Psychiatry won't exist?

[tespie]

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I know the title is a little far-fetched, but now that I've gotten you to open this thread...

I was talking to a Psych professor at my university during a Major Fair and he was saying that non MD/DO psychologists would be able to prescribe medications in the near future and that I should be weary about entering medical school to become a psychiatrist. I had heard of this before and googled some things, but I'm still not completely sure what this means. Does it mean that trying to become an md/do to become a child psychiatrist is counterproductive now? I'm so confused. Any insight would be greatly appreciated.

 

[john182]

I know the title is a little far-fetched, but now that I've gotten you to open this thread...

I was talking to a Psych professor at my university during a Major Fair and he was saying that non MD/DO psychologists would be able to prescribe medications in the near future and that I should be weary about entering medical school to become a psychiatrist. I had heard of this before and googled some things, but I'm still not completely sure what this means. Does it mean that trying to become an md/do to become a child psychiatrist is counterproductive now? I'm so confused. Any insight would be greatly appreciated.

The vast majority, > 95% of psychiatric medications are prescribed by non-psychiatrists already, such as primary care doctors. Specialism is always needed and always more so. Being a general psychiatrist may be less of an option as you really need a specialist niche area now that research in each subfield is so big.

 

[Manicsleep]

This wont happen.

Is there a chance that psychology prescribing rights will advance? Or other mid level providers for that matter? Probably, although in the way that they have been going about it so far it is unlikely. The APA and AMA have started to join forces and have become relatively successful. Once the economic downturn lifts, they really need to approach it better (with better training and under physician supervision).

Having said that, there will always be a place for psychiatry as mid level providers are already present and psychiatrists are still the highest level of care. This is true even within the field of medicine. FPs and internists can do lots of procedures that subspecialties do and get paid the same. Most don't because of the potential risk involved.

I don't think psychologists prescribing under proper physician supervision is that bad as long as they get proper training and it isn't this hocus pocus training that they are trying to push these days. In the end it is better for psychiatrists, better for medicine and most importantly, better for the patient.

 

[st2205]

Had you have been at a religion fair rather than a majors fair and talked with a Scientologist instead of a psychologist, he would have likely told you that psychiatry would die out in favor of Scientology helping people with their problems.

Had you have walked over to the bioinformatics major's table, he would have likely told you of psychiatrists becoming obsolete in the next two decades as genetic screening and treatment will replace the psychiatric evaluation.

Had you gone to the nursing practice table, you'd learn of the number of nurse practitioners already practicing in the field and how with the new healthcare bill the NPs will be the big winners and have a monopoly on the field in 10 years.

Had there been a chiropractic booth recruiting students, you'd learn of the ever-expanding scope of chiropractic that assesses patient holism in ways no other field can. You'd also be equipped to join the fight in stopping one of the most preventable neurobehavioral conditions -- autism -- through public awareness of immunization toxicity and mercury poisoning.

You should follow up with him and tell him that you found your way to the social work table. Tell him that they had informed you that 90% of clinical psychologists will be replaced by MSWs in the near future and ask him his opinion on that.

 

[nitemagi]

Had you have been at a religion fair rather than a majors fair and talked with a Scientologist instead of a psychologist, he would have likely told you that psychiatry would die out in favor of Scientology helping people with their problems.

Had you have walked over to the bioinformatics major's table, he would have likely told you of psychiatrists becoming obsolete in the next two decades as genetic screening and treatment will replace the psychiatric evaluation.

Had you gone to the nursing practice table, you'd learn of the number of nurse practitioners already practicing in the field and how with the new healthcare bill the NPs will be the big winners and have a monopoly on the firld in 10 years.

Had there been a chiropractic booth recruiting students, you'd learn of the ever-expanding scope of chiropractic that assesses patient holism in ways no other field can. You'd also be equipped to join the fight in stopping one of the most preventable neurobehavioral conditions -- autism -- through public awareness of immunization toxicity and mercury poisoning.

