of thing, they would do well to sit through the class.

2. Why are psychiatrists bashed for not utilizing therapy, when one could make the same argument about psychologists that don't do _________ (insert either non-eclectic therapy or formal assessment here).

3. As far as psychiatry residents bashing psychologists...that does occur mostly in the rxp thread. The subject of this thread is one that involved, among other things, psychologists inappropriately expanding their scope of practice. Even the very minute notion of a psychiatrist attempting to do testing is met with viscious repose on this forum. The difference? The psychology forum, in many many more threads and almost universally, feels the need to attempt to justify their existence by putting down another profession, calling us "a failure to our patients" and other outrageous comments. There's not even an rxp thread visible on the psychiatry residency forum page...you've got to search to find it. Psychiatry residents, except for myself, unfortunately, aren't effected by this chest-beating battle, and are more concerned with their busy attempts at either procuring a residency spot, or practicing psychiatric medicine.
 
Psychiatrists do GREAT work, and save lives daily! Anyone here or elsewhere who disputes that is misinformed. WE can disagree about the rest, and I hope we do as that is what makes this forum interesting... ;)
 
Thanks for the props...

Likewise, I referred a patient today for neuropsychological testing...a tough case that I could use an opinion on before I decide on treatment.

At least a couple psychologists are informed enough to have this opinion.
 
PublicHealth said:
The scientist-practitioner idea has to go. There are no such animals! If they exist, there are very few of them, and they're not doing exceptionally well in both areas. This problem is analogous to MD-PhDs. Perhaps this is why clinical psychology PhD programs take so damn long to complete. And then people graduate from these programs, take research jobs to pay the bills, and ultimately never use their psychotherapy skills which they spent three or more years acquiring!

Bottom line: Clinical psychology training programs need to be restructured to capitalize on the strengths of the profession, add training or at least a track that offers "hard sciences," and ultimately produce practitioners who are NEEDED and SOUGHT AFTER in behavioral healthcare, not just some adjunctive tools that are relied upon for assessments.
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Its interesting to see how clinical psychology has been evolving from an academic discipline to a healthcare one.
I believe that it is the only PhD discipline that has scientists providing healthcare.
Maybe the problem is not that psychology has endorsed the Vail model but that it endorsed the Boulder one in the first place and continues to do so.
Maybe the time has come, if clinical psychology is really going to have a seat at the healthcare table, to promote a restructured PsyD program for practitioners while continuing to promote PhD training for scientists; and maybe a combined PsyD, PhD dual degree for those few, who like MD, PhD recipients, are really interested in being both.
IMO, this restructured PsyD program needs to emphasize predoc education and training in biomedical and psychosocial interventions as well as psychological evaluation. Postdoc would be for specialization (med, neuro, forensic, health, geriatric, pediatric).
Maybe then psychology as a field will really be needed and sought after in healthcare.
It will be interesting to see whether clinical psychology continues to evolve as a healthcare discipline or whether the intransigence of some of its own members to do so results in its, and their own, extinction.
 
Paendrag said:
Heh. You're another born again. Psychology is really needed and sought after in healthcare.


What will contribute to the extinction of psychology is socialized medicine and continued efforts by society to have healthcare provided by the lowest common denominator.
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:rolleyes:
 
Paendrag said:
Heh. You're another born again. Psychology is really needed and sought after in healthcare.


What will contribute to the extinction of psychology is socialized medicine and continued efforts by society to have healthcare provided by the lowest common denominator.
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On the contrary, it would seem that increasing use of social workers providing psychotherapy in an insurance-driven model is evidence of non-socialised medicine using the lowest common denominator.
 
For those skeptical of psychologists obtaining prescription privileges, how might the model described on this site be improved so that psychologists may prescribe psychotropic medications safely and effectively?: http://www.asppb.org/publications/guidelines/paq.aspx

Please don't say "Go to medical school," as there are several doctoral-level providers who never completed medical school and have independent prescription privileges. I'm interested in your thoughts about the current training model and how it may be improved to ensure safe and effective pharmacotherapy for psychiatric disorders.
 
