NP's PA's and Psychs

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What do you folks think about psychologists with further training being allowed to prescribe?

:)

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as long as they have a year of pharm like I did I have no problem with it as long as it is limited to psych drugs. they should take the full year though to gain an appreciation of side effects, interactions, etc.
I am sure every phd psychologist out there knows more about mental illness than the avg pa or np.
 
year of bio chem as well. A and P, gross, patho, histo, come guys.

This is what I scream at students about every day. The difference between providers and ancillary staff is we are supposed to know the "how", not just the what and when.
 
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I reviewed the coursework at Nova Southeastern Univ. and think that they would have a wonderful understanding about psychopharmacology (and should), but that simply isn't enough. I think psychologists would need training in general medicine as well (like a PA's). I think it's important to be conversant and have the ability to identify illness that is far more encompassing to a person?s health. It's about being trained using a medical model with a solid foundation of science courses. What happens when a patient lands in a psychologist office that has mental illness compounded by COPD, has an unidentified heart condition, type I diabetes and is on dialysis. Is the psychologist going to pick up a stethoscope or be aware of other signs from a physical assessment to know enough to order other medical diagnostic tests (or even which ones to order, and I know they are not fighting to have this privilege as well), but the point is having psychopharmacological prescription rights is great, but a persons health often extends much further than mental illness. I can already anticipate the responses to this ("in situations like that they would know enough to refer/consult with a physician" ect...) , but I still think psychologist would need to be able to size up a persons health situation globally, not just one aspect of it. I remember reading a great quote on one of the student doctor forums that said, "What the mind does not know, the eyes cannot see." I say with the training they have, they could be a great resource to a physician by simply recommending what prescription a patient would benefit from best and let the medical expert make the decision based on the dynamics of a persons health. I know more than anybody that what I have just said is nothing novel, but I think it?s a legitimate answer to any organizations political efforts to include prescription rights into there scope of practice. If you want to be a psychologist, become a psychologist, if you want to be a psychiatrist, become a psychiatrist. I understand that there are many differences between the professions; one of them is medical school.
 
Good responses all ...thanks. I do not know the Nova program, but the one I went to had over one year of clinical medicine in addition to A&P, biochem, pathophys etc.. Also, the right to prescribe will always include the right to order labs etc.. There are many what ifs that scare people, even myself about us prescribing, but any good prescribing psych would know when they have exceeded their limits and skills. This is true for MD's as well, but many GPs are still diagnosing bipolar disorder in 4 year old etc and prescribing incorrectly. We all have limits and to function professionally we will need to know them. BTW, I was trained in the same manner a NP is on how to do a physical assessment, but I would never prescribe for a person with many other medical problems (COPD, Diabetes, liver, kidney problems etc..). We will see the garden variety depressed and anxious as we do now....the real difficult cases go to MD's and always will.

:)
 
psisci said:
BTW, I was trained in the same manner a NP is on how to do a physical assessment, but I would never prescribe for a person with many other medical problems (COPD, Diabetes, liver, kidney problems etc..).
:)

Simply a question. you mention being trained in the same manner as an NP -from my understanding NP's train using a nursing model as opposed to a medical model like a PA. Do psychologist have the same experiences as PA's or NP's with rotations within hospitals and outpatient clinics developing their the physical assessment skills under the supervision of a seasoned medical professional? I suspect that there is a huge difference, but I'm not that savvy about the psychology profession and its developments. I have a hard time believing that a psychologist could extrapolate information about medicine without the training that goes along with being an NP or PA. Lets say that each one requires a 7 semester masters degree. NP's and PA's (NP's are certainly debatable) spend there entire 7 semesters focused on medicine. Despite the fact that psychologist may have some physical assessment training, there is no way they can approach the level of detail in medicine when the focus is in psychology. I don't think that psychologist just cram in more information and experience in the same amount of time.

With what I just wrote I sound like I'm strongly opposed and I'm actually not. I'm just curious about the physical assessment training that is similar to an NP's. It almost sounds like a psychology instructor or psychologist remarking on the training, but lacks the scruples or understanding to understand the difference. Myself included, we are all proud of our professions and sometimes don't think others understand the depth or the amount of training that goes into our respective professions. I just think that if you were to compare the training and experience with respect to physical assessment between NP's and Psych's there would be a profound difference.
 
