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

[Therapist4Chnge]

It is sad how true CGOPsych's post is in today's HMO world.

Oh, and the light bulb answer is 3. 1 to do the work, 1 to consult, and 1 to supervise and ask about counter-transference issues.

---

Members don't see this ad.

 

[CGOPsych]

How many sessions does the bulb get to be screwed?

The bulb has an adjustment disorder. Cognitive-behavioral therapy and social skills training from one psychologist are all that's needed to help it fit in.

 

[busi26]

These weak arguements against properly trained psychologists prescribing psychotropic medications sounds very similar to those levied against optometrists, podiatrists, nurse practitioners, and any other field that has dared to challenge the medical establishment.

The medical establishment has eventually lost all of these "wars." So, why do they keep using the same inaccurate and inflammatory arguments? Their goal is to slow down the legislation. They realize that they cannot fool people forever into believing that measures can't be taken to ensure safe prescribing by nonphysicians. Oregon will pass legislation this year allowing properly trained psychologists to prescribe psychotropic medications. Missouri will do the same this year or next. Hawaii will do the same as soon as a democrat governor is elected. Then other states will rise to carry the cause for rural and disadvantaged patients.

All the groaning and fearmongering will only accomplish delay, ultimately the data will speak for itself!

 

[Red Beard]

Then other states will rise to carry the cause for rural and disadvantaged patients.

Lets get real, this has nothing to do with "carrying the cause for rural and disadvantaged patients" and everything to do with psychologists increasing their ability to make money. Couching it in any other way is disingenuous.

I am not saying there is something inherently wrong with wanting to make more money. But to claim that psychologists are somehow miraculously all going to want to move to rural areas and save the poor is ludicrous. They want the same thing we all want: to live in a hip urban area and be able to actually afford it. And statistics back me up on that--the relative geographic distribution of psychologists and psychiatrists is nearly identical.

And as a potential future psychiatrist, I know that this would affect me significantly. There are ~1400 licensed psychologists in Oregon vs. ~400 psychiatrists...this legislation would send competition for a piece of the mental health pie into the stratosphere.

The most important argument, however, is whether or not you can get sufficient training to do this safely. At this point, you don't know what you don't know, so you aren't the best person to decide how much training is enough training.

On the other hand, I will have to agree that it shouldn't take 4 years of medical school and 4 years of residency to learn to safely manage a small selection of psychoactive medications in a patient who is also being followed by a primary care doctor and who does not carry a significant load of medical comorbidity.

You are right that it looks inevitable; it is problematic to me that no one seems to be focusing on HOW it can be done SAFELY.

 

[edieb]

The following is a list of prescribing psychologists and their respective locations in New Mexico. The person located in Texas actually flies out to Indian reservations and prescribes for the Indian Health Service there is an article about this on the Am. Psychological Ass'n website).

As you can see, the majority of RxP psychologists are in rural, not urban, areas. Granted, NM is a mostly rural state but I think the list still makes a valid point: that the majority of prescribing psychologists are not in "hip" urban areas like Alubuquerque but rather in smaller towns.

Lic # License Type Location
William Bernstein, Ph.D 0012C RxP Conditional Prescription Santa Fe, NM
Steven M. Cobb, Ph.D. 0005C RxP Conditional Prescription Roswell, NM
Rosalie S. Davis, Ph.D. 0008C RxP Conditional Prescription Albuquerque, NM
Marlin C. Hoover, Ph.D. 0007C RxP Conditional Prescription Flossmoor, IL
C. Alan Hopewell, Ph.D. 0009C RxP Conditional Prescription Fort Worth, TX
Stuart S. Kelter, Psy.D. 0004C RxP Conditional Prescription Las Cruces, NM
Elaine Levine, Ph.D. 0001 RxP Prescription Certificate Las Cruces, NM
James M. Mash, Ph.D. 0013C RxP Conditional Prescription Taos, NM
Robert C. Mayfield, Ph.D. 0010C RxP Conditional Prescription Las Cruces, NM
E. Mario Marquez, Ph.D. 0002 RxP Prescription Certificate Albuquerque, NM
Robert E. Sherrill, Jr., Ph.D. 0011C RxP Conditional Prescription Farmington, NM
Soterios J. Soter, Ph.D. 0006C RxP Conditional Prescription Evanston, IL
Thomas C. Thompson, Ph.D. 0003 RxP Prescription Certificate Las Cruces, NM
Marianne G. Westbrook 0014C RxP Conditional Prescription Hobbs, NM


Additionally, just because a prescribing psychologist is in a city does not mean he/she isn't helping to increase access to mental health care. You have to remember that the waitlist to see a psychologist or psychiatrist is very long, even in many urban areas. Allowing psychologists to prescribe in cities curtails this wait time.

 

[kugel]

Lic # License Type Location
William Bernstein, Ph.D 0012C RxP Conditional Prescription Santa Fe, NM - NOT rural
Steven M. Cobb, Ph.D. 0005C RxP Conditional Prescription Roswell, NM
Rosalie S. Davis, Ph.D. 0008C RxP Conditional Prescription Albuquerque, NM - NOT rural
Marlin C. Hoover, Ph.D. 0007C RxP Conditional Prescription Flossmoor, IL - NOT rural
C. Alan Hopewell, Ph.D. 0009C RxP Conditional Prescription Fort Worth, TX - NOT rural - but if he practices at a rural location, I'll give him the "rural" designation.
Stuart S. Kelter, Psy.D. 0004C RxP Conditional Prescription Las Cruces, NM - NOT rural (2nd largest city in NM)
Elaine Levine, Ph.D. 0001 RxP Prescription Certificate Las Cruces, NM -NOT rural (2nd largest city in NM)
James M. Mash, Ph.D. 0013C RxP Conditional Prescription Taos, NM
Robert C. Mayfield, Ph.D. 0010C RxP Conditional Prescription Las Cruces, NM -NOT rural (2nd largest city in NM)
E. Mario Marquez, Ph.D. 0002 RxP Prescription Certificate Albuquerque, NM - NOT rural
Robert E. Sherrill, Jr., Ph.D. 0011C RxP Conditional Prescription Farmington, NM
Soterios J. Soter, Ph.D. 0006C RxP Conditional Prescription Evanston, IL - NOT rural
Thomas C. Thompson, Ph.D. 0003 RxP Prescription Certificate Las Cruces, NM -NOT rural (2nd largest city in NM)
Marianne G. Westbrook 0014C RxP Conditional Prescription Hobbs, NM

 

[busi26]

Lets get real, this has nothing to do with "carrying the cause for rural and disadvantaged patients" and everything to do with psychologists increasing their ability to make money.

We will just have to agree to disagree here. Most psychologists don't go to school for 10+ years to "increase their ability to make money." Most psychologists actually do care about their patients and want prescription privileges to prescribe and UNPRESCRIBE meds for patients who have no access to a psychiatrist or only have access to an incompetent psychiatrist (those prescribing stimulants for children with ADHD - after spending only 10 minutes with the parents of the child).