PsychEval said:
My impression is that some of the most influential and powerful people within the American Psychological Association are members of division 55 (American Society for the Advancement of Pharmacotherapy). Consequently, as these determined and influential psychologists continue to advance RxP in order to provide better patient care, we will see more changes in both pre and post doctoral training. While it will be important to add some new course work to pre doctoral training (neuroscience, anatomy, pathophysiology and physical assessment), I am not convinced radical course work change would be beneficial. It is critical that we are trained first as psychologists. The sub specialty training should come after graduate school, or psychology may simply attract pill pushers. Besides, not every psychologist wants to prescribe, just like not every psychologist wants to do pediatric neuropsych testing all day. Interestingly, there are discussions about the emerging professional identity of the prescribing psychologist. In the DOD program, the psychologists were found to be a very different type of prescribing provider than their MD counterparts. This is because of our training, a biopsychosocial model. An outdated, reductionistic, medical model is not ideal. In mental health, the medical model has failed patients, why would we want to learn that model? I hope our training in psychology will forever positively influence our case conceptualization and patient care. Our goal is not to be junior psychiatrists, this approach would not benefit our profession or our patients.
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A psychologist who has the authority to Rx does not have to do so. He/she can just as easily practice as a traditional psychologist. The authority to Rx does not mean one must do so. I know one psychiatrist here in Michigan who almost never prescribes and uses psychotherapy as his primary tx modality. He's unusual, true, but still...no one puts a gun to his head and says "prescribe or die!".

It's better to have the training and authority than to not have it. You can always elect to not prescribe.

If psychologists don't embrace these changes, you might end up becoming overly trained social workers.
 
Anasazi23 said:
I hate to intrude on the psychology forum parade, but...Have you guys ever picked up a psychiatry journal?

PsychEval, you sound like some sort of unsophisticated public statement sounding board spewing nonsensical propaganda about psychiatry. I know you're smarter than this from your other posts. You are not a psychiatrist. Please don't begin to assume that we've "all failed our patients." These statements are just asinine and come from no first hand knowledge.

Go ahead...tell me that I've never helped a patient, and that I've "failed them all" because I'm a psychiatrist. Ludicrous.

By the way, again not to sound elitist, but psychiatry residency *gasp* trains you in multiple forms of psychotherapy, and will begin to be formally tested as an additional competency for ACGME accredidation. Residencies have informally done this for decades. If you bother to look over psychiatry residency rotations, you'll always find one year dedicated to outpatient therapy. This may or may not include pharmacotherapy. You receive additional coursework during this time, and are supervised by a psychiatrist - in my residency supurb therapists, analysists, DBT experts, and the like. What's so wrong with this? If psychiatrists choose to do psychopharm, let them. It's not your problem. Many choose to do this, and you know what? Many have not! Do you have a statistically validated way of determining how many patients were able to return to their jobs after bipolar or psychotic episodes, from a "psychopharmacologist?" I don't either, but take my word from it. I see it every single day. They're providing a type of service that may not be perfect, but prevents a hell of a lot of people from a worsening condition that they wouldn't otherwise have time to see if they saw them for 5 hours every week and engaged in endless testing and therapy. That may also seem hard to believe to you....not every psych patient needs or wants intensive therapy. You'll learn this.

