Oregon House Bill 2702 coming out of State Senate Committee for a full vote

[zihuatanejo]

As I have indicated in a previous thread, I emailed all of the Oregon State Senators to register my opposition to Oregon House Bill 2702, which had recently passed the Oregon State House earlier this month and would give independent prescriptive authority to psychologists. I used the sample letter provided by Bluemirage as my template. To my surprise, I ended up engaging in a spirited discussion through email with one of the Oregon State Senators, who apparently represents a largely rural district in eastern Oregon and thus appears to be in favor of psychologists getting independent prescriptive authority based on the tenor of his responses.

Today, I received an email from a legislative aide to another Oregon State Senator indicating that HB 2702, which is the bill allowing independent prescriptive authority for psychologists, will likely come out of the Senate Committee and to the full Senate soon for a vote. I would urge all of you opposed to this legislation to email the Oregon State Senators before they vote on this legislation and to do it ASAP. I have attached the sample letter provided originally by Bluemirage, which you can use as a template when emailing the Oregon State Senators. I have also included below the names of the leaders of the Oregon State Senate, a list of all thirty Oregon State Senators, and their email addresses and other contact information.


Senate Leadership:
Senate President Peter Courtney - (D-Salem/Gervais/Woodburn)
Senate President Pro Tempore Senator Rick Metsger - (D-Welches)
Senate Majority Leader Senator Richard Devlin - (D-Tualatin)
Senate Republican Leader Senator Ted Ferrioli - (R-John Day)



Oregon State Senators

Below is a list of Oregon State Senators. Click on a senator name to find contact information including capitol/interim address, phone, fax, email, and web page addresses

Jason Atkinson-R
Alan C Bates-D
Suzanne Bonamici-D
Brian Boquist-R
Ginny Burdick-D
Margaret Carter-D
Peter Courtney-D
Richard Devlin-D
Jackie Dingfelder-D
Ted Ferrioli-R
Larry George-R
Fred Girod-R
Mark Hass-D
Betsy Johnson-D
Jeff Kruse-R
Rick Metsger-D
Laurie Monnes Anderson-D
Rod Monroe-D
Bill Morrisette-D
Frank Morse-R
David Nelson-R
Floyd Prozanski-D
Diane Rosenbaum-D
Martha Schrader-D
Bruce Starr-R
Chris Telfer-R
Joanne Verger-D
Vicki L Walker-D
Doug Whitsett-R
Jackie Winters-R



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Senator Jason Atkinson Back to Top
Party: R District: 2
Capitol Phone: 503-986-1702
Interim Phone: 541-955-0911
Capitol Address: 900 Court St. NE., S-415, Salem, OR, 97301
Interim Address: PO Box 1704, Grants Pass, OR, 97528
Email: [email protected]
Website: http://www.leg.state.or.us/atkinson

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Senator Alan C Bates Back to Top
Party: D District: 3
Capitol Phone: 503-986-1703
Capitol Address: 900 Court St. NE., S-205, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/bates

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Senator Suzanne Bonamici Back to Top
Party: D District: 17
Capitol Phone: 503-986-1717
District Phone: 503-627-0246
Capitol Address: 900 Court St. NE, S-403, Salem, OR, 97301
District Office Address: PO Box 990, Beaverton, OR, 97075
Email: [email protected]
Website: http://www.leg.state.or.us/bonamici

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Senator Brian Boquist Back to Top
Party: R District: 12
Capitol Phone: 503-986-1712
Capitol Address: 900 Court St NE, S-305, Salem,, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/boquist

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Senator Ginny Burdick Back to Top
Party: D District: 18
Capitol Phone: 503-986-1718
Capitol Address: 900 Court St. NE., S-213, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/burdick

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Senator Margaret Carter Back to Top
Party: D District: 22
Capitol Phone: 503-986-1722
Interim Phone: 503-282-6846
Capitol Address: 900 Court St. NE., S-209, Salem, OR, 97301
Interim Address: PO Box 3722, Portland, OR, 97208
Email: [email protected]
Website: http://www.leg.state.or.us/carter

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Senator Peter Courtney Back to Top
Party: D District: 11
Capitol Phone: 503-986-1600
Capitol Address: 900 Court St. NE., S-201, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/senate/senpres

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Senator Richard Devlin Back to Top
Party: D District: 19
Capitol Phone: 503-986-1700
Capitol Address: 900 Court St. NE., S-223, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/devlin

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Senator Jackie Dingfelder Back to Top
Party: D District: 23
Capitol Phone: 503-986-1723
Interim Phone: 503-493-2804
Capitol Address: 900 Court St. NE., S-407, Salem, OR, 97301
Interim Address: PO Box 13432, Portland, OR, 97213
Email: [email protected]
Website: http://www.leg.state.or.us/dingfelder

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Senator Ted Ferrioli Back to Top
Party: R District: 30
Capitol Phone: 503-986-1950
Capitol Address: 900 Court St. NE., S-323, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/ferrioli

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Senator Larry George Back to Top
Party: R District: 13
Capitol Phone: 503-986-1713
Capitol Address: 900 Court St. NE, S-307, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/georgel

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Senator Fred Girod Back to Top
Party: R District: 9
Capitol Phone: 503-986-1709
Capitol Address: 900 Court St. NE, S-421, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/girod

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Senator Mark Hass Back to Top
Party: D District: 14
Capitol Phone: 503-986-1714
District Phone: 503-641-2742
Capitol Address: 900 Court St. NE., S-419, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/hass