You are right, psychologists have little or no physical assessment training. I am talking about the advanced training they can choose to get over 2.5 years in medical psych and psychopharmacology. I have this, as well as an NP license, and they are similar. :)
 
Open mouth and insert foot! I'm sorry. Obviously I'm completely ignorent about this extra training. If you could educate us on the process and training one must undergo to get to the prescription rights, I would appreciate it. With the physical assessment training they recieve in the classroom, do they follow it up with clinical application (rotations in different settings) much the same way that a PA would in the last year of training? Lawguil
 
They are very different in some ways and very similar in others. Psychologists operate under a license that, for the most part does not allow us to touch or examine patients. So, the training we get is assuming we will not be doing phys assessments unless we have to, but with similar training to a NP on how to do so. NP's are out there seeing all sorts of things, but psychs only will be seeing psych patients and will need to know all the rule-outs and how to assess if needed (panic, migraines, MVP..etc). The science is the same, but the clinical focus is different....

s :D
 
I'm a little ignorant here so can someone fill me in?

With PSYC's be RX'ing from a formulary? Will they have authority to RX controlled substances? Someone please tell me they'll be under someones direct supervision?

Cosmo
 
It all depends on individual state law. In NM they can prescribe controlled subs, including SII as long as it is psych related. In LA, they can not prescribe painpills, but other controlled meds are OK. Both laws give them DEA #'s.

:)
 
This is prob a very trivial question psisci but the DEA numbers for psychs, do they begin with the 'A' or 'B' like MD, DO, DDS, DMD, DPM, and DVM

or do they begin with
'M' like OD, PA, NP ???


I'm just a pharamacy tech and i was curious about this little triviality
 
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I do not know, but my guess is A or B as they are not supervised in any way.

s :)
 
Psisci,

Based on what you said - Psych's have classroom instruction on physical evaluation, but lack the application of the skills in a formal setting. My understanding is that this is much different than an NP or PA. My interpretation: Psych's lack the necessary skills to competently perform physical evaluations. You cannot develop these skills in a classroom. If your not practicing and developing your skills in a practical setting, how can you suggest they are equal to an NP or PA with respect to physical evaluations (at least I think you suggested they did when you said that you are both a Psych and NP and the training was similar). It scares me when a profession like this has some political clout and end up with privileges they don't deserve. Further, you suggest that a psych can Rx controlled substances with more autonomy than a PA in some states. This just proves what a little politicking can get you. Sounds like a broken system to me. I guess I'm from the school of people who believes that prescription rights belong only to PA, DO, MD, DPM, DVM, and DDS/DMD. I'm not fond of NP's with prescription rights (again the nursing organization has a great deal of political strength, thus the prescription rights.) - Just my thoughts/opinions. L.
 
anyone here interested in becoming a Nurse Anastasias?
 
Prescription rights for Psychologists

Greetings all

The discussion that has been taking place in this forum has been based on one man?s uninformed opinion (Psisci) and has perpetuated further to the point that some of us have began to take a stand on the issue based on incomplete/inaccurate information. I encourage all who have interest in this topic to do their own investigations before making up ones mind.

I have taking the liberty of providing very brief information regarding the training of those psychologists interested in pursuing RxP. More info can be found on http://www.apa.org/apags/profdev/prespriv.html

CAPP identifies the following prerequisites to participate in postdoctoral training in psychopharmacology:

1. A doctoral degree in psychology; (6-8yrs. Of education post BA/BS)
2. Current state license as a psychologist; and
3. Five-years of practice as a ?health services provider? psychologist as defined by state law or by the APA. (This is generally defined as psychologists who are duly trained and experienced in the delivery of prevention, assessment, diagnostic and therapeutic intervention services relative to the psychological and physical health of consumers.)

Psychopharmacology training requires didactic and clinical components with faculty who have expertise in physiology, biochemistry, neuroscience, pharmacology, psychology, pharmacy, medicine, and psychiatry.

A minimum of 300 contact hours of didactic instruction is recommended in the following core content areas:

1. Neuroscience;
2. Clinical and Research Pharmacology and Psychopharmacology;
3. Physiology and Pathophysiology;
4. Physical and Laboratory Assessment ; and
5. Clinical Pharmacotherapeutics.

The clinical practicum suggested by CAPP is designed to be an intensive, closely supervised experience involving exposure to a range of patients and diagnoses, taking place in both inpatient and outpatient settings. A minimum of 100 patients should be seen by the psychologist-trainee who assumes direct clinical responsibility to achieve competency in treating a sufficiently diverse patient population. Appropriate didactic instruction and a minimum of 2-hours of weekly individual supervision is also a requisite component of the practicum. It is noteworthy that this 2-hour weekly supervision is more individual supervision time than physicians receive.

Examination Domains for Psychopharmacology Competency
The APA College of Professional Psychology constructed ten content areas for examining psychopharmacology competency based on extensive research and evaluating the validity of these content areas. The exam content areas are:
1) Integrating clinical psychopharmacology with the practice of psychology; 2) Neuroscience;
3) Nervous system pathology;
4) Physiology and pathophysiology;
5) Biopsychosocial and pharmacologic assessment and monitoring;
6) Differential diagnosis;
7) Pharmacology;
8) Clinical psychopharmacology;
9) Research; and
10) Professional, legal, ethical, and inter-professional issues.