Have you ever looked at a psychiatry residency curriculum? Here's a typical curriculum. I suggest you read it. This "mindless pill pusher" mantra is getting real old, and only demonstrates a pretty sad ignorance of an entire medical specialty. If it weren't so pathetic, it would be laughable that psychologists, who legally still can't prescribe anywhere as of yet, already know more about psychiatry than psychiatrists in their own warped view. Unbelievable and incredibly arrogant. It is psychiatrists that have come up with the dosing strategies that you hope to understand, it's psychiatrists that have done much of the pharmacological research on how to improve drug effects and decrease interactions. It is primarily psychiatrists that come up with the DSM that psychologists use every day and claim that their testing can nail so completely. It's the psychiatry journals that you'll read during your rxp program that provides you with a fraction of the medical knowledge you need to approach patients comprehensively in the office. It (should be) psychiatrists that you'll approach and ask to mentor you through the rxp training. It will be them that tell you what you're doing wrong and why the orders as you'll like to write them will seriously hurt someone or their family.

This kind of talk makes you look very dissatisfied and mean-spirited. I have a feeling you don't know how much you don't know.

Go ahead and flame away. I'll do my best not to respond and just bow out at this point, seems it seems like educating about psychiatry is fruitless at this point. I really should stay out of the psychogy forum...it's lately filled with so much propaganda, mininformed opinions, bashing, and hatred. I only keep coming back to read these posts because it's like a morbid fascination akin to watching a train wreck. God forbid I come to the forum at this point to ask about recommendations for good therapy books or the like. I'd get flamed out of the place.
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I'm a psychiatrist and I don't agree with your comments. No one here is acting mean-spirited, except perhaps one person who is constantly negative. The main point here is to advocate for a group of highly trained non-physicians to achieve RxPs in order to better serve people with mild to severe mental disorders. What is wrong with that?

Why is psychiatry bashed so often? I'll tell you: most psychiatrists see way too many patients and spend too little time with them. MOST (not all), MOST psychiatrists do not do psychotherapy, and based on my experience, very few would even know how to do it. MOST, but not all, are too quick to Rx rather than examine the problem from all sides. As far as saving lives? Well, it does happen, but most of the life-saving is not done by psychiatrists.

I'm not sure how it is in your state, but MOST of the psychiatrists in Michigan are FMGs (foreign medical grads) from India, China, Korea, and the Middle East. I'm not trying to be elitist, but it's been my experience that MOST (not all) of these FMG psychiatrists are incompetent. They don't listen to the patients, they prescribe powerful psychotropics, even to young prepubertal kids, and have a poor understanding of Western culture. In many parts of Asia, and especially the Middle East, depression is a sign of weakness, not disease. Many of these older FMGs bring their cultural biases into their clinical practice and it shows. They often have poor English skills (how anyone can practice as a psychiatrist in the US with poor English skills is beyond me) and do not understand their patients, and more often than not, their patients do not understand them. Fewer medical students go into psychiatry. Most physicians feel psychiatry is at the bottom of the specialty hierarchy. ALMOST ALL of my MD friends and acquaintances tell me that psychiatry is a useless profession. Yes, it bothers me, but I can see a lot of truth in what they say.

You seem to be defensive and your comments seem to indicate that you feel a little threatened. Very typical. Puff up your own profession and put down the profession of the perceived competitor. There are many health care professions out there that have limited or full RxP and have never gone to medical school: dentistry, podiatry, optometry, nurse practitioners, and even PAs with a lowly BA/BS degree. The literature shows that dentists and podiatrist have Rx'd some powerful meds for many years with safety and professionalism. More MDs and DOs harm patients through improper prescribing than any DDSs and DPMs. If a nurse with a master's degree in nursing can Rx meds safely, and an optometrist can Rx some meds safely, why shouldn't a PhD or PsyD level psychologist? Based on some of the FMGs I've worked with, I'm sure most psychologists trained in psychopharm can do a much better job!

In law school, I took several health care law classes. Do you know that in the US, the majority of medical malpractice claims involve FMGs? Did you know that FMG psychiatrists often Rx powerful meds, like neuroleptics or TCAs, without taking a medical history or even asking what other meds the patient is taking? Did you know that in some instances, chiropractors receive more pharmacology training than some FMGs? In the inner cities, FMGs make up 80% of the primary care and speciality care physician staff. They treat some of the nation's most vulnerable and needy citizens, yet their care is often substandard and inept. This is especially true in CMH centers throughout the US. Too few psychiatrists. Too few competent psychiatrists.