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Senator Betsy Johnson Back to Top
Party: D District: 16
Capitol Phone: 503-986-1716
Capitol Address: 900 Court St. NE., S-215, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/johnson

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Senator Jeff Kruse Back to Top
Party: R District: 1
Capitol Phone: 503-986-1701
Interim Phone: 541-673-7201
Capitol Address: 900 Court St. NE., S-316, Salem, OR, 97301
Interim Address: 636 Wild Iris Lane, Roseburg, OR, 97470
Email: [email protected]
Website: http://www.leg.state.or.us/kruse

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Senator Rick Metsger Back to Top
Party: D District: 26
Capitol Phone: 503-986-1726
Capitol Address: 900 Court St. NE., S-315, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/metsger

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Senator Laurie Monnes Anderson Back to Top
Party: D District: 25
Capitol Phone: 503-986-1725
Interim Phone: 503-618-3071
Capitol Address: 900 Court St. NE., S-413, Salem, OR, 97301
Interim Address: PO Box 1531 , Gresham, OR, 97030
Email: [email protected]
Website: http://www.leg.state.or.us/monnesanderson

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Senator Rod Monroe Back to Top
Party: D District: 24
Capitol Phone: 503-986-1724
Capitol Address: 900 Court St. NE, S-409, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/monroe

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Senator Bill Morrisette Back to Top
Party: D District: 6
Capitol Phone: 503-986-1706
Capitol Address: 900 Court St. NE., S-207, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/morrisette

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Senator Frank Morse Back to Top
Party: R District: 8
Capitol Phone: 503-986-1708
Capitol Address: 900 Court St. NE., S-311, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/morse

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Senator David Nelson Back to Top
Party: R District: 29
Capitol Phone: 503-986-1729
Interim Phone: 541-278-2332
Capitol Address: 900 Court St. NE., S-211, Salem, OR, 97301
Interim Address: 1407 NW Horn Ave., Pendleton, OR, 97801
Email: [email protected]
Website: http://www.leg.state.or.us/nelson_david

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Senator Floyd Prozanski Back to Top
Party: D District: 4
Capitol Phone: 503-986-1704
Interim Phone: 541-342-2447
Capitol Address: 900 Court St. NE., S-417, Salem, OR, 97301
Interim Address: PO Box 11511, Eugene, OR, 97440
Email: [email protected]
Website: http://www.leg.state.or.us/prozanski

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Senator Diane Rosenbaum Back to Top
Party: D District: 21
Capitol Phone: 503-986-1721
Interim Phone: 503-231-9970
Capitol Address: 900 Court St. NE., S-405, Salem, OR, 97301
Interim Address: 1125 SE Madison St., Suite 100B, Portland, OR, 97214
Email: [email protected]
Website: http://www.leg.state.or.us/rosenbaum

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Senator Martha Schrader Back to Top
Party: D District: 20
Capitol Phone: 503-986-1720
Capitol Address: 900 Court St. NE, S-425, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/schrader

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Senator Bruce Starr Back to Top
Party: R District: 15
Capitol Phone: 503-986-1715
Capitol Address: 900 Court St. NE., S-411, Salem, OR, 97302
Email: [email protected]
Website: http://www.leg.state.or.us/starrb

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Senator Chris Telfer Back to Top
Party: R District: 27
Capitol Phone: 503-986-1727
Capitol Address: 900 Court St. NE, S-423, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/telfer

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Senator Joanne Verger Back to Top
Party: D District: 5
Capitol Phone: 503-986-1705
Interim Phone: 541-756-4140
Capitol Address: 900 Court St. NE., S-401, Salem, OR, 97301
Interim Address: 3696 Broadway PMB 344, North Bend, OR, 97459
Email: [email protected]
Website: http://www.leg.state.or.us/verger

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Senator Vicki L Walker Back to Top
Party: D District: 7
Capitol Phone: 503-986-1707
Capitol Address: 900 Court St. NE., S-309, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/walker

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Senator Doug Whitsett Back to Top
Party: R District: 28
Capitol Phone: 503-986-1728
Interim Phone: 541-882-1315
Capitol Address: 900 Court St NE., S-303, Salem, OR, 97301
Interim Address: 23131 North Poe Valley Rd., Klamath Falls, OR, 97603
Email: [email protected]
Website: http://www.leg.state.or.us/whitsett

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Senator Jackie Winters Back to Top
Party: R District: 10
Capitol Phone: 503-986-1710
Capitol Address: 900 Court St. NE., S-301, Salem, OR, 97301
Email: [email protected]
Website: http://www.leg.state.or.us/winters

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Members don't see this ad.

 

[stn2006]

will do but it's more effective if we live in Oregon. this is there reason I am debating if I will do psych residency.

 

[stn2006]

i spoke to some PA and Nurse anaesth, some are watching this movement. if successful, they also want their independence because they have more medical training than psychologists. so the ramification is enormous.

 

[peppy]

Thanks for raising awareness of this issue. I hope that if we have any board posters who live in Oregon that they will write in.

 

[MDchouette]

Check out my response from Senator David Nelson himself:

"Get a life and move to Oregon and see what the real problem is. Your comments are not well taken from [my state]. Do you want me to come and tell you how to live? Again get a life. David"

Who elects these people?

 

[Faebinder]

Check out my response from Senator David Nelson himself:

"Get a life and move to Oregon and see what the real problem is. Your comments are not well taken from [my state]. Do you want me to come and tell you how to live? Again get a life. David"

Who elects these people?

Sounds like the scientologists in Florida need to move to Oregon.

