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Illinois becomes third state to allow psychologists to prescribe medication (limited rights). What is your opinion? Do you think this will spread to other states?
Illinois becomes third state to allow psychologists to prescribe medication (limited rights). What is your opinion? Do you think this will spread to other states?
A compromise was reached this spring, and the resulting measure requires psychologists to undergo extensive training and work under the supervision of a physician. They’ll only be permitted to prescribe a limited class of drugs and will be prohibited from writing prescriptions for minors, seniors or any patient with a serious mental condition.
“We have to make sure people across Illinois can be properly cared for by a medical professional they know and trust,” Quinn said in a statement. “If someone needs help and lives on a budget, they shouldn’t have to make multiple appointments or travel far and wide to get a prescription.”
Illinois joins New Mexico and Louisiana in granting the right to prescribe to psychologists.
Under the new law, psychologists could earn prescription rights after they have completed 2-1/2 years of additional, postdoctoral training, with course work requirements including graduate-level instruction in numerous areas such as neuroscience and psychopharmacology. In addition, training would require that psychologists treat a minimum of 100 patients under the supervision of a qualified medical practitioner, according to the legislation. Psychologists would be able to prescribe antidepressants, such as Prozac, but not stimulants, such as Ritalin, commonly used for attention deficit disorder. http://www.chicagotribune.com/news/...ist-prescription-bill-20140624,0,953771.story
Who's to say it will be a greatly discounted price?Here's a recent excerpt of what I though about it in the "competitiveness" thread... figure it is relevant here to:
As an employer, you have someone that is presumably well-versed in therapy and can also do basic meds...at a greatly discounted price...sounds like a good deal for the employing psychiatric practice. If you are a psychiatrist looking for an employed position youself, it might be a neutral development at best -- this will not help your cause.
If these are states with high malpractice claim ceilings, I would think just a few avoidable bad outcomes from psychology prescribing would drive up the malpractice coverage rather severely. If not, and psychologists are doing meds as safely as we do meds, maybe we should let them do it.
The way I see it, psychologists are better at therapy and not as good with meds. We are better at meds and not so good (with exceptions of course) at therapy, or at least less trained. Patients put their faith more in one or the other camp. If they believe in medication as their solution and they are not getting better under a psychologist, they will come to us if they can.
Who's to say it will be a greatly discounted price?
As an employer, you come up with the initial salary offer...given enough time and with a large enough net you can almost always find an employee eager enough to fill a position.
Heck, take the popular, cynical psychiatrist on this forum. Didn't he say he had (chose?) to accept a job offer that only paid 100k. I'd say that is greatly discounted already.
I did but that unfortunately didn't work out. It turns out that the owner of the practice wasn't going to let me practice 'my way' exclusively....which I get it's his practice and money and all.
I'm sorry to hear they switched stuff around on you like that. Are you back to looking or have you already found an alternative?
Oh no I found an alternative. It will give me enough time to hopefully pursue what I really want to do(real estate).
Oh no I found an alternative. It will give me enough time to hopefully pursue what I really want to do(real estate).
Well that's awesome if you are getting to pursue a dream (or something at least closer to a dream).
Are you thinking single family homes? Multi-unit facilities? Business properties?
Are you going to try to mindf**k people into buying/renting your properties? Or just take them to a gentleman's club?
Well I've already dabbled in single-family homes a little...so I'm just going to expand what I've done there. But eventually yeah....I want to grow out and do all of that.
As an employer, you come up with the initial salary offer...given enough time and with a large enough net you can almost always find an employee eager enough to fill a position.
Heck, take the popular, cynical psychiatrist on this forum. Didn't he say he had (chose?) to accept a job offer that only paid 100k. I'd say that is greatly discounted already.
If I am an enterprising psychiatrist looking to build up my practice, when it comes to hiring staff (that can prescribe) I can either go with a psychiatrist, a nurse practitioner, or a prescribing psychologist.
If you are looking to get people to respond to a job listing for 100k, I'd bet that the latter two would be more likely to reply to the listing than the psychiatrist that can go easily elsewhere for 150k+.
Assuming that the prescribing psychologist is well-trained, I would prob rather have one of those than a nurse practicioner employed at my practice (when it comes to personal philosophy).