Examination Domains for Psychopharmacology Competency
The APA College of Professional Psychology constructed ten content areas for examining psychopharmacology competency based on extensive research and evaluating the validity of these content areas. The exam content areas are:
1) Integrating clinical psychopharmacology with the practice of psychology; 2) Neuroscience;
3) Nervous system pathology;
4) Physiology and pathophysiology;
5) Biopsychosocial and pharmacologic assessment and monitoring;
6) Differential diagnosis;
7) Pharmacology;
8) Clinical psychopharmacology;
9) Research; and
10) Professional, legal, ethical, and inter-professional issues.

http://www.apa.org/apags/profdev/prespriv.html
 
P.s. If anyone is interested in the safety of the patients (as we all should) under the supervision of a psychologists with prescription authority they should refer to the Department of Defense?s Pilot project that has demonstrated proven safety of the patients under the care of RxP.

http://www.apa.org/apags/profdev/advancingprof.html

Four independent evaluations of a United States Department of Defense (DoD) pilot program concluded that psychologists can be trained to prescribe psychotropic medication safely and effectively. Psychologists receive more extensive training in diagnosis, biopsychosocial assessment, and empirically supported treatment for mental disorders, than do physicians and other prescribers, and are well prepared to undertake the additional training necessary to prescribe competently. APA accredited psychology programs already require coursework in the physiological and biological foundations of behavior and many psychologists who would pursue prescriptive authority have experience in neuropsychology, health psychology, and other more "medical" areas of the profession. Additionally, the curriculum offered by the various programs that train prescribing psychologists was designed to be both comparable to the training of other prescribers, and cost effective. These programs include courses in psychopharmacology, neuroanatomy, neurophysiology, clinical pharmacology, pathophysiology, pharmacology pharmacotherapeutics, pharmacoepidemiology, and physical and lab assessments, as well as a supervised clinical practicum. Although the current training programs require fewer hours than did the DoD project, one must remember that this was a pilot program that served as a starting point and facilitated the identification of elements necessary to train competent prescribing psychologists.

Looking outward for other examples, non-physician providers (e.g., dentists, podiatrists, advanced nurse practitioners, and optometrists) have clearly demonstrated that one does not have to attend medical school to become a competent prescriber. Some opponents of prescriptive authority for psychologists argue that becoming a nurse practitioner is the solution. While this is a legitimate route (and one which some psychologists are already taking), it poses additional difficulties. For example, it requires a dually licensed professional, which means separate liability insurance, continuing education requirements, license renewals, and billing procedures - one as a psychologist and one as a nurse practitioner. Many see such an arrangement as artificial, overly burdensome, and an obstacle to psychologists providing comprehensive mental health treatment to their clients.


http://www.apa.org/monitor/jun04/gaining.html

The model was based on guidelines developed by the U.S. Department of Defense (DOD) demonstration project, in which 10 military psychologists were trained to prescribe, as well as APA's Committee for the Advancement of Professional Practice's RxP task force, the Blue Ribbon panel of the Professional Education Task Force of the California Psychological Association and the California School of Professional Psychology (now Alliant International University), and a report by the American College of Neuropsychology.

The training is offered only to those who have completed their doctorate degrees. APA's curriculum also stipulates that the training should prepare psychologists to evaluate new advances in psychopharmacology research and prepare them for inevitable changes in the field of psychopharmacology during their careers.

In approximately 22 to 27 months, students learn about brain chemistry, the basics of psychotropic drugs and how these drugs affect the body and mind. The coursework is heavy on biophysical and neurophysiological science. APA recommends that students receive at least 300 hours of didactic education; most programs require even more.

In fact, says Lt. Col. James Meredith, PhD, director of the organizational health center at Kirtland Air Force Base in New Mexico and a DoD grad, the programs improved on the DoD project and the hours are much better focused.

He notes that "in DoD we had a lot of extra hours--645 to be exact--but we spent many hours listening to heart sounds or checking for breast lumps, for example"--things that he says he hasn't used in clinical practice. "I think these folks come out with better ability and knowledge to help with the kind of tasks you're faced with when prescribing," he adds.


MAKE AN INFORMED DECISION!!

THANK YOU
 
Wow, thanks for spending the time to write all that good info out for us! Don't flame me though, I am on your side. If you had read my posts in this section as well as my posts in the section you referred everyone to you would see that I an an RxP trained psychologist who is pro RxP!!?? :cool:
I posted here to see what NP's and PA thought, and it was very clear that they are very ill-informed on the issue.
My point in this forum was to say that RxP is similar in scope to NP training, but much better in all areas involving psych/psychopharm. Why did you pick me to bash??
 
