Psychologist Prescribing Passes Illinois Senate by Wide Margin
- Thread starter edieb
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This bill will allow psychologists to prescribe medication after a course of online training and WITHOUT a collaborative agreement with a physician. Instead of being overseen by the medical board, the psychologists will have oversight by a separate board, including non prescribing psychologists, who have not even completed the woefully inadequate educational requirements to prescribe. All of the physician groups in Illinois oppose this bill. Interestingly, it is also opposed by the consumer group, NAMI (National Alliance for the Mentally Ill), which sees it as allowing our most vulnerable citizens to receive substandard treatment
This is the cheapening of American Medicine. Reduce costs by funneling work to less skilled folks. They're juicing up PA's, NP's, pyschologists, optometrists, etc, who all want legistaltion to allow them to Rx meds or even perform surgical procedures. And often they contribute more to their political action committees than the physicians.
This is the cheapening of American Medicine. Reduce costs by funneling work to less skilled folks. They're juicing up PA's, NP's, pyschologists, optometrists, etc, who all want legistaltion to allow them to Rx meds or even perform surgical procedures. And often they contribute more to their political action committees than the physicians.
Where is your evidence for being "less skilled?" Psychologists have been prescribing for many years in two states and in the military without even 1 adverse reaction or complaint. They have written something like 50,000 prescription total. Do any physicians have this incredible track record?
I wonder if this will be killed in the house though? In case you haven't noticed, the House is full of politicians who can't understand basic data and don't follow any logic. I personally am not interested in pursuing prescription right.
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What about all the complaints that are reported against physicians? Why aren't those hidden? Nice conspiracy theory.
What data do you have for this certainty?
Can you smell the fear? "They're juicing up PA's, NP's, pyschologists, optometrists, etc, who all want legistaltion to allow them to Rx meds or even perform surgical procedures. And often they contribute more to their political action committees than the physicians." is especially rich...
I hope this happens in PA soon. I'm not sure I would pursue it, but I think it would be a great option to have for psychologists and clients alike... Most psychiatry outpatient clinics are on a three month or longer wait her for initial assessment... Done right, this could be great for the profession (and cause issues, both predicted and unforeseen... nothing is ever black or white).
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Before osteopaths were allowed to prescribe medications, osteopathy had to incorporate all of allopathic medicine into its curriculum. If psychologists want to do the same, they should have similar requirements. Good medicine treats the whole person, not just one aspect of some disease process. Anybody who prescribes any psychotropic medications should be familiar with enough medicine to recognize diseases of other systems that affect the mind. What a tragedy could it be, for example, to treat hypothyroidism in children as depression or hyperthyroidism as mania.
I mean, this is silly... what if the same child presented today and the psychologist attempted to treat it with CBT? Most any credible psychologists is going to request a full workup by a PCP when there is any question of a physiological condition... just like they do now.
and this "the bill was amended earlier this week in committee, requiring psychologists to enter into a collaborative, contractual agreement with a prescribing medical doctor if they wish to prescribe themselves"...
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Totally silly. Do you actually think a prescribing psychologist (let alone any competent mental health professional) would ever be trained overlook thyroid function in a mood disorder?! That's ridiculous. Take a look at the curriculums.
This will never pass in Illinois. The AMA owns that state. Won't happen--mark my words.
It seems everyday that there is uproar or a debate about social workers doing tasks that psychologists should do. Why then, do we feel that prescription privileges are warranted? If it is truly for the good of the patient, then we should not mind social work and others doing our JOB in the best interest of the patient. Truly hypocrites we are if these bills should continue to pass. If we put as much time and effort into advocating our professional boundaries like the AMA will, maybe our field can be further united rather than divided.
Psychologists who desire prescriptive authority have to spend 2 years in school and take a very difficult examination to pass + complete a practicum. I spent 3 hours/day for 18 months studying. If a social worker wishes to put this much effort into learning psych testing, they are more than welcome to do so.
If social workers were to do equivalent training to psychologists then that is fine, but it does not happen in the real world. Especially when training is provided by other social workers and not psychologists in most situations.
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MD psych resident here. A special request to you psychologists on behalf of patients. At the end of the day you have to do what's best for the patient. If you know therapy, then that's your focus. If there's any hesitation over prescribing medications, side effects, or medical conditions, then please refer that patient to an MD (psychiatrist preferably). Thank you.
Likewise, if I have a patient who can benefit from special therapy from a psychologist, then I will refer him or her to you.