 

[whopper]

Get a life and move to Oregon and see what the real problem is. Your comments are not well taken from [my state]. Do you want me to come and tell you how to live? Again get a life. David"

Hmm, hey most of us don't live in Oregon, but then again, I'm sure this guy doesn't have medical training and therefore is as arguably clueless to the real problem too if not more.

However this is a reason why I have not chosen to write those senators. The Oregon APA (psychiatric) really ought to be addressing this issue. I can tell you when I was in the NJPA, if this issue had been brought up, it'd be a hot topic, and a lot of people would be working on it. Specific legislation had been passed based on NJPA recomendations. I'm wondering what the Oregon's PA stance on this is & what are they doing about it.

http://www.orpsych.org/index.asp

 

[Therapist4Chnge]

Check out my response from Senator David Nelson himself:

"Get a life and move to Oregon and see what the real problem is. Your comments are not well taken from [my state]. Do you want me to come and tell you how to live? Again get a life. David"

Who elects these people?

Issue aside, I'd expect more from an elected official.

 

[OldPsychDoc]

Check out my response from Senator David Nelson himself:

"Get a life and move to Oregon and see what the real problem is. Your comments are not well taken from [my state]. Do you want me to come and tell you how to live? Again get a life. David"

Who elects these people?

The people of their home districts, perhaps?

 

[Faebinder]

It's really funny cause Oregon is notorious for being one of the hardest states to get a medical license in.... they will stall and stall and stall. Fortunately I have not experienced this and at this rate will likely not need to.

 

[silas2642]

Check out my response from Senator David Nelson himself:

"Get a life and move to Oregon and see what the real problem is. Your comments are not well taken from [my state]. Do you want me to come and tell you how to live? Again get a life. David"

Who elects these people?

Charming.

 

[peppy]

Wow. That response was very unprofessional. I guess that guy has abandoned all hope of ever advancing to a national office.

 

[stn2006]

Wow, I am surprised with the undiplomatic answer, especially for a public official. I am also wondering about the PA in Oregon. I hope it is just a few isolated cases where P.As are hoping for independent prescription, but then again, nothing is absolute.

 

[notdeadyet]

Check out my response from Senator David Nelson himself:

"Get a life and move to Oregon and see what the real problem is. Your comments are not well taken from [my state]. Do you want me to come and tell you how to live? Again get a life. David"

Who elects these people?

Meh. The guy's a state senator, not a national politician. His responsibility is to the 160 households in his little district in Oregon. Not to anyone else.

Unsolicited email is spam. It's spam whether it's a penis pump, Canadian medications, or a free this-prisoner-of-the-month appeal. It's spam when a Scientologist from Idaho sends you an email about his thoughts on psychiatry and what a travesty it is. It's also spam when a psychiatrist you don't know sends you an email about what a travesty expanding prescription rights is. I get irritated when I get spam from politicians who represent me; I can only imagine that I'd get irritated as a politicain if I were to get spam from people that I don't even represent.

I fully support political involvement. Write your state representatives, senators, and govenor and express your opinion; it's their job to listen to you. If what's going on in another state irritates you, write the APA (who, unlike Senator Nelson, is supposed to represent you) and light a fire under them so that they act in Oregon, if you're so inclined.

But if you're not an Oregonian, spamming a bunch of local Oregonian politicians is not going to have the desired effect. I truly hope that my state senator File 13's every email he gets from anti-abortion OB-GYNs from Alabama when an abortion vote comes up.

 

[whopper]

I am surprised with the undiplomatic answer

My sister in law wrote a local politician, and got back a similarly immature answer.

Most people I know don't even know who their state senators are, even ones that read the paper everyday like myself. I've heard a few things here & there about local politicians throughout my life making me think they're no bigger or better than most regular people.

 

[zihuatanejo]

Meh. The guy's a state senator, not a national politician. His responsibility is to the 160 households in his little district in Oregon. Not to anyone else.

Unsolicited email is spam. It's spam whether it's a penis pump, Canadian medications, or a free this-prisoner-of-the-month appeal. It's spam when a Scientologist from Idaho sends you an email about his thoughts on psychiatry and what a travesty it is. It's also spam when a psychiatrist you don't know sends you an email about what a travesty expanding prescription rights is. I get irritated when I get spam from politicians who represent me; I can only imagine that I'd get irritated as a politicain if I were to get spam from people that I don't even represent.

I fully support political involvement. Write your state representatives, senators, and govenor and express your opinion; it's their job to listen to you. If what's going on in another state irritates you, write the APA (who, unlike Senator Nelson, is supposed to represent you) and light a fire under them so that they act in Oregon, if you're so inclined.

But if you're not an Oregonian, spamming a bunch of local Oregonian politicians is not going to have the desired effect. I truly hope that my state senator File 13's every email he gets from anti-abortion OB-GYNs from Alabama when an abortion vote comes up.

I agree that a letter or email from a constituent carries more weight. I am not an Oregon resident but I clearly stated that I had a stake in what is happening in Oregon by asserting that I was seriously considering relocating to Oregon after residency and thus have a clear interest in what is going to happen there. This legislation will also have national implications but these local politicians likely don't care about that.

Senator David Nelson is the only one who responded to my emails in a less than courteous manner. Instead of addressing my points directly, he would make generic, unhelpful, and condescending comments such as asserting that I don't see the picture or don't live in the real world without elaborating on what that means exactly. I wouldn't worry too much about him. By the way he is one of the cosponsers of HB 2702, the legislation allowing prescriptive authority for psychologists. That is not to excuse his behavior because I did get an email from a legislative aide to Senator Boquist, who along with Senator Nelson is one of the three senators sponsoring this legislation, and that email was much more professional and stated that my letter will be included in a file for Senator Boquist's reference.