Brilliant.

 

[Manicsleep]

Had you have been at a religion fair rather than a majors fair and talked with a Scientologist instead of a psychologist, he would have likely told you that psychiatry would die out in favor of Scientology helping people with their problems.

Had you have walked over to the bioinformatics major's table, he would have likely told you of psychiatrists becoming obsolete in the next two decades as genetic screening and treatment will replace the psychiatric evaluation.

Had you gone to the nursing practice table, you'd learn of the number of nurse practitioners already practicing in the field and how with the new healthcare bill the NPs will be the big winners and have a monopoly on the field in 10 years.

Had there been a chiropractic booth recruiting students, you'd learn of the ever-expanding scope of chiropractic that assesses patient holism in ways no other field can. You'd also be equipped to join the fight in stopping one of the most preventable neurobehavioral conditions -- autism -- through public awareness of immunization toxicity and mercury poisoning.

And if you had found your way over to the social work booth, you would have discovered that MSWs will be replacing 90% of clinical psychologists in the future. So I suppose it's no wonder that psychologists will move to replace psychiatrists, with all that competition from MSWs and all.

👍
Great post.

 

[Ollie123]

Agree with the above. Psychiatry isn't going anywhere anytime soon (if ever), and I say this as a psychologist so that isn't just a defense mechanism😉 RxP for psychologists has progressed very slowly from a legal standpoint, and even within the states that do have mechanisms for it, there are not exactly an overwhelming number of psychologists pursuing it. I do suspect that (for better or worse) it will eventually happen that most states allow it, but it does not seem like a widespread "takeover" is likely in the near future.

I think what any mental health field will look like, what techniques it will involve, how compensation will be structured and what it will be like, etc. in 10, 20, 30 years is an open question that no one can know for certain. However, I hold no doubts that all involved will continue to play an important part, albeit perhaps with a slightly different role than they do currently.

 

[ieatmop]

A psychologist would be of very little help to any patient in the throes of acute psychosis or mania. Likewise with an MD of any specialty other than psychiatry. That's why psychiatry will be around forever.

 

[MissAmanda]

this is an interesting topic... what is the status of this in California? I know it is not yet legal in CA, but has it been at all close? Where can I go to read up to date info on this legislation?

 

[whopper]

In several states, supporters of the psychologist prescriber movment are trying to enact laws to allow for psychologist prescribing powers. In the overwhelming majority of states, it has failed. In the few states where it was allowed, the laws specifically state there has to be physician oversight and the physician has the final say.

I've heard some legislatures describe the psychologist prescription bills as something they pretty much just vote no without spending any real thought on it because they've already done so when these proposals were first introduced. The lobbyists supporting the bill just try again next year...and then the politician votes no again.

One exception was Oregon, where several months ago, the state houses voted for psychologist prescription, but ultimately it was vetoed by the governor.

So, to answer your question, what's going on in California. I don't specifically know but it's likely that there's some type of psychologist prescription lobby working on it, and it's likely that they'll try again this year and fail. If you want a more specific answer, I recommend you contact the state branches of the American Psychiatric Association and Psychological Association branches and ask their lobby groups. Those are usually the two main players in this tug of lobby war. If you are a member of either of these two groups, the lobbyists will likely give you some time when you ask.

 

[Manicsleep]

Become an MIT member of the APA and CPA.

The CPA can direct you to whatever is going on. The MIT rate is cheap if you are a resident, I think it is free if med student.

http://www.calpsych.org/

 

[tespie]

Thanks for all the input!

 

[st2205]

I figure I'll throw in another ground-breaking update. Yesterday I was at a hospital fair and was speaking with a faculty member of a stand-alone FP residency. She had asked me what I was interested in. I said I was somewhat interested in psychiatry so she pulled out her faculty info, showed me the behavioral scientist they had on staff, and told me how the great thing about their program is that it allows you to taylor your experiences with electives (kind of like any program) and that I could approach that aspect through their FP residency.

