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

[CGOPsych]

He...and yes, I think the training needs to be improved, particularly the deliver of the education and the hour requirements for the "residency" portion. I think where RxP support really hits a snag is with the issue of autonomy. A collaborative agreement where the prescribing psychologist is able to consult as needed with cases not only leverages both professional's abilities, but it also addresses a major concern raised by people who oppose RxP rights for psychologists.

Ummm, the training needs to be improved so that it's credible medical training. The DOD psychologists initially had two full years of university medical education and a full year of fulltime supervised practice.

The APA model calls for 300 "contact hours" taken online with ridiculous requirements for "supervision".

By the way, the DOD psychologists were AGAINST doing what you are suggesting. The Reason? Inadequate training.

---

Members don't see this ad.

 

[CGOPsych]

I just read the latest draft of the bill that was available online.

http://www.leg.state.or.us/bills_laws/concepts/sen/SB1046.pdf

I'm still against it, though it's a better bill than the one I read months ago. It does require a medical professional as designated by the Ohio Medical Board to be part of a collaboration with the psychologist-prescriber.

That's better.

But I still got several problems with it.

The psychologist is still the prescriber. What if the 2 in the party disagree? I can think of several situations where that can happen and since the psychologist is the prescriber, the medication can still go through. This brings up several legal problems. E.g. what if the psychologist prescribes against the recommendation of the M.D. or D.O., there's a bad outcome? Who then is medically responsible? I didn't see much data there.

Does that happen in real life? Yes. I've had disagreements with several other M.D.s and psychologists on the treatment of my patients. I can list several examples but in the end, legally, the way the laws and our responsibilities were, it left a much clearer direction of who'd be responsible if there was a bad outcome.

IMHO what should happen, and this would be very acceptable to me for an existing practitioner who can prescribe as the final authority, while the psychologist can offer recommendations for psychotropic medication in a general sense, not a very specific sense. E.g. the person is depressed, they could recommend an SSRI. The M.D. or D.O. can take the recommendation or not of the psychologist since ultimately there will be a large grey area as to the responsibility of the medical issues. E.g. if the person is on Paxil, gains weight and get's diabetes, who's responsible?

Why general? Well the medical training is not very extensive in comparison to what M.D.s have to go through. Several non-psychotropic medications for non psychiatric disorders can cause problems if mixed with psychotropic meds. Just one example is hyperammonemia caused by topamax mixed with Depakote. That's just one out of thousands. Lithium and motrin also have a problem when mixed. Or how about an SSRI in someone with a bleeding disorder? In all the cases, the problems could lead to fatal outcomes. The suggestion must be generalized because there could be medical issues that clearly indicate a suggested medication should not be given that a psychologist-prescriber could miss, and then if there's a bad outcome who's responsible?

Is it inconvenient? IMHO no more than the Oregon bill. That bill still requires a collaboration. A medical doctor could simply call up the pharmacy at the end of the day after the psychologist prescriber gave a recommendation and the medical doctor reviews the case without having to see the patient unless the medical doctor wants to see the patient again over the issue--which would've happened anyway in the Oregon bill.

In terms of convenience, my idea is very similar to the bill. There's still a required collaboration, but what's different is the medical professional has the training and ultimately it's their responsibility for the medical consequences. That clears up a lot of problems that the bill can bring up.

Whopper,
The bill puts the major decisions in the hands of the state medical board with consultation from a committee made up mostly of psychologists. These decisions would include the formulary and training standards. The devil is in the details.

By the way, in New Mexico the prescribing psychologists -- the only state that has them now after 15 years of APA's multi-million-dollar campaign -- the formulary is restricted to FDA indications, no off-label prescribing. The RxPer forces there tried to change that a few years ago but they were shut down.

 

[edieb]

Ummm, the training needs to be improved so that it's credible medical training. The DOD psychologists initially had two full years of university medical education and a full year of fulltime supervised practice.

The APA model calls for 300 "contact hours" taken online with ridiculous requirements for "supervision".

By the way, the DOD psychologists were AGAINST doing what you are suggesting. The Reason? Inadequate training.

NOT true -- many of the DoD psychologist own the schools doing the current RxP training and MANY (ALL?) have them have testified in favor of RxP bills in various states. You know this. If I am wrong, PLEASE give me the sources showing the DoD psychologists are against this. You are so big on everybody producing data, I want to see your data on this.

 

[whopper]

The bill puts the major decisions in the hands of the state medical board with consultation from a committee made up mostly of psychologists. These decisions would include the formulary and training standards. The devil is in the details.

Well if that's the case, then hmm....well I'm now more against the bill. (Remember I was still against it, though I thought it was an improvement).

Kind of off on the side Edieb...I'm going to respond to this comment.

You are so big on everybody producing data, I want to see your data on this.

Asking for data is a legitimate request, especially for us. We're supposed to be scientists right?

Well then, why is it that you have made several rather pointed claims that fly in the face of evidenced-based data?

Don't remember any? In the past, you called psychologists the top provider of mental health (not true, PCPs are), among a few other comments. If you don't remember, then fine, I'll drop the issue, but you do often times come to the psychiatry forum pushing a lot of "us vs them" data--trying to point to several other professionals as somehow inferior without actual real-evidenced based data to back it up, whether it's psychiatry vs. psychology, medical doctors from other countries etc.

If I am wrong, PLEASE give me the sources showing the DoD psychologists are against this.

A legitimate comment, quid pro-quo. Some of the times you brought up data that was not evidenced-based, I engaged you on this issue, brought up links to the evidenced-based data..then I didn't get a response from you.

