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Psychologists Defeated in Hawaii Again

Anasazi23

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    From the Hawaii Medical Association

    Opinion piece from the Honolulu Advertiser

    :thumbup:

    I'm back working in the inpatient unit for a couple months. I recently saw one serious medication side effect that nobody could have predicted. Psychologists want to prescribe - even in hospitals. Who will do the workups and medical management when things go wrong? They're not qualified to do this, despite the rxp training. That's a fact.

    For example, if a patient developed a serious medication side effect from a psychologist that prescribed on an inpatient unit, would they have to call the psychiatry resident to assess the patient and write medical orders? What if there's no psych resident? Many (most) attending psychiatrists will not want to be responsible for medical management of a patient that they did not treat initially on a floor. It doesn't make medical or financial sense.
     

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      Anasazi23 said:
      From the Hawaii Medical Association

      Opinion piece from the Honolulu Advertiser

      :thumbup:

      I'm back working in the inpatient unit for a couple months. I recently saw one serious medication side effect that nobody could have predicted. Psychologists want to prescribe - even in hospitals. Who will do the workups and medical management when things go wrong? They're not qualified to do this, despite the rxp training. That's a fact.

      For example, if a patient developed a serious medication side effect from a psychologist that prescribed on an inpatient unit, would they have to call the psychiatry resident to assess the patient and write medical orders? What if there's no psych resident? Many (most) attending psychiatrists will not want to be responsible for medical management of a patient that they did not treat initially on a floor. It doesn't make medical or financial sense.


      :thumbup: :thumbup: :luck:
       

      OldPsychDoc

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        Anasazi23 said:
        From the Hawaii Medical Association

        Opinion piece from the Honolulu Advertiser

        :thumbup:

        I'm back working in the inpatient unit for a couple months. I recently saw one serious medication side effect that nobody could have predicted. Psychologists want to prescribe - even in hospitals. Who will do the workups and medical management when things go wrong? They're not qualified to do this, despite the rxp training. That's a fact.

        For example, if a patient developed a serious medication side effect from a psychologist that prescribed on an inpatient unit, would they have to call the psychiatry resident to assess the patient and write medical orders? What if there's no psych resident? Many (most) attending psychiatrists will not want to be responsible for medical management of a patient that they did not treat initially on a floor. It doesn't make medical or financial sense.

        I suppose they could get a PA to come and write the orders. :p
        [ducks and runs for cover]
         
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          Anasazi23 said:
          From the Hawaii Medical Association

          Opinion piece from the Honolulu Advertiser

          :thumbup:

          I'm back working in the inpatient unit for a couple months. I recently saw one serious medication side effect that nobody could have predicted. Psychologists want to prescribe - even in hospitals. Who will do the workups and medical management when things go wrong? They're not qualified to do this, despite the rxp training. That's a fact.

          For example, if a patient developed a serious medication side effect from a psychologist that prescribed on an inpatient unit, would they have to call the psychiatry resident to assess the patient and write medical orders? What if there's no psych resident? Many (most) attending psychiatrists will not want to be responsible for medical management of a patient that they did not treat initially on a floor. It doesn't make medical or financial sense.

          a matter of time
           

          Anasazi23

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            PsychEval said:
            I billed out $1,230 today. Its not about money.
            One of the supposed hundreds of comments like these:
            edieb said:
            Unfortunately, psychologists have lost a great deal of ground
            financially in the past 20 years
            . I am the Clinical Director in a state
            psychiatric hospital and when I started working for state government as
            staff psychologist my salary was higher than nurses, pharmacists,
            occupational therapists and LCSW's. Today we routinely pay equal or
            significantly more to these other disciplines, who hold associates to
            masters degrees, than we do our newly hired doctoral level
            psychologists. This trend is common in state government and other
            agencies across the country. While access to quality services is a
            wonderful selling point for prescription privileges, we also need to be
            realistic and accept that our financial survival depends upon expanding
            the scope of our practice.
            I have seen a similar decline in the
            reimbursement of services in my private practice. Our profession has
            fallen behind many other disciplines in earning potential during a
            relatively short period of time.

            Take care,

            This is the more realistic picture....
             

            edieb

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              Posted on: Thursday, March 30, 2006
              COMMENTARY
              Psychologist prescription bill is a must

              By Beth Giesting



              With the stroke of a pen, Hawai'i lawmakers have the power to improve access to mental healthcare for an estimated 55,000 people served by nonprofit community health centers in our state's poorest and most underserved rural areas.

              Their need is dire, and the situation is only getting worse.

              The solution is the Hawai'i Primary Care Association's House Bill 2589, which would allow appropriately trained licensed psychologists working at community health centers to prescribe and adjust medication to treat mental-health issues.