Likewise, if I have a patient who can benefit from special therapy from a psychologist, then I will refer him or her to you.
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The MD's who are butting in on our board here fail to recognize that their profession is doing a terrible job caring for the mentally ill. Terrible. There are not nearly enough psychiatrists. Patients are left with a 6 month wait to see a psychiatrist around here. This is in part due to a huge portion of greedy psychiatrists who have decided that they will charge astronomical cash rates simply because they are so in demand. Most people can't afford to pay that. So people are left with their reckless PCP (often a general NP anyway) to rx. PCP's have so little training in mental health and typically very bad at recognizing the limits of the scope of their competence. How often do PCP's screen for bipolar before loading their patients up with ssri's? Any psychologist who has been in practice for a little while has seen some disasters with regard to this. How often do PCP's just move from one ineffective psych med to the next for years and never tell their patient that they need a specialist because they have reached the limits of their capabilities? I see it all the time. Not to mention that the PCP's will throw a first rx for ssri's at their patient with three refills and then not check back in on them for 3 months.
I understand you are all worried about your bottom line. We do that around here too. But your arguments would be much more convincing if your own profession were doing a better job.
Dr. E
I understand you are all worried about your bottom line. We do that around here too. But your arguments would be much more convincing if your own profession were doing a better job.
Dr. E
I completely agree with Dr E. After many years in practice I am fed up with the lack of availability of psychiatric services and the lack of competence of many PCP and NP's prescribing psychiatric meds. Apparently, after 4 years of med school, MD's are deemed competent to prescribe something like 3500 different meds. Rx Psychologists, after 3 years post doctoral training with an MS in Psychopharmacology are prescribing about 100 meds. Some of the training is done on line, but we're not talking a weekend continuing Ed class here. These programs are rigorous and intensive.
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This concerns me. I am for RxP but I don't think this is the way to go about it. RxP programs should be highly competitive to ensure those admitted are capable, motivated, and serious about competent practice. If all it takes is an online course, we are truly widening (not opening - that's already done) the floodgates.
The courses allow for some online study, but are rigorous, take 3 years to complete, require supervised practica and are POST DOCTORAL How much more competitive do you want them to be? Check out the course requirements.
I think my above quote got lost... they won't be prescribing without consulting.
Exceedingly well put, I could not agree more. I believe rx is coming to most areas... but man is it taking a long time.
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Actually, my dissertation (not yet published) says otherwise. In sum, physicians (and I mean this nicely) suck balls at using screening measure results, referring, and paying attention to mental health appropriately. It's a lot easier to slap a misguided Axis I/II dx on an unsuspecting person and prescribe them antidepressants, right? This was in a co-located clinic, too which was a teaching location for family medicine residents. Note: learning the term "Cognitive Behavioral Therapy" isnt exactly knowledgable about mental health. Note that this wasnt an isolated event. Last year, I went to a national conference and presented preliminary data... and guess what? A lot of others had the same exact experience. Two people, in fact, were presenting virtually identical data (though their overall project was a tad different).
Perhaps you're just not as good as you think you are.
Signed,
Everyone else
In all seriousness, I count two people in here who probably need to get off their high horse. Just because you have some training doesnt make you the end-all be-all. And no, I'll likely never try to get Rx privledges-- just not my thing. Seems like a lot of work just to give people placebos.
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If this does eventually pass and become law, then it is a lot different than the other states. Chicago is a huge FSPS hub and a saturated market. The two current states with Rx seem to have justified it due to underserved needs in rural areas. Chicago will be a very interesting place.
Many counties in Illinois have no psychiatrists or MH prescribers. Thus, Illinois is also very, very underserved. Believe it or not -- I believe it is one of the top 10 most underserved states in regards to MH services
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Oh sure I know it is a big state. I just was commenting on Chicago specifically. I wonder how many Rx providers will migrate to other parts of the state when hundreds of psychologists graduate every year from FSPS in the city.
I think this is a great time for psychologists to advocate for increased MH funding in general. I know that there are congressional fellowships out there for psychologists to work in policy positions in government. We need more psychologists in Washington. I think our training is perfect for being able to consult to high level officials on social policy programs.
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This gave me a chuckle for some reason. I envision motiational interviewing with John Boehner and perhaps erg working with Chris Christie to do a bariatric eval.
But your point is well taken. Lobbying needs to happen. Some psychologists do work on more public policy oriented projects.
