DrFocker

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The Quacks are back and have their hopes set on Tennessee:

ASAP READER volume 4 number 3 February 25, 2005

Greetings ASAP Readers,

Much has happened during the last three weeks. The Tennessee Psychological Association’s RxP bill was passed out of subcommittee in its first hearing. Another hearing before the full Committee is scheduled for next week. Dr. Keith Hulse posted the following 2/24/05 to: TPA Email and Fax Networks

Dear Colleague:

We are very pleased to report that our Prescribing Psychologist's bill has been successfully passed out of the House Professional Occupations Subcommittee Wednesday without amendment! This was a major victory for us, and a major hurdle to have overcome.

The bill next goes before the full House Health and Human Resources Committee-AND WE EXPECT IT TO GO BEFORE THIS COMMITTEE THIS COMING TUESDAY! Consequently, we URGENTLY need your continued support to maintain our bill's momentum. Now that we have passed this bill out of subcommittee, our opposition is in high gear, with no holds barred, so we must have your continued strong support!

As before, we are asking you to do several things--the first four of which are on the APA Legislative Action Center website and will literally take you ONLY SECONDS to do:

Go to our private TPA website: http://tpaonline.org/rxp/
Follow the link from there directly to the APA Legislative Action Center: ALL FOUR ALERTS ON OUR APA SITE ARE NEW-SIMPLY COMPLETE THEM ALL.
Then go back to the private TPA website and download, print out, fax, and mail the "hard copy" versions of these new letters.
Finally, PLEASE forward this email to everyone you know, colleagues, family, friends, neighbors, etc, who you know to be supportive of RxP. Ask them to take these same steps, substituting their own occupation or "mental health consumer" or "concerned citizen" for "psychologist " or "psychological examiner" in the signature line.


REMEMBER-THESE NEED TO BE RECEIVED BY THIS COMING TUESDAY MORNING, MARCH 1, 8 AM CENTRAL TIME-THE COMMITTEE MEETS SHORTLY THEREAFTER

THANK YOU for all your ongoing help in this legislative marathon!

Sincerely, C. Keith Hulse, Ph.D. President, Tennessee Psychological Association
 

john182

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DrFocker said:
The Quacks are back and have their hopes set on Tennessee:

ASAP READER volume 4 number 3 February 25, 2005

Greetings ASAP Readers,

Much has happened during the last three weeks. The Tennessee Psychological Association’s RxP bill was passed out of subcommittee in its first hearing. Another hearing before the full Committee is scheduled for next week. Dr. Keith Hulse posted the following 2/24/05 to: TPA Email and Fax Networks

Dear Colleague:

We are very pleased to report that our Prescribing Psychologist's bill has been successfully passed out of the House Professional Occupations Subcommittee Wednesday without amendment! This was a major victory for us, and a major hurdle to have overcome.

The bill next goes before the full House Health and Human Resources Committee-AND WE EXPECT IT TO GO BEFORE THIS COMMITTEE THIS COMING TUESDAY! Consequently, we URGENTLY need your continued support to maintain our bill's momentum. Now that we have passed this bill out of subcommittee, our opposition is in high gear, with no holds barred, so we must have your continued strong support!

As before, we are asking you to do several things--the first four of which are on the APA Legislative Action Center website and will literally take you ONLY SECONDS to do:

Go to our private TPA website: http://tpaonline.org/rxp/
Follow the link from there directly to the APA Legislative Action Center: ALL FOUR ALERTS ON OUR APA SITE ARE NEW-SIMPLY COMPLETE THEM ALL.
Then go back to the private TPA website and download, print out, fax, and mail the "hard copy" versions of these new letters.
Finally, PLEASE forward this email to everyone you know, colleagues, family, friends, neighbors, etc, who you know to be supportive of RxP. Ask them to take these same steps, substituting their own occupation or "mental health consumer" or "concerned citizen" for "psychologist " or "psychological examiner" in the signature line.