              Waiting times for these patients to see a psychiatrist range from six weeks to three months. On the Neighbor Islands, where the shortage of psychiatrists is most acute, many patients are told they can't get an appointment at all. In 2005, only five new psychiatrists finished their training in Hawai'i, compared to 34 new psychologists. In 2004, the most recent available data, there were only six psychiatrists serving three of Hawai'i's 13 community health centers, compared to 10 psychologists serving nine of the centers.

              The primary opposition to this bill comes from the state psychiatric association. This issue is not new to the Legislature. For more than a decade, psychiatrists have fought giving psychologists the authority to prescribe by promising to improve care in rural areas, yet year after year, the situation has remained dismal.

              It's not that psychiatrists don't care. It's just that there are simply not enough of them to go around, and as with many things in life, the poor and the needy go without.

              And 55,000 individuals, real people in desperate need of mental healthcare, are at risk and waiting in vain.

              This bill is widely supported by the medical directors and administrators of the community health centers and also by the Hawai'i Nurses Association, HMSA, and the Hawai'i Psychological Association. Indeed, the bill was drafted by Rep. Josh Green, vice chairman of the House Health Committee and a Big Island physician who provides emergency room care in a rural setting.

              In written testimony supporting the bill, HMSA states that this "could have a large impact for individuals in need of these services."

              But is it safe?

              Absolutely. Precedent has been set time and time again: Non-medical doctors, including dentists and optometrists, have safely prescribed medication within their areas of expertise for years. In Hawai'i, advanced practice nurses and physician assistants can also prescribe medication.

              Moreover, psychologists are already prescribing in New Mexico, Louisiana and within the Department of Defense; the latter has been prescribing for nearly 10 years. In Louisiana, psychologists have written more than 10,000 prescriptions without incident. In fact, there is no record of a patient being harmed by a prescribing psychologist in any of these settings.

              Elaine Orabano Mantell, Ph.D., a DOD prescribing psychologist since 1997, reports: "I have never had a single adverse outcome. I have never had a single complaint leveled against me with regard to any of my clinical work, including my use of medications. On the contrary, I continue to receive more referrals than any one individual can handle because the need for treatment is so great."

              HB 2589 would require doctorate-level psychologists to undergo four and a half years of intensive supervised training prior to prescribing a limited number of medications for our neediest individuals. This is in addition to the seven years of doctoral training in the diagnosis, assessment and treatment of mental and emotional disorders already required to become a licensed psychologist.

              This advanced curriculum is based on the recommendations of a blue-ribbon panel of experts that included input from people in psychiatry, pharmacology and psychology. And just as dentists and optometrists only prescribe medications related to their expertise, appropriately trained psychologists would only prescribe medicines relating to mental health.

              The current bill has already been amended to limit the types of medications to address safety concerns.

              But most importantly, this bill will improve the safety of the people of Hawai'i by increasing access to high-quality mental healthcare in underserved rural areas.

              But can we afford it?

              The bill will cost the taxpayer nothing. Psychologists are already working in the rural health clinics. The cost of additional training will be borne by the individual psychologists. The real question is, can we afford not to do this?

              We have nothing to lose but the artificial roadblocks that prevent our most underserved populations from getting the care they need.
               
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              edieb

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                Although there are other postings about psychologist salaries being fine, you pick one data point (that one negative posting about salaries) and make a gross generalization... You're a real scientist, dude. With scientific aptitude like that, I feel for your patients.


                Anasazi23 said:
                One of the supposed hundreds of comments like these:


                This is the more realistic picture....
                 

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                  You know, if you guys cut down the med check times form 15 minutes to 10 minutes, you could see %50 more patients. It seems that the psychiatrists are selfishly taking to much time with each patient, purposely witholding treatment.
                   

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                    Psyclops said:
                    You know, if you guys cut down the med check times form 15 minutes to 10 minutes, you could see %50 more patients. It seems that the psychiatrists are selfishly taking to much time with each patient, purposely witholding treatment.


                    Hey hey hey, what a wonderful idea, and one my pal at Merril Lynch will just LOVE.

                    Let me also point out that no one from psychiatry has disrupted YOUR discussion on your forum on this matter. Thanks for the hijack. Please keep your inflammatory and erroneous comments in YOUR arena. Please lets maintain some professionalism. If you aspire to take care of patients on a clinical level you will need it.
                     
                    Hmmm what was this oh holier one, solideliquid??
                    Doh!!
                    Originally Posted by PublicHealth
                    Drum roll please.....

                    2/24/2006 H Bill scheduled for decision making on Wednesday, 03-01-06 at 2:00 pm in conference room 325.




                    Heres hoping the courts make the right decision.
                     

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                      Ok SL, let me explain what I meant by my post. It was very sarcastic but it wasn't meant to put psychiatrists down per se. Let me break it down for you. It is true that psychologists often chide psychiatrists for only spending 15 minutes with each client. However, it has been my experience that psychiatrists aren't usually the driving force behind te 15 minuted med checks, it comes from the pressure of insurance companies demanding that the MD spend their time like that. Essentially asking for the most they can get out of the least they can pay for. MDs I know usually resent this and would like to spend more time with each client. This was meant to be a jab at the system. And the system is one of the reasons there is a push for psychologist RxPs. Read the post again, does it still seem very unprofessional and insulting? If so, sorry for offending your sensibilties.