This gave me a chuckle for some reason. I envision motiational interviewing with John Boehner and perhaps erg working with Chris Christie to do a bariatric eval.
/QUOTE]
There are many ways to get involved through professional organizations. I was talking specifically about APA congressional fellowships. They sound really awesome and the stipend is 75-90K--so not so bad.
http://www.apa.org/about/awards/congress-fellow.aspx
There are different types on the APA fellowship website.
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Daniel Carlat, editor of the Carlye Report and a psychiatrist in pp & at mass general, wrote a very interesting take on the practice of psychiatry in his book Unhinged. In the final chapter of his book, he discusses the military experiment with prescribing psychologists last decade and also provides a thought provoking overview and analysis of what has happened with prescribing psychologists in New Mexico. Lastly, his reflections on how to change psychiatry (and psychology) training were quite fascinating. His book is here http://www.amazon.com/Unhinged-Trouble-Psychiatry-Revelations-Profession/dp/141659079X
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I believe it may still need to be approved by the House first...?
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Anecdotally, I see near misses and medical errors all the time, by those far more trained in medicine than an RxP. Most of those go unreported, for various reasons including the patient has no alternative provider and doesn't want to ruin the relationship, the patient doesn't know any better, or the fact that throughout all of healthcare we protect our own.
Your logic says that since doctors have some grievances, psychologists with LESS training should naturally have ZERO grievances against them? Does more training then equate to higher risk, or are psychologists naturally superior clinicians that can avoid medical errors in which they lack training, even though they don't know what they're trying to avoid? Maybe they can go take over surgery while they're at it and help with the errors there, too.
I always love the thyroid argument. As if the only physical health issue to be concerned about is thyroid disease. Medical mimics of psychiatric disease, and the systemic issues of psychopharmacology (and polypharmacy) are the real concerns. To pretend that the CNS is an isolated system and that "psychotropics" only affect the CNS just illustrates the perpetuation of ignorance and hubris rampant in this whole debate.
Try re-reading the extended sticky on this whole debate. Rehashed many many times. Usually by psychology students who still don't know what they don't know. Jon Snow and T4C at least recognize the large risks inherent in this process. There may be small benefits, theoretically, but IMPO the risks far outweigh those, as do the costs. How about the millions required to create the bureaucracy in the state. All that for 22 providers licensed in New Mexico, 5 of whom don't live in the state at all and most others not living in underserved areas. The money would be better spent and more safely spent recruiting those with actual training, even mid-levels, or increasing psychiatric training for PCP's.
For further lists of counterarguments, look to your psychology brethren -- http://psychologistsopposedtoprescribingbypsychologists.org
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I think you are confused. The thyroid argument was actually brought up by the other physician posting here. I think you mean to say that your colleague is ignorant and full of hubris. The psychologists were the ones who pointed out that his comment was ridiculous.
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No, I was referring to your reductionistic response, as if stating "Of course we would request full workups" defeats the point intended to be illustrated by my colleague. Thyroid disease is an example, and responses dismissing it as if it is the entirety of the problems and concerns is shortsighted and attempting to obfuscate the legitimate concerns here.
But you probably know that, because you're educated. And because the actual concerns have not and cannot be reasonably answered without generalizations and misdirection.
I think folks were responding to this example from your colleague. I never responded to it. What kind of response did you expect from a ridiculous statement like this?
What do you make of the fact that there has been no legal action against any prescribing psychologist so far (I believe over 50,000 prescriptions have been written by psychologists)?
You mean like this. Your colleague came onto this forum and posted this initially. Do you expect this type of statement to lead to an effective debate?
This bill will allow psychologists to prescribe medication after a course of online training and WITHOUT a collaborative agreement with a physician. Instead of being overseen by the medical board, the psychologists will have oversight by a separate board, including non prescribing psychologists, who have not even completed the woefully inadequate educational requirements to prescribe.
This is the cheapening of American Medicine. Reduce costs by funneling work to less skilled folks. They're juicing up PA's, NP's, pyschologists, optometrists, etc, who all want legistaltion to allow them to Rx meds or even perform surgical procedures. And often they contribute more to their political action committees than the physicians.
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Your objections are valid, though dlm has some fair points as well, regarding supervision by a board of psychologists. PCP's (who will likely be the ones supervising) have inadequate psychotropic training as well, leading to a false sense of security, placed into the law to bypass basic complaints.