On the other hand, I will have to agree that it shouldn't take 4 years of medical school and 4 years of residency to learn to safely manage a small selection of psychoactive medications in a patient who is also being followed by a primary care doctor and who does not carry a significant load of medical comorbidity.

Agreed! However, the postdoctoral masters in psychopharmacology does cover handling cases with "significant" medical comorbidity.

You are right that it looks inevitable; it is problematic to me that no one seems to be focusing on HOW it can be done SAFELY.

You are incorrect here. In LA, NM, and now in Oregon many in the medical community have become convinced that psychologists who get the training, as laid out by the law, can safely prescribe these medications.

I am not sure if you know this, but the bill was tabled last year in the Oregon legislature to allow a panel including 2 psychologists, 2 physicians, and 1 pharmacist to agree upon the safe and proper training that psychologists should undergo to prescribe psychotropics in Oregon. That is why the training is structured the way it is now.

 

[whopper]

Agreed! However, the postdoctoral masters in psychopharmacology does cover handling cases with "significant" medical comorbidity.

When this issue was being more actively debated several months ago, I bothered to read the Oregon bill.

The level of training proposed in that bill would not cover the amount of I think would be needed to handle medical comorbidity.

For example, I doubt someone without a medical level residency training could handle someone with chronic kidney issues, where the only medication that stabilizes them is lithium. While that is an extreme situation, it is one that a psychiatrist can realistically expect to handle in their career. Another situation is having a patient who while on medications is stabilized, (otherwise the person is homicidal and suicidal) but the medication is teratogenic, and the patient wants to become pregnant.

If you've read my past posts, especially in this thread, I have a high respect for the field of psychology. I just don't think psychologists should be given prescription power under a guise that they are an equivalent to someone with physician level training, even if the Oregon bill does have some medical training. I assure you, the medical training in that bill nowhere on par with what physicians must do.

Having medical training is on differing degrees. Being able to do CPR does not make one an M.D. Giving psychologists medical training on the general order of a nurse's aid does not make one the equivalent of a psychiatrist, yet the Oregon bill apparently seeks to give psychologists with this level of training the same power.

Yes the training is not the same as a nurse's aid, but then again it is nowhere near that of going through an ACGME approved residency program.

 

[Sneezing]

What a joke.

I'll have no problem testafying in court as an experet witness against these over zealous quacks.

All this does is further support the dichotomy in medicine. Affluent people with money and good insurance get the quality of a physician, those without will be left with the others.

Oregon will succumb. However, this isn't anything new in that backwards state. They allow DCs and Natropaths to be called physicians and function as PCPs. Their state budget is already so far in the red and their infrastructure is crumbling, that it is only a matter of time before every physician leaves to Washington or Idaho.

 

[silas2642]

We will just have to agree to disagree here. Most psychologists don't go to school for 10+ years to "increase their ability to make money." Most psychologists actually do care about their patients and want prescription privileges to prescribe and UNPRESCRIBE meds for patients who have no access to a psychiatrist or only have access to an incompetent psychiatrist (those prescribing stimulants for children with ADHD - after spending only 10 minutes with the parents of the child).



Agreed! However, the postdoctoral masters in psychopharmacology does cover handling cases with "significant" medical comorbidity.



You are incorrect here. In LA, NM, and now in Oregon many in the medical community have become convinced that psychologists who get the training, as laid out by the law, can safely prescribe these medications.

I am not sure if you know this, but the bill was tabled last year in the Oregon legislature to allow a panel including 2 psychologists, 2 physicians, and 1 pharmacist to agree upon the safe and proper training that psychologists should undergo to prescribe psychotropics in Oregon. That is why the training is structured the way it is now.

I agree that polypharmacy is a huge problem in medicine, but I feel that "unprescribing" medications without having the proper training can be dangerous as well.

After almost 3 years of med school, I still don't know enough medicine where I would feel comfortable writing for anything except maybe Colace so I don't know why a psychologist, who didn't complete the med school pre-requisites and has no formal training in medicine would be competent enough to do this after 2 years.

 

[whopper]

After almost 3 years of med school, I still don't know enough medicine where I would feel comfortable writing for anything except maybe Colace

In residency, hardly any resident felt comfortable doing anything until after several months of doing it.

(The exception were those students and residents gung-ho to the point of fool-hardiness. e.g. a medstudent who demanded to do a C-section on his first day of Ob-Gyn, yes I've seen that).

The Oregon Bill's medical training is nowhere near on the par of that of a physician, academically and clinically. In fact, it pretty much left guidelines to the effect of only having to shadow a doctor for a few months. As we all know from medschool electives, if you shadow a doctor, most of the time you're just following a guy around while in a daydream half the time, and that doc doesn't make you do much. In fact half the time you get out by noon.

In residency--for 4 years, you're doing it yourself under supervision, somewhere between 50-80 hrs/week, not just following someone.

If a psychologist's training to prescribe meds was on par with that of a psychiatrist, I say make them take USMLE 1, 2, and 3, make them do a residency and see if they can perform successfully in it. Let's see if that person can do an IM rotation for 4 months.

To give equal powers is ridiculous. It'd be like giving us psychiatrists the legal ability to do an MMPI after a mere class in basic statistics.

As I said before, if you're a forensic psychiatrist in Oregon, you can make quite a market following the new psychologist prescribers to see if they were committing malpractice. I can think of plenty of medical issues psychologist prescribers may miss. e.g. Hgb A1C levels, interpreting cholesterol levels, EKGs, being able to identify an arrhythmia on an EKG, being able to name the various kidney disorders and how lithium would affect the kidneys with these disorders, etc.

If I were a cross-examining lawyer, I would vigorously test any psychologist-prescriber before I accepted that person as an expert witness. I would show them 50 EKGs and ask them to correctly interpret all of them. If they couldn't do it, they're going to look real bad in front of a jury...and you know what? Given the amount of training in the Oregon bill, no psychologist-prescriber I'd think would be able to do it, unless they continued to study them on a routine basis for several months afterwards on their own and outside their curriculum.

 

[Therapist4Chnge]

The Oregon Bill's medical training is nowhere near on the par of that of a physician, academically and clinically. In fact, it pretty much left guidelines to the effect of only having to shadow a doctor for a few months. As we all know from medschool electives, if you shadow a doctor, most of the time you're just following a guy around while in a daydream half the time, and that doc doesn't make you do much. In fact half the time you get out by noon.

From my understanding Oregon is requiring a collaborative agreement with a physician, and it is not setup for independent practice. The training seems in line with NP and PA training, both of which have collaborative agreements (with a number of states allowing independent prescribing for NPs). I'd like to see more hours of supervision required before granting prescribing rights, but I don't think the current requirements are completely lacking. I also agree with everything being taught residentially and not online, though I'm not sure if that will be a requirement in the end.

To give equal powers is ridiculous. It'd be like giving us psychiatrists the legal ability to do an MMPI after a mere class in basic statistics.

This happens EVERY DAY with neurologists wanting to interpret neuropsychological testing, so your example is indeed relevant.