It will take time to figure out who is good when it comes to midlevels. I prefer to get a good night's sleep and do not hire any. Illinois malpractice climate is such that I only take responsibility for myself.
Can't wait for one of the old timers to say "there are plenty of psychiatry patients around" when hearing this news,.
there are....the problem is that a ton of psych nps doing the same thing drives down the prices hospital systems, community mental health centers, etc have to pay us to treat them.
Can't wait for one of the old timers to say "there are plenty of psychiatry patients around" when hearing this news, while they already have one foot out the door. You guys know who you are.
Damn, medicine is going down the ****ters quicker than I have imagined...
Yes we do, and 30 years ago I was saying things just like you. Didn't happen though....
Exactly. Psych services are becoming a commodity and may very well be the next primary care/anesthesiology in terms of midlevel encroachment.
well if I made anesthesia dollars(even now) I'd be more than happy.
Can't wait for one of the old timers to say "there are plenty of psychiatry patients around" when hearing this news, while they already have one foot out the door. You guys know who you are.
Damn, medicine is going down the ****ters quicker than I have imagined...
Here's what the psychologists in Illinois think of this law:
From: Marlin Hoover <[email protected] /* */ >
Date: May 30, 2014 at 3:18:23 PM CDT
To: [email protected] /* */
Subject: [IPA-SERVE] My thoughts about our prescriptive authority bill.
While the bill is still being passed in Illinois, I want to add my perspective on what this bill may achieve. For those who do not know who I am, I’m a prescribing psychologist in New Mexico and past president of the Illinois Psychological Association and past chair of the RxP committee for Illinois. I did not negotiate this bill. I was “consulted” from time to time, and lobbied when asked and did a couple media interviews on behalf of the IPA and this legislation.
1. The bill is not all, nor nearly all that I hoped for. What I hoped for was not possible and what has been negotiated is the best that could be done at this time. It was not a choice between this compromised bill and “something better.” Rather, it creates the right to prescribe for some psychologists for some needy patients rather than no psychologists prescribing for any patients.
2. The bill will enable some (not all) psychologists with RxP training to prescribe from a limited formulary to subsets of the people of Illinois, many of whom are badly in need of services.
3. The bill establishes a precedent that it is possible that a very medicalized populous state can permit some RxP psychologists to prescribe safely. Other states can argue now that “it is permissible in Illinois and the history of safe prescribing in New Mexico, Louisiana, the military and the HIS as well as Illinois shows that the Illinois bill may be too stringent.
4. There is no record of additional states passing legislation within the last 10 years so this advances RxP. Compared to our fantasy about what “should be” it is inferior, but compared to the reality that NO state has passed RxP legislation in the last 10 years it is superior.
5. The current bar against prescribing for children and the elderly parallels the training in psychiatry where the “state of the art” is to get additional sub-specialty training in Child and Adolescent or Geropsychiatry beyond the generalist training. It simply doesn’t have the “tracks” for C & A or Gero (yet we hope).
6. The barring of the prescribing of benzodiazepines will keep RxP’s on the “best practice” course of utilizing psychotherapeutic (behavioral) techniques to treat anxiety disorders in conjunction with SSRI’s when appropriate and keep us from an easy and addictive reliance on BZ medications that is what medicine has fallen prey to. I spend a lot of time taking people off those BZ’s when they should have had non-Rx treatment in the first place. I refused BZ’s in every patient who asked me for them yesterday because they were not in the patient’s best long term interest.
7. Barring of stimulants appears related to a controversy regarding simulant use in children. This is unfortunate but child psychologists have been dealing with not being able to prescribe these for a long time, obtaining the needed Rx’s from pediatricians and child psychiatrists.
8. The bill bars RxP’s from prescribing for the most vulnerable patients. Inadvertently this will protect us as we continue the tradition of being “safe” prescribers which will provide evidence for the expansion of the scope of the practice. For instance: I would rather not prescribe for a pregnant woman; I never do it here without the consent of the OB/Gyne or FP and the woman and then only after truly informed consent. I would just as soon have the OB/Gyne or a psychiatrist take over at that point.
9. The bill PERMITS some RxP’s to treat some very important segments of the population who are otherwise free of “serious medical illnesses.” Think of one of the neediest groups, veterans of the last decade of military service who are in great need; university students; young adults and middle aged adults suffering the stresses and strains of life for whom depression and anxiety may be debilitating conditions as well as young “trying to launch” adults with serious mental illnesses who have not yet lived long enough to accumulate serious medical illnesses.