In summary, don't be discouraged by the unprofessional and unstable behavior of one senator. There are twenty nine other senators in the Oregon State Senate who might be more open-minded and open to being persuaded.

 

[MDchouette]

Meh. The guy's a state senator, not a national politician. His responsibility is to the 160 households in his little district in Oregon. Not to anyone else.

Unsolicited email is spam. It's spam whether it's a penis pump, Canadian medications, or a free this-prisoner-of-the-month appeal. It's spam when a Scientologist from Idaho sends you an email about his thoughts on psychiatry and what a travesty it is. It's also spam when a psychiatrist you don't know sends you an email about what a travesty expanding prescription rights is. I get irritated when I get spam from politicians who represent me; I can only imagine that I'd get irritated as a politicain if I were to get spam from people that I don't even represent.

I fully support political involvement. Write your state representatives, senators, and govenor and express your opinion; it's their job to listen to you. If what's going on in another state irritates you, write the APA (who, unlike Senator Nelson, is supposed to represent you) and light a fire under them so that they act in Oregon, if you're so inclined.

But if you're not an Oregonian, spamming a bunch of local Oregonian politicians is not going to have the desired effect. I truly hope that my state senator File 13's every email he gets from anti-abortion OB-GYNs from Alabama when an abortion vote comes up.

Point taken. I hadn't thought about it that way. Even if his first obligation is to his constituents, I like to think that politicians care about the greater implications of their actions, and this bill certainly has a possibility to change the way that other states do mental health.

Anyway, from the tone of his email, it sounds like I would have been better off offering him the aforementioned pump...

 

[5HT2]

What is happening in Oregon right now is about much more than mental health practice. We are talking about a group of talk therapists who have never before attempted so much as biology 101 taking "prescriptive authority training" in one weekend per month online for 18 to 26 months and then practicing medicine. It's unprecedented.
Most of these folks became psychology majors to avoid science classes in college and now they are skipping to medicine.
Who is going to want to match with a psychiatry residency on the west coast now knowing that they are soon going to be legislated out of existence? Oregon legislators are replacing physician experts in mental health with one weekend per month amateurs.

Physical therapists are actually much better poised based on their science prereqs to have lobbied for prescriptive authority. Many of them now have doctoral training. Is Oregon going to tell their rehab physicians, internists, sports medicine and orthopedic docs to take a hike in favor of prescribing physical therapists next?
Are drug companies already knocking on the doors of professional organizations of other groups and offering to underwrite legislative fights to gain prescriptive authority for them also?
I actually testified in front of the Oregon senate healthcare committee against this bill and as I did so, I looked into the eyes of each of the senators and felt like I was wasting my breath. My impression was that the fix was already in. One of the authors of the bill (state congressman Bill Kennemer) has lobbied in the senate extensively for the bill. One of the most disappointing aspects of the process has been that Oregon senate healthcare committee member Alan Bates, who is an MD, sponsored the bill and thereby put politics above his professional oath.
They say that politics is a lot like sausage making in that it is best not to watch how it's done. Still, I don't think it's a bad idea for people to email Oregon senators. In fact, I'd say copy in the governor of Oregon because he has the power to veto the bill when it passes the senate. Hawaii's gov actually did this with a psychologist prescriber bill. The Oregon Governor's office contact info can be found at the link below:
http://governor.oregon.gov/Gov/contact_us.shtml

 

[Therapist4Chnge]

We are talking about a group of talk therapists who have never before attempted so much as biology 101 taking “prescriptive authority training” in one weekend per month online for 18 to 26 months and then practicing medicine. It’s unprecedented.

Most of these folks became psychology majors to avoid science classes in college and now they are skipping to medicine.

Great first post.



Some may actually prefer psychology to medicine. In my case med school was the backup plan, though thankfully I found a solid research and clinical match, so it was a moot point.

 

[5HT2]

Great first post.



Thanks. I tend to go in blazing. Perhaps I should clarify that I'm 100% behind psychology in and of itself as a discipline and believe that there are plenty of legitimate opportunities for role expansion with that profession other than treating people with drugs.
All current prescribers take science classes prior to and independent of their professional training. That goes for MD, DO, NP, PA, Aud, Pod, Dentists and even naturopaths. Attempts to circumvent that or avoid that minimum standard should be blocked in my opinion. If someone wants to practice within the scope of one of the professions listed above, that's okay, but they should join the club and take science classes with the rest of us first. Bio, chem., micro, patho, A&P and the like are viewed as so important by most professions that they actually have an expiration date and have to be retaken prior to application to a school if they are over 7 years old. Psychologists don't have to take any of those to get into psychology programs. That doesn't mean that they don't make good therapists or diagnosticians. It just means that I don't want them going near patients with prescription pads. And, I don't want boneheaded state legislators to open the door to other professions to practice beyond the safe limits of their knowledge either.

 

[stn2006]

Does anyone have any data or experience on how the prescribing psychologists effect psychiatrists and patients in Louisiana/New Mexico? From what I have read so far, it seems like there is no limit on the type of psychotropic medications. Most primary care docs that I know only touch SSRI, but I am wondering about the prescribing psychologists’ comfort zones? thank you very much and sorry for diverting from the topic a little bit.

 

[peppy]

Who is going to want to match with a psychiatry residency on the west coast now knowing that they are soon going to be legislated out of existence?

Good point. If the legislators want to do what's best for their communities, it might be worth thinking about how their decisions will influence medical professionals from other states in making the decision to become invested in the community. That could affect not just psychiatrists, but also other fields which feel vulnerable to mid-level encroachment (like anesthesia, FP, etc.)