 

[235750]

From my understanding Oregon is requiring a collaborative agreement with a physician

In fact, the person supervising the clinical hours can be a NP. That really confuses me (see section 3, point 6)

The training seems in line with NP and PA training

Now, I think we can objectively qualify that statement as not true. This bill says that 250 clinical hours are required. PAs have 2400 hrs by the time they graduate. Not to mention all the science prereqs they need just to get into school in the first place.

PAs are also required to complete 100 hrs of continuing education which is double the amount for psychologists in this bill.

I read over the training requirements and I don't see anything as intensive as PA training. To echo Whoppers concerns, the training laid out in this bill does look like the summer shadowing that I have setup, except that I'll still be a student at the end of my experience.

And honestly, I don't see why expert, doctorate-level psychologists would voluntarily take a step down and become mid-levelers, which is what this bill creates. Is it really all about money? I hear a lot of the psychologists complaining about 'diploma mills' that graduate PsyDs at an alarming rate, maybe they have issues with oversupply and this is a way out for them.

I think the interesting question this whole debate brings up is: what qualifies a person to prescribe drugs? Do you just need a year and half of crash courses in pharm, some clinical time, and boom, you're done? When I complete my first year of medical school I'll have had more lectures hours in the sciences then the prescribing psychologists by several years, and coupled with a BA in psychology, should I be able to get a restricted license after my summer's shadowing? Send me off to rural Albuquerque, maybe I can help make a dent in that psychatrist shortage

This is all nuts!!!!

 

[whopper]

I'd like to see more hours of supervision required before granting prescribing rights, but I don't think the current requirements are completely lacking.

The problem is that with several electives (and emphasis on electives, these are the minority of medschool courses, only a few months out of a 4 year curriculum), medstudents shadow doctors.

During that time, medstudents aren't given a structured program along the lines of ACGME guidelines. It's actually more work for the doctor to try to actually teach the student.

The clinical guidelines for psychologist prescribers in the bill, last time I checked (maybe they changed it) was setup similarly to a medstudent elective.

In residency, residents must provide the bulk of the labor in a hospital, in fact most departments cannot function without residents.

250 clinical hours is on the order of 4 weeks of residency. No resident I've seen was ever comfortable treating patients after 4 weeks. In fact several are thankful they did not accidentally kill someone (through action or inaction) their first few months. Pretty much no resident I've seen ever did anything without getting approval from an attending or a senior resident for the first few months. It was only after 1 year of residency where most residents feel they had a good grasp, but that grasp was sophomoric. There was still plenty to learn. Even as a first year attending I still felt I had much more to learn.

(edit, and to compare the 2 really isn't fair because residencies are structured by ACGME guidelines. 250 hours of shadowing is not going to compare to 250 hours of a structured program).

That said, I have the utmost respect for good psychologists. I have a problem with this curriculum that gives psychologists equal powers as psychiatrists.

From my understanding Oregon is requiring a collaborative agreement with a physician, and it is not setup for independent practice.

If that's the case, then I'd be more comfortable with it. The drafts for the law may have changed since the last time I read it. IMHO there is nothing wrong with a psychopharm-trained psychologist working with a non-psychiatric doctor in making recommendations for psychotropic medication in conjunction with a physician. That way there is someone actively monitoring the needed labs, physical exams and medical comorbidity issues. Heck, I love working with good psychologists because there's angles psychologist know of that I don't and vice-versa.

 

[blueadams]

sour grapes.

 

[busi26]

sour grapes.

Agreed!

 

[busi26]

These weak arguements against properly trained psychologists prescribing psychotropic medications sounds very similar to those levied against optometrists, podiatrists, nurse practitioners, and any other field that has dared to challenge the medical establishment.

The medical establishment has eventually lost all of these "wars." So, why do they keep using the same inaccurate and inflammatory arguments? Their goal is to slow down the legislation. They realize that they cannot fool people forever into believing that measures can't be taken to ensure safe prescribing by nonphysicians. Oregon will pass legislation this year allowing properly trained psychologists to prescribe psychotropic medications. Missouri will do the same this year or next. Hawaii will do the same as soon as a democrat governor is elected. Then other states will rise to carry the cause for rural and disadvantaged patients.

All the groaning and fearmongering will only accomplish delay, ultimately the data will speak for itself!

Don't the psychiatrists on the thread at least recognize that it is possible that I am correct here? Weren't physicians wrong about NPs, podiatrists, optometrists?

 

[MLT2MT2DO]

These weak arguements against properly trained psychologists prescribing psychotropic medications sounds very similar to those levied against optometrists, podiatrists, nurse practitioners, and any other field that has dared to challenge the medical establishment.

The medical establishment has eventually lost all of these "wars." So, why do they keep using the same inaccurate and inflammatory arguments? Their goal is to slow down the legislation. They realize that they cannot fool people forever into believing that measures can't be taken to ensure safe prescribing by nonphysicians. Oregon will pass legislation this year allowing properly trained psychologists to prescribe psychotropic medications. Missouri will do the same this year or next. Hawaii will do the same as soon as a democrat governor is elected. Then other states will rise to carry the cause for rural and disadvantaged patients.

All the groaning and fearmongering will only accomplish delay, ultimately the data will speak for itself!

Don't the psychiatrists on the thread at least recognize that it is possible that I am correct here? Weren't physicians wrong about NPs, podiatrists, optometrists?

I had more than 250 clinical hours in my field in my UG and have been a lab tech for 10 years.
According to you it sounds like I am properly trained and I should be allowed to order patient labs.

 

[st2205]

These weak arguements against properly trained psychologists prescribing psychotropic medications sounds very similar to those levied against optometrists, podiatrists, nurse practitioners, and any other field that has dared to challenge the medical establishment.

The medical establishment has eventually lost all of these "wars." So, why do they keep using the same inaccurate and inflammatory arguments? Their goal is to slow down the legislation. They realize that they cannot fool people forever into believing that measures can't be taken to ensure safe prescribing by nonphysicians. Oregon will pass legislation this year allowing properly trained psychologists to prescribe psychotropic medications. Missouri will do the same this year or next. Hawaii will do the same as soon as a democrat governor is elected. Then other states will rise to carry the cause for rural and disadvantaged patients.

All the groaning and fearmongering will only accomplish delay, ultimately the data will speak for itself!

Don't the psychiatrists on the thread at least recognize that it is possible that I am correct here? Weren't physicians wrong about NPs, podiatrists, optometrists?

What's your opinion on BSWs doing psychotherapy?

 

[whopper]

properly trained psychologists

You're making an assumption that the training is proper.

If the training were proper, then IMHO the person would be able to pass USMLE 1, 2, 3, and successfully be able to complete training on the order of a psychiatry residency.

250 hours is not proper training even if the person had an M.D. Like I said, 250 hrs would be only 4-6 weeks of psychiatry residency, and even that is a poor statement because the Oregon bill did not give much guidelines for structure, nor would the person be working the amount a psychiatry resident works--usually over 50 but not more than 80 hrs per week. IMHO 4 years is a good period of training even with the hard and structured curriculum ACGME demands.