                      Additionally, since these are open forums, you are more than welcome to visit the psychology, or plastic surgery, or whatever forum floats your boat.
                       

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                        edieb said:
                        Although there are other postings about psychologist salaries being fine, you pick one data point (that one negative posting about salaries) and make a gross generalization... You're a real scientist, dude. With scientific aptitude like that, I feel for your patients.

                        Dude(ette?), I didn't take one data point, and I didn't quote those case reports, since they're just that. I don't care if your uncle Sherman the psychologist makes 300k per year. And, I know fully licensed psychologists making 40k per year, and ones making over 100k. Psychologist salaries are lower than psychiatrists. Not that I really care. It's just a fact. If you're upset about this, go to medical school.

                        My science aptitude is just fine, thanks. Although I don't have the track record of writing over 15,000 prescriptions without having one side effect (complete bull*&^%), my patients do well despite your vitriole. An important thing that I realize that many psychologists apparently do not, is that I have a tremendous amount still to learn about psychopharmacology and psychiatry in general.

                        Care to address the post above where psychologists on their listserv rail on about needing to expand their practice? I notice that was completely not addressed by anyone.
                         

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                          The fact that the psychiatry folks in this forum are so bitter is telling. If psychology RxP was such a silly idea, psychiatry folks would be sitting back and laughing as psychologists make asses of themselves. But that's not the case -- what may that suggest?

                          As a medical student considering psychiatry, I am indeed concerned about psychologist RxP, but do not believe that it threatens psychiatry or the patients psychiatrists treat to the extent that some people may believe. Psychiatry will always be the "ultimate" in behavioral healthcare, but that does not mean that psychologists cannot be properly trained to treat pharmacologically much like NPs and PAs.

                          The fact that psychiatry wants to dictate what training model they think would suffice is a restriction of trade. Nursing has developed their own model, and now doctoral-level degree, independent of medicine. Why must the "old boy network" dominate healthcare in America?
                           

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                            PublicHealth said:
                            The fact that the psychiatry folks in this forum are so bitter is telling. If psychology RxP was such a silly idea, psychiatry folks would be sitting back and laughing as psychologists make asses of themselves. But that's not the case -- what may that suggest?

                            As a medical student considering psychiatry, I am indeed concerned about psychologist RxP, but do not believe that it threatens psychiatry or the patients psychiatrists treat to the extent that some people may believe. Psychiatry will always be the "ultimate" in behavioral healthcare, but that does not mean that psychologists cannot be properly trained to treat pharmacologically much like NPs and PAs.

                            The fact that psychiatry wants to dictate what training model they think would suffice is a restriction of trade. Nursing has developed their own model, and now doctoral-level degree, independent of medicine. Why must the "old boy network" dominate healthcare in America?

                            Personally I am not threatened by psychology as a field. Simply because we reply to posts is not "telling". Internet+anonymity=making an ass of yourself.

                            The only thing that bothers me is that while we are trying to have meaningful discussion about our field. Let me point you in the direction of my self-defense thread. I simply had a concern since I am starting my residency in a few months. The psychologists came in and started trolling, as they usually do. I'm sure you read the thread. And the thread did not go on due to senseless bickering and I feel the thread could have gone on.
                             

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                              Solideliquid said:
                              The only thing that bothers me is that while we are trying to have meaningful discussion about our field. Let me point you in the direction of my self-defense thread. I simply had a concern since I am starting my residency in a few months. The psychologists came in and started trolling, as they usually do. I'm sure you read the thread. And the thread did not go on due to senseless bickering and I feel the thread could have gone on.

                              Huh? :confused:
                               
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                                PublicHealth said:
                                The fact that psychiatry wants to dictate what training model they think would suffice is a restriction of trade.

                                Oh you mean the same RESTRICTION OF TRADE in which teh psychologists successfully lobbied that only a PhD can be referred to as a "psychologist"?

                                Thats whats so infuriating about all these midlevels; they are so hypocritical.

                                If MSWs started lobbying to be called psychologists and get the same practice rights, psychologists would be UP AT ARMS RAILING AGAINST THEM.

                                So dont give me your hypocritical BS.
                                 

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                                  MacGyver said:
                                  Oh you mean the same RESTRICTION OF TRADE in which teh psychologists successfully lobbied that only a PhD can be referred to as a "psychologist"?

                                  Thats whats so infuriating about all these midlevels; they are so hypocritical.

                                  If MSWs started lobbying to be called psychologists and get the same practice rights, psychologists would be UP AT ARMS RAILING AGAINST THEM.

                                  So dont give me your hypocritical BS.