So chalk up another pathway that will assist in the death of psychiatry.

 

[MissAmanda]

I've heard some legislatures describe the psychologist prescription bills as something they pretty much just vote no without spending any real thought on it because they've already done so when these proposals were first introduced. The lobbyists supporting the bill just try again next year...and then the politician votes no again.

...

So, to answer your question, what's going on in California. I don't specifically know but it's likely that there's some type of psychologist prescription lobby working on it, and it's likely that they'll try again this year and fail.

That, in my opinion, is good news. How can an online course provide the same prescribing rights as 4 years of medical school?!

 

[MissAmanda]

I figure I'll throw in another ground-breaking update. Yesterday I was at a hospital fair and was speaking with a faculty member of a stand-alone FP residency. She had asked me what I was interested in. I said I was somewhat interested in psychiatry so she pulled out her faculty info, showed me the behavioral scientist they had on staff, and told me how the great thing about their program is that it allows you to taylor your experiences with electives (kind of like any program) and that I could approach that aspect through their FP residency.

So chalk up another pathway that will assist in the death of psychiatry.

What is the training of a "behavioral scientist"?

 

[st2205]

What is the training of a "behavioral scientist"?

I don't know, but I hear they're close to Rx privleges. Kidding, of course. It can be a pretty general term that could probably mean just about anything. I looked at the packet she gave me and she's actually a psychologist. I think I may be confusing it with a separate conversation that someone mentioned something about a behavioral scientist.

 

[OldPsychDoc]

It's probably just their way of assuring their patients that "No, we're not saying that 'It's all in your head' " and "No, we're not sending you for psychological treatment..." 🙄

 

[kugel]

It's probably just their way of assuring their patients that "No, we're not saying that 'It's all in your head' " and "No, we're not sending you for psychological treatment..." 🙄

but my psychiatrist told me that it IS all in my head??!!

 

[carlosc1dbz]

I know the title is a little far-fetched, but now that I've gotten you to open this thread...

I was talking to a Psych professor at my university during a Major Fair and he was saying that non MD/DO psychologists would be able to prescribe medications in the near future and that I should be weary about entering medical school to become a psychiatrist. I had heard of this before and googled some things, but I'm still not completely sure what this means. Does it mean that trying to become an md/do to become a child psychiatrist is counterproductive now? I'm so confused. Any insight would be greatly appreciated.

How would psychologist having prescribing privileges, be counterproductive to you becoming a child psychiatrist? You would still be able to help children.

 

[IT514]

Is your prof a clinical psychologist or in another field of psych? As a 3rd year clinical psych student, I wouldnt worry about what your prof said. Looking back, my non-clinical undergrad profs gave plenty of unfounded advice about the clinical world.

Even if the law passes in most states, which I dont see happening, I dont think there are that many psychologists out there who would want to prescribe. I could be wrong and I have no data to back it up, but thats been my experience thus far. For me, I imagine that having to manage meds would take time away from what I enjoy doing (mostly assessment). I help a lot of people through what I do...if I wanted to do it through prescribing meds, I would have gone to medical school.

 

[loveoforganic]

"Behavioral scientist" I would generally see as a health psychologist, which is pretty far removed from what a psychiatrist would generally be doing. e.g. counseling on implementing exercise, ceasing smoking, general behavior modification and coping strategies, etc. Probably some C&L work, but still nothing like what an ER psychiatrist would be seeing.

 

[Suenya]

I think with appropriate training, psychologists should be able to prescribe. Maybe it's my bias as someone who originally started on the path towards clinical psych, but I strongly suspect that with a good masters level course they would probably be better suited to it than PCPs.

Quite honestly, I would suspect that psych NPs have more to fear from that than psychiatrists, but it's not as if most areas of the country don't need more psych providers in general.