" MAKE AN INFORMED DECISION!!"


Thank-you PsyDRxPnow. Still my questions go unanswered. What you have just posted looks very similar to the information posted at Nova Southeastern univ. with respect to there medical psych program. It carries a great deal of depth with respect to psychopharmacology, but SEEMS to lack the breadth of knowledge as experienced in other "medical training" programs. Since the experiences of psychologist are channeled towards mental illness and in no way are as encompassing as training one experiences in medical school or PA school, I would have a hard time qualifying the privilege. Why wouldn't it be appropriate that a psych simply be an advisor to a physician about a patients psychopharmacological needs (pharmacist do this all the time.) I'm actually very open minded about this, but I feel like I have to play devils advocate to get a straight forward answer without all the sugarcoated words with witch anybody can pull from an organizations website in order to sound official. I have looked elsewhere and still haven?t found my answer. DO Medical Psych's spend time in the ER, OR, Family practice, OB/GYN/ Orthopedics/ Pediatrics/ ect as part of there training?
 
Psychs have no access to hospitals in many states, but the answer to your question is YES. We have to treat 100 patients, before we can sit for the exam (PEP), and most laws require a 1-2 year period where our practice is supervised by an MD while we do such things as phys assessments and the like. This is a new thing, and is not nearly as organized as the PA and NP systems, but you were once where psychs are now...that is why I asked the question in this forum.

:)
 
Sorry, but a study of 10 military doctors just ain't gonna cut it in this litigation-prone world to prove safety. How many patients could they possibly have treated?
 
Seaglass said:
Sorry, but a study of 10 military doctors just ain't gonna cut it in this litigation-prone world to prove safety. How many patients could they possibly have treated?

I know that 10-20 people are not going to cut it but how much will? Its obvious that it will take some time before RxP is more uniformed and more regulated but don?t you think that all fields regardless if its medicine or engineering, initially had to go through what RxP is going through now and eventually, will, you know where medicine and engineers stand now in regards to organization. RxP will eventually happen in all states, furthermore, I want to encourage the field of medicine who has overcome numerous obstacles to get to where they are today to encourage the American Psych. Association to gain prescription rights in other states and to teach us to do it better. Attacking RxP may just hinder it but will not stop its progress.
 
PsyDRxPnow said:
I know that 10-20 people are not going to cut it but how much will? Its obvious that it will take some time before RxP is more uniformed and more regulated but don?t you think that all fields regardless if its medicine or engineering, initially had to go through what RxP is going through now and eventually, will, you know where medicine and engineers stand now in regards to organization. RxP will eventually happen in all states, furthermore, I want to encourage the field of medicine who has overcome numerous obstacles to get to where they are today to encourage the American Psych. Association to gain prescription rights in other states and to teach us to do it better. Attacking RxP may just hinder it but will not stop its progress.

I have a genuinely good idea to help you PsychD's to learn how to manage patients on medications. My suggestion would be that you apply to an MD or DO school, get accepted, and attend!! :laugh: You see, only a bunch of behavioral gurus like you would have come up with an idea so senseless. I mean why don't we just start allowing PT's to prescribe medications related to rehabilitation, or Audiologists to prescribe drugs related to ENT? Or how about allowing midwives to do C-sections in emergency situation? Oh hell, I have the best option...why don't we just give pharmacists prescribing rights, and then everyone can just go to Eckerds and get their meds without having to see any physician?

Although it seems a solution to allow PsychD's to prescribe, it is nothing short of a disaster waiting to happen. How many dead or sick patients will it take to show that you cannot provide such care with a limited scope of training. Here are some examples as to why. Without medical training, you will be clueless about these common drug issues:

Ever heard of serotonin syndrome, neuroleptic malignant syndrome, acute dystonia, agranulocytosis, hepatic and renal insufficiency, hypothyroidism, chronic Lithium induced dermatitis, etc??? All these are MEDICAL problems caused by what most would term SIMPLE psych drugs, but yet how can you identify, treat, or otherwise help a patient with these problems when you are not trained to ID them. You simply CANNOT draw a dividing line between where psych drugs and psych conditions become general medical issues.

Even I as a PA, having far superior clinical and pharm training, do not pretend that I was capable of independent practice outside that which a physician only can provide. I really wanted though to be my own boss, prescribe what I felt the patient needed, and serve an underserved population with services they might not otherwise have. So you know what I did? I went to medical school!!! Sure I could have mustered up a few hundred PA's who felt like me, and convinced a few sympathetic rural congressmen to vote to allow independence for PA's, but it simply made more sense to do what most people do who want to practice medicine....GO TO MEDICAL SCHOOL!!!

And no, I can promise you that it will never pass in every state. Hell, even PA's who have real clinical and pharm training don't have script rights in all 50 states.
If there is some critical shortage of psychiatrists, then perhaps there should be more of a push by the government to create more Psychiatry residencies and give big tuition breaks for anyone willing to go into it!!
 