Look around you. Then ask yourself why psychiatry is bashed.
 
You make many broad sweeping generalizations that are so absolutely uninformed that it makes me wonder if you're not a glorified psychology troll, and not a psychiatrist at all. (Who uses their own pic as an avatar while posting their curriculum vitae as their signature? It's almost too narcissistic to believe). The assumptions you make about an entire profession are almost laughable. As far as putting another profession down to puff up my own....try again.

I know what psychology is. I was in psych grad school and dropped out to pursue medical school. You, on the other hand, appear chronically dissatisfied with every profession you enter (masters in bio, MD, JD).

What words will you use to bash psychology when you decide after your PsyD that you don't like that either? Perhaps you'll pursue an MBA at that point to get a few more letters after your name. It's interesting that the arguments you make against psychiatry are the exact points (some of them) that I refute with other logic, that you clearly ignore.

FMG psychiatrists are a reality, as are neurosurgeon FMGs, cardiology FMGs, and family practice FMGs. A couple of the smartest, most capable psychiatrists I know are from Russia, and other countries. They'd be interested to hear your comments. While I agree that a psychiatrist that can't speak the language is a problem, you make straw man arguments as to why the entire profession is bad. How would one become so disillusioned with a medical specialty? You state psychiatrists see too many patients and prescribe too many meds. So what do you do? Why do you care what others do?! Nobody holds a gun to your head forcing you to prescribe. Try using a little introspection and make yourself a good psychiatrist first, then worry about others or run from the profession screaming the praises of psychology.

Psychiatry is a "useless profession?" I'm taking a break from the 9 psych consults I have today, not including the ER patients still waiting to see me. Useless? I'll let them know how you feel as well. You state that I should "look around me, and see why psychiatry is bashed." I look around me every day. I see people from medicine transferring into our psychiatry residency. I have humorous conversations with other residents about how it's not fair that I'll make more money than them, while they have tougher hours. I have consults asked of me all day. People thank me for the help I provide. I'm not defending psychiatry. I'm responding to others bashing a the field of psychiatry. If you're worried about some elitist surgeon or other medical schmo that bashes psychiatry, that's your problem. If you really went to medical school, you'll know that every specialty bashes the others. From your troll-like amount of posts, I'm sure that you've read the other forum threads. Radiologists bash dermatologists, ophtlalmologists bash optomotrists, medicine bashes family practice, surgery bashes everyone. So what? You'd think a psychiatrist would be more actualized. I'm happy where I am, and look forward to the future. Something you clearly do not.

Good luck in PsyD school. Maybe you'll find satisfaction there.
 
Anasazi23 said:
You make many broad sweeping generalizations that are so absolutely uninformed that it makes me wonder if you're not a glorified psychology troll, and not a psychiatrist at all. (Who uses their own pic as an avatar while posting their curriculum vitae as their signature? It's almost too narcissistic to believe). The assumptions you make about an entire profession are almost laughable. As far as putting another profession down to puff up my own....try again.

I know what psychology is. I was in psych grad school and dropped out to pursue medical school. You, on the other hand, appear chronically dissatisfied with every profession you enter (masters in bio, MD, JD).

What words will you use to bash psychology when you decide after your PsyD that you don't like that either? Perhaps you'll pursue an MBA at that point to get a few more letters after your name. It's interesting that the arguments you make against psychiatry are the exact points (some of them) that I refute with other logic, that you clearly ignore.

