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PhD/PsyD Post doc. Master in psychopharmacology

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by Healthinfo104, Sep 9, 2017.

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  1. Healthinfo104

    Healthinfo104

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    For psychologists that have no interest in prescribing or live in a state where there's no prescribing privileges, is this post doc masters in psychopharm still worthwhile if you want to be more involved in discussing meds with your clientt and their doctor and understanding their side effects or effect on clients behaviors?

    Or if you work in a medical setting or with patients with medical issues that might compound their mental state, would this training be of use?
     
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  3. psych.meout

    psych.meout

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    I don't think an additional master's degree would be worth the time, money, and energy for psychologists, especially if they are not going to be prescribing medication. There are plenty of ways to obtain enough knowledge about psychopharmacology for the limited role you would have with it without completing another degree. During their normal training, many grad programs have formal courses in psychopharmacology (mine does) and many external practica, internships, and post docs provide opportunities to learn about it in very practical, clinical manners. There are continuing education opportunities for currently practicing psychologists to improve their knowledge and practice in this area.
     
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  4. Healthinfo104

    Healthinfo104

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    Oh I see, well that's good that there are continuing education courses and such to learn the relevant information needed.

    So why are so many of these psychopharm masters programs popping up around the country and so many people vesting the time and money to get them if only a few states allow them to prescribe and if many of these people getting them don't seek to prescribe anyways?
     
  5. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    Because there are a lot of financially stupid people out there willing to pay for something that is a horrible return on investment. If you're not planning on doing RxP ever, just too expensive for what you get. Same reason midlevels pay thousands of dollars t get "trained" in EMDR.
     
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  6. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus 10+ Year Member

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    I disagree with the EMDR comparison, but agree in general about the cost/benefit issue for non-prescribers.
     
    Last edited: Sep 10, 2017
  7. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    Fair enough, the EMDR comparison was more meant to highlight that ROI is a real thing that should be considered. The training costs an exorbitant amount and you have to buy all of the fairy dust equipment to go with it. When, compared to the likely free training you can get in PE and/or CPT, is just ridiculous. If you're not planning on doing RxP, going through the courses for it and paying the hefty tuition is just a poor use of resources and will likely add little to nothing in your earning potential. If you didn't get psychopharm training/coursework in grad school or later training, your better bet is some CEs focused on meds that your population commonly uses (e.g., opiates, anticholinergics, etc) or just do some guided reading on the subject.
     
  8. PSYDR

    PSYDR Psychologist 10+ Year Member

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    I did it, and do not practice as a medical psychologist. I also doubt I am financially stupid.

    For me, the training was a decent idea for a few reasons:

    1) I like having more education, felt like it helped me more effectively communicate with other professionals, and I had the cash for it. Same reason I am getting another degree.
    2) The masters program counted towards my CE requirements for my state so it was nice to have 2 years of that stuff laid out in a program.
    3) I have a use for the degree outside of clinical practice.
    4) I think that the rxp movement is good for the field in general.
     
  9. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    If you're using money that you would have spent for CEs anyway, and you have something like your #3 point, I can see some of the worth. My comments were more on people who will go through the entire course for no real purpose. for many of those people, several CE opportunities/side reading will be more than sufficient for what they need. This seems to be the OPs case, they want to know if it's worth it to have simply because they are in a medical setting. In that case, I still argue that it's a terrible investment. If you have a solid and reasonable plan for how the money spent on this will contribute to some increased earning potential, it may be good, but for the majority of practicing psychologists, probably a net loss.

    I support the theory of RxP as well, maybe just not the current implementation of it.
     
  10. Psycycle

    Psycycle Psychologist 10+ Year Member

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    I have seen it benefit people financially in terms of salary in family practices wherein the psychologist's knowledge assists the residents & physicians in prescribing psychotropics,
     
  11. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    I'd have to imagine this is an outlier circumstance. I can't imagine most medical settings to renegotiate a psychologist's salary after they get this. In most places if it doesn't somehow increase what you can bill for, no one cares.
     