Real debate should involve the use of requests for data, and a sincere desire to look at that data on it's merits. From you, we get a lot of seemingly angry posts, then when counter-posts are brought up, either silence or more angry posts.

That's not the way a real debate should be conducted. If you conduct yourself differently from now on, then fine. I'll drop this. Your history doesn't back this.

 

[busi26]

The military, guam, new mexico, and lousiana have shown that psychologists who complete 2 years of training have the "medical and biological" understanding to safely prescribe psychotropic medications.

It seems that you believe that NPs, dentists, PAs, optometrists, and podiatrists are not safely prescribing meds as well (since they don't attend medical school). Try to take a step back and look at the big picture. IF psychologists can be trained to safely prescribe pyschotropics, wouldn't it increase access to patients? If it could be done with 100% safety (hypothetically) wouldn't you all endorse it?

 

[whopper]

You are beating a dead horse by repeating the same thing over and over again.

You could actually gain some ground by showing the data of the "safety." E.g. an actual study!

Just because a small amount were given a license and we don't see a front-page headline that 100 people died at the hands of a psychologist-prescriber does not mean that it is safe.

In your own words...

What are you citing? I would appreciate a recent citation.

 

[edieb]

Whopper, you're right and I shouldn't have called psychologists the "top providers." I think that was said in the heat of the moment and, because this is a subjective statement, I have no data for this.

Anyway, Oregon just passed the final RxP bill

 

[busi26]

You are beating a dead horse by repeating the same thing over and over again.

You could actually gain some ground by showing the data of the "safety." E.g. an actual study!

Just because a small amount were given a license and we don't see a front-page headline that 100 people died at the hands of a psychologist-prescriber does not mean that it is safe.

In your own words...

Tell me, what data would you like me to present? How do you suggest we go about comparing the psychologist prescribing data to psychiatrist prescribing data.

It is really funny how some will protect what they perceive to be their turf, regardless of how this will effect their patients. Just as podiatrists, NPs, PAs, Optometrists, and dentists prescribe meds safely - so do psychologists.

It is nostalgic to hear the same old tired mantra "patients will die, patients will die?" The AMA pulled it out of the box, dusted it off, and is trying to convince the public that MDs are the only ones who can be trained to prescribe meds. The psychiatrists are the most vocal in this fight because they see their turf being impinged on by others who might take their jobs. Once RxP passes in 25 states this whole argument will fade away, just like what happened with podiatrists, NPs, PAs, and Optometrists.

 

[busi26]

Whopper, you're right and I shouldn't have called psychologists the "top providers." I think that was said in the heat of the moment and, because this is a subjective statement, I have no data for this.

Anyway, Oregon just passed the final RxP bill

Whoo hooo! 3 states down and 47 to go. In the long run, I hope the psychiatrists on this thread realize that no one is out to get them. Allowing properly trained psychologists to prescribe psychotropic medications is in the best interest of their patients.

 

[whopper]

Tell me, what data would you like me to present? How do you suggest we go about comparing the psychologist prescribing data to psychiatrist prescribing data.

Well that just get's to the heart of the issue. If you can't even define safety, yet propose it's safe, not much of an argument to stand on.

The only study as I've mentioned that it seems any of us are aware of is the DOD study which doesn't apply to Oregon because the guidelines in the DOD study are different than the Oregon bill, and as I've said, the DOD study didn't give convincing data to support psychologist-prescribers.

As for protecting my turf? Really? I've said several times in this forum that I do think the field of psychology is a legitimate field, there's plenty of good psychologists, that under certain circumstances I could support a psychologist-prescriber (but not the Oregon bill) and thought it'd be a great thing to have psychologists work with PCPs so more meds could be given out. I've also criticized psychiatrists for attacking the field of psychology as a whole because of the psychologist-prescriber issue.

That's protecting my turf?

Just as podiatrists, NPs, PAs, Optometrists, and dentists prescribe meds safely - so do psychologists.

Apples and oranges. The guidelines set out for the above have different levels and types of training than that in the Oregon bill. To compare them as the same is misleading at best. The guidelines for an optometrist training have several significant differences than that in the Oregon bill.

Give us some data.

In your own words...

What are you citing? I would appreciate a recent citation.

 

[whopper]

Whopper, you're right and I shouldn't have called psychologists the "top providers." I think that was said in the heat of the moment and, because this is a subjective statement, I have no data for this.

Which is fine.

Listen Edieb. You really don't know me, I really don't know you other than what you post. I have in the past been a bit bugged by some of your comments.

That said, if I worked with you in person, we might actually get along great and do great work for patients. I'm fine with what you wrote. People say/write things in the heat of the moment.

I do want to ask everyone on the board, in the interests of collegiality, intellectual honesty, and science to keep debates to a Daubert Standard. In short for us non-lawyers---that's a standard federal law uses to accept an expert witness's testimony.

In short, data should be evidenced based: it should be cited in a study, it should be falsifiable. If it's anectdotal, it must be stated as such and all have to accept that anectdotal data can be validly disregarded by others because it's only anectdotal.

Getting into hissy fits over anectdotal data should be beneath a doctor. If we disagree, it should only be because the current data is still in the grey-zone, in which case we should all agree that more data needs to be obtained.

 

[busi26]

As for protecting my turf? Really? I've said several times in this forum that I do think the field of psychology is a legitimate field, there's plenty of good psychologists, that under certain circumstances I could support a psychologist-prescriber (but not the Oregon bill) and thought it'd be a great thing to have psychologists work with PCPs so more meds could be given out.

Gee thanks for your generous stamp of approval of psychology being a "legitimate field." Do you hear yourself?