If the 250 hrs is on the order I believe it is, it is more realistically on the order of 1-3 weeks of psychiatry residency training. 4 years of psychiatry residency vs a few mere weeks--the two hardly compare.

All the groaning and fearmongering will only accomplish delay, ultimately the data will speak for itself!

Wow, are you aware of the data? There's hardly any available. The military did a study which by it's own admission was not applicable to the public and the psychologist prescribers were not cost effective in comparison with psychiatrists. The psychologists in those cases only gave out SSRIs, nothing else. Of the few psychologist prescribers, they are not a large enough sample size to make a good foundation for scientific data.

If medical professionals are concerned about others giving out medications which can potentialy be fatal without the proper training, that's not fear mongering IMHO.

Don't the psychiatrists on the thread at least recognize that it is possible that I am correct here?

First, do you have medical training? If so what is it? What is your basis that the training is proper? Do you have the expertise to make that decision?

Second, if you've been reading this and the other threads in this forum, some of your own psychological colleagues don't believe psychologists should be given prescription power unless they follow the more traditional and already established routes such as getting an M.D., or becoming a physician's assistant or nurse practitioner.

The tone of your posts highly suggests you think this is about psychiatry vs. psychology. In the end it should be about what's best for the patients.

 

[busi26]

The tone of your posts highly suggests you think this is about psychiatry vs. psychology. In the end it should be about what's best for the patients.

It is about the patients! Waiting months to get an appointment with a psychiatrist when it is clear that a patient would benefit from an SSRI or another psychotropic is very frustrating. Especially when the psychiatrist sees the patient for 10 minutes and hands them an outrageous bill. How would you recommend rural states handle this problem? How do you suggest these patients get the care that they need?

The legislatures of and many physicians in LA, NM, the military, Guam, and now Oregon and Missouri have put their stamp of approval on the training required for psychologists to prescribe psychotropics. Are all the physicians who support RxP wrong? Do they not have access to the same information that you are using to base your decision?

Your opinion is valid, but outweighed by others in your and other fields.

 

[billypilgrim37]

How do you suggest these patients get the care that they need?

Their PCPs.

 

[SpiritiualDuck]

I haven't been following this closely. As a pgy2, I'm just too busy. I can't imagine why a psychologist would feel comfortable prescribing meds. I'm on consults now and I know internist/Oby-gyn folks that don't know psychotropic meds well enough to comfortably prescribe them and they're physicians.

I've seen pts with hypoactive delirium being misdiagnosed as being depressed. How would they work that up? I had a pt last week that was encephalopathic 2/2 to elevated ammonia who is on depakote and he also had elevated amylase/lipase all 2/2 to vpa. They're not ready to handle and manage this level of care.

My mother who was on an SSRI ended up being hyponatremic. S/Es are real and need to be recognized.

What about risk for torsades, proloned QTc. The list goes on and on of things that a PhD in psychology will never know about and likely miss.

This is scary. I'm a 2nd year resident and still not ready to be out on my own yet. I have supervision for a reason. And I'm better trained than any PhD will ever be. This is scary.

 

[HMSPSYCH]

I haven't been following this closely. As a pgy2, I'm just too busy. I can't imagine why a psychologist would feel comfortable prescribing meds. I'm on consults now and I know internist/Oby-gyn folks that don't know psychotropic meds well enough to comfortably prescribe them and they're physicians.

I've seen pts with hypoactive delirium being misdiagnosed as being depressed. How would they work that up? I had a pt last week that was encephalopathic 2/2 to elevated ammonia who is on depakote and he also had elevated amylase/lipase all 2/2 to vpa. They're not ready to handle and manage this level of care.

My mother who was on an SSRI ended up being hyponatremic. S/Es are real and need to be recognized.

What about risk for torsades, proloned QTc. The list goes on and on of things that a PhD in psychology will never know about and likely miss.

This is scary. I'm a 2nd year resident and still not ready to be out on my own yet. I have supervision for a reason. And I'm better trained than any PhD will ever be. This is scary.

I couldn't agree with you more. Overall, our medications are powerful and can have unpredictable side effects throughout the body and probably second to the cancer medications in terms of potential debilitating/permanent adverse SEs. I think the non-MDs are unaware and maybe under the impressions that prescribing and monitoring these medications are easy and are mindless endeavors. Perhaps this is our fault as many psychiatrists make it look easy. But I feel for any non-MDs being questioned by the trial lawyers why he/she didn't think about the possibility that a patient throw a PE while taking both OCP and Olanzapine due the 1A2 interaction and metabolic risks.

My belief is that most non-MDs are unaware we study for years in those basic medical science classess, countless hours in clinical rotations across all fields of medicine, studying and taking Steps 1/2/3, and the learning experiences while on-call. Our medications can really do a number on patients if they are not monitored properly. NPs and PAs provide needed service in surgery, anesthisiology, IM, psychiatry, pediatric, etc but these people are supervised by MDs. As far as the argument about podiatrist and optometrist goes, these professionals prescribing ability are very limited. At the end of the day, patient care should come first, but not at the expense of shoddy training and the opinions of those with narcissistic, lofty ambition.

 

[edieb]

I couldn't agree with you more. Overall, our medications are powerful and can have unpredictable side effects throughout the body and probably second to the cancer medications in terms of potential debilitating/permanent adverse SEs. I think the non-MDs are unaware and maybe under the impressions that prescribing and monitoring these medications are easy and are mindless endeavors. Perhaps this is our fault as many psychiatrists make it look easy. But I feel for any non-MDs being questioned by the trial lawyers why he/she didn't think about the possibility that a patient throw a PE while taking both OCP and Olanzapine due the 1A2 interaction and metabolic risks.

My belief is that most non-MDs are unaware we study for years in those basic medical science classess, countless hours in clinical rotations across all fields of medicine, studying and taking Steps 1/2/3, and the learning experiences while on-call. Our medications can really do a number on patients if they are not monitored properly. NPs and PAs provide needed service in surgery, anesthisiology, IM, psychiatry, pediatric, etc but these people are supervised by MDs. As far as the argument about podiatrist and optometrist goes, these professionals prescribing ability are very limited. At the end of the day, patient care should come first, but not at the expense of shoddy training and the opinions of those with narcissistic, lofty ambition.

Correct me if I am wrong, but I believe NPs are indpendent, or very loosely supervised, in many states.

I think you're right that patient care should come first and part of patient care is adequate access to mental health care. Psychologist prescribing fills this need. If only one rurally located psychologist obtains prescriptive authority, then access to care will be increased and much suffering will be mitigated.