I think the point people like our last poster fail to see is nobody is allowing psychologists to prescribe. However, laws are beginning to allow psychologists with proper medical training, equivalent to a NP or PA, after they already have a doctorate and license in psychology to prescribe certain medications. I personally have heard of and treated all of the conditions you specified, and even though I have NP and RxP training I am on staff as an attending clinician, as a psychologist in a california hospital. It really amazes me how ignorant physicians can be about the training of other health professions. By the way PharmD's do prescribe in many states, and this is not new????

:cool:
 
In several states I think pharmd's can administer a few vaccinations like pneumococcal and flu vacs and hand out emergency contraception following an algorithm written by the state medical boards. I don't know if it is truly prescribing in the true sense of the meaning because it is 100% delegated practice for < 5 conditions and not free reign to write for anything like an md/do, pa/np, dpm, dvm.
 
PACtoDOC said:
I have a genuinely good idea to help you PsychD's to learn how to manage patients on medications. My suggestion would be that you apply to an MD or DO school, get accepted, and attend!! :laugh: You see, only a bunch of behavioral gurus like you would have come up with an idea so senseless. I mean why don't we just start allowing PT's to prescribe medications related to rehabilitation, or Audiologists to prescribe drugs related to ENT? Or how about allowing midwives to do C-sections in emergency situation? Oh hell, I have the best option...why don't we just give pharmacists prescribing rights, and then everyone can just go to Eckerds and get their meds without having to see any physician?

Although it seems a solution to allow PsychD's to prescribe, it is nothing short of a disaster waiting to happen. How many dead or sick patients will it take to show that you cannot provide such care with a limited scope of training. Here are some examples as to why. Without medical training, you will be clueless about these common drug issues:

Ever heard of serotonin syndrome, neuroleptic malignant syndrome, acute dystonia, agranulocytosis, hepatic and renal insufficiency, hypothyroidism, chronic Lithium induced dermatitis, etc??? All these are MEDICAL problems caused by what most would term SIMPLE psych drugs, but yet how can you identify, treat, or otherwise help a patient with these problems when you are not trained to ID them. You simply CANNOT draw a dividing line between where psych drugs and psych conditions become general medical issues.

Even I as a PA, having far superior clinical and pharm training, do not pretend that I was capable of independent practice outside that which a physician only can provide. I really wanted though to be my own boss, prescribe what I felt the patient needed, and serve an underserved population with services they might not otherwise have. So you know what I did? I went to medical school!!! Sure I could have mustered up a few hundred PA's who felt like me, and convinced a few sympathetic rural congressmen to vote to allow independence for PA's, but it simply made more sense to do what most people do who want to practice medicine....GO TO MEDICAL SCHOOL!!!

And no, I can promise you that it will never pass in every state. Hell, even PA's who have real clinical and pharm training don't have script rights in all 50 states.
If there is some critical shortage of psychiatrists, then perhaps there should be more of a push by the government to create more Psychiatry residencies and give big tuition breaks for anyone willing to go into it!!

Oh, I see your logic. If you can?t use a rational and a well thought out argument lets just blast them. Well, that is not very intelligent on your behalf. I have been exposed to all of the medical/psychiatric conditions that you have stated. Can?t say that I have treated them yet since I am currently a second year doctoral student (PsyD) but give me some time and I will treat them as well as a psychiatrist or MD and maybe even better. What you fail to mention is that psychologists are already highly trained and most are even welling to go through the extra training to gain RxP in order to holistically treat their patients.

You are accurate on one point. I should just go to med school and become a psychiatrist only if I was interested in pursuing a 15 minutes medication management (push meds) but I choose to attend graduate school to become a psychologist in order to provide more methods of treatment (e.g. psychotherapy, behavioral therapy, testing (IQ, personality, and soon RxP). This is holistic treatment and is more respectful for the patient/client).

Patient?s safety does not appear to be more compromised from psychologists with RxP then MD/Dos. Psychiatrists should take more effort in assisting psych with RxP to prescribe better in order to provide for more and enhanced treatment for the people suffering from mental illness. I do understand that you as a psychiatrist might be threatened by RxP (hence your attacks) but have no fear, RxP is not developed to threaten you but to help your patients.
 
In some states like NM, PharmD's with extra training can prescribe antibiotics, pain meds, etc...; anything that may be needed quickly. :)
 
The psychiatrists I know are very good at treating a patient as a whole, not just a mental illness. They are always careful to monitor a patients MEDICAL condition when a medication they are writing could cause adverse effects.

What is a psychologist going to do when a patient has new onset HTN with Effexor or Cymbalta?
What about an elevated lipids or HgBA1c when giving Zyprexa? Are they even going to check for these things?

