Well, I see the point in your comment. After all there isn't a heck of a lot of data showing psychologists maiming people, though I also disagree with Carlat because he wants to push something that hasn't been tested. Psychologist prescribing has only been tested and measured in the military, and the military study on this didn't exactly show it to be the best thing since sliced bread. It showed pros and cons, and the study itself said it wasn't applicable to the public.
Yet the advocates of psychologist prescription powers keep citing this study as if it's scripture as to the only proof needed to pass a bill.
I love the Carlat Report. I find the Carlat Blog worrisome at times.
I see it as if Carlat is two different people. One, based on the Carlat Report, is about good evidenced-based practice with a strong foundation in medical knowledge. That is something several psychiatrists forget about. Several imporant medical issues are brought us such as psychotropic interactions with existing medical conditions, liver metabolism, etc.
Yet the other Carlat is one that has openly written things to the effect that psychiatrists hardly use medical training in their work, and just hand out scripts with as much attention to a patient's medical condition as any psychologist, and then argued that because of this, psychologists should get prescription power. I specifically brought a link to an interview where he said such things, and put it on the forum about a year ago, but I don't recall where it is now.
The two concepts are in contradiction to each other. Why his Carlat Report emphasizes good medical skills so much, yet his blog downplays it, I don't understand. He argued that psychologist prescribing will create a reform within psychiatry for better psychotherapy. I don't think it would. If anything I think it would create psychologists that could now do what bad psychiatrists do--just medicate without trying to figure out the problem for real. I honestly don't think bad psychiatrists will have a lightbulb moment and say to themselves that maybe they should actually learn psychotherapy and listening because a competitor could now prescribe.
Great conversation, which was exactly what I was hoping for. And I get a free diagnostic evaluation at the same time!
(picture of me with DID).
Anyway, medical knowledge is absolutely crucial for psychiatric practice, and I have never argued that anybody should be allowed to prescribe meds without that. The question is whether we need all of medical school to get the training required. I don't think so. I am advocating for an alternative. This could be a minor tweak to medical school, such as a "psychiatry track" as someone on this list mentioned. But I think we should go further, learning a lesson from dentists and optometrists. They are clearly both medical specialists--more "medical" in terms of their routine work than psychiatrists--and yet neither goes to medical school. Instead, they get a BA, then go to four year professional colleges of dentistry or optometry. They don't end up with an MD, but rather a DDS or a DO.
Why can't we create an analogous training program for psychiatrists? After all, you can pack a lot of training in physiology, pharmacology, endocrinology, pharmacokinetics....plus training in all evidence-based psychotherapies, substance abuse treatment, neuropsych testing etc.... into a four year program. After four years, you would graduate with a "DP" (Doctor of Psychiatry?) or some other yet to be dreamed up designation. You would be allowed to prescribe from a limited formulary of neuropsychiatric meds (just as dentists and optometrists can prescribe from formularies appropriate to their specialties).
This would not be a substitute for standard psychiatric training, but simply another option.
Advantages:
--A shorter training period would alleviate the shortage of psychiatrists
--The program would attract more psychologically minded students--those, like me, who struggled about whether to go into medical school or clinical psychology grad school after college
--Less post-graduate debt burden, so less of a need to churn out 15 minute 90862s to pay off that debt
--Better training in psychotherapy and psychological testing
--Graduates could provide truly integrated psychiatric care--which is incidentally the theme of the new APA president, Dr. John Oldham. (see Psychiatric News, June 17 2011 issue).
Of course, "DPs" would not be as medically sophisticated as those who go through medical school, and would refer their more medically complicated cases to psychiatrists. This is analogous to optometrists referring tough cases to ophthomologists, or dentists to oro-facial surgeons.
Radical idea? Absolutely. But I think it represents one way to solve the mental health crisis of access to high quality psychiatric care.