 

[edieb]

Lic # License Type Location
William Bernstein, Ph.D 0012C RxP Conditional Prescription Santa Fe, NM - NOT rural
Steven M. Cobb, Ph.D. 0005C RxP Conditional Prescription Roswell, NM
Rosalie S. Davis, Ph.D. 0008C RxP Conditional Prescription Albuquerque, NM - NOT rural
Marlin C. Hoover, Ph.D. 0007C RxP Conditional Prescription Flossmoor, IL - NOT rural
C. Alan Hopewell, Ph.D. 0009C RxP Conditional Prescription Fort Worth, TX - NOT rural - but if he practices at a rural location, I'll give him the "rural" designation.
Stuart S. Kelter, Psy.D. 0004C RxP Conditional Prescription Las Cruces, NM - NOT rural (2nd largest city in NM)
Elaine Levine, Ph.D. 0001 RxP Prescription Certificate Las Cruces, NM -NOT rural (2nd largest city in NM)
James M. Mash, Ph.D. 0013C RxP Conditional Prescription Taos, NM
Robert C. Mayfield, Ph.D. 0010C RxP Conditional Prescription Las Cruces, NM -NOT rural (2nd largest city in NM)
E. Mario Marquez, Ph.D. 0002 RxP Prescription Certificate Albuquerque, NM - NOT rural
Robert E. Sherrill, Jr., Ph.D. 0011C RxP Conditional Prescription Farmington, NM
Soterios J. Soter, Ph.D. 0006C RxP Conditional Prescription Evanston, IL - NOT rural
Thomas C. Thompson, Ph.D. 0003 RxP Prescription Certificate Las Cruces, NM -NOT rural (2nd largest city in NM)
Marianne G. Westbrook 0014C RxP Conditional Prescription Hobbs, NM

So 4-5 out of the few who prescribe are located in rural areas. If they each see see 8 people/day, that's 200 people/week with increased access to care. That's a big impact!

 

[whopper]

The legislatures of and many physicians in LA, NM, the military, Guam, and now Oregon and Missouri have put their stamp of approval on the training required for psychologists to prescribe psychotropics. Are all the physicians who support RxP wrong? Do they not have access to the same information that you are using to base your decision?

Your opinion is valid, but outweighed by others in your and other fields.

1) You put some states, ok fine, but this has been debated in several other states (more than the states that allowed psychologist-prescribers) and they were defeated.

2) My opinion is outweighed by others? Really? Again where's your data? Did you read the military study? That's the only real data obtained and as I said, it has several strong differences with the guidelines in the Oregon bill. The military also said it's study was not applicable to the general public, nor did it's results offer anything conclusive to support psychology prescribers.

Let's not reduce this debate to talking-points. I don't wish to treat this issue like it's a Fox opinion show. Show some data showing that it's safe to allow prescribers to give out medications with the equivalent of just a few weeks of medical residency training.

In the end it should be science, not talking points that should be used to debate the safety of someone prescribing medications.

 

[SpiritiualDuck]

Since I've read this thread, I keep thinking how naive it would be for a someone with such limited knowledge/no knowledge of medicine/meds to be prescribing meds.

For instance, I've seen SSRI-induced akathisia treated by thinking it was anxiety and making it worse by increasing pt's antidepressant. The benefit of my residency is that I see these things, I have faculty that guide me, that have seen more than me and we are continually learning. How can they possibly see enough to manage all the issues that could arise?

I only have one pt on an MAOI and I've used TCA's a few times, but I'm still learning. This is so wrong.

 

[appelsoranjes]

As a psychologist, I think the current RxP movement has been poorly implemented. Unfortunately, professional schools (CSPP, Argosy et al.) are behind this movement and their motivations are purely financial.

I would be behind the movement if the training was much more substantial. There is a need for more psychopharmacologists, and I think combined therapy by one provider is a good model. The level of training should be on-par, if not more rigorous than a Psych-NP. And even then, a prescribing psychologist shouldn't be on the same playing field as a psychiatrist.

That being said, I live in an area where it takes a couple months to get someone into see a psychiatrist... I'm thinking of doing a Psych-NP program to add med management to my repertoire, but I'm a bit skeptical of whether the training would be sufficient...I cant imagine someone doing the Argosy-Masters and feeling confident with prescribing.

 

[maranatha]

As a psychologist, I think the current RxP movement has been poorly implemented. Unfortunately, professional schools (CSPP, Argosy et al.) are behind this movement and their motivations are purely financial.

I would be behind the movement if the training was much more substantial. There is a need for more psychopharmacologists, and I think combined therapy by one provider is a good model. The level of training should be on-par, if not more rigorous than a Psych-NP. And even then, a prescribing psychologist shouldn't be on the same playing field as a psychiatrist.

That being said, I live in an area where it takes a couple months to get someone into see a psychiatrist... I'm thinking of doing a Psych-NP program to add med management to my repertoire, but I'm a bit skeptical of whether the training would be sufficient...I cant imagine someone doing the Argosy-Masters and feeling confident with prescribing.

Thanks for speaking for some of the many psychologists that question, or at least have serious problems, about this whole thing. I respect your comments and concerns.

I think what is so concerning is the way several psychologists who respond on this site give the impression that they think prescribing medications is easy. What is more concerning is that they don't understand medicine and how critical it is to have a medical background to prescribe medications--the brain doesn't work in isolation from the rest of the body! I wrote on about RxP rights on the psychology forum that I am a 3rd year resident with 4 years of medical training and am just starting to feel comfortable prescribing. The response was something like "of course you're not comfortable, you're training doesn't prepare you for prescribing and psychologists are better trained to prescribe." Those comments are really concerning and only highlight their lack of understanding of medicine (or at least those that responded)...

 

[maranatha]

As a psychologist, I think the current RxP movement has been poorly implemented. Unfortunately, professional schools (CSPP, Argosy et al.) are behind this movement and their motivations are purely financial.

I would be behind the movement if the training was much more substantial. There is a need for more psychopharmacologists, and I think combined therapy by one provider is a good model. The level of training should be on-par, if not more rigorous than a Psych-NP. And even then, a prescribing psychologist shouldn't be on the same playing field as a psychiatrist.

That being said, I live in an area where it takes a couple months to get someone into see a psychiatrist... I'm thinking of doing a Psych-NP program to add med management to my repertoire, but I'm a bit skeptical of whether the training would be sufficient...I cant imagine someone doing the Argosy-Masters and feeling confident with prescribing.

I used to agree with this, but am not so sure a one provider model is the best approach anymore. As I work in a multi-disciplinary clinic, I've found that a team approach is highly effective. When I have a patient that I'm prescribing meds for with a psychologist doing therapy, I think we can provide much better care then if either one of us worked alone. We often communicate about our patients and are able have a more complete picture of our patient. I also think there can be a lot transference issues that come up in medication management that can complicate therapy.

 

[whopper]

I think what is so concerning is the way several psychologists who respond on this site give the impression that they think prescribing medications is easy.

Wow, the non-medically trained claiming they know what constitutes proper medical training over those who are medically trained, and with no specific data to back it up other than a claim that there's others in the field that disagree with me.

And my opinion is "outweighed" despite that all 50 states, in fact almost all nations (even third world countries) give clear and similar guidelines on what is proper medical training to prescribe medications, but I'm, outweighed in the eyes of someone without medical training.

Wow, this is pretty sad that these arguments are coming from people that I'm assuming have graduate degrees or working on them.

Hey if someone could at least pull out some real scientific data instead of talking points, the debate IMHO would actually have some substance.

Repeat: the only real data so far is the military study and it did not offer any conclusive data that was applicable to the general public, nor similar to the bills that have been passed.