Not saying this can't work but if they are not going to have the training to treat the WHOLE patient then it needs to be a requirement that they are in contact with Primary Care or some sort of means by which there is someone there to watch the medical side of these patients conditions. I don't go off writing major psychotropic medications without consulting with a psychiatrist and I don't want a diabetic patient comming in with a 10lb weight gain and BS in the 400's and me not knowing what on earth has happened to the good control they had two weeks ago because someone (and this can be ANYONE) has given them a medication that could cause this but not bothered to monitor for it. This is just not something I've EVER had to worry about with the psychiatrists I've referred patients to. Maybe they've spoiled me but they are very careful to watch for it "all". If they have a question about an issue with the patients medical care, they call us.

I just worry that someone with only training on one side of the issues will leave a stone unturned (or cause an avalanche) and patient care will suffer.

Cosmo
 
psisci said:
In some states like NM, PharmD's with extra training can prescribe antibiotics, pain meds, etc...; anything that may be needed quickly. :)

I have a feeling you are spinning the truth on this one to the Nth degree. How about a reference to this point.

You guys simply do not get it. You cannot possibly treat a patient with medication and expect that you will be able to understand the potential complications. Any PsychD that can say they have treated and understand the complications I listed above is not only lying, but is also holding a thick medical reference book in their lap as they type!! Bottom line, the only way a PsychD could be made capable of prescribing safely even under supervision would be to complete a minimum of 2 years of post PsychD training to include 2 full semesters of complete pharmacology to include all drugs, not just psychotropic drugs, as well as biochem, pathophysiology, microbiology, and do at least one year of supervised clinical training. Anything less is taking the short cut and puts patients at risk, and if you can't see this, then you are blind.
 
I think the blind part is not realizing that this is what we have been saying all along. Please read before you respond with such animosity and ignorance. I was called to the acute care portion of our hospital by the attending there for a consult along with the psychiatrist I work with. The problem was clear to both of us when we saw the patient and the record..withdrawl dyskinesias. The attending internal med doc did not know you can get this when 20 mg of Olanzapine is abruptly withdrawn!!! We all have limits, as they should have taught you well in med school, and we all need to be appropriately trained to do what we do...this is not an argument with anyone psych or MD. :sleep:
 
psisci said:
I think the blind part is not realizing that this is what we have been saying all along. Please read before you respond with such animosity and ignorance. I was called to the acute care portion of our hospital by the attending there for a consult along with the psychiatrist I work with. The problem was clear to both of us when we saw the patient and the record..withdrawl dyskinesias. The attending internal med doc did not know you can get this when 20 mg of Olanzapine is abruptly withdrawn!!! We all have limits, as they should have taught you well in med school, and we all need to be appropriately trained to do what we do...this is not an argument with anyone psych or MD. :sleep:

I have been kind up until now. Gloves off jerk!! Bottom line is, you PsychD's looking for script priviledges are nothing more than glorified liberal arts professors. At least my English prof back in the day wasn't trying to get script privs!! You will always be looking up the ass end at psychiatrists, like it or not. And don't try and tell me that the training that the PsychD's in New Mexico got is anywhere near that what I outlined previously. Truth is, you guys aren't even allied health providers. Yeh I am sure you got all teary eyed when you showed up the internist, but semething tells me that the internist knows a great deal about a lot, while you might know a little about a little. The argument here is not whether an internist should be prescribing psychotropics, but whether or not YOU should. Most internists are smart enough to stay out of that arena. Botton line----nuttin but wannabes!!
 
psisci said:
I see, you are not a doctor yet.......

:)

True. I will be next year, and you never will be. You will just be "playing one on television" professor. Funny though, I have years of prescribing these meds, so you want to start a war of titles? Wannabe!!
 
It seems as though whenever a non-physician allied health provider attempts to gain Rx privileges, the physician organizations oppose on the basis of safety...fair enough. However, a trend has begun to emerge that points to the conclusion that non-physicians are not necessarily unqualified or incompetent prescribers. Physicians opposed NPs, ODs, and PharmD's prescribing and no study has shown that with these practioners prescribing that quality of care has diminished. I do not know for sure but I imagine that physicians also opposed DPMs prescriptive authority and they too has not been shown to be hazardous. PsyDs are now trying to pursue a similar extension of scope within their own area and the same unfounded arguement persists. Of course a physcian prescriber is more proficent in the medical sciences; however, how often would this difference require the additional medical skills of the physician? Do not give me emotionally-charged anecdotal support of the neccesity of the additional medical expertise of the physician because it carries no weight. Anecdotal evidence is about as scientific as psychic hotline predictions. A study would need to be conducted using mock patients and having each practitioner assess and offer analysis and course of action for the situation. With a large enough sample size, statistical significance, effect size, etc. could yield useful information pertaining to the relevancy of proported differences in competency.
 