 

[Chimed]

I think with appropriate training, psychologists should be able to prescribe. Maybe it's my bias as someone who originally started on the path towards clinical psych, but I strongly suspect that with a good masters level course they would probably be better suited to it than PCPs.

Quite honestly, I would suspect that psych NPs have more to fear from that than psychiatrists, but it's not as if most areas of the country don't need more psych providers in general.

Oh no, please don't get us started on this topic again!

 

[whopper]

Agree.

Not once when the psychologists and psychiatrists get into a debate on this forum has is remained civil, evidenced based, and enlightening.

It was a lot of name calling, cheerleading, political talking points, and other bull. There were a few people that remained civil and tried to keep it on track, but too many others that did not.

 

[Majesty]

Agree.

Not once when the psychologists and psychiatrists get into a debate on this forum has is remained civil, evidenced based, and enlightening.

It was a lot of name calling, cheerleading, political talking points, and other bull. There were a few people that remained civil and tried to keep it on track, but too many others that did not.

Well, thank the heavens you are here to remain civil, evidence based and enlightened.

I also can't stand when other people name call. Its great that you are here to say they have nothing real to say and just spouting bull. They are such hypocrites right?

 

[loveoforganic]

bannnnnnnnnnn

 

[tennreb]

Psychologists in Louisiana (among other states) have had prescribing privileges for years, yet the demand for psychiatrists there is huge. Pay is very good in Louisiana.

 

[silas2642]

Psychologists in Louisiana (among other states) have had prescribing privileges for years, yet the demand for psychiatrists there is huge. Pay is very good in Louisiana.

I do think that prescribing privs of psychologists is something that needs to be on our radar-- look at CRNA's and anesthesiologists.

 

[Therapist4Chnge]

There appears to be enough demand, though I'd be more worried about healthcare in general. Dwindling reimbursement rates, insurance company lobbyists, government interference, etc...those are the real threats.

 

[Majesty]

I do think that prescribing privs of psychologists is something that needs to be on our radar-- look at CRNA's and anesthesiologists.

The fact that CRNAs make more than family practice doctors is absurd.

I totally agree. This is something we need to be looking out for and stopping. Don't fall for the everything will be alright song and dance routine.

 

[UNMorBUST]

I attend college in New Mexico, obviously. One of my professors is very involved with healthcare in New Mexico. For the years that psychologist have been able to recieve training apparently only a hand full of Psychologist have even gone through thte training. My Professor could only recall 3. All which were at the end of their careers and were just trying it out. Reason given as to why Psychologist were not recieving training;1. They did not want to go through additional schooling not making any money. 2. Perscribing is not what they signed up for.

 

[Therapist4Chnge]

I attend college in New Mexico, obviously. One of my professors is very involved with healthcare in New Mexico. For the years that psychologist have been able to recieve training apparently only a hand full of Psychologist have even gone through thte training. My Professor could only recall 3. All which were at the end of their careers and were just trying it out. Reason given as to why Psychologist were not recieving training;1. They did not want to go through additional schooling not making any money. 2. Perscribing is not what they signed up for.

From discussions I've had with other psychologists (obviously anecdotal), most agreed that they would have gone to medical school if they wanted to primarily prescribe.

 

[DD214_DOC]

There is so much more to the field of psychiatry than simply a handy DSM and a good foundation in pharmacology. I was always aware that it is deeper than I felt but never realized how deep and complex the field actually is until I started my psych internship this year. If you want a glimpse of how complex this stuff really is, flip through any textbooks by Gabbard or McWilliams. Psychiatry will be around for a very, very long time.

 

[Manicsleep]

I attend college in New Mexico, obviously. One of my professors is very involved with healthcare in New Mexico. For the years that psychologist have been able to recieve training apparently only a hand full of Psychologist have even gone through thte training. My Professor could only recall 3. All which were at the end of their careers and were just trying it out. Reason given as to why Psychologist were not recieving training;1. They did not want to go through additional schooling not making any money. 2. Perscribing is not what they signed up for.