REMEMBER-THESE NEED TO BE RECEIVED BY THIS COMING TUESDAY MORNING, MARCH 1, 8 AM CENTRAL TIME-THE COMMITTEE MEETS SHORTLY THEREAFTER

THANK YOU for all your ongoing help in this legislative marathon!

Sincerely, C. Keith Hulse, Ph.D. President, Tennessee Psychological Association
It's a prescribing fest for the pharm corps! Next up: Social workers seek script rights! Soon to come: EVERYBODY can prescribe!
 

Anasazi23

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DrFocker said:
PLEASE forward this email to everyone you know, colleagues, family, friends, neighbors, etc, who you know to be supportive of RxP. Ask them to take these same steps, substituting their own occupation or "mental health consumer" or "concerned citizen" for "psychologist " or "psychological examiner" in the signature line.
Jeeez......

Why don't we just make it like Mexico and put every medication over the counter?
 

OldPsychDoc

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Anasazi23 said:
Jeeez......

Why don't we just make it like Mexico and put every medication over the counter?
Actually, we're already there, if you consider the internet the "counter".
 

Anasazi23

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Particulary humorous was the reading of the "MD support pack." It's worth a good laugh if you have time to see it. They basically want physicians to run around and recruit all the MDs they can to signing this paper stating how competent psychologists will be in prescribing. They use phrases like "appeal to your personal relationship with them" as instructions on how to get other physicians to sign this thing. Then they tell you to ask them to write letters on their own letterhead supporting psychologists in the endeavor.

...all this for their strive toward the ego ideal. Kinda sad really.
 

whopper

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Prescribing medications can have plenty of physiological complications. Just how much training do psychologists have in reading EKGs, considering liver metabolism and such when prescribing meds?

Now I will say I know plenty of psychiatrists who out of what I will call laziness forget how to read their EKGs among other things all MDs should know how to do, but as far as I know and I do have a degree in Psychology, this stuff is never handled and can be completely avoided in one's training in Clinical Psychology.

Neuroleptics can cause QT prolongation, certain psychiatric meds can screw with the metabolism of other drugs that you need a medical mind to handle, SSRI's can cause serotinergic syndrome etc. Just how much training would a Ph.D. in Psychology know of this, especially since the curriculum doesn't require it?

Psychiatrists have plenty to learn from Psychologists, my own training in psychology IMHO gives me an edge that other psychiatrists don't have, but giving psychologists prescribing power is extremely questionable reasoning at best.

Hey, the drug companies probably want them to have this power. The drug companies carry the most clout. Any psychiatrists out there in Tennesee ought to try to fight this bigtime--and that goes for all of us outside of the state too. MDs have been getting their butts kicked too often in the last few years in other fields by insurance companies, lawsuits, what have you. Not only to protect our own profession but for the benefit of the patient we ought to stick up on this one. However--let's not forget that psychology and psychiatry should be working together.
 

john182

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whopper said:
Prescribing medications can have plenty of physiological complications. Just how much training do psychologists have in reading EKGs, considering liver metabolism and such when prescribing meds?

Now I will say I know plenty of psychiatrists who out of what I will call laziness forget how to read their EKGs among other things all MDs should know how to do, but as far as I know and I do have a degree in Psychology, this stuff is never handled and can be completely avoided in one's training in Clinical Psychology.
Ironically, given the range of ill effects that occur on ECGs from psychotropics, people seem to slag off the psychiatrist but show and ECG to a surgeon and they'll look at it like it's in Greek. Same with dermatology, general radiology, etc., .

Hey, the drug companies probably want them to have this power. The drug companies carry the most clout. Any psychiatrists out there in Tennesee ought to try to fight this bigtime--and that goes for all of us outside of the state too. MDs have been getting their butts kicked too often in the last few years in other fields by insurance companies, lawsuits, what have you. Not only to protect our own profession but for the benefit of the patient we ought to stick up on this one. However--let's not forget that psychology and psychiatry should be working together.
It's basically a divide-and-conquer method. Mental health for patients suffer as specialities head to the bunkers and get backed into defensive positions. Rather, psychologists should emphasise what *they* can do and for better payments from that, and not simply money-grab outside their field because insurance companies have backed them into a corner with payments.