chicoborja said:
It seems as though whenever a non-physician allied health provider attempts to gain Rx privileges, the physician organizations oppose on the basis of safety...fair enough. However, a trend has begun to emerge that points to the conclusion that non-physicians are not necessarily unqualified or incompetent prescribers. Physicians opposed NPs, ODs, and PharmD's prescribing and no study has shown that with these practioners prescribing that quality of care has diminished. I do not know for sure but I imagine that physicians also opposed DPMs prescriptive authority and they too has not been shown to be hazardous. PsyDs are now trying to pursue a similar extension of scope within their own area and the same unfounded arguement persists. Of course a physcian prescriber is more proficent in the medical sciences; however, how often would this difference require the additional medical skills of the physician? Do not give me emotionally-charged anecdotal support of the neccesity of the additional medical expertise of the physician because it carries no weight. Anecdotal evidence is about as scientific as psychic hotline predictions. A study would need to be conducted using mock patients and having each practitioner assess and offer analysis and course of action for the situation. With a large enough sample size, statistical significance, effect size, etc. could yield useful information pertaining to the relevancy of proported differences in competency.

OD's, DO's, MD's, PA's, DPM's, and even NP's, all have one thing in common. They are all trained professionals with studies based in PHYSICAL SCIENCES. A PsychD could perhaps never have even taken biology, chemistry, organic, physics!!! How the hell can you prescibe meds when you have never even taken bio 101. So yes, in addition to my previous course requirements I listed, add bio and gen chem to the list of courses a PsychD will need to be able to prescribe. How can you expect to understand receptor physiology in pharmacology when you have never even drawn a carbon skeleton. You guys are a bunch of wannabes!!!
 
I see, you are not a doctor yet.......

No but I am, and I'll second his comments.

I certainly can see why PsyDs want script rights - in many places it is very hard to get into see a Psych for scripts and no doubt it fragments care to add another care giver, but the medical side of psychotropics are so complex and effect ALL areas of physiology that you really need to be competent to evaluate and treat all those areas if you are going to be giving them. Personally I don't think that professionals other than MD/DOs or experienced PAs or NPs have that level of experience to prescribe them without direct medical supervision. What the PsyD profession is asking us to accept is akin to setting a MS3 loose to prescribe psychotropics without supervision, except that the MS3 has a lot more preclinical training.
 
Of course a physcian prescriber is more proficent in the medical sciences; however, how often would this difference require the additional medical skills of the physician?

In my (limited) experience, often.

As far as literature is concerned, AFAIK there is little supporting either side. As far as medical knowledge is concerned, we all know that psychotropics, even when properly prescribed, can cause fatal complications and are among the most deadly drugs in overdose. Therefore I would say the burden is on PsyDs to show that they can do this safely. So far no one is buying it (at least here). The only evidence I have seen cited is a reference (without any data) to 10 prescribers in the military where a) the numbers are likely to be small (since some of these illnesses have incidences in the 1000's you would need a large sample to demonstrate safety), and the population different from the general population.
 
PACtoDOC said:
True. I will be next year, and you never will be. You will just be "playing one on television" professor. Funny though, I have years of prescribing these meds, so you want to start a war of titles? Wannabe!!

Perhaps you should educate yourself a little more about other fields (psychology education) instead of just excessive nonfactual talking. I, as a 2nd yr. PsyD student, was required to take numerous ?hard science? classes during my undergrad and I am expected to take more in my PsyD program plus a post doctorate masters degree in psychopharmacology (RxP). But you (Pactodoc) do not bother to educate yourself because your just assuming that other people will take your word as a fact due to your higher education. I am frankly concerned for the safety of your future patients that is if you ever get to see any.

Let us help you become educated on psychology if you want but you should act more like a professional and just stop the propaganda.

You say that we are a few wannabe doctors but I think you?re a wannabe intellectual. :laugh:
 
PsyDRxPnow said:
Perhaps you should educate yourself a little more about other fields (psychology education) instead of just excessive nonfactual talking. I, as a 2nd yr. PsyD student, was required to take numerous ?hard science? classes during my undergrad and I am expected to take more in my PsyD program plus a post doctorate masters degree in psychopharmacology (RxP). But you (Pactodoc) do not bother to educate yourself because your just assuming that other people will take your word as a fact due to your higher education. I am frankly concerned for the safety of your future patients that is if you ever get to see any.

Let us help you become educated on psychology if you want but you should act more like a professional and just stop the propaganda.

You say that we are a few wannabe doctors but I think you?re a wannabe intellectual. :laugh:

Your the one passing on the rhetoric and propaganda!! Show me a curriculum that is standardized amond the pyschology profession where ALL undergrad and graduate Psych majors are required to take hardcore sciences!!