That said, psychology is a fine field and I'd be open to psychologist prescribers--though much more training would be needed than in the curriculums currently offered in the Oregon bill.

I have no more tolerance for psychiatrist who believes he can interpret an MMPI simply based on a statistics course than I do a psychologist who believes he can judge what is medically sound when he has no general medical training. Psychopharm does not count as general medical training. If you even start to think it does, you just proved my point that your knowledge of general medicine is pretty clueless. If you think that because you may find a few M.D.s who think it's alright (and I don't know who they are because I don't see them publically rallying M.D.s to support this cause), I'd hardly call that a proving your argument right.

I generally try not to make pointed comments, but for a graduate level student or above to claim expertise and argue with someone in a field with the expertise and have no data to support your argument other than political talking points is pretty ridiculous. There should be no tolerance for that IMHO. I'm wondering if any of the people pushing their political talking points actually read the one study which has almost no validity to this situation.

I think we'd all agree if someone with a sociology degree claimed they could do an MMPI without any training in psychology would be seen as absurd. Same here. I will apologize if any of you psychologists claiming the Oregon bill is "proper" medical training have an M.D., D.O. P.A. or R.N.

And by the way, feel free to take a look at my past posts. I've defended the field of psychology several times and I do have a degree in psychology.

I'd be happy to debate someone, in a friendly and truth seeking manner, if the person did have medical training (such as one of those "in my field") that busi26 suggested--if one were to appear here and use actual data, not talking points.

As for psychotropics, the largest prescriber of psychotropics are not psychiatrists. The largest body of prescribers are PCPs. This is published in several studies.

As I said in the past, I find no problem with psychologists working with M.D.s, even non-psychiatrist M.D. in making suggestions for psychotropics, but ultimately prescription power requires clinical training higher than just the equivalent of a few handful of weeks.

 

[busi26]

Repeat: the only real data so far is the military study and it did not offer any conclusive data that was applicable to the general public, nor similar to the bills that have been passed.

That said, psychology is a fine field and I'd be open to psychologist prescribers--though much more training would be needed than in the curriculums currently offered in the Oregon bill.

You and CGO are asking for data that you yourself cannot provide. Where is the data that suggests that psychiatrists or PCPs can safely prescribe psychotropics??

Where is the data that suggest that psychologists (who receive 2 years of training in prescribing ONLY psychotropics) are less able to prescribe this limited formulary?

I'll await your reply.

 

[whopper]

Oh boy...

Where is the data that suggests that psychiatrists or PCPs can safely prescribe psychotropics??

I'm not even going to go here. Your question in and of itself IMHO merits this debate end (at least with you).

And IMHO, I've seen too many good psychologists to believe you are indicative of the general state of psychology.

Where is the data that suggest that psychologists (who receive 2 years of training in prescribing ONLY psychotropics) are less able to prescribe this limited formulary?

Hmm, do you know that one must prove being able to safely prescribe before you give prescription power, not disprove it? Are we supposed to give laymen prescription power and have to prove they don't have medical knowledge first?

The only real study that's been cited here is the military study which was cited several times on this board, and by the study's own admission, it was not applicable to the general public, nor gave any strong data that supported that psychologists should prescribe. While it did give some good points in favor of psychologists, it also pointed out to several problems such as psychologist prescribers actually cost-ineffective.


I've never seen anyone on this forum yet give such poor responses other than the occasional troller, yet oddly I think you actually are serious. I really try to refrain from making comments expressing this level of frustration, but it really suggests to me that you do not understand the qualifications needed to prescribe, yet you keep pushing your argument as if you have medical expertise.

 

[billypilgrim37]

Never before in a thread have I wished a scientologist would step in to save the day!

 

[busi26]

Oh boy...I'm not even going to go here. Your question in and of itself IMHO merits this debate end (at least with you).

And IMHO, I've seen too many good psychologists to believe you are indicative of the general state of psychology.

Hmm, do you know that one must prove being able to safely prescribe before you give prescription power, not disprove it? Are we supposed to give laymen prescription power and have to prove they don't have medical knowledge first?

The only real study that's been cited here is the military study which was cited several times on this board, and by the study's own admission, it was not applicable to the general public, nor gave any strong data that supported that psychologists should prescribe. While it did give some good points in favor of psychologists, it also pointed out to several problems such as psychologist prescribers actually cost-ineffective.

I've never seen anyone on this forum yet give such poor responses other than the occasional troller, yet oddly I think you actually are serious. I really try to refrain from making comments expressing this level of frustration, but it really suggests to me that you do not understand the qualifications needed to prescribe, yet you keep pushing your argument as if you have medical expertise.

I was not questionning whether psychiatrists or PCPs have enough training to prescribe psychotropics, although many PCPs DO NOT feel qualified to prescribe psychotropics in complicated cases. I was merely pointing out that the that the "safety" data that you ask for is not even available for psychiatrist or PCP providers. The DOD program DID demonstrate that psychologists CAN prescribe safely, the only question that remains is the amount of training that is required to do so! In addition, psychologists have been prescribing for over 5 years now in LA. Doesn't that provide at least a modicum of evidence that psychologists can prescribe safely? Geeze.

Tell me, how many times did podiatrists, NPs, and optometrists prescribing bills fail before they were given the right to prescribe in each state? The fearmongerers were out in full force suggesting that patients would be harmed if prescribing rights were given to nonphysicians. Look were we are today.

 

[whopper]

I was merely pointing out that the that the "safety" data that you ask for is not even available for psychiatrist or PCP providers.

Again, I'm not going here. I just can't even take the question seriously and I'm finding it, well let's just say fascinating that you may have graduate level training. I think this is the first time in years I've actually made of post of this tone because I can't believe this. Residents, medstudents--all your years of training, hard work, FDA, Dept of Health, ACGME, CDC what have you studies on the level of training that goes hand in hand with successful outcomes--and poof!

The DOD program DID demonstrate that psychologists CAN prescribe safely, the only question that remains is the amount of training that is required to do so!

I'm ending the debate here.

It's not because I still disagree, it's because despite the fact that I've written something several times and that it's true, it's not getting through, and the political talking points continue despite my attempts to keep the debate evidenced-based.

As I've written several times, and this is actually making me doubt you actually even read the DOD report, the DOD report even stated that it's findings were not applicable to the general public and it's review of psychologist prescribers was somewhere between mildy cold to lukewarm. It pointed out some good things such as a collegial partnership between the psychologist prescribers and psychiatrists, but also bad things that occurred such as the psychologist prescribers were actually cost-ineffective. And as I wrote several times, the standards used in the DOD paper are nowhere even close to the Oregon bill (SSRIs only and only in those who were found to not have any physical medical problems by an M.D. vs psychologist-prescribers being able to prescribe any psychotropic medication without any prior medical clearance and clinical training on the order of a mere fraction of the duration that M.D.s must go through in residency--250 hrs vs 12480?). That can hardly be used as a gauge to justify someone giving out potentially fatal medications.