There are definitely many intelligent and science-oriented individuals in psychology (I majored in psychology in undergrad so of course I think well of the field ). However, one problem is that even though competition to good quality psychology PhD programs is fiercer than even med school admissions, it's well known that some PsyD programs are essentially diploma mills. Do we really want those people to be able to go out there prescribing too?

 

[edieb]

So psychologists are "talk therapists" and psychiatrists are "pill pushers".........what's your point? You are NOT looking at the data: NO adverse complications have been shown when psychologists prescribe. If it does not fit, you must acquit...


It shows that all you're trying to do is protect your tenuous turf. It's so transparent that even the senators in Oregon see right through your motives. And like I told you, it is backfiring. The law is going into the Senate now and has well documented support.

Maybe I am wrong, but it seem that you don't care if people go without care. Rather, you would rather protect your turf, not a very health attitude for a helping profession. Of course if you really wanted to help people, you wouldn't be giving anti-psychotics to children , would spend longer with your patients, et cetera. However, that's another story

Great first post.



Thanks. I tend to go in blazing. Perhaps I should clarify that I’m 100% behind psychology in and of itself as a discipline and believe that there are plenty of legitimate opportunities for role expansion with that profession other than treating people with drugs.
All current prescribers take science classes prior to and independent of their professional training. That goes for MD, DO, NP, PA, Aud, Pod, Dentists and even naturopaths. Attempts to circumvent that or avoid that minimum standard should be blocked in my opinion. If someone wants to practice within the scope of one of the professions listed above, that’s okay, but they should join the club and take science classes with the rest of us first. Bio, chem., micro, patho, A&P and the like are viewed as so important by most professions that they actually have an expiration date and have to be retaken prior to application to a school if they are over 7 years old. Psychologists don’t have to take any of those to get into psychology programs. That doesn’t mean that they don’t make good therapists or diagnosticians. It just means that I don’t want them going near patients with prescription pads. And, I don’t want boneheaded state legislators to open the door to other professions to practice beyond the safe limits of their knowledge either.

 

[Doc Samson]

Double post

 

[Doc Samson]

you wouldn't be giving anti-psychotics to children

What if they're, you know, psychotic? Just let 'em hallucinate?

 

[stn2006]

Personally, I believed the training hours need to be more. Not only it would deter psychiatrists but also other primary care doctors. So in the long run, health care for Oregonians may not improve. I am comfortable with the idea of training primary care doctors to prescribe more psychotropic meds than psychologists, especially with that such minimal medical training.

 

[erg923]

I would jsut like to say that this edieb character seems to have some sort of "chip on the shoulder," "axe to grind," or something, and is not really representative of a your closest allied profession of clinical psychology. We should be working together, and even if we do feel we have we are better trained in a certain aspect of mental health care, Im not sure it is productive to throw it in the other profession's face with a "take that" kind of attitude.

 

[maranatha]

Of course if you really wanted to help people, you wouldn't be giving anti-psychotics to children

What if they are autistic or MR and can't be redirected and are hurting themselves by banging their head against the wall?

Perhpas your statement points to the difference of experience between what we see in a more medical background and your training?

 

[5HT2]

"If it does not fit, you must acquit..."

It’s completely fitting that this quote comes from one of the greatest scams in American legal history.
So if I’m not behind someone who has never taken a science class independent of a psychology program prescribing drugs after some 12 weekend per year training then I’m against patients?
I can just see Billy Flynn from “Chicago” as a lobbyist arguing in front of the legislature saying “If you care about patients, must allow these folks to bypass the training that all other prescribers take and fast track them by dvd or teleconference or internet into prescriptive authority.”
At the risk of being branded by some as “anti-patient”, I think that this will establish a poor standard against which other professions will wish to measure themselves and follow suit. This is why I urge people to help guide Oregon legislators by offering their professional opinions -even if it’s just a few polite words. I thank Zihuatanejo for the original post with legislative contact info. Get those emails out.

 

[maranatha]

It's completely fitting that this quote comes from one of the greatest scams in American legal history.

I'm glad I wasn't the only one who noted the irony in using this analogy to the topic.

 

[PsychevalIII]

What if they're, you know, psychotic? Just let 'em hallucinate?

Well….most are not psychotic though. Look at the prevalence rates. She might be talking about kids who are irritable, cranky, argumentative, and moody who get put on an atypical after a brief 90801. Then, 9 times out of 10, a weight, waist circumference, BP, fasting plasma glucose, lipid profile, etc is never done. Nice.

 

[FURY 161]

What if they're, you know, psychotic? Just let 'em hallucinate?

I doubt that he knows what is psychosis.
I think that this whole debate is pointless. Psychologists are in demand as well as psychiatrists. Even in NYC it is hard to find qualified psychologists to refer patients with specific psychotherapy needs.
The underserved areas cannot solve the problem this way, because there is not enough manpower to handle the patients. The demand is so huge that it is highly unlikely that psychologists prescibing will affect the income of psychiatrists. Yes, it is dangerous for patients to let them prescribe, but I guess in certain states this will be learned the hard way. Psychologists will be very vulnerable to lawsuits, given their limited biological training and inadequate credentialing. Moreover, this is done in states, where family physicians are also in huge demand, which means that there will be the inevitable need of knowledge of general medicine to handle the patient in a comprehensive manner and to know when to refer to a PCP or to the ER for medical work up. Once you start prescribing meds without knowing what they might interact with and be flooded with multiple somatic complaints, your anxiety level will go high if you don't know general medicine and when to worry and when not to worry about the patient. This means a lot of inappropriate referrals to the ER and the angry PCP ultimately rising the cost of healthcare. At least 50% of my general psych outpatients present with somatic complaints that I know that are psychiatric in nature and not a side effect of a medication or interaction or a medical illness, because they don't make medical sense. I have no clue how a psychologist would deal with this.
Obviously the Oregon guy is doing this out of despair. It will prove short sighted. What they need to do is to stimulate psychiatrists to move to the underserved areas in the short run. For longer term, an increase in the number of the residency slots in these areas is needed .