Reason 3. Lawyers.

 

[Therapist4Chnge]

Reason 3. Lawyers.

I haven't heard of any court cases yet, even though the laws have been on the books for a number of years. Do you know of any cases?

 

[Manicsleep]

Fear is the mind killer.

Even with the DoD psychologists who were much better trained than the ones in NM or LA, they were not really willing to go near psychotic disorders or inpatient units.

The first time there was a bad outcome...its bound to happen...these psychologists would get eaten alive by even partially senile lawyers with online degrees. They would settle very quickly.

More likely of course is that they would stay away from anything risky. The problem with that is determining risk can take quite some time and the stress associated with prescribing would be too much. It would only be left to older psychologists who could afford to retire should their reputation take a hit. Which is what has happened for the most part (anecdotally from what I have seen and heard from NM).

 

[Majesty]

What are their prescribing habits?

Are they giving 25mg of zoloft to mild depression?

 

[loveoforganic]

Fear is the mind killer.

Even with the DoD psychologists who were much better trained than the ones in NM or LA, they were not really willing to go near psychotic disorders or inpatient units.

The first time there was a bad outcome...its bound to happen...these psychologists would get eaten alive by even partially senile lawyers with online degrees. They would settle very quickly.

More likely of course is that they would stay away from anything risky. The problem with that is determining risk can take quite some time and the stress associated with prescribing would be too much. It would only be left to older psychologists who could afford to retire should their reputation take a hit. Which is what has happened for the most part (anecdotally from what I have seen and heard from NM).

FWIW, I think one of the DoD psychologists was on an inpatient unit

 

[Therapist4Chnge]

The first time there was a bad outcome...its bound to happen...these psychologists would get eaten alive by even partially senile lawyers with online degrees. They would settle very quickly.

Statistically you'd think that of the tens/hundreds of thousands scripts that have been written since the DoD project, that if the prescribers were so bad and unqualified that there would have been at least one court case, no?

More likely of course is that they would stay away from anything risky. The problem with that is determining risk can take quite some time and the stress associated with prescribing would be too much. It would only be left to older psychologists who could afford to retire should their reputation take a hit. Which is what has happened for the most part (anecdotally from what I have seen and heard from NM).

So prescribing psychologists are cherry picking cases? It seems that is common for outpatient PCPs, NPs, and yes...even psychiatrists. Again, I go back to the simple probabilities of negative outcomes, and wonder that if such poor training was occurring, why aren't there ANY court cases with a tar and feathering to follow?

As for who is going for prescription privileges, it does seem like more established psychologists are going, though I think that has more to do with the economics involved with taking time away from their practices.

As a general point, I happen to agree that the current training requirements are not sufficient for independent prescribing, nor do I think the supervision requirements are sufficient before a full license is granted. In the end I don't think having a wider availability of prescribing psychologists will be a realistic thread to psychiatry as a practice (NP proliferation has provided supportive evidence in that regard), though I do think there is work that is needed to raise the standards for if/when additional states grant psychologists the opportunity to pursue prescription privileges.

 

[edieb]

I attend college in New Mexico, obviously. One of my professors is very involved with healthcare in New Mexico. For the years that psychologist have been able to recieve training apparently only a hand full of Psychologist have even gone through thte training. My Professor could only recall 3. All which were at the end of their careers and were just trying it out. Reason given as to why Psychologist were not recieving training;1. They did not want to go through additional schooling not making any money. 2. Perscribing is not what they signed up for.

As someone who just started the psychopharmacology classes @ New Mexico State, I can tell you that most of the psychologists are younger (some just out of school) and in states other than New Mexico. In fact, most are from Oregon and Wisconsin, two of the states where the thrust for RxP is most intense. I think New Mexico has around 30 prescribing psychologists and Louisiana around 100.