                                  Mullet Wearer, I don't think this is the best analogy. It would apply more to PAs and Nurse practitioners wanting to be called physicians. It is meant to protect the consumer, which incidently is some if not all of what the RxP is about. Psychologists contend (I'm not necessarily conviced) that they want the RxP so that they can treat all the folks that psychiatrists can't get to. Psychiatrists contend(I'm not bying this either) that they would be happy if psychologists had RxP, but they could just never master the titration skills necessary to avoid poisoning half the MH clients. So both are looking out for the public from the bottom of thir hearts.
                                   
                                  MacGyver said:
                                  Oh you mean the same RESTRICTION OF TRADE in which teh psychologists successfully lobbied that only a PhD can be referred to as a "psychologist"?

                                  Thats whats so infuriating about all these midlevels; they are so hypocritical.

                                  If MSWs started lobbying to be called psychologists and get the same practice rights, psychologists would be UP AT ARMS RAILING AGAINST THEM.

                                  So dont give me your hypocritical BS.

                                  So true. Although many states have protected the title of "psychologist" and reserved it for those with doctorates, it's a bit of a paper tiger. Since psychology's own research shows equal psychotherapeutic efficacy regardless of the graduate degree of the clinician (MA/MSW/PhD/PsyD) what's left? Psychometrics and psychopharmacy.

                                  There continues to be much rending of garments and gnashing of teeth in the psychology profession over the loss of ground to lesser trained purveyors of the trade - not to mention it's concomitant depression of reimbursement. I don't think the pursuit of "RxP" is dead by any stretch.

                                  I also still fail to be convinced that the best way to reach the underserved is to give out more prescription pads. What about recruiting more med students into the profession that is already trained in psychopharmacology? What about educating the primary care docs who are statistically the strongest movers of the popular pills?
                                   

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                                    Pterion said:
                                    What about recruiting more med students into the profession that is already trained in psychopharmacology? What about educating the primary care docs who are statistically the strongest movers of the popular pills?

                                    Medical students are generally not interested in psychiatry because (1) it's one of the lowest paying specialties; (2) they don't want to work with chronically mentally ill people; and (3) psychiatrists tend to be less respected than other physicians.

                                    While primary care doctors may receive additional education in psychopharmacology, they are generally uncomfortable treating and closely monitoring the effects of psychotropics on psychiatric disorders. I have heard several stories about children and adolescents who were seeking psychotropics from their primary care doctor, and who were then put on a several month long waitlist to get evaluated by a psychiatrist. Further, given the complexity of diagnosing psychiatric disorders and managing psychotropics, primary care doctors would have to follow-up regularly to see if their patients are responding to the drugs. They would also not be providing psychotherapy. Combination pharmacotherapy and psychotherapy tends to be the best for most psychiatric conditions.

                                    Psychologists are very well trained in psychiatric diagnosis and psychotherapy. They also see their patients for therapy on a weekly basis. With additional training in psychopharmacology, they will provide optimal care for psychiatric patients. This is already happening in NM and LA. Last I heard, medical psychologists in LA have written 10,000+ scripts for on- and off-label drugs of various schedules without a problem. This prescribing is done in collaboration with the patient's primary care physician to ensure safety. Most importantly, patients love that they can get their pharmacotherapy and psychotherapy from one clinician.
                                     
                                    PublicHealth said:
                                    Medical students are generally not interested in psychiatry because (1) it's one of the lowest paying specialties; (2) they don't want to work with chronically mentally ill people; and (3) psychiatrists tend to be less respected than other physicians.

                                    While primary care doctors may receive additional education in psychopharmacology, they are generally uncomfortable treating and closely monitoring the effects of psychotropics on psychiatric disorders. I have heard several stories about children and adolescents who were seeking psychotropics from their primary care doctor, and who were then put on a several month long waitlist to get evaluated by a psychiatrist. Further, given the complexity of diagnosing psychiatric disorders and managing psychotropics, primary care doctors would have to follow-up regularly to see if their patients are responding to the drugs. They would also not be providing psychotherapy. Combination pharmacotherapy and psychotherapy tends to be the best for most psychiatric conditions.

                                    Psychologists are very well trained in psychiatric diagnosis and psychotherapy. They also see their patients for therapy on a weekly basis. With additional training in psychopharmacology, they will provide optimal care for psychiatric patients. This is already happening in NM and LA. Last I heard, medical psychologists in LA have written 10,000+ scripts for on- and off-label drugs of various schedules without a problem. This prescribing is done in collaboration with the patient's primary care physician to ensure safety. Most importantly, patients love that they can get their pharmacotherapy and psychotherapy from one clinician.

                                    First I should clarify. I should have said "educate the primary care docs so they will no longer be the primary pushers of popular pills". My error of omission.

                                    As to your list of 3, those are really the targets of my post. Let's fix those. I certainly don't have a good answer on the "how".