 

[whopper]

NO adverse complications have been shown when psychologists prescribe

Do you have any data that backs this up? I can tell you plenty of adverse complications that have happened when any medical doctor in any field prescribe.

Obviously the Oregon guy is doing this out of despair. It will prove short sighted. What they need to do is to stimulate psychiatrists to move to the underserved areas in the short run. For longer term, an increase in the number of the residency slots in these areas is needed .

You know, the funny thing is that I as a psychiatrist have never gotten any data to move to an underserved area that I was informed was such as part of an organized effort as far as I know.

This is really pathetic. I actually was considering moving to underserved areas because I felt I could do some good work, make a name for myself, while financially establishing myself well. I was actually considering moving to New Orleans because I knew they needed more psychiatrists. It came down to Tulane or U of Cincinnati for my choice fellowship. My knowledge of what was going on in NO wasn't on the part of an organized effort. I was hearing about it on the news--> not from professional organizations or the gov. I chose UC because I liked the program more, and my wife couldn't imagine us living near an orgy house on Bourbon st., though the idea of really putting myself in an area that needed my help most did weigh heavily on my mind.

APA (psychiatric), US government, the localities that are in need of more doctors--they really are doing a bad job of trying to draft more doctors to places they are needed.

A few months ago, I even put up a thread asking others about underserved areas, and did my own research on it. All the sources I was getting were badly organized & presented.

 

[ronin12]

undeserved areas are increasingly inclined to hire NP's , so don't expect dramatic bounce in salary. my recent experience was almost shocking when they were not willing to negotiate with me , at the same time they are paying psychiatrist's salary to a NP .my state is undeserved for psych .I don't believe this notion that quacks prescribing meds will not affect psychiatrists. it will definitely affect as i am witness to mid level effects on the practice of psychiatry.

 

[maranatha]

Then, 9 times out of 10, a weight, waist circumference, BP, fasting plasma glucose, lipid profile, etc is never done. Nice.

Really? "9 times out of 10" it is never done." Can you please present the study showing this as I would be interested in your source. Or is that anecdotal? If it's true that is obviously concerning. However, the two child and adolescent programs I've worked on have a standing policy that EVERY kid placed on an antipsychotic gets a basic metabolic work up. I'm skeptical that we're one of the few places that do this.

 

[Anasazi23]

Really? "9 times out of 10" it is never done." Can you please present the study showing this as I would be interested in your source. Or is that anecdotal? If it's true that is obviously concerning. However, the two child and adolescent programs I've worked on have a standing policy that EVERY kid placed on an antipsychotic gets a basic metabolic work up. I'm skeptical that we're one of the few places that do this.

Everyone admitted to any hospital gets at least basic labs, lfts, ecg, weight, full vitals, and more when they reach the floor, if not before. Again, psychologists using big words and not knowing how real medicine works. It's easy for them to read this in a textbook and think they then have the same amount of medical knowledge. The gall to actually criticize psychiatrists based on a few paragraphs that they read on the pharmacists' powerpoint in their rxp program. It would almost be like me criticizing psychologists that use computerized printouts of MMPI results and copy/paste it into their reports.

Oops, did I just let out a trade secret?

 

[Anasazi23]

Of course if you really wanted to help people, you wouldn't be giving anti-psychotics to children , would spend longer with your patients, et cetera. However, that's another story

Wait..lemme write this down: No antipsychotics to children. Gotcha.

So, I assume you're a board certified child and adolescent psychiatrist? Oh wait, you've never had primary responsibility for a psychiatric patient, nor written a prescription, nor taken a blood pressure in your life? Oh, never mind then.

You're into this farce of "accesss to care." I assume you support master's people from giving all psych tests then....you know, in order to increase access to care?

 

[JimZflam]

Honestly,

I think someone should send a link to a thread such as this to all of the legislators. Let them see the debate that is playing out. Let them follow the logic of how this will ultimately impact healthcare in the region according to the coalition of Med students, Residents and Docs talking amongst themselves. No pulling punches. Let them see the brass tacks of the matter with respect to how this issue will affect the medical profession locally and nationally, how this will impact the draw (or lack thereof) of future professionals to the region. In fact, I believe the Governor himself should read it.

 

[hereandnow]

A person should only be able to prescribe only if they are competent to prescribe.

The current agreed upon measure of competency for independent, unsupervised prescription of psychotropic medication would appear to be the psychiatry Board certification / recertification exams.

If a person can meet this competency then IMHO he/she has a reasonable case for being given prescription privileges.

Perhaps a solution would be to require aspiring medicating psychologists to pass the psychiatry Boards.

 

[whopper]

Again, psychologists using big words and not knowing how real medicine works

Anasazi, I think there's been enough posts from this individual showing data without references, and data that's been debunked, in addition to unneeded polemics. If this person really is a psychology student or grad student, he/she is not presenting his/her profession well. The other locked threat about the Oregon law had plenty of statements that were questionable, several of them not true. (Oh and by the way-I respect psychologists as a whole).