  12. erg923

    erg923 Psychologist 10+ Year Member

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    How would that benefit the institution financially?

    I also find it hard to believe a MD would be taking Rxing advice from a Ph.D./Psy.D who didnt have years of actual experience Rxing psychotropics themselves.
     
  13. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    This part I actually don't find all that surprising. I've lost count of how many times I've been asked for a medication recommendations. I generally refuse to answer, of course, unless it's to ask that they do something to lessen the benzo/opiate/anticholinergic load because it's gorking the patient out.
     
  14. MamaPhD

    MamaPhD Psychologist, Academic Medical Center 7+ Year Member

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    Same. I've fielded a lot of questions about prescription meds.
     
  15. PSYDR

    PSYDR Psychologist 10+ Year Member

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    I've had this as well. This is not the referral source I want in my life.
     
  16. psych.meout

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    Especially because you can't bill for it?
     
  17. smalltownpsych

    smalltownpsych 2+ Year Member

    It happens every time I'm on call. It is true that it doesn't really benefit the institution since it can't be billed.

    To me this is one of the better arguments for RxP because we are often the expert on mental health in the case and when medications are indicated and there is no psychiatrist available, then we end up with docs who have limited knowledge and expertise or even comfort level being pressured or required to prescribe medications to treat an illness that they don't understand very well. At our hospital, it seems about split 50/50 with docs who feel comfortable treating mental illness and about half of those actually have some competence and are aware of their limitations and consult closely with us. The scary group are those who feel comfortable, but don't see their limitations. Although recently one of them wanted to play the hero for a frequent flyer non-compliant substance user with schizophrenia and I said have at it.
    :=|:-):
     
  18. HooahDOc

    HooahDOc 10+ Year Member

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    What's the general opinion for psychologists who want to become RxP? Is it similar to the NP's in other areas of medicine, where they have the mistaken belief that their knowledge and expertise is now equivelant to a psychiatrist with regards to medications? Or do they typically realized and understand that the level of training is not the same but the ability to provide this service is beneficial to the overall population in need?

    This is coming up now where I practice and I'm genuinely interested. I'm also trying to compare the typical psychopharm curriculum to get an idea of what the, "standard" is.
     
  19. PSYDR

    PSYDR Psychologist 10+ Year Member

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    That's sorta like someone asking "are physicians under the mistaken understanding that their education leads to better outcomes for patients than the education of NPs or do they realize empirical evidence finds otherwise?" See? You wouldn't think that someone asking that question was actually curious. You'd assume they were only looking to support their own opinion. A competent clinician might even have some ideas about the implications of that.

    Being more graceful, the rxp laws require physician oversight.
     
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  20. Healthinfo104

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    I'm not too sure, I know there is a lot of controversy over it... many people including a lot of psychologists are against it because they are afraid it will make psychology medicalize everything too much like psychiatry has done over the years, and many physicians, especially psychiatrists are against it because of turf battles... other physicians such as family physicians are more welcoming because they often have to do the prescribing for many mental health cases.

    I also know that there is a lot of questions regarding what level of training should be required for practice... I think the current training is good but should probably include some rotations in the hospital as well.
     
  21. MamaPhD

    MamaPhD Psychologist, Academic Medical Center 7+ Year Member

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    You'll find many opinions on this and other forums. The opinion I have most often heard expressed is not that psychologists' training is superior to physicians' but that, with additional training, it can be adequate to the task of prescribing in some situations specific to mental health. I've also known a fair number of NPs and I've never heard a single one claim to have the level of training or expertise of a physician, so it's possible I've just worked among folks with more moderate attitudes toward non-physician prescribing in general.

    Most studies of psychologists' attitudes on RxP don't assess behavioral intentions, but I saw one published survey in which a single digit percentage of psychologists indicated intent to actually obtain the additional training and licensure requirements to prescribe. So, while I am not a fan of RxP, I really don't think it's psychologists you need to worry about.
     