                                    Lastly, I dispute the assertion that psychologists, because of their expertise, are somehow uniquely qualified to be better at overall patient care than psychiatrists. Market forces and the realities of cost-to-train versus income will adjust the approaches of many new prescribing psychologists. Time will tell. I am well aware of the training of a psychologist; I have a doctorate in clinical psychology and am now a second year medical student.
                                     

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                                      Pterion said:
                                      First I should clarify. I should have said "educate the primary care docs so they will no longer be the primary pushers of popular pills". My error of omission.

                                      As to your list of 3, those are really the targets of my post. Let's fix those. I certainly don't have a good answer on the "how".

                                      Lastly, I dispute the assertion that psychologists, because of their expertise, are somehow uniquely qualified to be better at overall patient care than psychiatrists. Market forces and the realities of cost-to-train versus income will adjust the approaches of many new prescribing psychologists. Time will tell. I am well aware of the training of a psychologist; I have a doctorate in clinical psychology and am now a second year medical student.

                                      Interesting. What made you decide to pursue medical school? Are you planning to pursue psychiatry?
                                       
                                      PublicHealth said:
                                      Interesting. What made you decide to pursue medical school? Are you planning to pursue psychiatry?

                                      It quickly became apparent to me the limitation in my training regarding the patients I was seeing. I regularly was faced with the presentation of psychiatric symptoms that were in fact sequelae of medications or other, systemic disorders. One particular case was appropriately identifed and diagnosed before I was able to initiate our "screening". Not only would I have missed the systemic disease of origin, but my recommendations might have proven very harmful to the patient. The actual job setting was horrendous, but for different reasons. A combination of all of these reasons and more led me to the decision to enter medicine.

                                      My graduate program was a good one, despite detractors of the PsyD model. Post-licensure interests were in the biological basis of mental illness. I was under considerable pressure from my colleagues to abandon such interest and simply accept the "black box" magic of psychotherapy.

                                      Finally, although I worked with arguably the worst psychiatrists in the state, it never occurred to me that I could do better simply with a two-year pharmacology degree. Even the bad ones knew when the problem was more than just a serotonin/NE imbalance. Now that I have 2 years of medical school under my belt I am more convinced of the necessity for full medical training for prescription privileges.

                                      As for pursuing psychiatry, its unlikely. I have seen a whole new world in medical school and am not ready to commit to a specialty just yet.
                                       

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                                        Pterion said:
                                        It quickly became apparent to me the limitation in my training regarding the patients I was seeing. I regularly was faced with the presentation of psychiatric symptoms that were in fact sequelae of medications or other, systemic disorders. One particular case was appropriately identifed and diagnosed before I was able to initiate our "screening". Not only would I have missed the systemic disease of origin, but my recommendations might have proven very harmful to the patient. The actual job setting was horrendous, but for different reasons. A combination of all of these reasons and more led me to the decision to enter medicine.

                                        My graduate program was a good one, despite detractors of the PsyD model. Post-licensure interests were in the biological basis of mental illness. I was under considerable pressure from my colleagues to abandon such interest and simply accept the "black box" magic of psychotherapy.

                                        Finally, although I worked with arguably the worst psychiatrists in the state, it never occurred to me that I could do better simply with a two-year pharmacology degree. Even the bad ones knew when the problem was more than just a serotonin/NE imbalance. Now that I have 2 years of medical school under my belt I am more convinced of the necessity for full medical training for prescription privileges.

                                        As for pursuing psychiatry, its unlikely. I have seen a whole new world in medical school and am not ready to commit to a specialty just yet.

                                        Thank you for sharing your story. I chose medical school for these same reasons -- especially being able to care for the whole patient.

                                        You mention full medical training for prescription privileges. What about PAs and psychiatric NPs, and the MS programs in psychopharmacology? Do you think clinical psychologists with this additional "mid-level" training and practice safely and effectively IN COLLABORATION with their patients' primary care physicians? Clinical psychologists' ability to diagnosis psychiatric disorders is clearly better than GPs'. What do you think?

                                        Last I heard regarding Hawaii was that psychiatrists there want to devise a psychopharmacology training program for people who seek RxP. Of course, this program would be under their control, not psychology's. Criticism is that medicine tried doing this with PAs, the majority of whom choose higher-paying specialities (e.g., surgery, dermatology) instead of psychiatry in order to secure their $100K+/year.
                                         
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                                        PublicHealth said:
                                        Thank you for sharing your story. I chose medical school for these same reasons -- especially being able to care for the whole patient.

                                        You mention full medical training for prescription privileges. What about PAs and psychiatric NPs, and the MS programs in psychopharmacology? Do you think clinical psychologists with this additional "mid-level" training and practice safely and effectively IN COLLABORATION with their patients' primary care physicians? Clinical psychologists' ability to diagnosis psychiatric disorders is clearly better than GPs'. What do you think?