So, we agree, under the right circumstances psychologists can be trained to prescribe psychotropics safely. That is what I have been saying all along. We only differ in how we define "adequate training."

 

[whopper]

We only differ in how we define "adequate training."

No. Apparently we have differing standards of debate.

I believe in evidenced-based debate. Do you? If you are truly a clinical psychologist (and therefore wouldn't you have a Psy.D. or Ph.D.?) and don't understand that debates between scientists should be evidenced-based, then you missed a major point of the doctorate.

But if you do understand...then in your own words....

What are you citing? I would appreciate a recent citation.

 

[SpiritiualDuck]

This worries me. As a pgy2, I have more training than will be expected of an RxP and I'm still learning. I can create a broader differential, one that goes beyond the DSMIV, to conceptualize a pt's clinical presentation that takes into consideration a number of possible other disorders not classically considered to be a primary axis 1 disorder, but a general medical condition.

And how will a psychologist know when to refer to one of our colleagues like a neurologist, an internist, etc? Will they even be able to?

What are we talking about here: Are they prescribing SSRI's, benzos, what? What about antipsychotics? Clozapine? Where does this end? Are they going to monitor lipids, QTC prolongation, blood levels of lithium, etc. They're not docs.

How about prescribing vpa to young females, weighing risks/benefits. Are they going to get a pregnancy test before prescribing? I can sit here generating concern after concern. It may look easy as an outsider, but it's not just about writing out a script for zoloft 50mg p.o. daily.

And the real questions is: Would any of us refer a family member to them? I have friends that are psychologist and they are great at what they do, but they're not medical providers.

This is a slippery slope, what about MSWs? I met a chiropractor who was convinced he could function a primary care physician and that he should have prescribing rights.

 

[busi26]

What are we talking about here: Are they prescribing SSRI's, benzos, what? What about antipsychotics? Clozapine? Where does this end? Are they going to monitor lipids, QTC prolongation, blood levels of lithium, etc. They're not docs.

How about prescribing vpa to young females, weighing risks/benefits. Are they going to get a pregnancy test before prescribing?

Yes, yes, and yep. What do you think is covered in the two years of training?

 

[st2205]

Yes, yes, and yep. What do you think is covered in the two years of training?

We could talk about what it is on paper, but how about in reality? A pre-med curriculum takes at least 2 years, and that's just prerequisite to the prerequisite (med school being prerequisite to psych residency). I haven't seen any prerequisites on these programs aside from being a clinical psychologist, which leaves them starting teaching at square one.

2 years of undergrad prerequisites + 2 years basic science in med school + 2 years clinical rotations + 4 years residency = 10 years

They must have a damn efficient teaching model.

 

[busi26]

No. Apparently we have differing standards of debate.

I believe in evidenced-based debate. Do you? If you are truly a clinical psychologist (and therefore wouldn't you have a Psy.D. or Ph.D.?) and don't understand that debates between scientists should be evidenced-based, then you missed a major point of the doctorate.

I guess it is amateur hour on this tread. Whopper, your arguments are really unsophisticated. Are you really a psychiatrist? You seem more like a 3rd year med student to me.

All of the available evidence (the DOD report, 5 years of prescribing in Louisiana, years of prescribing in guam and New Mexico, etc.) supports the fact that psychologists can be trained to prescribe psychotropics (i.e., completing a 2 year postdoctoral masters degree in psychopharmacology). Simple as that! How do you think the legislature of Oregon was convinced that the training is adequate? They are not out to get you.

As more and more states pass RxP, the evidence will continue to mount. I can only hope that you realize that you are wrong on this issue. I'd hate to see you continuing this debate years after you become a psychiatrist.

 

[busi26]

We could talk about what it is on paper, but how about in reality? A pre-med curriculum takes at least 2 years, and that's just prerequisite to the prerequisite (med school being prerequisite to psych residency). I haven't seen any prerequisites on these programs aside from being a clinical psychologist, which leaves them starting teaching at square one.

2 years of undergrad prerequisites + 2 years basic science in med school + 2 years clinical rotations + 4 years residency = 10 years

They must have a damn efficient teaching model.

What you fail to realize is that psychologists won't be doing heart surgery, or brain surgery for that matter. The psychopharmacology training is a supplement to 10+ years of training in psychology. Come on, how many years of training do you think is necessary to prescribe only psychotropics? Do you really believe that only those with an MD can be trained to prescribe certain medications?

As Whopper would say "show me the evidence."

 

[Therapist4Chnge]

The only study as I've mentioned that it seems any of us are aware of is the DOD study which doesn't apply to Oregon because the guidelines in the DOD study are different than the Oregon bill, and as I've said, the DOD study didn't give convincing data to support psychologist-prescribers.

Pulled from the GAO review section "Graduates are reported to provide good quality of care"

Overwhelmingly, the officials with whom we spoke, including each of the graduates' clinical supervisors, and an outside panel of psychiatrists and psychologists who evaluated each of the graduates rated the graduates' quality of care as good to excellent. Further, we found no evidence of quality problems in the graduates' credential files.

The graduates' clinical supervisors have the most extensive knowledgeabout the graduates' clinical performance because they have been responsible for reviewing the graduates' charts, discussing cases with thegraduates, and observing the graduates' interactions with patients. Without exception, these supervisors—all psychiatrists—stated that the graduates' quality of care was good. One supervisor, for example, noted that each of the graduate's patients had improved as a result of the graduate's treatment; another supervisor referred to the quality of care provided by the graduate as "phenomenal." The supervisors noted that the graduates are aware of their limitations and know when to ask for advice orconsultation or when to refer a patient to a psychiatrist. Further, the supervisors noted that no adverse patient outcomes have been associatedwith the treatment provided by the graduates.