FMG psychiatrists are a reality, as are neurosurgeon FMGs, cardiology FMGs, and family practice FMGs. A couple of the smartest, most capable psychiatrists I know are from Russia, and other countries. They'd be interested to hear your comments. While I agree that a psychiatrist that can't speak the language is a problem, you make straw man arguments as to why the entire profession is bad. How would one become so disillusioned with a medical specialty? You state psychiatrists see too many patients and prescribe too many meds. So what do you do? Why do you care what others do?! Nobody holds a gun to your head forcing you to prescribe. Try using a little introspection and make yourself a good psychiatrist first, then worry about others or run from the profession screaming the praises of psychology.

Psychiatry is a "useless profession?" I'm taking a break from the 9 psych consults I have today, not including the ER patients still waiting to see me. Useless? I'll let them know how you feel as well. You state that I should "look around me, and see why psychiatry is bashed." I look around me every day. I see people from medicine transferring into our psychiatry residency. I have humorous conversations with other residents about how it's not fair that I'll make more money than them, while they have tougher hours. I have consults asked of me all day. People thank me for the help I provide. I'm not defending psychiatry. I'm responding to others bashing a the field of psychiatry. If you're worried about some elitist surgeon or other medical schmo that bashes psychiatry, that's your problem. If you really went to medical school, you'll know that every specialty bashes the others. From your troll-like amount of posts, I'm sure that you've read the other forum threads. Radiologists bash dermatologists, ophtlalmologists bash optomotrists, medicine bashes family practice, surgery bashes everyone. So what? You'd think a psychiatrist would be more actualized. I'm happy where I am, and look forward to the future. Something you clearly do not.

Good luck in PsyD school. Maybe you'll find satisfaction there.
Click to expand...


Rather than argue the points, you choose to attack me -- an ad hominem attack speaks volumes about you. I can see how you provide such competent help to your patients. I am a psychiatrist. I went to medical school. Am I unhappy with my chosen field? Yes, I admit that and have admitted that in other posts. Was I dissatisfied with every career path I made? No, not at all. It's nice that you can assume that with no knowledge of who I am.

I majored in political science in college. I didn't know what I wanted to do even in my senior year. My father is a surgeon, my mother is a clinical pharmacist, my sister is an osteopath. Everyone in my family encouraged me to go to medical school. In order for me to do that, I needed to get all of my pre-reqs in. That's why I chose the biomed MS program. It gave me the pre-reqs I needed to get into a decent medical school without having any undergrad preparation.

From there, I was able to get into a fairly decent medical school. The problem was, I felt somewhat pressured to specialize. I really wanted to do IM or even FP, but I bought into the specialization bandwagon, and I admit, I was looking for a specialty that would allow me to make a very nice living. There are a ton of reasons why I chose to go into psychiatry, but I felt pretty comfortable with my choice at first. My residency, however, was dominated by FMG psychiatrists, and none of them were from Russia or Europe -- they were all from China, Korea, Egypt, Lebanon, and India. There were some good preceptors, but more often than not, they were average or poor.

I don't know it was me, or my environment, but I guess it was a combination of both, but I became increasingly more dissatisfied with what I was doing. A few of my colleauges said I was a frustrated psychologist, others suggested I should go into academia. To be honest, I didn't know what to do. Finally, a friend of mine asked me what I wanted to do back in college and I laughed and admitted that I had considered law school. So, my friend smiled and said, "well, you can still do that, right?" I decided to take the LSAT and one thing led to another and I did it.

That's how I got to where I am. I'm not a troll. In fact, my posts are usually pretty neutral or supportive and I've received quite a few positive comments in private message. I'm sorry you think I'm a troll and I'm sorry if I upset you. I never meant to. I think you're right, I over generalized. I suppose I transferred my feelings of professional dissatisfaction to the entire profession, which is wrong. I've considered going back to IM, or after taking the bar exam, practicing law exclusively. I still don't know.

As far as your comment about getting a PsyD -- no way. I'm almost 35 and I have no desire to ever set foot in another classroom unless I'm teaching. Since I've obviously offended you, I think it best I leave the forum.

I'm sorry.