  22. HooahDOc

    HooahDOc 10+ Year Member

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    I agree, and I'm not necessarily worried about RxP for psychologists, but I am concerned that psychologists may have an inaccurate perception of the difficulty in managing medications. I recently had a case where the patient presented to their primary care physician with lethargy and orthostasis who was diagnosed with hypovolemia secondary to dehydration and sent home. This actually wasn't correct, as his vitals were not consistent with hypovolemia but actually were consistent with a cardiogenic etiology -- pretty significant symptomatic bradycardia due to an unexpected interation with Celexa and another medication. I, as the psychiatrist, was able to recognize this even when the PCM didn't and knew what to do about it. I am very doubtful that a medical psychologist would have been able to do the same. The problem with prescribing medications is that you own everything about that patient and the responsibility of handling anything that may come up, including the ability to differentiate between problems that may be related to what you have prescribed or problems unrelated to what you have prescribed. Management is never limited to strictly the known side effects of a particular medication. I honestly don't see how I would be competent to do this without having had the extensive medical training and clinical experiences outside of psychiatry.

    The extensive training and education of physicians is not so we have the ability to handle the routine things that go well. It's to know how to handle the complications.

    My friend and colleague where I practice is a psychologist who has had this training, but the hospital won't grant privileges. I think he has a reasonable perspective in that the training and skillset is not equivalent to that of (most) psychiatrists. I can respect this. My only reservation is that medication management, in general, is incredibly easy -- until it isn't. If not for all of my other medical training outside of psychiatry, I would entirely miss a fair number of things in patients.

    I am more concerned about the NP's more than anything. They are dangerous, and that entire profession is a perfect example of the Dunning-Kruger effect.
     
    Last edited: Sep 13, 2017 at 6:42 AM
  23. Psycycle

    Psycycle Psychologist 10+ Year Member

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    I thought you worked in PCMHI?

    As for billing, in the situations where a psychologist was offered additional monies for the degree, it was viewed as an overall financial benefit for the institution to be better able to manage mental health, as well as better training for residents.

    It may indeed be an outlier experience, I have not seen this often but I also do not know many psychologists who sought the degree. I myself have not because I cannot see any benefit to my career other than to satisfy my intellectual curiosity. And at this point in my life, intellectual curiosity through obtaining a degree simply costs too much.
     
  24. Healthinfo104

    Healthinfo104

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    Is there financial gain from other post doctoral traning, like neuropsych for instance?
     
  25. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    Yes, the salary surveys for the APA and the salary survey for neuropsychologists through AACN are available for viewing. Our compensation, on average, is higher for npsych than psychologist's in general. If you do IMEs, it far outpaces what most people will make in general psychology.
     
  26. MamaPhD

    MamaPhD Psychologist, Academic Medical Center 7+ Year Member

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    Yes, I share this concern, and I would hate to be the patient who finds out the hard way that their prescribing psychologist isn't up to the task of identifying a medication interaction. There will always be fewer practitioners who actually identify such events than who should be able to identify them, but if that ratio is meaningfully higher for physicians than for non-physician prescribers (and I believe it is), then prescribing privileges need to be handled very carefully.

    Hypothetically I could get behind an "extender" model where, working under a physician-supervised protocol, a psychologist could do something like refill a non-scheduled prescription for a stable patient. I just don't see the value of that for my profession, frankly. I didn't train to be a midlevel. My standard for independent practice is to be competent to manage, from start to finish, the realistic spectrum of positive and negative outcomes of any treatment I provide.

    Some comments I have heard from inexperienced psychologists or trainees, especially those who have had little exposure to working with other disciplines, concern me. Fortunately it's been very infrequent, but I have encountered people who say things like "I went through 6 years of doctoral training in psychology, so I have the same amount of training in mental health as a psychiatrist," and they just miss the point entirely. Just cringeworthy. The worst kind of hubris is the kind that comes from being unable to fully conceptualize what could go wrong.