I work with over a dozen psychologists, a few of them are some the nation's best. One of them will be my boss in a few months and is a highly respected local authority on anxiety disorders. I got nothing but respect for these people. If you truly are a psychologist, I hope you will eventually learn the merits of keeping debates between scientists evidenced-based and avoid use of political talking points as is apparent in your last post. (OK, now I'm sounding like myself again).

I tried to keep it evidenced based--3 swings, I'm out.

 

[maranatha]

Again, I'm not going here. I just can't even take the question seriously and I'm finding it, well let's just say fascinating that you may have graduate level training. I think this is the first time in years I've actually made of post of this tone because I can't believe this. Residents, medstudents--all your years of training, hard work, FDA, Dept of Health, ACGME, CDC what have you studies on the level of training that goes hand in hand with successful outcomes--and poof!



I'm ending the debate here.

It's not because I still disagree, it's because despite the fact that I've written something several times and that it's true, it's not getting through, and the political talking points continue despite my attempts to keep the debate evidenced-based.

As I've written several times, and this is actually making me doubt you actually even read the DOD report, the DOD report even stated that it's findings were not applicable to the general public and it's review of psychologist prescribers was somewhere between mildy cold to lukewarm. It pointed out some good things such as a collegial partnership between the psychologist prescribers and psychiatrists, but also bad things that occurred such as the psychologist prescribers were actually cost-ineffective. And as I wrote several times, the standards used in the DOD paper are nowhere even close to the Oregon bill (SSRIs only and only in those who were found to not have any physical medical problems by an M.D. vs psychologist-prescribers being able to prescribe any psychotropic medication without any prior medical clearance and clinical training on the order of a mere fraction of the duration that M.D.s must go through in residency--250 hrs vs 12480?). That can hardly be used as a gauge to justify someone giving out potentially fatal medications.

I work with over a dozen psychologists, a few of them are some the nation's best. One of them will be my boss in a few months and is a highly respected local authority on anxiety disorders. I got nothing but respect for these people. If you truly are a psychologist, I hope you will eventually learn the merits of keeping debates between scientists evidenced-based and avoid use of political talking points as is apparent in your last post. (OK, now I'm sounding like myself again).

I tried to keep it evidenced based--3 swings, I'm out.

Whooper, I actually like you taking a bit of a tone. I also find it very frustrating that some of these point are just not getting through.

Great post!

 

[busi26]

I tried to keep it evidenced based--3 swings, I'm out.

How dare anyone disagree with the great "whopper."

How many years of successful and safe prescribing by psychologists are needed for you to change your mind? Remember, psychologists have been prescribing in LA for over 5 years. Would you say that psychologists who have written thousands of scripts (with no adverse events) are not practicing safely?

 

[Sneezing]

How dare anyone disagree with the great "whopper."

How many years of successful and safe prescribing by psychologists are needed for you to change your mind? Remember, psychologists have been prescribing in LA for over 5 years. Would you say that psychologists who have written thousands of scripts (with no adverse events) are not practicing safely?

 

[CGOPsych]

Again, I'm not going here. I just can't even take the question seriously and I'm finding it, well let's just say fascinating that you may have graduate level training. I think this is the first time in years I've actually made of post of this tone because I can't believe this. Residents, medstudents--all your years of training, hard work, FDA, Dept of Health, ACGME, CDC what have you studies on the level of training that goes hand in hand with successful outcomes--and poof!



I'm ending the debate here.

It's not because I still disagree, it's because despite the fact that I've written something several times and that it's true, it's not getting through, and the political talking points continue despite my attempts to keep the debate evidenced-based.

As I've written several times, and this is actually making me doubt you actually even read the DOD report, the DOD report even stated that it's findings were not applicable to the general public and it's review of psychologist prescribers was somewhere between mildy cold to lukewarm. It pointed out some good things such as a collegial partnership between the psychologist prescribers and psychiatrists, but also bad things that occurred such as the psychologist prescribers were actually cost-ineffective. And as I wrote several times, the standards used in the DOD paper are nowhere even close to the Oregon bill (SSRIs only and only in those who were found to not have any physical medical problems by an M.D. vs psychologist-prescribers being able to prescribe any psychotropic medication without any prior medical clearance and clinical training on the order of a mere fraction of the duration that M.D.s must go through in residency--250 hrs vs 12480?). That can hardly be used as a gauge to justify someone giving out potentially fatal medications.

I work with over a dozen psychologists, a few of them are some the nation's best. One of them will be my boss in a few months and is a highly respected local authority on anxiety disorders. I got nothing but respect for these people. If you truly are a psychologist, I hope you will eventually learn the merits of keeping debates between scientists evidenced-based and avoid use of political talking points as is apparent in your last post. (OK, now I'm sounding like myself again).

I tried to keep it evidenced based--3 swings, I'm out.

Welcome to my world Whopper. Drinking the Kool-Aid at the RxP Cult compound renders its victims blind and deaf to anything but the official APA propaganda line. We've considered kidnapping them and de-programming them but we fear this is somehow organic and not functional, so it's up to you medical types to develop a cure. Consider some sort of proton-knife ECT.

In addition to the DOD report, the ACNP reports that virtually all of the PDP grads agreed that the quickie short-cut civilian attempts to get RxP through their pitifullly embarrassing correspondence school training is "ill-advised" but the RxP Cultists just glaze over and repeat their mantra "PDP shows we can prescribe by reading the directions off the back of a soup-can label".

When we destroy their child-like claims of safety with the truth, they just shut up for a day or two, then it returns ... as I said, that's obviously organic and not functional. It is impervious to repeated learning trials. Their blank stares and the rapidity in which the latest scam-claims spread throughout their ranks sometimes make me wonder if there's some sort of possession of their bodies by invaders from outer space, but I'm trying to be more scientific than that.

 

[CGOPsych]

Originally Posted by busi26
How many years of successful and safe prescribing by psychologists are needed for you to change your mind? Remember, psychologists have been prescribing in LA for over 5 years. Would you say that psychologists who have written thousands of scripts (with no adverse events) are not practicing safely?


I challenge you to show us any citation of this so-called "safety data". As I have said elsewhere, this has been challenged to the faces of some of those central to the RxP scam, and they admit that THERE IS NO DATA.

They made it up. The head of the Farleigh-Dickinson RxP training program admits it. Glenn Ally admits it. They freakin' made it up.

At one point these clowns were saying there were bazillions of prescriptions written without incident, and one of the Cultists told me he meant FDA reports. Well ... once again we tediously track down this foolishness ... seems that the FDA system is self-report ... so that means none of the RxP Cultists who actually write prescriptions have called the FDA to report that they screwed up. Now THERE's a solid piece of science. And I assume that they didn't actually contact the FDA to find out if there were any such reports.

It is bizarre that these RxP Cult members keep repeating these myths as facts. Then there's the one that almost all psychologists support their little campaign to incorporate medicine into psychology ... but that's another little scam to be dispelled. There isn't enough time in one's life to keep tracking down this baloney and shooting it out of the sky. They just create more mythology and pass it around for the gullible cult members to swallow.