Zack
 
Anasazi23 said:
You make many broad sweeping generalizations that are so absolutely uninformed that it makes me wonder if you're not a glorified psychology troll, and not a psychiatrist at all. (Who uses their own pic as an avatar while posting their curriculum vitae as their signature? It's almost too narcissistic to believe). The assumptions you make about an entire profession are almost laughable. As far as putting another profession down to puff up my own....try again.

I know what psychology is. I was in psych grad school and dropped out to pursue medical school. You, on the other hand, appear chronically dissatisfied with every profession you enter (masters in bio, MD, JD).

What words will you use to bash psychology when you decide after your PsyD that you don't like that either? Perhaps you'll pursue an MBA at that point to get a few more letters after your name. It's interesting that the arguments you make against psychiatry are the exact points (some of them) that I refute with other logic, that you clearly ignore.

FMG psychiatrists are a reality, as are neurosurgeon FMGs, cardiology FMGs, and family practice FMGs. A couple of the smartest, most capable psychiatrists I know are from Russia, and other countries. They'd be interested to hear your comments. While I agree that a psychiatrist that can't speak the language is a problem, you make straw man arguments as to why the entire profession is bad. How would one become so disillusioned with a medical specialty? You state psychiatrists see too many patients and prescribe too many meds. So what do you do? Why do you care what others do?! Nobody holds a gun to your head forcing you to prescribe. Try using a little introspection and make yourself a good psychiatrist first, then worry about others or run from the profession screaming the praises of psychology.

Psychiatry is a "useless profession?" I'm taking a break from the 9 psych consults I have today, not including the ER patients still waiting to see me. Useless? I'll let them know how you feel as well. You state that I should "look around me, and see why psychiatry is bashed." I look around me every day. I see people from medicine transferring into our psychiatry residency. I have humorous conversations with other residents about how it's not fair that I'll make more money than them, while they have tougher hours. I have consults asked of me all day. People thank me for the help I provide. I'm not defending psychiatry. I'm responding to others bashing a the field of psychiatry. If you're worried about some elitist surgeon or other medical schmo that bashes psychiatry, that's your problem. If you really went to medical school, you'll know that every specialty bashes the others. From your troll-like amount of posts, I'm sure that you've read the other forum threads. Radiologists bash dermatologists, ophtlalmologists bash optomotrists, medicine bashes family practice, surgery bashes everyone. So what? You'd think a psychiatrist would be more actualized. I'm happy where I am, and look forward to the future. Something you clearly do not.

Good luck in PsyD school. Maybe you'll find satisfaction there.
Click to expand...


I just had to say this also...I put my pic as my avatar because I wanted to personalize it. I don't think that's narcissistic. It's my face, so why shoudln't I use it? As for my "cv" in my sig...well, I've seen several other similar sigs out on this board. I thought it would be a good way to explain who I am. I've seen students advertise what exams they took, what schools they applied to, their GPA and admission test scores, etc. Many indicate their school. I just summarized where I went to school.

It seems that you have a problem with everything I do and say.
 
Do not leave. I have personally pissed off anasazi many times, and we are both mods.

:)
 
ProZackMI said:
I'm a psychiatrist and I don't agree with your comments. No one here is acting mean-spirited, except perhaps one person who is constantly negative. The main point here is to advocate for a group of highly trained non-physicians to achieve RxPs in order to better serve people with mild to severe mental disorders. What is wrong with that?

Why is psychiatry bashed so often? I'll tell you: most psychiatrists see way too many patients and spend too little time with them. MOST (not all), MOST psychiatrists do not do psychotherapy, and based on my experience, very few would even know how to do it. MOST, but not all, are too quick to Rx rather than examine the problem from all sides. As far as saving lives? Well, it does happen, but most of the life-saving is not done by psychiatrists.