External evaluators also provided information on the graduates' quality ofcare. In 1998, an ACNP panel composed of board-certified psychiatrists and licensed clinical psychologists performed a final evaluation of the graduates—interviewing the graduates, their supervisors, and other officials, and reviewing a portion of each graduate's patient charts. In its resulting report, ACNP described each graduate's location and role, discussed the results of interviews with the graduates' clinical supervisors and others, and discussed the results of patient chart reviews. In its report, ACNP stated that the graduates had performed well in all the locations where they were assigned, that they had performed safely and effectively as prescribing psychologists, and that no adverse outcomes had been associated with their performance.

---

Just to clarify, the DOD was not in support of the financial resources needed in the study, NOT the training of the prescribing psychologists.

 

[Abacab]

What you fail to realize is that psychologists won't be doing heart surgery, or brain surgery for that matter. The psychopharmacology training is a supplement to 10+ years of training in psychology. Come on, how many years of training do you think is necessary to prescribe only psychotropics? Do you really believe that only those with an MD can be trained to prescribe certain medications?

As Whopper would say "show me the evidence."

"only psychotropics"....that statement shows how ignorant you are about the human body. It may not seem like a big deal to you, but all of these medications can and do have adverse effects on the entire body. Also, there are many contraindications with non-psychotropic medications that you have to understand.

You seem to salivate at the thought of being able to prescribe medications. Indeed, you seem almost entitled. Funny that you are so deserving of something that it took the rest of about 8 or more years and many, many sleepless nights after college to learn. Even now after I have gained seniority and experience in residency, I still think carefully and constantly recheck everything I do because I'm not foolish enough to think "playing doctor" is so easy.

These are human lives that we deal with...don't be so quick to dismiss the potential for grave implications if the utmost care isn't taken in preparing oneself thoroughly for the responsible application of medical care.

I took an oath to "do no harm." I certainly wouldn't want to half-ass my way through prescribing after a crash course in "psychotropic meds only."

 

[busi26]

"only psychotropics"....that statement shows how ignorant you are about the human body. It may not seem like a big deal to you, but all of these medications can and do have adverse effects on the entire body. Also, there are many contraindications with non-psychotropic medications that you have to understand.

Even now after I have gained seniority and experience in residency, I still think carefully and constantly recheck everything I do because I'm not foolish enough to think "playing doctor" is so easy.

These are human lives that we deal with...don't be so quick to dismiss the potential for grave implications if the utmost care isn't taken in preparing oneself thoroughly for the responsible application of medical care.

I took an oath to "do no harm." I certainly wouldn't want to half-ass my way through prescribing after a crash course in "psychotropic meds only."

Truely laughable. You really seem to believe that only MDs can be trained to understand the human body, contraindications, and adverse events. "These are human lives that we deal with..." Really? Your narcissism is amazing to me.

 

[CGOPsych]

Pulled from the GAO review section "Graduates are reported to provide good quality of care"

Overwhelmingly, the officials with whom we spoke, including each of the graduates’ clinical supervisors, and an outside panel of psychiatrists and psychologists who evaluated each of the graduates rated the graduates’ quality of care as good to excellent. Further, we found no evidence of quality problems in the graduates’ credential files.

The graduates’ clinical supervisors have the most extensive knowledgeabout the graduates’ clinical performance because they have been responsible for reviewing the graduates’ charts, discussing cases with thegraduates, and observing the graduates’ interactions with patients. Without exception, these supervisors—all psychiatrists—stated that the graduates’ quality of care was good. One supervisor, for example, noted that each of the graduate’s patients had improved as a result of the graduate’s treatment; another supervisor referred to the quality of care provided by the graduate as “phenomenal.” The supervisors noted that the graduates are aware of their limitations and know when to ask for advice orconsultation or when to refer a patient to a psychiatrist. Further, the supervisors noted that no adverse patient outcomes have been associatedwith the treatment provided by the graduates.

External evaluators also provided information on the graduates’ quality ofcare. In 1998, an ACNP panel composed of board-certified psychiatrists and licensed clinical psychologists performed a final evaluation of the graduates—interviewing the graduates, their supervisors, and other officials, and reviewing a portion of each graduate’s patient charts. In its resulting report, ACNP described each graduate’s location and role, discussed the results of interviews with the graduates’ clinical supervisors and others, and discussed the results of patient chart reviews. In its report, ACNP stated that the graduates had performed well in all the locations where they were assigned, that they had performed safely and effectively as prescribing psychologists, and that no adverse outcomes had been associated with their performance.

---

Just to clarify, the DOD was not in support of the financial resources needed in the study, NOT the training of the prescribing psychologists.

Here's what the ACNP report ALSO said. I know you will not respond to this, since you've been drinking the RxP Kool-Aid for too long:

"Should the PDP be emulated? There was discussion at many sites about political pressures in the civilian sector for
prescription privileges for psychologists. Virtually all graduates of the PDP considered the "short-cut" programs proposed
in various quarters to be ill-advised. Most, in fact, said they favored a 2-year program much like the PDP program conducted
at Walter Reed Army Medical Center, but with somewhat more tailoring of the didactic training courses to the special
needs, and skills of clinical psychologists. Most said an intensive full-time year of clinical experience, particularly
with inpatients, was indispensable."

In other words, the PDP grads themselves said that this program should not be emulated because of inadequate training. The first wave of PDP had two full years of university education in medicine, plus a full year of supervised experience.

The shameless and tawdry excuse for medical education proposed by APA and its surrogates calls for 300 "contact hours" obtained in correspondence school. Not even close.