Really? "9 times out of 10" it is never done."

At the hospital I work at, its policy to do the ADA/APA approved guidelines such as weight, waist circumference, fasting glucose & lipids etc before antipsychotics are prescribed. If you don't do it, someone will catch you as there are quality control measures in place--more specifically a nurse practitioner that I highly respect that has a checklist that goes through every new patient's chart within 1 week of their admission that double checks this among several other guidelines that need to be followed (E.g. an AIMS test, for depakote the proper labs, and recheking the labs every 3 months etc).

Perhaps a solution would be to require aspiring medicating psychologists to pass the psychiatry Boards.

Although this would be a good measure, and better than the current existing Oregon law, still not enough IMHO. Remember that psychiatrists are practicing physicians, and much of the data in the psychiatry boards required previous medical training over the current Oregon laws. I'm studying for my psychiatric boards right now & there's plenty of questions on pediatric & neurological disorders that can cause psychiatric like symptoms such as Lesch Nyan Syndrome--which requires Biochemistry (not one of the required Oregon courses) to understand the biochemical pathway involved. Further several psychiatric medications can cause distinct medical side effects such as paralytic ileus, agranulocytosis, seizures, arrhythmias, hyopentension leading to loss of conciousness, etc--> all of which can be fatal. Remember, 1/3 of the exam is Neurology in addition to psychiatry--> and yes that does become important. Once in awhile in psychiatry you get someone who looks psychotic, who in fact is having meningitis, encephalopathy, 3rd stage syphillis, Wilson's Disease, Lewy Body Dementia, etc.

Shoot as much antipsychotic you want at a person with 3rd stage syphillis, its not going to get rid of that syphillis.

And despite the education provisions in the Oregon law, there's no mention (and someone correct me if I'm wrong) of the standard of their testing. For example in the USMLE--there's quality controls & research on what's considered acceptable questions, as well as statistical models to rate the validity of the test. Since a psychologist prescriber program is a new field, with a new curriculum, I'm wondering how they will create the line between who passes & who does not. New students going into the field may fall victim of testing measures not fair, or may be allowed to pass on standards far inferior to that of medical school.

 

[5HT2]

"Who elects these people?"

The people of their home districts, perhaps?

This is an excellent point. Most of the postings left on this thread would make very informative and thoughtful legislative letters or even in-person testimony. The state congress members and senators who make big scope of practice decisions are sometimes very educated, but are often ordinary people with no specialized knowledge. They may be bus drivers or own car dealerships in their off-season lives. They've been entrusted by the people to do an important job for the public. As experts, it's our duty to hold their feet to the flames now and then to see that they don't screw up that job.
If we become so apathetic that we fail to just pick up the phone and talk to one of their aids or send an email, the next stop will be chiropractors opening pain clinics. This by the way, is totally a possibility if 2702 is allowed to pass and thereby create a new minimum standard for practicing medicine. And, the chiropractors (god bless every one of them) won't be to blame for seeking prescriptive authority to write for pain meds any more than those among us in the know who never tried to protect the public by insisting that legislators uphold quality of care.

 

[whopper]

, but are often ordinary people with no specialized knowledge. They may be bus drivers or own car dealerships in their off-season lives.

Unfortunately true.

I have actually looked up a few of the politicians on the above list. This person--
Alan C Bates
Is a physician. I'd be interested in his opinion. However as I said, this really is in the Oregon Psychiatric Association's court. Anyone here care to call them up and ask them what they're doing about it? How about residency programs. Are the Oregon psychiatrists themselves actually doing their part to help their local APA chapter?

 

[stn2006]

We originally considered moving to an underserved area. However, with two huge loans compounded with the present of midlevel care competition forces to reconsider our options. If psychiatrists are to see difficult cases referred by midlevel care, would their malpractice increases?

 

[Therapist4Chnge]

Oops, did I just let out a trade secret?

No, though you did take a pot shot which I thought you were above......

 

[5HT2]

If you go to: http://www.leg.state.or.us/listn/

And click on:

"2009 session" under audio archives
"Archives of Committee Meetings from the 2009 Session"
"Health Care and Veterans' Affairs" under Senate Committees
"05/28/09 at 8:00 AM"


You can advance to the 56 min 15 sec point in the hearing if you want to hear Senator Bates' position. The Oregon Psychiatric Assoc rep comes into the picture at 57 min 53 sec.

Unfortunately true.

I have actually looked up a few of the politicians on the above list. This person--
Alan C Bates
Is a physician. I'd be interested in his opinion. However as I said, this really is in the Oregon Psychiatric Association's court. Anyone here care to call them up and ask them what they're doing about it? How about residency programs. Are the Oregon psychiatrists themselves actually doing their part to help their local APA chapter?

 

[hereandnow]

@whopper: Thanks for your thoughts and insights. Appreciate your perspective.

Re: "The Use of the Psychiatry Board exams as a Criteria for Psychotropic Prescriptive Competence" and your concerns about the insufficiency of the Psychiatry Boards as a criteria for psychotropic prescriptive competence.

If a person passes the Psychiatry Boards with a score above the uniformly and professionally deemed standard of competence on that exam, then (assuming that the Boards are a valid measure), then it would seem to follow that this Board-passing individual would be competent in those areas in which the Board exam measures competence, including, e.g., the administration of psychotropic medication.

So, if an aspiring psychiatrist successfully passes these Boards or if an aspiring medicating psychologist successfully passes these Boards -- including the "tough" biochemistry laden questions, Neurology sections, etc. -- then it would seem to me in both instances that he/she has demonstrated competence in this domain.