As I've written many times before, this is lowering the bar when really we should be raising it. The rationale in place is that bad prescribing to many is better than good prescribing to fewer. I disagree with that logic, though do sympathize with all the untreated. I see far too many iatrogenic problems from bad prescribing (by PCP's, psychiatrists) to believe that anyone with good intentions and less training is going to do much better. Therapy should be more highly prioritized throughout the system. What's funny about all this is the longer term picture --
Step 1. Psychiatrists do prescribing and therapy (and few others do any)
Step 2. Psychologists take up more therapy and Psychiatrists move towards primarily prescribing (because insurance pays better for this).
Step 3. It becomes a commonly believed myth that all medication management is more cost efficient than good therapy.
Step 4. Masters level therapists start flooding the market, as do for-profit psychology programs, lessening the value of a psychology degree and increasing competition.
Step 5. Since med mgmt is more cost efficient, it becomes a standard and expectation to be used in areas that have little of it. We now push to spend millions of dollars and create entire new bureaucratic systems to add more prescribers, even though there is little evidence it will substantially add more access in rural areas. Also it ignores the available treatment that IS there and available (therapists) which may ultimately be more cost effective to use.
[political tangent]
Really we should be using all the gun debate right now and the rights attempt to attribute it all to mental illness to secure better funding (particularly psychotherapy) across the country, and to improve screening procedures. The political will is there if harnessed.
I agree with this. I believe we should be spending more time advocating for psychotherapy funding.
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Unfortunately, prescribing psychologists will not remedy this issue (Baird, 2007). There are almost no psychologists in rural areas in IL.
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A little defensive are we? The doctors who strive for excellence, including myself, never slap anyone with any diagnosis. Incompetent psychologists are prone to misdiagnosing their patients as well. Easier to slap someone with an Axis disorder and give meds? What are you dumb? You assume what is easy is what doctors do by default? I work with some of the brightest doctors I've ever met and we all work very hard to properly diagnose and treat patients, often consulting other specialists. Maybe when you develop a mental disorder one day you will be thankful for having an excellent and compassionate physician to save you (and you will learn an ounce of humility and perspective.) What are you 19 years old? And please post your thesis on here when you finish it so we can all say how great you are for coming up with such an original conclusion, and please include the methods and statistical analysis as I am sure they are robust.
I wanted to say that psychologists and psychiatrists can BOTH do a better job at serving MH patients. Don't be a hypocrite about it. Both sides should swallow their pride and see how to improve the system.
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The reason that I dislike RxP political advocacy is because I feel like it's distracting us from the larger issue: scope creep. I think that if APA put half the effort towards restricting testing, for instance, that they do towards RxP we would be better off.
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Agreed re: putting more effort toward not just necessarily "protecting our turf," but even more importantly on improving awareness about the validity of our profession as a whole and the utility of the services we provide. I've mentioned it before--we see all sorts of direct-to-consumer advertising by big pharma for medications, but when was the last time you saw just one commercial talking about therapy?
Unfortunately, testing doesn't pay as well (right now). Although again, if APA spent more time advocating for what it is psychologists actually currently do, maybe that would change.
Let's play nice. There is incompetence in every profession so I agree that we should try and stay away from generalizations about whole groups here.
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agreed.
The factors that lead to poor prescribing habits are not going to disappear just because the prescriber is a psychologist. There is no reason to assume that psychologists will not fall prey to the same issues (e.g., overprescribing, inappropriate dx, reliance on med management) that face psychiatrists.
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That's a good point: declining reimbursement rates is another huge issue that APA should be working on addressing more.
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actually the APA has made at least two commercials (which are pretty cheesy). Of course, I have not seen these on TV yet.
http://www.youtube.com/watch?v=fbo_dtAOLD0&feature=youtu.be
http://www.cbsnews.com/8301-504763_...therapy-as-depression-treatment-before-pills/
I agree. However, how can we compete with big pharma companies that have billions at their disposal? A campaign to increase awareness of therapy would be great, but how do we get enough funding to have an impact on the public? I think we can also publish articles about what we do and send it to major news outlets as an op-ed.
Does anyone know how much of our resources are spent trying to attain prescription priv. for psychologists? I am not against this movement, but I am concerned that after 30 years of fighting for this we have only gotten this law passed in two states. That doesn't seem like a great use of resources. It doesn't affect even 0.5% of psychologists.
I think part of the problem is that our field is not united. Other professions do not seem to have this much discord about what is important.