I'm not sure how it is in your state, but MOST of the psychiatrists in Michigan are FMGs (foreign medical grads) from India, China, Korea, and the Middle East. I'm not trying to be elitist, but it's been my experience that MOST (not all) of these FMG psychiatrists are incompetent. They don't listen to the patients, they prescribe powerful psychotropics, even to young prepubertal kids, and have a poor understanding of Western culture. In many parts of Asia, and especially the Middle East, depression is a sign of weakness, not disease. Many of these older FMGs bring their cultural biases into their clinical practice and it shows. They often have poor English skills (how anyone can practice as a psychiatrist in the US with poor English skills is beyond me) and do not understand their patients, and more often than not, their patients do not understand them. Fewer medical students go into psychiatry. Most physicians feel psychiatry is at the bottom of the specialty hierarchy. ALMOST ALL of my MD friends and acquaintances tell me that psychiatry is a useless profession. Yes, it bothers me, but I can see a lot of truth in what they say.

You seem to be defensive and your comments seem to indicate that you feel a little threatened. Very typical. Puff up your own profession and put down the profession of the perceived competitor. There are many health care professions out there that have limited or full RxP and have never gone to medical school: dentistry, podiatry, optometry, nurse practitioners, and even PAs with a lowly BA/BS degree. The literature shows that dentists and podiatrist have Rx'd some powerful meds for many years with safety and professionalism. More MDs and DOs harm patients through improper prescribing than any DDSs and DPMs. If a nurse with a master's degree in nursing can Rx meds safely, and an optometrist can Rx some meds safely, why shouldn't a PhD or PsyD level psychologist? Based on some of the FMGs I've worked with, I'm sure most psychologists trained in psychopharm can do a much better job!

In law school, I took several health care law classes. Do you know that in the US, the majority of medical malpractice claims involve FMGs? Did you know that FMG psychiatrists often Rx powerful meds, like neuroleptics or TCAs, without taking a medical history or even asking what other meds the patient is taking? Did you know that in some instances, chiropractors receive more pharmacology training than some FMGs? In the inner cities, FMGs make up 80% of the primary care and speciality care physician staff. They treat some of the nation's most vulnerable and needy citizens, yet their care is often substandard and inept. This is especially true in CMH centers throughout the US. Too few psychiatrists. Too few competent psychiatrists.

Look around you. Then ask yourself why psychiatry is bashed.
Click to expand...


This response is painfully on target (as you said, for most not all). A while back, Anasazi wrote, “I fear more the cowboy psychologist that finally thinks they are a "real doctor" because they get a sphygmomanometer on ebay and listen to a cardiac sound .wav file on the internet, thinking they can look cool walking to the bagel shop with a stethescope around their neck and get the respect they've been yearning for.” I am a CBT guy, but I wondered if this was some type of projection. The tension is obvious, and it is easy to get caught up in it (which I am guilty of). At the time, I decided not to share that many of my physician friends do not consider psychiatrists to be real doctors (RIDICULOUS). Regardless, both professions do matter, and do make a difference. Please stick around, you do contribute to this Forum.
 
ProZackMI said:
Since I've obviously offended you, I think it best I leave the forum.

I'm sorry.

Zack
Click to expand...

Hi ProZackMI,

I don't agree with everything you've said or with how you have always said it but I don't think that you should leave this forum. You have a lot of very interesting insights about psychology and psychiatry that I for one value both as a current psychologist and as a future psychiatrist.
I think the whole mental health field stands to benefit from someone like you who may be frustrated with the status quo but who is so for all the right reasons, i.e., lack of access to adequate mental health services for large numbers of people.
I suspect that your apology was genuine and that it will be accepted, permitting all to move forward.
I truly hope that you reconsider your decision to leave this forum and even the decision to leave the practice of psychiatry. IMO, those of us here and your current/future patients will benefit greatly from your continued advocacy.

Peace. :)
 
What's with all the "I"m leaving this forum" crap?
 
mmm I dont think they mean it!
 
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