If this is not the case, then it calls into question the validity of the Psychiatry Boards as a measure of competence -- and it seems to me that we should all find a new standard by which to measure competence.

Once we find a valid measure of competence and revise the Psych Boards accordingly, then perhaps we might apply this newly-valid-Board-measure to determine who should be permitted to prescribe psychotropic medication.

 

[billypilgrim37]

If this is not the case, then it calls into question the validity of the Psychiatry Boards as a measure of competence -- and it seems to me that we should all find a new standard by which to measure competence.

You can't call into question the validity of something that most people consider pretty invalid already.

Not passing the boards may be a fair indicator of being incompetent. Passing the boards may not be a fair indicator of being competent. These are mutually exclusive ideas.

The boards share the same properties that all screening test in medicine do, and certainly have some yet-to-be-quantified sensitivity and specificity. Those numbers not being 100% isn't exactly a proper indictment.

 

[whopper]

If psychiatrists are to see difficult cases referred by midlevel care, would their malpractice increases?

It can. Malpractice is billed from what I understand on a local geographic level. E.g Ob Gyns in NJ are paying much more because the litigious NJ culture has driven up their premiums.

So, if an aspiring psychiatrist successfully passes these Boards or if an aspiring medicating psychologist successfully passes these Boards -- including the "tough" biochemistry laden questions, Neurology sections, etc. -- then it would seem to me in both instances that he/she has demonstrated competence in this domain.

No.

That psychiatrist who has also passed the psychiatry boards has also passed USMLE 1, 2 & 3. There will also be a segment of the population who can pass the exam simply because they took it multiple times such as this person:
Frank Abagnale Jr

http://en.wikipedia.org/wiki/Frank_Abagnale

He passed the Bar exam without going to law school--faking a law degree. He only passed because he took it multiple times, and by luck and memorizing the questions & answers which were from a limited pool. In actual law practice, he did not know what he was doing & fouled up several times.

I could for example give someone some books on treating meningitis, have them take an exam with only meningitis questions, and then if the person were able to pass that exam, would that make them qualified to treat meningitis? No. That person would have to also see it in the field quite extensively while under a structured & supervised setting which is what residency does. As I mentioned in the other thread, the clinical standards for the psychologist prescriber only equate to a handful of months of residency training, and has little written standards that compare in terms of structure & supervision. If I recall correctly-and someone correct me if I'm wrong, they only have to work under a doctor for a certain amount of hours, which could amount to the person simply watching TV all day in a doctor's office.

And menigitis does not exist in a vaccuum. It exists in a person who may have several other medical problems, or may develop them as a result of the meningitis. The psychiatry boards only test psychiatry & neurology. They do not test EKG patterns, or several of the other comorbid disorders such as myocardial infarction etc,. all of which were tested prior to psychiatry board testing on the medical boards.

One can practice psychiatry without passing the psychiatry boards--so long as they have graduated from residency which requires graduation from an accreditted medical school & passing USMLE 1,2 & 3. Board certification only ups your street cred. You don't need it to practice.

As I've mentioned before, I have a tremendous amount of respect for psychologists. IMHO psychopharm training at best under the current Oregon training should only lead to them having the right to suggest medications with a medical doctor they are working with. A NP or PA degree would be better for the psychologist prescriber, and not as difficult as an M.D. One could pursue a combined nurse/psychology bachelors degree, then get the NP degree before or after a psychology Ph.D.

A stronger argument is if the would be psychologist prescriber could pass the USMLE 1,2 & 3, and do a much more structured clinical training program which included internal medicine (which pretty much requires a medical degree anyway).

 

[Faebinder]

If a person passes the Psychiatry Boards with a score above the uniformly and professionally deemed standard of competence on that exam, then (assuming that the Boards are a valid measure), then it would seem to follow that this Board-passing individual would be competent in those areas in which the Board exam measures competence, including, e.g., the administration of psychotropic medication.

Absolutely NOT! The board is well enough to test your ability as a psychiatrist but not your knowledge as a physician, which is CRITICAL to prescribing psychiatric meds. Giving psychotric medication is not just a psychiatric application... it's a whole body application. The board is not enough to go through the effects on the whole body, that's why Psychiatry is tested in the medical licensing exams STEP 1, 2 and 3. The board for example will not sit there and test you, at what point will you call the patient diabetic and should not avoid Seroquel/Zyprexa/Clozaril etc. Is it well controlled and the patient can tolerate the meds mentioned? That's all the domain of the medical license tests. And if you reply that the whole body is not the business of someone giving psychotric meds then you are simply stating a stubborn lie.

 

[hereandnow]

Thanks for these interesting perspectives.

From what I understand, given what whopper, billypilgrim, and faebinder have said, it appears that passing the Psych Boards is neither a necessary (according to whopper) nor sufficient (according to whopper, billypilgrim, faebinder) criteria for determining psychotropic prescriptive competence. Thanks for these considered arguments.

I can totally get that Passing-Psych-Boards may not be a sufficient criteria for determining prescriptive competence. There might be more needed than simply passing a test, as whopper and others have mentioned.

I have a harder time buying, though, that Passing-Psych-Boards is not a necessary criteria for determining psychotropic prescription competence. It would appear to me that any aspiring psychiatrist who wished to claim psychotropic prescriptive competence would need to pass it.

It was suprising to me to find (from whopper's post) that an aspiring psychiatrist might actually fail (or never take) their Psychiatric Board Examinations and yet still be deemed competent to prescribe psychotropic drugs.

This, to me, seems dangerous.