10. The bill PERMITS RxP’s to be principal investigators in RCT’s including psychopharmacological and psychological interventions. It is my opinion that only when RxP’s can “control” the research will the literature give a balanced view of the benefits and limits of Rx compared to psychological treatments. The literature, at this time, is so biased (in my view) in the direction of Rx treatments in general that it has led to an overreliance on Rx rather than psychological interventions. The bill permits psychologists to do research with the primary population of people who can be, by IRB usual standards, subjects (i.e. healthy, age of consent, adults without medical illnesses). This, if it happens, will be tremendous boost to the treatment of mental disorders.
11. The bill PERMITS psychologists to treat a segment of the population, thus freeing psychiatrists to focus on populations where their additional medical training may have the most value. It may bring closer collaboration between psychiatrists and psychologists to the benefit of both through the collaborative agreements and lead to sensible specialization based on training.
12. It is my opinion that without this bills passage, the movement for RxP was essentially “dead.” This bill establishes a precedent that will permit some RxP’s in any state that passes similar legislation to get started and then, based on experience, expand the scope of practice over time.
13. Harder work on the part of the Illinois Psychological Association would not have produced a better bill. This was a maximally energized, maximally funded, maximally ingenious campaign fought against the biggest obstacles in the nation (except maybe New York where it might be harder). This is simply the best that could be done.
14. If you, in your consideration of the bill, think the team “missed something” I suggest that it is maximally unlikely that the team, led by Beth Rom-Rymer did not also think of it, consider it, or try it. Try to avoid the tendency to “Monday morning quarterback” what was done. I am offering this unsolicited advice as a prescribing psychologist who would love to be able to gain prescriptive authority in Illinois in addition to New Mexico but who probably does not qualify under this bill. RxP’s with my training can practice in Louisiana, New Mexico, the military and the HIS. They ARE needed in those states and services. Or, they can get whatever additional training they need to prescribe in Illinois. Additionally, they may need to wait until there is an increase in the scope of practice and in the training regulations in Illinois.
Respectfully Submitted by Marlin Hoover.
On Fri, May 30, 2014 at 12:00 PM, Michael Tilus < [email protected] /* */ > wrote:
Thanks for the call Marlin. I've fielded 11 calls today, all from practitioners, who are essentially seeing the IL RxP bill as a 'total loss' to the national RxP objectives; indentured servanthood; and ultimately a 'political decision', for 'Beth', but a lhuge oss for practice and a massive step backwards.
Not sure if you are willing, but it may be useful to have your points thrown out in the Div 55 list serve as counter punches...
I'm personally chewing on your optimism.. as I personally feel extremely disillusioned with what I perceive was given up for what we got....
I'm not discussing my opinion openly with anyone... outside you... but with so much traffic, I think your voice might be received on the list.
My biased opinion of course...
M
--
They say it is "indentured servanthood". I take great offense to that comment.
Yup. Better get out while you can. Make sure the door doesn't hit you.
Thanks for sharing.
Exactly. Psych services are becoming a commodity and may very well be the next primary care/anesthesiology in terms of midlevel encroachment.
Couple thoughts...
Medicine unfortunately is a commodity in general.
Physicians can be replaced in hospitals, albeit some specialties harder than others.
Hell, head over to the derm forum and check out the Derm PA thread...now that is some heavy propaganda.
RxP’s aren't technically midlevels...rather a different career track entirely (ie terminal academic degree) within the same sector (mental health) as psychiatrists (ie terminal professional degree).
I agree. But just because it's becoming a trend for most specialties (I don't see surgery having encroachment any time soon), doesn't mean you should freely allow it to happen and be so indifferent about it.
Maybe they don't see it as such a bad thing and maybe there is room for psychiatrists and psychologists to work together coming from two different perspectives. Or maybe we fight each other while the mid-levels take over all of our business. Don't think for a minute that we aren't concerned about the proliferation of Master's level "therapists".I agree. But just because it's becoming a trend for most specialties (I don't see surgery having encroachment any time soon), doesn't mean you should freely allow it to happen and be so indifferent about it.