                                        Touchy issue. There is no question that psychologists have superior diagnostic skills compared to GP's, and I would extend that judgment to NP's and PA's, although I will admit my experience with these groups is less thorough. A difficulty I have in the collaborative model you suggest is less with the psychologists' abilities than with the GP/PCP's, who have a solid history of very narrow expertise in all things - most notably psychopharm. I guess my question is why would that be better than recruiting more psychiatrists? I don't mean to be argumentative. I can't answer that question myself. I'm afraid only time will tell overall. 10,000 scripts written - but for what level of pathology, with what follow-up, etc. It's inevitable they will miss something. For the patients' sake I hope I'm wrong.


                                        PublicHealth said:
                                        Last I heard regarding Hawaii was that psychiatrists there want to devise a psychopharmacology training program for people who seek RxP. Of course, this program would be under their control, not psychology's. Criticism is that medicine tried doing this with PAs, the majority of whom choose higher-paying specialities (e.g., surgery, dermatology) instead of psychiatry in order to secure their $100K+/year.
                                        Yes, and I think that those who have not studied history are doomed to repeat it. I believe that the APsychologicalA has so zealously pursued RxP that they have failed to execute the analysis and research skills of which they are so proud. There seems to be little attention paid to economics, market forces, the realities of actually finally procuring third party payment for services rendered, marginalization of psychopharmacology, the ACTUAL power of Pharma, etc. All the while the master's level practitioners are systematically picking away at what was once proud doctoral territory.

                                        When one needs a truck, selling them a wheelbarrel will only suffice for so long.

                                        End of rant.
                                         

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                                          Pterion said:
                                          Touchy issue. There is no question that psychologists have superior diagnostic skills compared to GP's, and I would extend that judgment to NP's and PA's, although I will admit my experience with these groups is less thorough. A difficulty I have in the collaborative model you suggest is less with the psychologists' abilities than with the GP/PCP's, who have a solid history of very narrow expertise in all things - most notably psychopharm. I guess my question is why would that be better than recruiting more psychiatrists? I don't mean to be argumentative. I can't answer that question myself. I'm afraid only time will tell overall. 10,000 scripts written - but for what level of pathology, with what follow-up, etc. It's inevitable they will miss something. For the patients' sake I hope I'm wrong.


                                          End of rant.


                                          Things are getting better for psychiatry. The outcome of this year's match in psych was very encouraging. More and more med students are going into psych and the field is growing. There is talk of loan forgiveness for psychiatrists coming out of residency (especially child psych).

                                          Things will get better. I am not worried about psychology and RxP, psychologists will never be able to replace psychiatrists and the service we provide.

                                          Any psychologists out there willing to take my call? /joking
                                           

                                          sasevan

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                                            Pterion said:
                                            It quickly became apparent to me the limitation in my training regarding the patients I was seeing. I regularly was faced with the presentation of psychiatric symptoms that were in fact sequelae of medications or other, systemic disorders. One particular case was appropriately identifed and diagnosed before I was able to initiate our "screening". Not only would I have missed the systemic disease of origin, but my recommendations might have proven very harmful to the patient. The actual job setting was horrendous, but for different reasons. A combination of all of these reasons and more led me to the decision to enter medicine.

                                            My graduate program was a good one, despite detractors of the PsyD model. Post-licensure interests were in the biological basis of mental illness. I was under considerable pressure from my colleagues to abandon such interest and simply accept the "black box" magic of psychotherapy.

                                            Finally, although I worked with arguably the worst psychiatrists in the state, it never occurred to me that I could do better simply with a two-year pharmacology degree. Even the bad ones knew when the problem was more than just a serotonin/NE imbalance. Now that I have 2 years of medical school under my belt I am more convinced of the necessity for full medical training for prescription privileges.

                                            As for pursuing psychiatry, its unlikely. I have seen a whole new world in medical school and am not ready to commit to a specialty just yet.

                                            Hey Pteiron (PH and Sazi too),
                                            Great response. Like u (all), i'm glad i made the mental change and decided to pursue medicine (though i still very much value psychology and continue to support that discipline's evolving appreciation of the bio in the biopsychosocial model and its striving for limited RxP).
                                            Anyway, i'm taking MCAT next Saturday; hopefully med school next year; please wish me luck!
                                            Peace.
                                            P.S. I can understand u're openness to all different specialties but have u considered that psychiatry (with development in imaging, genetics, interventions) seems poised to be the frontier in medicine?
                                             
                                            sasevan said:
                                            Hey Pteiron (PH and Sazi too),
                                            P.S. I can understand u're openness to all different specialties but have u considered that psychiatry (with development in imaging, genetics, interventions) seems poised to be the frontier in medicine?

                                            Very much so. The new (to me) integration of neuroscience, psychiatry and general clinical medicine is very interesting and encouraging. As an aside, I was initially encouraged by the experiences of our moderator, who seemed to me to be the kind of psychiatrist who defied the stereotype purveyed by the competing APA.

                                            Solideliquid said:
                                            Things are getting better for psychiatry. The outcome of this year's match in psych was very encouraging. More and more med students are going into psych and the field is growing. There is talk of loan forgiveness for psychiatrists coming out of residency (especially child psych).