So while you love to cite the PDP, it is not only irrelevant, but its grads say you're wrong.

 

[CGOPsych]

Truely laughable. You really seem to believe that only MDs can be trained to understand the human body, contraindications, and adverse events. "These are human lives that we deal with..." Really? Your narcissism is amazing to me.

Psychologists can be trained to understand the human body, through a medical education.

300 "contact hours" taken in correspondence school is not a medical education.

It's a fraud, perpetrated on the vulnerable by the greedy.

 

[CGOPsych]

What you fail to realize is that psychologists won't be doing heart surgery, or brain surgery for that matter. The psychopharmacology training is a supplement to 10+ years of training in psychology. Come on, how many years of training do you think is necessary to prescribe only psychotropics? Do you really believe that only those with an MD can be trained to prescribe certain medications?

As Whopper would say "show me the evidence."

According to the PDP grads, you should have at least one full year of university medical education and a solid year of nothing but supervised practice. And you should be heavily embedded in the medical system.

NOT 300 "contact hours" obtained in correspondence school. Have you no shame at all?

 

[CGOPsych]

Yes, yes, and yep. What do you think is covered in the two years of training?

Two years of training? It's 300 "contact hours" of correspondence school. That's not medical training.
Be a doctor right in your own living room on your laptop.

 

[CGOPsych]

NOT true -- many of the DoD psychologist own the schools doing the current RxP training and MANY (ALL?) have them have testified in favor of RxP bills in various states. You know this. If I am wrong, PLEASE give me the sources showing the DoD psychologists are against this. You are so big on everybody producing data, I want to see your data on this.

As noted elsewhere, the ACNP reports says:

Should the PDP be emulated? There was discussion at many sites about political pressures in the civilian sector for
prescription privileges for psychologists. Virtually all graduates of the PDP considered the "short-cut" programs proposed
in various quarters to be ill-advised. Most, in fact, said they favored a 2-year program much like the PDP program conducted
at Walter Reed Army Medical Center, but with somewhat more tailoring of the didactic training courses to the special
needs, and skills of clinical psychologists. Most said an intensive full-time year of clinical experience, particularly
with inpatients, was indispensable.

 

[CGOPsych]

Well if that's the case, then hmm....well I'm now more against the bill. (Remember I was still against it, though I thought it was an improvement).

Kind of off on the side Edieb...I'm going to respond to this comment.



Asking for data is a legitimate request, especially for us. We're supposed to be scientists right?

Well then, why is it that you have made several rather pointed claims that fly in the face of evidenced-based data?

Don't remember any? In the past, you called psychologists the top provider of mental health (not true, PCPs are), among a few other comments. If you don't remember, then fine, I'll drop the issue, but you do often times come to the psychiatry forum pushing a lot of "us vs them" data--trying to point to several other professionals as somehow inferior without actual real-evidenced based data to back it up, whether it's psychiatry vs. psychology, medical doctors from other countries etc.


A legitimate comment, quid pro-quo. Some of the times you brought up data that was not evidenced-based, I engaged you on this issue, brought up links to the evidenced-based data..then I didn't get a response from you.

Real debate should involve the use of requests for data, and a sincere desire to look at that data on it's merits. From you, we get a lot of seemingly angry posts, then when counter-posts are brought up, either silence or more angry posts.

That's not the way a real debate should be conducted. If you conduct yourself differently from now on, then fine. I'll drop this. Your history doesn't back this.

Whopper,
I've just posted the quote from the same ACNP report. I'm sure this will make a big impression on the RxPers and they'll suddenly see that they are wrong, lol.

Additionally, a survey in Illinois showed that 78 percent of all licensed clinical psychologists believe that psychologists who want to prescribe should have to have the same amount of training as other non-physician prescribers. Since PA's, APN's etc. don't get their Rx rights with 300 "contact hours" of correspondence school, then obviously the RxPers' model is unacceptable to them.

But don't count on the trolls to respond to this.

Furthermore, the actions of the Louisiana psychologists rejects the APA model. They said that they realized prescribing is the practice of medicine and should be done with a medical license and under the regulation of the state medical board.

So ... the PDP grads and 78 percent of psychologists say the training is inadequate and the Lousiana prescribers say they should not be practicing with psychology licenses or regulated by psychologists.

What on earth is left?

Oh .. .right ... plenty of RxP Kool Aid from APA, where money is the object.

 

[Therapist4Chnge]

Here's what the ACNP report ALSO said. I know you will not respond to this, since you've been drinking the RxP Kool-Aid for too long:

"Should the PDP be emulated? There was discussion at many sites about political pressures in the civilian sector for prescription privileges for psychologists. Virtually all graduates of the PDP considered the "short-cut" programs proposed in various quarters to be ill-advised. Most, in fact, said they favored a 2-year program much like the PDP program conducted at Walter Reed Army Medical Center, but with somewhat more tailoring of the didactic training courses to the special needs, and skills of clinical psychologists. Most said an intensive full-time year of clinical experience, particularly with inpatients, was indispensable."

So while you love to cite the PDP, it is not only irrelevant, but its grads say you're wrong.

If you read my comments, which others have referenced, I have supported exactly what the PDP graduates advocated. I would appreciate you not paint in broad generalizations overall all RxP supporters. Additionally, I would appreciate a more professional discourse, as inferring others are trolls (myself included) is not only incorrect but it is also inflammatory. As others have noted, I am more than happy to have a professional discussion about this, though your continued jabs at people who oppose your way of thinking is growing old.

 

[edieb]

Truely laughable. You really seem to believe that only MDs can be trained to understand the human body, contraindications, and adverse events. "These are human lives that we deal with..." Really? Your narcissism is amazing to me.