    Working closely with medical subspecialists has made me appreciate that level of expertise. But it's having had the tables turned a few times that has driven it home for me. Because I have expert knowledge in a very specific area (which took years to acquire, mostly in the context of research), I have been able at times to catch something that eluded a physician in a shared patient. It has nothing to do with my being a psychologist specifically, and everything to do with the fact that in this one circumscribed area, I have knowledge that most clinicians don't. So I respect immersing oneself for years in a specialty to become competent at it, and it frustrates me to see it devalued.

    If a licensed prescribing psychologist can pass the ABPN exam, I will revisit my opinion.
     
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  27. erg923

    erg923 Psychologist 10+ Year Member

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    Not anymore. And when I did, I worked with PACT, but was careful not to make or suggest any specific medications (maybe other than to discourage benzo scripts for most anxiety disorders), as I have seen disciplinary actions taken against psychologist in my state for such.
     
  28. Healthinfo104

    Healthinfo104

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    Oh ok, I see... maybe as psychopharm training becomes more widespread it's rates will also increase
     
  29. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    Maybe like 20-30 years down the road, if RxP becomes more widespread, maybe. But, I wouldn't plan on it moving the needle any time soon.
     
  30. erg923

    erg923 Psychologist 10+ Year Member

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    MBA (if one is to pursue any education/training beyond the Ph.D) opens up many more doors, in my experience.
     
  31. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus 10+ Year Member

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    It is definitely state dependent bc in the states I have practiced we are within our scope to make those recs. If solicited by the referrer I will, though I tend to be conservative with my comments.
     
  32. Psycycle

    Psycycle Psychologist 10+ Year Member

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    Regardless of whether you made or suggested meds, I would be surprised if someone working in PCMHI was not regularly approached for advice in this regard.
     
  33. erg923

    erg923 Psychologist 10+ Year Member

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    Well, half the PCMHI staff at my former VA were LCSWs, so i doubt it. And that (meds) really was not the thrust of the integration aspect at all...at least in my facility and its CBOCs. I did alot of care coordination, shared med appts, education about approach and MI, education about program offerings, value of combined service offerings, etc.
     
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  34. Psycycle

    Psycycle Psychologist 10+ Year Member

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    I should have clarified in my statement that as a psychologist I'd be surprised if one was not approached regularly. It's not the focus of what I do either, but it certainly comes up a lot.
     
  35. HooahDOc

    HooahDOc 10+ Year Member

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    I would change that last part from the ABPN exam to the entire USMLE licensing exam -- all 4 parts. If they can pass that, then I'll reconsider as well. It's very frustrating as a physician to hear other disciplines talk about things they don't really appreciate or fully understand, knowing I can do nothing more than shake my head. I don't think this trend from both the medical psychologists or NP's will stop until the negative outcomes start piling up. Unfortunately, they are starting to, at least with autonomous NP's.
     
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  36. psych.meout

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    Something...something...Dunning-Kruger, irony...something...something...assessment, psychometrics, clinical science...
     
  37. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus 10+ Year Member

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    Interesting. I haven't heard this. Have there been any good studies about this yet? I'm curious if the incidence rate is higher than w MD/DO prescribers bc the most common response I hear is that there hasn't been a difference in adverse outcomes.

    I stopped following the RxP issue after I found a better paying niche with a lot less hassle....though I'd still be interested in hearing if there are actual data to suppose this DANGER! PATIENT HARM! rhetoric that seems to come up every time mid-level RxP or psych RxP is mentioned.
     
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  38. psych.meout

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    Hey! Respect the hierarchy! You talking to a psychiatrist here. It goes psychiatrist>psychologist>everyone else
     
  39. Healthinfo104

    Healthinfo104

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    So what is the consensus then, the post doc training in psychopharm is largely useless?
     