                                            Things will get better. I am not worried about psychology and RxP, psychologists will never be able to replace psychiatrists and the service we provide.

                                            With you on all counts. Psychologists can be an important part of the health care team. Good ones can do things that no other specialist can. I have oftened wondered why they don't spend more time actually doing those things than they do trying to gain "expanded scope of practice". I think I just burned some bridges, folks.
                                             

                                            PsychEval

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                                              Pterion said:
                                              Very much so. The new (to me) integration of neuroscience, psychiatry and general clinical medicine is very interesting and encouraging. As an aside, I was initially encouraged by the experiences of our moderator, who seemed to me to be the kind of psychiatrist who defied the stereotype purveyed by the competing APA.


                                              With you on all counts. Psychologists can be an important part of the health care team. Good ones can do things that no other specialist can. I have oftened wondered why they don't spend more time actually doing those things than they do trying to gain "expanded scope of practice". I think I just burned some bridges, folks.

                                              The stereotype is not coming from the competing APA, as public health pointed out:

                                              Medical students are generally not interested in psychiatry because (1) it's one of the lowest paying specialties; (2) they don't want to work with chronically mentally ill people; and (3) psychiatrists tend to be less respected than other physicians.
                                               

                                              Doc Samson

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                                                PsychEval said:
                                                The stereotype is not coming from the competing APA, as public health pointed out:

                                                Medical students are generally not interested in psychiatry because (1) it's one of the lowest paying specialties; (2) they don't want to work with chronically mentally ill people; and (3) psychiatrists tend to be less respected than other physicians.

                                                Talking of stereotypes...

                                                Medical students are generally not interested in psychiatry because:
                                                (1) it's one of the lowest paying specialties (doesn't seem to be an issue for primary care or peds, which are lower paid)
                                                (2) they don't want to work with chronically mentally ill people (might be true, but hardly represents the scope offered by psychiatric practice)
                                                (3) psychiatrists tend to be less respected than other physicians (depends on where in the country you are... I feel plently respected up here in the Northeast. Also a fairly dated notion; when I opted for psychiatry, you could grade the level of enthusiasm for my choice from attendings in other specialties by age... only the dinosaurs seemed disapproving).

                                                Make no mistake, recruitment of medical students into psychiatry is on the upswing. The increase in awareness of biological models of illness and treatment modalities is attracting students that might previously have opted for neurology or neurosurgery.
                                                 

                                                PsychEval

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                                                  Psyclops said:
                                                  You know, if you guys cut down the med check times form 15 minutes to 10 minutes, you could see %50 more patients. It seems that the psychiatrists are selfishly taking to much time with each patient, purposely witholding treatment.

                                                  Or they could go the other way, bill for a 30 min med check w/ psychotherapy. Provide only a long med check, and no psychotherapy. Then bill the 90805 and enjoy the higher pay. I know several psychiatrists who do this, and yes it does sound like insurance fraud.
                                                   

                                                  PublicHealth

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                                                    I've asked this question before, and I'll ask it again:

                                                    What level of training is needed in order for psychologists to prescribe and manage psychotropics in collaboration with their patients' primary care physicians? Medical school is NOT the only route. Do you think the most appropriate route to this type of practice is a PA or NP program?

                                                    Psychiatrists in Hawaii are supposedly devising a training program for "advanced practitioners" who want to prescribe. God help us if this category applies to social workers and other mid-levels.

                                                    Curious to know what folks in this forum have to say on the matter. Is there even a need for a new model such as MS in psychopharmacology programs?
                                                     

                                                    PsychEval

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                                                      PublicHealth said:
                                                      I've asked this question before, and I'll ask it again:

                                                      What level of training is needed in order for psychologists to prescribe and manage psychotropics in collaboration with their patients' primary care physicians? Medical school is NOT the only route. Do you think the most appropriate route to this type of practice is a PA or NP program?

                                                      Psychiatrists in Hawaii are supposedly devising a training program for "advanced practitioners" who want to prescribe. God help us if this category applies to social workers and other mid-levels.

                                                      Curious to know what folks in this forum have to say on the matter. Is there even a need for a new model such as MS in psychopharmacology programs?[/
                                                      QUOTE]

                                                      Before being overly critical, I hope that some of you remember the history of your profession.

                                                      The DO, March 2006

                                                      http://portal.osteotech.org/portal/...zine_portlet/articles/march_2006_issue_22.pdf
                                                       

                                                      Psyclops

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                                                        PublicHealth said:
                                                        God help us if this category applies to social workers and other mid-levels.


                                                        I whole heartedly agree with you there! And I know some like to say that the psychologists like to keep the mid levels down, etc etc. The scope of training is hugely different between master's level practitioners and doctorate level practitioners. 2 years vs. 6+.
                                                         

                                                        Anasazi23

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                                                          PsychEval said:
                                                          The stereotype is not coming from the competing APA, as public health pointed out:

                                                          Medical students are generally not interested in psychiatry because (1) it's one of the lowest paying specialties; (2) they don't want to work with chronically mentally ill people; and (3) psychiatrists tend to be less respected than other physicians.