Busi, I applaud your willingness to debate the RxP issue. However, you may find your efforts more effective by contacting your representatives regarding psychologist prescribing. In the state where I reside, we have been stealthily educating individual legislators and gaining their support for awhile. Next year, the APA and the state psychological association are going to stealthily introduce an RxP bill. If you like, PM me and I will give you some info on how you can get involved in your state.

 

[busi26]

Busi, I applaud your willingness to debate the RxP issue. However, you may find your efforts more effective by contacting your representatives regarding psychologist prescribing. In the state where I reside, we have been stealthily educating individual legislators and gaining their support for awhile. Next year, the APA and the state psychological association are going to stealthily introduce an RxP bill. If you like, PM me and I will give you some info on how you can get involved in your state.

Thanks edieb. I am involved in my state.

 

[whopper]

Busi26..

As Whopper would say "show me the evidence."

Quid pro-quo. If you demand evidence you should offer it. I'm all ears. Show me the data other than the DOD study because as we know that study mentioned it's not applicable to the public. Show me the data from the states you mentioned.

(the DOD report, 5 years of prescribing in Louisiana, years of prescribing in guam and New Mexico, etc.) supports the fact that psychologists can be trained to prescribe psychotropics (i.e., completing a 2 year postdoctoral masters degree in psychopharmacology). Simple as that! How do you think the legislature of Oregon was convinced that the training is adequate? They are not out to get you.

No. There is a DOD report which again was mentioned to have several problems in applying it to the general public. The prescribing in the states you mentioned--there are no published studies on it. Since you brought it up, get some of the data from the states you mentioned. Show me some studies from those states.

Edieb, would you actually consider this comment a debate? If you truly are a mental health professional take a step back and look at this debate as a professional.

Truely laughable. You really seem to believe that only MDs can be trained to understand the human body, contraindications, and adverse events. "These are human lives that we deal with..." Really? Your narcissism is amazing to me.

Really? Your narcissism is amazing to me.[/

Truely laughable

CGOpsyche, I got to ask you to do the same. Yes, I do think some people here have crossed the line with their decorum. Don't do the same. T4C brought in some evidenced-based data, and you countered it. He has consistently brought in evidenced-based data and did not resort to personal attacks. I do think the jab at T4C was a bit unwarranted given that he's maintained very good decorum.

 

[Therapist4Chnge]

T4C--read the data from the GAO office. First, I appreciate you actually giving some data. Unfortunately the problem with that data which was countered well was that the DOD study (as I've mentioned several times) was reported to not be applicable to the general public.

Hence, applying the DOD study to the public is pretty moot when the study itself said it shouldn't be done.

I believe it was the ACNP report also mentioned how the prescribing psychologist who provided care to family members and dependents had a population that was similar to a psychiatry out-patient practice. I'll need to get back to you about where I read that (as I have a flight to catch), but in one of the reports there was mention of this. I'm not saying that the reference means everything is generalizable, but the opposition seems so "absolute" in everything, that it at least speaks to that.

 

[whopper]

but the opposition seems so "absolute" in everything, that it at least speaks to that.

I think there's a lot of absolutism. Agree there.

Hey, T4C, and CGOpsyche, where are you guys? PM me if you'd like. Both of you are the only people in this debate that I feel that I can talk to where I can learn something from you. Maybe we can catch a drink at a conference. Edieb, I think we made some progress.

 

[Abacab]

Truely laughable. You really seem to believe that only MDs can be trained to understand the human body, contraindications, and adverse events. "These are human lives that we deal with..." Really? Your narcissism is amazing to me.

You might want to work on basic english skills before worrying about playing doctor.

FYI, having concern for the safety of my patients isn't narcissism. Why don't you read my post again? In spite of the vast number of years in training, I still often think long and hard before acting because I'm aware of the potency and dangers of these medications.

 

[whopper]

FYI, having concern for the safety of my patients isn't narcissism

Hey, I've been trying to get Busi26 to simply just show some published data to support his (or her, sorry don't know the gender) claims. Something Busi26 has requested in other threads in the psychology forum in a debate over the merits of psychodynamic psychotherapy.

I'm accused of being "unsophisticated" and a "3rd year medical student."

I think I'm just going to observe the thread--unless Busi26 actually shows some data. No point in beating a dead horse.

 

[Sneezing]

No point in beating a dead horse.

 

[CGOPsych]

CGOpsyche, I got to ask you to do the same. Yes, I do think some people here have crossed the line with their decorum. Don't do the same. T4C brought in some evidenced-based data, and you countered it. He has consistently brought in evidenced-based data and did not resort to personal attacks. I do think the jab at T4C was a bit unwarranted given that he's maintained very good decorum.

(Hangs head in shame) ... Yes, you're right.
I confuse the trolls with those who have been more appropriate.
Time for my Abilify

 

[Therapist4Chnge]

(Hangs head in shame) ... Yes, you're right.
I confuse the trolls with those who have been more appropriate.
Time for my Abilify

 

[FURY 161]

Whoo hooo! 3 states down and 47 to go. In the long run, I hope the psychiatrists on this thread realize that no one is out to get them. Allowing properly trained psychologists to prescribe psychotropic medications is in the best interest of their patients.

The patients don't need psychologists to prescribe meds. The lawyers need that.

The country simply needs more doctors - more residency slots to be precise. This is the only way to fight the shortage of physicians in the country.

 

[CGOPsych]

The patients don't need psychologists to prescribe meds. The lawyers need that.

The country simply needs more doctors - more residency slots to be precise. This is the only way to fight the shortage of physicians in the country.

We need several good solutions. More physicians and other medically trained personnel is definitely among them.