As an aside, New Mexico recently passed a law allowing prescribing psychologists to prescribe in all state institutions... In fact, two of the psychologists in my cohort work at the NM state hospital in Las Vegas.

 

[Majesty]

Statistically you'd think that of the tens/hundreds of thousands scripts that have been written since the DoD project, that if the prescribers were so bad and unqualified that there would have been at least one court case, no?

I am so happy someone has this data!

Can I see this data regarding the 100,000+ prescriptions.

Since data regarding prescriptions is usually pretty thorough and you wouldn't post such rubbish without actually having the data, can I see anything regarding how much of these prescriptions were mood stabilizers or antipsychotics and how many were in the inpatient setting.

So prescribing psychologists are cherry picking cases? It seems that is common for outpatient PCPs, NPs, and yes...even psychiatrists. Again, I go back to the simple probabilities of negative outcomes, and wonder that if such poor training was occurring, why aren't there ANY court cases with a tar and feathering to follow?

I have always thought that they were cherry picking and leaving those who really needed help out in the cold.
No, it isn't common for PCPs or Psychiatrists because someone has to see the difficult cases but that's another discussion. One that I am happy to have in another thread if you want to start it.

Again, it goes back to your straw man. I would love to see that data! SHOW ME THE DATA BABAY!

It will go a long way to calm my fears that psychologists are cherry pickers who are a danger to patient lives because they want the reward without doing the actual work.

Please if you are going to respond to this. Respond to the request for data.

As someone who just started the psychopharmacology classes @ New Mexico State, I can tell you that most of the psychologists are younger (some just out of school) and in states other than New Mexico. In fact, most are from Oregon and Wisconsin, two of the states where the thrust for RxP is most intense. I think New Mexico has around 30 prescribing psychologists and Louisiana around 100.

I would think they would be younger because they have difficulty finding jobs now and they have little to lose if they get sued. They can always go back to being a psychologist. Its a different story for the patients.

REMEMBER...THE DATA!!!

 

[Ibid]

Manic
The first time there was a bad outcome...its bound to happen...these psychologists would get eaten alive by even partially senile lawyers with online degrees. They would settle very quickly.*

More likely of course is that they would stay away from anything risky. The problem with that is determining risk can take quite some time and the stress associated with prescribing would be too much. It would only be left to older psychologists who could afford to retire should their reputation take a hit. Which is what has happened for the most part (anecdotally from what I have seen and heard from NM).

A little absurd to posit a general human factor into the debate. The truth is that after an incident be it homicide or suicide everyone in a clinical team becomes more risk adverse. Psychiatrists notably so because their decisions are highly visible as clinical leaders of their teams. To argue that they do not is fanciful when it is observed consistently as it is such a pervasive phenomena. Psychiatrists are not robots and nor would prescribing psychologists be.

Majesty
SHOW ME THE DATA BABAY!

Professional indemnity rates for prescribing psychologists v non prescribing are negligible. Mr. Market is NEVER wrong. (please note the subtle use of irony). My guess is the underwriters are not far from the mark.

 

[whopper]

A problem here is no one here is the data behind the safety of psychologist prescribers does not seem to be available to the public. Yes there's the DOD study, but that study even mentioned it was not an indicator of psychologist prescribers performances in the community. The study found several things good and bad with psychologist prescribers which is not exactly the way it's presented to the public. It's often presented with a spin depending on which side presents it.

Someone must have the data. Insurance companies need to monitor these things so they could plug it into their actuarial tables. No one has been able to present such data on this forum and I've looked but can't find any.

Other psychologists on the forum have written that the APsychologicalA manages that insurance, which if anything causes problems because if such data is ever presented or not if in fact that comment is true (that I do not know). That will bring conflicts of interest with the data. If this comment is true, then why not present the data? If it's favorable, it'd only bolster the psychologist prescriber movement, which could lead some to theorize that the data is not favorable. Even if favorable data were true and accurate, one could point the conflict of interest.