  40. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    Depends, do you plan on moving to an RxP state, or can you use the RxP in some financially meaningful way? Then sure, it may be worth it. If not, probably not worth the expense at all.
     
  41. PSYDR

    PSYDR Psychologist 10+ Year Member

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    1) I think part of the problem is that there is an interaction between the state granting license and psychometrics. The privilege to practice is granted by the state, and not the medical profession. Ideally, a licensing test would has 100/100 sens/spec for providing care and avoiding harm. Step 1 of usmle is NOT correlated with outcome and has been called unscientific (e.g. Mcgahie, 2011). Board certification in medicine has also not been found to correlate with patient outcomes, complaints, etc. IMO, this is the problem not dissimilar to some treatments which should theoretically work, but when studies show no benefit. It would be great if such a test was created. Until then, this is all supposition based upon tradition.

    2) I'm assuming you know that Dr. Dunning has pointed out that using the Dunning Kruger Effect as an insult is tautological. Becaus, you know, you'd have to be able to assess your own competence as superior to rate others.....
     
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  42. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus 10+ Year Member

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    :laugh:

    I forgot about that...the downside to working in a practice with colleagues who treat each other like equals. I'll be sure to remind my NP of the pecking order.

    I have a question though...we have docs from PM&R, Anesthesiology, Occ Med, and Neurology...how do I know how to rank them in the pecking order?!
     
  43. psych.meout

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    Earnings>Fellowship ranking>residency ranking>med school ranking>undergrad ranking
     
  44. MamaPhD

    MamaPhD Psychologist, Academic Medical Center 7+ Year Member

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    I don't know of reliable data sources that aren't skewed toward the very worst outcomes (malpractice claims or licensing board disciplinary actions). The AERS database doesn't include info on prescribers, and most medical errors and near-miss situations are never documented anyway. As long as the option exists to punt adverse events to the local ER or PCP's office, I think this will remain a philosophical rather than empirical issue.

    At least one psychiatrist has suggested just cutting out the middle man altogether: http://www.mdedge.com/clinicalpsych.../depression/should-ssris-be-sold-over-counter
     
  45. PSYDR

    PSYDR Psychologist 10+ Year Member

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  46. psych.meout

    psych.meout

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  47. erg923

    erg923 Psychologist 10+ Year Member

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    Ah yes. The Clan always had much more substantial message in their music than those west coasters...
     
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  48. HooahDOc

    HooahDOc 10+ Year Member

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    When it comes to medical knowledge and pharmacology, yes, that's true. Why wouldn't it be? Is there something inherently wrong with this concept?

    When it comes to other things, I do not believe that at all. I do not know psychometrics anywhere close to the level of knowledge and expertise as psychologists, because that isn't what I do or what I was trained to do. So what? I also don't believe I could take a couple classes about it to reach that same level.
     
  49. PSYDR

    PSYDR Psychologist 10+ Year Member

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    Since med school coursework is taught by PhDs with incredible depth of knowledge in their very narrow band of interest (e.g., pharmacology, molecular bio/genetics, anatomy, etc), I don't know if that's true. I do think everyone is struggling to determine the question of depth vs. breadth.
     
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  50. Healthinfo104

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    Well I do know theres a relatively newer specialty of psychology, "medical psychology," which uses psychopharm training for psychologists to undertand the biolology of physical illness and how it effects psychological states to be able to tailor their treatments... as well as how medications they are on effect psychotherapy... hospitals and primary care centers are recognizing this training and hiring psychologists as specialists to consult and give advice... I suppose that would be usefull.

    I guess my main question is, do you think all these psychopharm programs are going to fizzle out and dissapear? Or do you think there will always be people interested in them whether they decide to prescribe or not?
     
  51. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus 10+ Year Member

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    That is our frustration with some psychiatrists and neurologists trying to use psych and neuro tests after taking a couple CEs and/or buying a program from a hack company and proporting to be an expert; concussion evaluation and cog rehab in particular.
     
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