Ummm, let's compare the scope of practice of nurses 30 years ago to those of NPs and DNPs today. Yeah, that's what I thought.
http://www.nytimes.com/2014/04/30/opinion/nurses-are-not-doctors.html?_r=0
I bet back in the day they can prescribe without physician supervision huh. It's so damn easy for you to say **** like that now that you've already collected millions, not giving a crap about the future generation of physicians.
I was never in it to begin with. I really was interested in psych but that may change seeing as how most seniors are gutless. It is a shame to see the field headed where it seems to be heading now with all its potential for doing good.
All I can say is that if I do end up going into psych, I'll fight for the profession and not be a pansy about it.
Yeah, something will come of it, the law well pass then increase in scope soon after till parity exists. Of course the same thing will start happening in every state as well. Eventually they will have same scope of practice all over. Precedence exists now.Let's please keep things civil here.
While I am not happy about this new law as well, I know of dozens of psychiatrists that fought hard against it passing. It failed multiple legislations before getting passed in this restrictive format. Physicians are lobbying against it still, and hopefully something will come of it.
Yeah, something will come of it, the law well pass then increase in scope soon after till parity exists. Of course the same thing will start happening in every state as well. Eventually they will have same scope of practice all over. Precedence exists now.
What will it mean?I don't know.
I was never in it to begin with. I really was interested in psych but that may change seeing as how most seniors are gutless. It is a shame to see the field headed where it seems to be heading now with all its potential for doing good.
All I can say is that if I do end up going into psych, I'll fight for the profession and not be a pansy about it.
I imagine he means the precedent of a more populous state. I read somewhere that New Jersey is close to passing this, as well.I don't know all the intricacies... what precedent is set by this bill that wasn't set 10 years ago by New Mexico and Louisiana (other than being recent)?
My point is that the sky was supposedly falling in the 80s with the introduction of managed care. Everyone has been predicting the demise of medicine as a respected career and safe income choice for so long, it should have died a thousand times by now. In psychiatry specifically, we were complaining about MFCCs (now MFTs), LCSWs, psychologists, drug counselors as threatening our jobs.
With all due respect...Didnt they? The therapy market is completely saturated... I have not had a single patient that wanted to come in strictly for therapy because they felt they needed an expert with an MD trained in Psychiatry.
I am all for greater access to care. However, in my opinion, this will just further erode Psychiatry's financial competitiveness as a medical specialty. We are already hanging out at the bottom justifying our lower incomes by tweaking numbers ".
Yeah, something will come of it, the law well pass then increase in scope soon after till parity exists. Of course the same thing will start happening in every state as well. Eventually they will have same scope of practice all over. Precedence exists now.
What will it mean?I don't know.
My opinion is if a NP can prescribe without a doctor hovering around then a psychologist who has done 4 years of undergrad , 5 years to get there PHD and then continue on to do a course in pharmacology is more than ready to prescribe. I don't think it's a very good idea for NP's or psychologists to prescribe but times are changing. I would see a regular doctor anyday over a NP sorry I just don't trust someone with that little experience . I live in Illinois btw.
I'm sure the entry of other professions into psychiatry isn't going to help salaries, but I would be fairly surprised if it hurt them to the point where the ratio of psychiatry's average salary compared to other medical specialties became worse than it is currently seeing as many other specialties are getting a lot more salary cynicism from the general public compared to psych, so would be much more surprising to see psych salaries take a big hit compared to others. (Although the others would still obviously make more than psych)
From a more philosophical standpoint I kind of like the idea of opening up various aspects of medicine to others because I think it puts more pressure on physicians as a whole to actually strive to be the best as opposed to just meeting some minimum standard of practice that allows us to continue to indefinitely reap the benefits of our monopoly.
With all due respect...Didnt they? The therapy market is completely saturated... I have not had a single patient that wanted to come in strictly for therapy because they felt they needed an expert with an MD trained in Psychiatry.
.
Regarding who gets the best training: Psychiatrists vs. Psychologists. I did not go to an Ivy league residency but we received top notch training from attending who graduated from Yale who's father was also a psychoanalyst. The psychologists at my program didn't get nearly the amount of therapy training that we did. The only difference I see is that these psychologists go out and do therapy and we don't so they are "better".
Striving for your best doesn't mean anything in the eyes of policy makers and hospital administrators. If they can get away with having someone marginally care for a patient in order to save money, they will.