 

[whopper]

Hey like I said, I'm not going to continue the debate because there pretty much were no evidence-based data being presented to counter me, in fact much of the data presented was either patently-false or evidence that the oft-cited DOD report wasn't even read--because if you read it, you know it really didn't endorse psychologist-prescribers and actually cited some problems with psychologist prescribers they weren't expecting to see (such as the cost-ineffectiveness). Anyone equating a psychologist who only gave out SSRIs to patients who were already medically cleared by an M.D. (that's right--the psychologist couldn't do anything with the patient until an M.D. gave an okay to do so) as justification for a psychologist prescriber to give out any psychotropic without medical clearance by an M.D. either didn't read the report or is suffering from a delusion.

CGOpsyche--psychiatrists too are doing their own kool-aid bull. I sat through an NJPA meeting where a psychiatrist was inciting the room full of psychiatrists against psychologists over this same issue. Yes, I agree that under the existing guidelines psychologists should not prescribe (and again, I'd be open to psychologist prescribing if the appropriate training and/or limitations were put into place) but the crowd was angry in an "us vs them" manner. Group-think incarnate, and by mental health professionals no less. I was upset.

Several of the tests forensic psychiatrists use were developed by psychologists and the training psychologists receive have strengths we psychiatrists are not taught in medical school or residency. I see too many good psychologists to know this is not an "us vs them" issue. Too bad others are trying to draw us into a fight against each other, and even worse, a mob of idiots are following them.

I still fully endorse psychologists making psychotropic suggestions to non-psychiatric M.D.s which actually would solve the problem the psychologist-prescribers claim they want to solve, but nope--they aren't endorsing that. Too bad you aren't in my area because I'd love to work with you sometime.

 

[CGOPsych]

I still fully endorse psychologists making psychotropic suggestions to non-psychiatric M.D.s which actually would solve the problem the psychologist-prescribers claim they want to solve, but nope--they aren't endorsing that. Too bad you aren't in my area because I'd love to work with you sometime.

I agree fully that the collaborative model is the way to go. It would solve the problem immediately, require no legislative changes, and give the best assurance of safety.

The APA curriculum actually has three levels, with level 2 intended to give psychologists sufficient knowledge to collaborate with physicians. But of course you never hear about that because it doesn't give APA and its buddies the power and wealth they hunger for.

I hope you won't abandon the search for a cure for RxP Cultism. Perhaps it's a virus.

 

[busi26]

Too bad you aren't in my area because I'd love to work with you sometime.

Get a room

Interesting that neither of you can answer my question. "How many years of successful and safe prescribing by psychologists are needed for you to change your mind? Remember, psychologists have been prescribing in LA for over 5 years. Would you say that psychologists who have written thousands of scripts (with no adverse events) are not practicing safely?"

 

[st2205]

Get a room

Interesting that neither of you can answer my question. "How many years of successful and safe prescribing by psychologists are needed for you to change your mind? Remember, psychologists have been prescribing in LA for over 5 years. Would you say that psychologists who have written thousands of scripts (with no adverse events) are not practicing safely?"

If this be the case, why not just save all that time and trouble and just send them to their PCP? It seems like it would be much easier to get patients in to see their PCPs than trying to train a bunch of psychologists to do something 'as effective as PCPs' if "no adverse events" is the current gold-standard.

 

[Abacab]

Why don't we let Ph.D anatomists start practicing surgery? How about Ph.D. neuroscientists practicing neurology? Or biochemists doing oncology? When will the absurd dismantling of the medical profession stop?

Although the Ph.D. is a doctorate, it has absolutely nothing to do with being a medical doctor. Psychologists might as well try to practice law or dentistry because they receive about as much training in those fields as medicine. Just because both our fields overlap in terms of the patients that we see doesn't qualify psychologists to do the work we've trained so hard to become competent in. Psychiatrists and plastic surgeons often see the same patients...this doesn't mean we go around trying to assume their responsibilities.

Frankly, all this talk about psychologists filling some void in the availability of psychiatric care in rural/underserved areas is very strange to me. This deficit should be addressed by PCPs...they prescribe the majority of psych drugs and actually have real medical training to feel comfortable doing so.

 

[whopper]

Several PCP practices already do employ a psychologist to review some mental health cases. Where I did my family practice rortation, they had a psychologist there who was asked to review any case where a patient had a mental health issue. He worked very well with the PCPs.

That said, however, there is no organized or established movement to start the joining of PCPs with psychologists (as far as I'm aware, correct me if I'm wrong). No program I've seen has told PCPs to start calling up a psychologist to work hand-in-hand although PCPs already must do that with several other doctors such as radiologists, psychiatrists, hospitalists, etc.

This deficit should be addressed by PCPs...they prescribe the majority of psych drugs and actually have real medical training to feel comfortable doing so.

Exactly and it wouldn't exactly require large amounts of $$ being pumped into lobbying efforts that could take years, and years of training. It could literally start today, this very moment with a PCP and psychologist simply introducing themselves to each other and asking the other to review some cases. That's why it makes a very transparent argument that this is really not about treating as many patients with high standards of care.

 

[CGOPsych]

Get a room

Interesting that neither of you can answer my question. "How many years of successful and safe prescribing by psychologists are needed for you to change your mind? Remember, psychologists have been prescribing in LA for over 5 years. Would you say that psychologists who have written thousands of scripts (with no adverse events) are not practicing safely?"

This baloney about safe prescribing is getting old. Perhaps it is a case of Tourettes. There is no documentation of safe prescribing in La. and N.M.
None
Zero
Nada
Zip
Null, get it? This is an RxP fantasy.

Next: You have not shown evidence of necessity or effectiveness either.
None, Zero, Nada, Zip, etc etc etc.

 

[CGOPsych]

Several PCP practices already do employ a psychologist to review some mental health cases. Where I did my family practice rortation, they had a psychologist there who was asked to review any case where a patient had a mental health issue. He worked very well with the PCPs.

That said, however, there is no organized or established movement to start the joining of PCPs with psychologists (as far as I'm aware, correct me if I'm wrong). No program I've seen has told PCPs to start calling up a psychologist to work hand-in-hand although PCPs already must do that with several other doctors such as radiologists, psychiatrists, hospitalists, etc.



Exactly and it wouldn't exactly require large amounts of $$ being pumped into lobbying efforts that could take years, and years of training. It could literally start today, this very moment with a PCP and psychologist simply introducing themselves to each other and asking the other to review some cases. That's why it makes a very transparent argument that this is really not about treating as many patients with high standards of care.

True again.
Psychologists could be meeting all the needs of the underserved and having full, rich practices for many years now if it were not for the greed and political opportunism of the APA politicians.

The collaborative model would be an excellent answer to that. Also, if psychologists had simply gotten medical training rather than spend 15 years to get one single state for prescribing psychologists, they could have hundreds of prescribers in the community.

That's why I can only repeat for the zillionth time, this is NOT about helping our patients or serving society. Those goals could have been met decades ago. Instead it is about money and power. Because the RxPers cannot admit this, they must resort to all kinds of contortions, weird logic and blind repetition of propaganda slogans to press their embarrassing case.