Point being data from an independent carrier would be a better source of data.

Another source of data could be to see if psychologist prescribers differ in the types of patients they see and their prescribing practices. We all know that highly varies with the clinical scenario. In my inpatient unit, polypharmacy is much more common and unfortunately unavoidable because I have patients that kill people when psychotic or manic and treatment resistant. In outpatient, most of my patients are fine on one medication and I take efforts to see if they can do well even without a medication.

And another point to consider is in at least some states where psychologist prescribers work, a medical doctor has the final say. IMHO that's tantamount to any legislation. I have no problem with a psychologist with psychopharm training making recommendations so long as a medical doctor has the final say, in fact I think that is a good treatment model to help in the areas where there is a severe shortage of psychiatrists. In the Oregon bill that was vetoed, a medical doctor or other medical professional had to be involved, but the bill never clarified who had the final responsibility. That brings up several conundrums. In any hierarchy, there has to be a final arbiter. When two people disagree on a treatment and there is no clarification as to who is responsible, that will only lead to several further problems down the road both legal, ethical, and practice-wise.

 

[Ibid]

In any hierarchy, there has to be a final arbiter. When two people disagree on a treatment and there is no clarification as to who is responsible, that will only lead to several further problems down the road both legal, ethical, and practice-wise.


This is why the whole debate seems more about ego than patient care.

Once the Responsible Medical Officer (RMO) is established all of the roles in the clinical team are delegated through the RMO and it the RMOs professional and legal duty to be sure by whatever mechanism that they are appropriately trained to be delegated to.

Given this is true for all members of the multidisciplinary team, social worker, ward nurse, health care assistant, occupational therapist and that disagreements often breakout between the Psychiatrist (nearly always RMO) on a wide range of issues, one has to wonder why this issue leads to so much consternation. My surmise it is to only a small extent about patient safety, all such debates could be tagged with that, but more about ego and unfortunate professional protectionism driving some opinions.

A little cynical perhaps.

 

[whopper]

I don't find it cynical at all because daily I find myself in situations where someone has to have the final say.

In the ER, I often had patients that I did not feel were medically stable enough to be brought to an inpatient psychiatric unit. Who has the final say? The ER doctor. If we disagree, instead of the patient sitting there for hours, the ER doctor's opinion trumps mine. If it turns out the ER doctor was wrong, then he/she is held responsible.

In inpatient, I too have that issue with several other people in the team. Again, those problems occur daily but are easily and cleanly handled because there's people made to be responsible as the final arbiter should a disagreement occur. When you don't have someone held responsible as the final arbiter, it will lead to conflicts, confusion, and mistakes made because people will think the other person was supposed to do it.

In a court of law when the law does not point to who is supposed to be in charge, it will be very messy in determining what action needs to be taken if malpractice occurred. I wrote this before on the forum, but if the Oregon law passed and I practiced in that area, I wouldn't touch any psychologist prescriber with a 10 foot pole in practice. I would recommend no medical professional work with a psychologist prescriber in that state. That's not because I'm against psychologists--I'm not. It's because there will at some point be an disagreement between the medical professional and the psychologist and there would be no way to figure out who is supposed to fit where in the treatment heirarchy. If a bad outcome happened due to my psychologist prescriber colleague, I could still be held responsible. I would never put myself in that situation, nor do I think any medical professional would want to be in that if they actually knew the way the law was written.

I would, however, not have a problem working with a psychologist prescriber if I had the final say. In fact I'd welcome it if I knew the psychologist prescriber was a competent individual. That would lead to several benefits for me including having an additional partner to work with and increased output. That would mean monetary benefits for me if I ran a private practice. I reiterate if the person was competent. I find several psychologists or psychiatrists competent or not, not having to do with the profession but the individual.