I have many a friend who got their degree in undergrad psychology and never had to take a hardcore science one. The distinction is between the BS versus the BA in psychology, and it is not standardized to ANY degree. So what that you took a few hardcore sciences. There are PLENTY of PsychD's around the country that have never taken A&P even at an undergrad level, never taken bio, or gen chem, or organic chem, or physics. Show me ANY Physician from a Derm to an OBGYN, and even a Podiatrist or an Optometrist, and I will confidently point to them as a person who has indeed been REQUIRED to take these courses!!!!! Don't try and relate your experience as a zebra on the entire pack of horses running beside you!!! When there is a standardized PHYSICAL SCIENCE based curriculum for ALL PsychD's to go through prior to prescribing, then I doubt the AMA and all other physician organizations will step in your way to prescribe. But until then, we will all protect our patients from dangerous people like you who think that you have the right to manipulate a system that has been in place for decades. No one has ever successfully fought the AMA at this level and achieved success, and you guys will not be the first I can promise you. You may have attained small victories in few states, but the war will be fought nationwide, and you will eventually either have to seriously STANDARDIZE a curriculum that incudes what I have outlined, or you will simply continue to be sofa therapists!!

There are no shortcuts to practicing medicine.....remember that!!!
 
I'm going to let you neurotic PsychD's continue on your way to crazy. However, I am hopeful that PsyDRxPnow and Psisci will someday open there eyes to a more panoramic view of medicine. It really is a beautiful thing, but it?s hard to see without medical training. In the mean time, keep me posted on how many of these uninformed evil dragons who attend medical school your able to slay. :thumbup: Psisci started this thread asking what others thought about Psych's with scrip rights. Apparently it was a rhetorical question he intended to answer for us. Thank-you, Thank-you very much. Lawguil
 
You guys really get fired up about this!! As I stated early on in this forum, I am also a psych NP.

:)
 
PACtoDOC said:
Your the one passing on the rhetoric and propaganda!! Show me a curriculum that is standardized amond the pyschology profession where ALL undergrad and graduate Psych majors are required to take hardcore sciences!!

I have many a friend who got their degree in undergrad psychology and never had to take a hardcore science one. The distinction is between the BS versus the BA in psychology, and it is not standardized to ANY degree. So what that you took a few hardcore sciences. There are PLENTY of PsychD's around the country that have never taken A&P even at an undergrad level, never taken bio, or gen chem, or organic chem, or physics. Show me ANY Physician from a Derm to an OBGYN, and even a Podiatrist or an Optometrist, and I will confidently point to them as a person who has indeed been REQUIRED to take these courses!!!!! Don't try and relate your experience as a zebra on the entire pack of horses running beside you!!! When there is a standardized PHYSICAL SCIENCE based curriculum for ALL PsychD's to go through prior to prescribing, then I doubt the AMA and all other physician organizations will step in your way to prescribe. But until then, we will all protect our patients from dangerous people like you who think that you have the right to manipulate a system that has been in place for decades. No one has ever successfully fought the AMA at this level and achieved success, and you guys will not be the first I can promise you. You may have attained small victories in few states, but the war will be fought nationwide, and you will eventually either have to seriously STANDARDIZE a curriculum that incudes what I have outlined, or you will simply continue to be sofa therapists!!

There are no shortcuts to practicing medicine.....remember that!!!

I will not perform the searching for you do your own work. I am not sure if all undergrad psych programs are unified in their course work or not therefore, I will not presume to discuss it.

Show me ? Podiatrist or an Optometrist, and I will confidently point to them as a person who has indeed been REQUIRED to take these courses!!!!!?

You now presume to be accepting towards non-MD?s regarding prescribing and respecting them but yet the AMA was and is very reluctant in providing them with prescription and other procedural rights (perhaps your just trying to make a point and don?t care to be realistic).

Have you ever wondered why other psychiatrists and MD are in favor of RxP (e.g. http://forums.studentdoctor.net/showthread.php?t=118082&page=22&pp=20; http://www.apa.org/about/division/dialogue/MayJune04pract.html, ) perhaps that psychologists are making a valid argument for RxP.,

In regards to your comments regarding sofa therapist, that?s actually on psychiatrists since we all know that Sigmund Freud, MD was the founder and primary user of psychoanalysis on a couch.

?No one has ever successfully fought the AMA at this level and achieved success, and you guys will not be the first I can promise you?. Apparently, you are in denial of RxP progress. As for myself, there is no gain without pain therefore, I will continue to advocate for the better treatment and respect for my patients (RxP).

I would now like to discontinue this argument at this form to let the Allied Health people have their form back for their own issues and concerns. You want to carry this further bring it to the PhD/PsyD forum.
 
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