Likewise, drug companies are the ones who will benefit from this as restrictions on marketing to MDs will undoubedlty not apply until that loophole is plugged so it's an advertising dream without the regulations and restrictions that have been imposed.

It does nothing to improve mental health services and makes related specialities defensive so that they won't cooperate. Are we at the stage when Ainsworth wouldn't have answered the job ad with Bowlby because money is more important.

Skills of psychologists are many and varied: they should be unionising and increasing fees for it to get paid better if they feel underpaid. Not simply decide that more money = being able to write (with a degree of inexperience) a piece of paper that = money for an insurance company.

I suppose the corps have made the situation a face off and have directed the attention away from themselves. If the person who pays you won't increase payments, why simply go along with it and add "chargeable skills". Why not genuinely seek higher reimbursement rates?

The enemy is being marketed as being the medical profession and it's the cleverist marketing compaign I've seen.
 

Anasazi23

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Paendrag said:
Hey, I agree psychologists shouldn't be prescribing meds, but this isn't about an "ego" stroke. This is about money.
I think you're right to some degree. However, I think we'd all be naive to think that all those seeking rx privilages are doing so solely for money. I'm not sure what these folks malpractice insurance rates could be, but it can't be pretty. Unlimited formulary with no formal medical training? No regulated national exam (PEP? is not independently regulated as in medicine). Very scary...That cost would likely offset any additional profit and even run way into the red if they will continue to practice clinical psychology the way they claim they will - with extended therapy sessions, using medications only when necessary and in small amounts.

I think many of the folks in neuropsychology are there because it's the closest you can get to medicine as a psychologist. It seems to have more credibility. I feel rxp is a similar phenomenon.

The problem with Ph.D. clinical psychology education with regards to medicine is inconsistency in training. My research specialty deals with cardiovascular regulation. I have no problem reading EKGs. I know clinical psychologists whose specialty areas involve substantial amounts of psychopharmacology, who would be very good in a specific type of prescription setting; however, not all psychologists have a physio interest.
Right, which is why physicians are worried that this group of psychologists interested only in having an rx pad, without knowledge or interest in phyiology, anatomy, health and disease of organ systems, etc will create the public percpeption that those giving out psychotropics don't know what they're doing. It's a tired cliche, but it's still so true. If you truly want to be competent and practice aspects of medicine, go to medical school.

As for the ekg's. I've been reading them for years and still don't feel thoroughly confident. Especially with calipers involved. I know many others who feel the same way :laugh:
I felt very humbled in my cardiology elective as a medical student.

As for the lack of consistency of training...it seems that this has been a problem for years and years. As of today, any psychologist can STILL hang out their neuropsychology shingle with minimal training. It seems that their "guidelines" for training are still unenforceable. If you're lucky, they attended some weekend courses on the Halstead Reitan battery. Because of the inherent nature of medical specialties, the boundaries of practice are much more clear. Who can legally stop a psychologist from administering a WMS to test memory? Who's to say this isn't part of a "regular" psychological testing workup and not neuropsychological in nature? Medicine too has scope of practice issues, but since our interventions and medications are much more palpable and have physiological consequences, the respect for boundaries appear more clear - both in practice and even in court circumstances.

As an aside and a question I've asked many times on this forum but nobody has taken an interest in answering....is there a psychologist currently enrolled in an rxp program or who already prescribes (DoD) that has ever prescribed a non-psychiatric medication. If you're still in training, would you ever under any circumstance? I'm not referring to off-label uses...simply unrelated meds for non-psychiatric conditions. Would you ever prescribe Cleocin for your kid's acne, or a z-pack for your mother's cold? Ever?
 