I've been in clinical practice for 15 years. I have never had a problem collaborating with the physicians of my patients, who are often on several medications at a time, only some of them psychoactive.

When I call a physician I get a call back very soon. In some instances they walk out of an exam room to talk about a case with me. Or they give me their cell phones so we can discuss a case whenever necessary. When we talk, they are eager to hear from me and give my thoughts consideration.

My physician friends tell me they like working with psychologists, but that their chief complaint is that we don't collaborate with them very well. We don't communicate with them.

This is why the collaboration model does and can work. APA's psychopharmacology training actually has three levels. The second level educates psychologists so that they can become collaborators with physicians who write the prescriptions. Of course, you don't hear about that much since this pathway doesn't serve the economic and political interests of the organization which has shelled out millions of dollars to incorporate medicine into psychology.

This also speaks to the issue of extremely effective alternatives to the APA program of psychologists prescribing. If APA had been pursuing this pathway then the problems with treatment via medication would disappear, but APA wouldn't get anything out of it except to help society. I firmly believe that that motivation remains at APA, but it has become secondary to the drive for power and wealth. And for that, I am ashamed, as a longtime member of APA.

 

[sunlioness]

I guess it is amateur hour on this tread. Whopper, your arguments are really unsophisticated. Are you really a psychiatrist? You seem more like a 3rd year med student to me.

Wow. I am sorry, but resorting to personal attacks and insults is never called for. I read things like this and it makes me more apt to discount every other thing you say, legitimate or not.

 

[sunlioness]

What you fail to realize is that psychologists won't be doing heart surgery, or brain surgery for that matter. The psychopharmacology training is a supplement to 10+ years of training in psychology. Come on, how many years of training do you think is necessary to prescribe only psychotropics? Do you really believe that only those with an MD can be trained to prescribe certain medications?

As Whopper would say "show me the evidence."

Psychiatrists don't do heart surgery or brain surgery either. Despite our years of training, we are completely unqualified to do so. So I don't see how this argument even applies. I also think that prescribing psychotropics is just as important as being a brain surgeon and while it requires different skills and training, it still requires skills and training. So I also find the above comment to be dismissive of the skills and training required to prescribe psychotropics, which is a bit disturbing.

 

[busi26]

Wow. I am sorry, but resorting to personal attacks and insults is never called for. I read things like this and it makes me more apt to discount every other thing you say, legitimate or not.

Go back and read Whopper's and Cgo's personal attacks. Just as in football, it is usually the person who strikes back who gets flagged.

 

[sunlioness]

CGO's, I'll give you. And he apologized. Must have missed Whopper's . . .

(And honestly, I feel like a mother "It doesn't matter who started it, you shouldn't hit people.")

(Alright I'm going now.)

 

[SpiritiualDuck]

I should let this thread fade away, but I can't resist.

What about ECT? I think psychologist could learn the skills to do that by reading a pamphlet. Since psychopharm can be learned so easily, how hard can it be to train non-MD's to do ECT?

ECT is our most effective treatment we have for severe, treatment resistant depression.

The thing that burns me is: I've jumped through so many hoops, chem, physics, orgo, MCAT, Step 1, 2, 3, endless call nights, a surgery rotation as a med student, I've caught babies, hours of being pimped, and always functioning on little sleep.

And I'm not saying getting a PhD in psych isn't hard, but it's not the same and it's not medicine. And a 4.0 in psych, as an undergrad, is not that hard to come by.

So, if they can prescribe meds, let them do ECT too.

 

[Therapist4Chnge]

And I'm not saying getting a PhD in psych isn't hard, but it's not the same and it's not medicine. And a 4.0 in psych, as an undergrad, is not that hard to come by.

You seem to imply that since psych is generally easier as an undergrad, that it must be easier at the graduate level. I'd correct you, but I don't expect a physician to understand research concepts and pitfalls of poor hypothesis development, since they don't take the same level of research and statistic classes as a psychologist.*

*Does that sound as condescending as your statement?

Just trying to keep it fair in here.

 

[SpiritiualDuck]

therapist4change, I apologize for being condescending. You're right. Most MD's don't know stats/research design that well. I, however, do. I've done the course work and I've TA'd stats/research methods. And those are tough classes, but the road to medical school and getting through medical school is demanding on many levels. It's not conceptually hard. You just have to be very committed to the process.

Many folks start out on the premed path, but few make it. It's a long and difficult road by design and giving prescribing rights to folks with such a limited amount of medical knowledge is foolish. The hours that I put in the psych ED, on the floors, and on other services like med/neuro has given me a perspective about mental illness, treatment, within the frame of a medical model that goes beyond what you'll have in a 2 year post PhD program.

It's simply unrealistic to think that you'll have enough scope, depth, and understanding of how to manage the complexities that could potentially be involved.

There are some gero folks that are medical train wrecks, do you really think you'll feel safe prescribing to that population?

As a 2nd year resident, I'm always aware of what I don't, but I know my limits and I know when and where to get help. Try sorting out a hypoactive delirium from MDD in an 81 year old male who has multiple comorbidities, visual, hearing impairments, and is coming in on 20 meds that have various CPY3a4 interactions. Maybe he's even on dialysis too. Sadly, this isn't even the worst of the worst, that's a fairly typical elderly gent in America today. So, what are you going to do, an SSRI, labs, low dose risperidone, check a u/a, imaging, where are you going to begin, get collateral, talk to family. I worry about what psychologist will miss because they haven't seen it. We do the years of training to help prepare us for the hard stuff too.

Prescribing rights is a privilege that shouldn't be taken too lightly because bad stuff can and will happen. Docs with years of training make mistakes all the time.

 

[Psiguy]

And those are tough classes, but the road to medical school and getting through medical school is demanding on many levels. It's not conceptually hard. You just have to be very committed to the process.

Many folks start out on the premed path, but few make it.

SpiritualDuck,

Comparing the road to medical school with the road to a doctoral program in clinical psychology is pointless in a debate like this. As part of my doctoral training in clinical psychology, I have attended class at a local medical school. I also have friends in law school and vet medicine. Despite the differences in our training, we share much more in common than some of you seem to believe. Regardless, I assure you the majority of us work hard.

The problem we have now is that decisions regarding who is competent to prescribe psychiatric medications are being made by politicians based on input from biased groups on each side of the debate. Unlike what I have seen on this board, it is entirely possible to argue our side without resorting to attacks on individuals or professions. More importantly, we do more for our argument by avoiding these silly attacks. Trust me, I have argued against prescription rights for psychologists with my colleagues and supervisors for some time now.

If anything, this law should serve as a reminder to those of us who strive to provide the best treatment for our clients that there are questionably ethical practitioners out there who are willing, for whatever reason, to work against the best interests of clients. Those of us who truly care should be banding together to fight against these laws and get these bad practitioners away from clients.

 

[CGOPsych]

The associate editor of the Oregonian, the state's largest newspaper, has posted an op-ed piece calling for the governor to veto the bill that could lead to prescription privileges for psychologists:

http://www.oregonlive.com/news/oreg...f/2010/02/drugs_and_oregon_lawmakers_wri.html

 

[CGOPsych]

therapist4change, I apologize for being condescending. You're right. Most MD's don't know stats/research design that well. I, however, do. I've done the course work and I've TA'd stats/research methods. And those are tough classes, but the road to medical school and getting through medical school is demanding on many levels. It's not conceptually hard. You just have to be very committed to the process.

Many folks start out on the premed path, but few make it. It's a long and difficult road by design and giving prescribing rights to folks with such a limited amount of medical knowledge is foolish. The hours that I put in the psych ED, on the floors, and on other services like med/neuro has given me a perspective about mental illness, treatment, within the frame of a medical model that goes beyond what you'll have in a 2 year post PhD program.

It's simply unrealistic to think that you'll have enough scope, depth, and understanding of how to manage the complexities that could potentially be involved.

There are some gero folks that are medical train wrecks, do you really think you'll feel safe prescribing to that population?

As a 2nd year resident, I'm always aware of what I don't, but I know my limits and I know when and where to get help. Try sorting out a hypoactive delirium from MDD in an 81 year old male who has multiple comorbidities, visual, hearing impairments, and is coming in on 20 meds that have various CPY3a4 interactions. Maybe he's even on dialysis too. Sadly, this isn't even the worst of the worst, that's a fairly typical elderly gent in America today. So, what are you going to do, an SSRI, labs, low dose risperidone, check a u/a, imaging, where are you going to begin, get collateral, talk to family. I worry about what psychologist will miss because they haven't seen it. We do the years of training to help prepare us for the hard stuff too.

Prescribing rights is a privilege that shouldn't be taken too lightly because bad stuff can and will happen. Docs with years of training make mistakes all the time.

You touch on a couple of good issues. The first is the common fallacy of the naive that the work of highly trained professionals is easily accomplished according to some outward appearances or a few anecdotes. Since the RxP movement is economically and politically driven by the top brass of APA, exerting its power downward through the expenditure of millions of dollars of members' funds without evidence of their approval, then such claims also are just self-serving dismissals of the complexity of practicing medicine.

The other is the issue of comparing psychologists and physicians. As a psychologist who works often with physicians, I know that we are actually different species although the naive may believe that we are different only in some aspects of our knowledge base. Kingsbury 1987 (American Psychologist) outlined this very intelligently, as he was a clinical psychologist who also had the full training as a psychiatrist.

Psychology is far broader than the delivery of health care services. As the estimable John Kihlstrom said, it is the queen of the human sciences, with a promise to offer society much more than just the direct provision of clinical services. However, the narrowing of this view of our profession has been caused in great part by the professional schools which train persons to only deliver practice services and usually with an utter minimum of education outside of what is needed to be licensed as a practitioner. (This downgrading of the principles of science in these schools has led to controversy and creates a tendency to advocate scientifically questionable practices.) It is this limited and practice-focused part of our profession that has spawned extreme envy of physicians and also significant feelings of inferiority since they are always comparing themselves to the authority and scope of physicians. This has spawned the RxP movement as these practitioners covet the economic advantages and status of medicine.

For example, when I am in a hospital or a medical clinic, I am always treated with respect, but in the very hierarchical world of medicine (and especially hospitals) it is clear that the physicians have the greater status and responsibility. However, when I was attending research meetings with a world-famous psychotherapy researcher, where the group was all Ph.D.'s with considerable experience as scientists and clinicians, interestingly physicians were also regarded with respect, but as highly trained technicians.

Unfortunately, these practice-focused individuals often work only in an intellectual and professional context that causes them to compare themselves to the status of physicians within medicine, and thus feel they should have this status as well.

You'll notice that this sort of naive envy doesn't seem to occur in other areas of psychology, or clinical psychology. For example, I have attended forensic psychology seminars where the leaders and attendees know a good bit about the law, and some have JD's as well as psychology degrees. There simply is no thought given to the idea that psychologists should be allowed to practice law without having to go to law school. Their interest is how to apply psychology within the law, not how to become lawyers on the cheap so they can make more money and have more status. I am certain that if someone proposed that, everyone in the room would say: "Go to law school if you want to practice law."