 

[Manicsleep]

I would, however, not have a problem working with a psychologist prescriber if I had the final say. In fact I'd welcome it if I knew the psychologist prescriber was a competent individual. That would lead to several benefits for me including having an additional partner to work with and increased output. That would mean monetary benefits for me if I ran a private practice. I reiterate if the person was competent. I find several psychologists or psychiatrists competent or not, not having to do with the profession but the individual.

How would you judge the expertise of this person?

Why not independent prescription? If they are capable, why do they have to go through you?

 

[Ibid]

Apologies. I didn't make it clear that I was the one being cynical. What I do wonder about is how prescribing differs from other delegated roles with a multidisciplinary team where all decisions are joint. I thought making this point sounded cynical on my part.

In fact I'd welcome it if I knew the psychologist prescriber was a competent individual.

Yes, the above is my point. It would be unethical and should in every jurisdiction be illegal to delegate to or have as a member of your team some one who is not competent in the role they are assigned.

Their will always need to be an RMO or equivalent for every team and patient and if the law does not make that clear it's a bad law and not really about the principle of prescribing psychologists. It does demonstrate that context is everything.

Manic

You can delegate that to the employing organization if you don't feel confident yourself. It's called teamwork. lol

 

[Manicsleep]

Majesty.

You will not get Ze Data. Psychologists only ask for the data when its in their interest. On the whole their training, even in this supposed strength, is weak. As a psychiatrist you are just as qualified and probably more so than the majority of the psychologists licensed out there. Just go talk to a non academic psychologist, Bayes is very likely to be confused with bodies of water.

Someone must have the data. Insurance companies need to monitor these things so they could plug it into their actuarial tables. No one has been able to present such data on this forum and I've looked but can't find any.

Other psychologists on the forum have written that the APsychologicalA manages that insurance, which if anything causes problems because if such data is ever presented or not if in fact that comment is true (that I do not know). That will bring conflicts of interest with the data. If this comment is true, then why not present the data? If it's favorable, it'd only bolster the psychologist prescriber movement, which could lead some to theorize that the data is not favorable. Even if favorable data were true and accurate, one could point the conflict of interest.

The facts are that their are very few psychologists who have stuck their necks out to 'help the patients in underserved areas' as their party line goes. in NM for example, 30 psychologists, mostly in cities, where psychiatrists are already available. Its pathetic, its bad for medicine and for patients.

You can delegate that to the employing organization if you don’t feel confident yourself. It's called teamwork. lol

I am confident. Very confident that there is gross incompetence with prescribing psychologists and they represent a very real danger to patient lives and well being. That you find this funny just makes me more confident. The type of 'team' psychologists propose is unrealistic. Not everyone contributes, everyone is above average and all teams are contenders (except MFTs and LCSWs of course). Everyone can't be the quarterback. Look it up, it's called teamwork.

 

[Ibid]

Manic

What I find funny is that your demeanour is funny peculiar not funny ha ha. It’s transparently about professional protectionism and nothing to do with patient safety their lives or well being.

The truth is that sorting out lines of accountability is just a technical matter. Nothing in the world is going to force you personally to work with someone you personally regard as incompetent.

To be honest of all the reviews of critical incidents I have ever read the minutia of prescribing details have never been a critical factor. The only consistent element has been poor communication between professionals and agencies. As far as well being, what about the hundreds and thousands of people who are currently on inappropriate medication regimes? Again it’s the attitude of the transparent closet trade unionist I am laughing at.

 

[Majesty]

Nope no data.

RE: Ibid. His posts are disorganized, off topic and I am not sure what he is saying half the time anyways. Ignore.

RE assessment and delegation.
This is why we have the mcats, medical schools, usmle at various levels, residency/fellowships and boards.

I've said this before. No psychologist ever helps out LCSWs or MFTs to be paid as much as them. Psychotherapy isn't better when psychologists do it. Its all the same. When MFTs try to expand their scope, psychologists have a fit. This talk of psychiatric trade unions and professional protectionism goes straight out the window.