                                                          That, I believe, had nothing to do with what Pterion was referencing. I believe he/she was referencing the notion that psychiatrists are nothing but pill-pushing, non-inclusive, money hungry physicians that know of nothing but medication management.

                                                          All of this is, of course, ridiculous and amounts to nothing more than propaganda from the American Psychological Association.
                                                           

                                                          Anasazi23

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                                                            PsychEval said:


                                                            Or they could go the other way, bill for a 30 min med check w/ psychotherapy. Provide only a long med check, and no psychotherapy. Then bill the 90805 and enjoy the higher pay. I know several psychiatrists who do this, and yes it does sound like insurance fraud.

                                                            Tell me what a "med check" entails....from start to finish. You should know since you use the term so frequently. Then, tell me what an "extended med check" would entail - say a 25 or 30 min med check. Please provide details.

                                                            I'll wait...
                                                             

                                                            Anasazi23

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                                                              PublicHealth said:
                                                              I've asked this question before, and I'll ask it again:

                                                              What level of training is needed in order for psychologists to prescribe and manage psychotropics in collaboration with their patients' primary care physicians? Medical school is NOT the only route. Do you think the most appropriate route to this type of practice is a PA or NP program?

                                                              The answer is...it depends.

                                                              It depends on:
                                                              1. the diagnosis
                                                              2. the medical conditions
                                                              3. the medication prescribed, or medications being considered
                                                              4. the psychiatric history of the patient

                                                              You're looking for an easy answer to a complex question. An MS in psychopharm is fine for the simplest cases with the most benign medications. In other cases, patients will be harmed. That is inevitable. It happens under the closest observation and medical rigor. Why would it NOT happen under the guise of a much lesser trained practitioner?

                                                              Psychiatrists in Hawaii are supposedly devising a training program for "advanced practitioners" who want to prescribe. God help us if this category applies to social workers and other mid-levels.

                                                              Yes! Teachers, Rite Aid techs, bus drivers, waitresses! Prescription privilages for all! It'll be just like Mexico. Diagnose yourself, then go to the corner store and get whatever you feel you need. It seems to work well down there.

                                                              Watery diarrhea? No problem. Microbiology and infectious disease training be damned? Sanford guide? Don't need it! Resistance patterns? Bah! Just give me that antibiotic with the Z or Q in it. That sounds powerful enough. On second thought...ticarcillin....sounds like tiger - must be powerful stuff. I'll take that one!

                                                              There is a lack of lawyers in my household. I therefore propose that I be allowed to practice law after one year of internet night courses. Sound good?

                                                              Curious to know what folks in this forum have to say on the matter. Is there even a need for a new model such as MS in psychopharmacology programs?
                                                              You know my opinion already. Medicine is being dumbed down/watered down to the lowest, crappiest denominator in the name of money for insurance companies. All of this is a product of that. It's happening in every specialty.
                                                               

                                                              PsychEval

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                                                                Anasazi23 said:
                                                                Tell me what a "med check" entails....from start to finish. You should know since you use the term so frequently. Then, tell me what an "extended med check" would entail - say a 25 or 30 min med check. Please provide details.

                                                                I'll wait...

                                                                Med check defined:

                                                                90862 – Pharmacologic management, including prescription, use, and review, of medication with no more than minimal medical psychotherapy.
                                                                 

                                                                PsychEval

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                                                                  Anasazi23 said:
                                                                  Tell me what a "med check" entails....from start to finish. You should know since you use the term so frequently. Then, tell me what an "extended med check" would entail - say a 25 or 30 min med check. Please provide details.

                                                                  I'll wait...

                                                                  90805 – Individual psychotherapy approximately 20-30 minutes face to face, with medical evaluation and management services.
                                                                   

                                                                  Psyclops

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                                                                    I don't know if this will help with the ongoing arguemtn or not, but I think everyone will agree with me that when people point to the 15min med checks that are performed by psychiatrists, and use it as a pejorative description of thier practices, it is with the assumption that those are the only services being provided. Ignoring the actual state of affairs of the mental health field right now, I think all would also agree that for the most part, MH services consumers should receive more contact with providers than 15min/month on a med check. I think all would also agree that the expression of these disorders is not best targeted by purely pharmacological interventions. But maybe I'm wrong, maybe people disagree with the above statements. The question then becomes how is treatment being administered? Are psychiatrists really only doing 15min med checks? I know those on this board would disagree, but I don't think that stereotype was conjured up out of thin air either. I also want to know whether the psychiatrists (i.e., those in residency, after, or practicing) on this board feel that they are representative of psychiatrists as a whole, or are they more informed than your average practicing psychiatrist. These are real questions not intended to be loaded in any way.
                                                                     
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