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DrFocker

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I love being an imposter on the RXP email list, you just got to love what these quacks come up with. Obviously, they're completely ethical and have only patient interests at heart rather than monetary interests. Apparently, a credentialing process that is harmful to patients is okay, but god forbid it imposes on their AGENDA. Obviously the needs of the stakeholders is of primary importance (uh, what about patient welfare?) when considering the credentialing process for RxP. My favorites are in bold:

FYI, Jack
----- Original Message -----
From: "Katherine C. Nordal, Ph.D." <[email protected]>
To: <[email protected]>
Sent: Sunday, February 27, 2005 5:28 PM
Subject: Re: [DIV42] APA pres voting


> John: I am a strong supporter of prescriptive authority for
> psychologists! I believe this is one of the most important practice
> agendas and will do all I can to support it as CAPP chair this year and
> as president of APA. I was on the CAPP grants committee last year and
> we gave a signficant sum of money to states with prescriptive authority
> legislative agendas as we will do this year as well.
I am also on the
> CAPP RxP subcommitte. I support the APA model for RxP training which was
> endorsed by our Council (I was on the Council when that policy was
> adopted) and that I am very sensitive to the needs of our graduates and
> our current training programs in regard to current discussions about
> credentialing of RxP training programs. I do believe that credentialing
> of programs is an important activity but that it should be done in a way
> that takes into account the needs of all of the stakeholders and that it
> should be done in a way that is consistent with advancing APA's
> prescriptive authority agenda.
We do not need a credentialing process
> that could be used in any way that would be harmful to our agena.
I also
> plan to explore possible avenues to obtain federal funding for
> prescriptive authority training for psychologists in public service in
> settings such as the VAs, state hospitals, prison system, and community
> and rural health clinics.
I think there may be some exciting
> possibilities in those arenas and they are settings which provide much
> needed services to underserved populations. On a more personal note, I
> have been a regular contributor to fundraising efforts for RxP. Please
> feel free to contact me if you need additional information. Best,
> Katherine Nordal (Please visit my website at www.DrNordal.com)
>
> John L. Reeves II, Ph.D. wrote:
>
> >Jeff,
> >
> >What is Dr. Nordal's position on prescriptive authority? Thanks.
> >
> >John
> >
> >-----Original Message-----
> >From: Division 42 - Division of Independent Practice
> >[mailto:D[email protected]] On Behalf Of Jeff Barnett
> >Sent: Sunday, February 27, 2005 8:48 AM
> >To: [email protected]
> >Subject: Re: [DIV42] APA pres voting
> >
> >Katherine Nordal is the only one to provide a statement who is in
> >practice.
> >She is a full-time independent practitioner, Division 42's Finance
> >Committee
> >Chair, a former APA Congressional Fellow, a former member of the APA
> >Board
> >of Directors, and a very effective leader. For more information about
> >Katherine please visit her website at www.DrNordal.com .
> >
> >Also, seeking the nomination to be on the APA President election ballot
> >is
> >Paul Lloyd. He is a Division 42 member and consulting psychologist who
> >has
> >served on APA Council.
> >
> >Please nominate Katherine Nordal and Paul Lloyd to be on the ballot for
> >APA
> >President. The nominations ballots are due at APA before March 18.
> >Everyone please send them in. It's vital that we have strong leaders
> >with
> >an understanding of practice issues on the ballot. Thanks to all -
> >Jeff.
> >
> >
 

Anasazi23

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DrFocker said:
I do believe that credentialing
> of programs is an important activity but that it should be done in a way
> that takes into account the needs of all of the stakeholders and that it
> should be done in a way that is consistent with advancing APA's
> prescriptive authority agenda.
We do not need a credentialing process
> that could be used in any way that would be harmful to our agena.
Unbelievable....
 

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I have to agree with you there. APA is useless, and counterproductive. As a psychologist I have have had to go through the same credentialing process at hospitals as any MD, and it should always be that way. In some ways all this fuss is good. RxP is happening, but with enough oversight by psychiatry and other organizations it will be done well. :eek: