Psychologists gaining prescribing right?

[Pharmohaulic]

400 hours of clinical contact sounds like a lot, but that's about what a medical student may get in less than 2 months. Anyone in the medical field knows that a medical student with 2 months of clinical experience is near useless with their clinical judgment, let alone an intern with 400 hours of clinical contact in residency (5 weeks) or even 700 (less than a season).

I want to add that I did my undergrad at a top 3 clinical psychology university (according to the USWNR however useless it is), and I remember being caught up in the idea that psychologists should prescribe these "relatively simple medications" for "straightforward conditions." Now after completing medical school and starting residency as an intern, I can see that it is definitely not true. Side effect profiles for almost any psychiatric drug are extremely far ranging (probably more so than most other drugs) and require significant medical knowledge and experience to handle.

So would you be ok with the granting of the prescription rights if they beefed up the training programs to be at least on par with a PA program?

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[Extralong]

So would you be ok with the granting of the prescription rights if they beefed up the training programs to be at least on par with a PA program?

Instead, just go to one of those programs

 

[Pharmohaulic]

Instead, just go to one of those programs

But the problem with that is you are licensed under two different regulatory boards and it complicates things... Why not incorporate this somehow into a specialty psychology program.

NP's and MD's don't have to go get an MSW or PsyD to learn psychotherapy or psychosocial interventions. They have this knowledge provided in their own education programs so why not incorporate medical education into a PsyD tract?

 

[Tabicakes]

Aka your implying residency, great I get your point. So for example, a psychiatrist can't be a psychiatrist before they do a residency because they need the mental health experience... I get it... But a psychologist doesn't need a residency per say because they already have that experience.. They know about mental illness, diagnostics and heck even some psychopharmacology already, what they need is the biological/ physiological side... So it's like they did it in the reverse and go their specialist "residency" training first.

Wow, you is dumb, really, really dumb.

Signed,
a 3rd year medical student

 

[Pharmohaulic]

Wow, you is dumb, really, really dumb.

Signed,
a 3rd year medical student

And why is that? Because you have your white coat and mensa iq now so you now can talk down to everyone?

 

[Pharmohaulic]

And why is that? Because you have your white coat and mensa iq now so you now can talk down to everyone?

It makes perfect sense the only way it doesn't is if you feel a little threatened... Pinch a nerve yet?

 

[Shikima]

It makes perfect sense the only way it doesn't is if you feel a little threatened... Pinch a nerve yet?

It takes more than just writing a script for Prozac.

 

[deleted343839]

I didn't go to graduate school to follow a prescribing protocol and punt to a psychiatrist when things get too complicated. There is already enough of that.

 

[Pharmohaulic]

I didn't go to graduate school to follow a prescribing protocol and punt to a psychiatrist when things get too complicated. There is already enough of that.

I'm confused where your stance is? Your against it all together or want fully independent rights?

 

[deleted343839]

I'm confused where your stance is? Your against it all together or want fully independent rights?

My stance is that if a psychologist wants to prescribe medications then they should attend the appropriate training program for their needs (MD, PA, NP). I think it's important to develop practice and ethical models for clinicians who maintain more than one type of professional license, but I'm not necessarily opposed to the practice.

NP's and MD's don't have to go get an MSW or PsyD to learn psychotherapy or psychosocial interventions. They have this knowledge provided in their own education programs so why not incorporate medical education into a PsyD tract?

The faulty assumption is that the psychotherapy training that NPs and physicians receive is equivalent to that of a psychologist. As a general rule, it's not. And I say that even having done some training alongside residents in a program known for being therapy-friendly. I know several psychiatrists who are great therapists and I would not hesitate to refer to them specifically to provide psychotherapy, but they're the outliers. It's a matter of emphasis. The critical difference is that mediocre psychotherapy (which abounds) is still pretty low risk, whereas mediocre medical practice is not.

 

[Extralong]

I believe I received incredible and amazing training in psychotherapy, but I would refer to a psychologist in a heart beat, end of story.

 

[trophyhusband]

So as the husband of a Psychiatrist and someone who works in healthcare finance/operations let me see if I'm getting your proposal straight:

You want to have prescribing rights based on some course work and 400 hrs of clinical training. Whereupon you'll see the "straight forward" cases which are mostly going to be the commercially insured folks who can hold down steady jobs. So the Psychiatrist can see the more complicated patients which are mostly on various government assistance programs (at best) or uninsured (at worst).

The "easier" patients that she can see relatively quickly and use the extra time to work on notes/get other things done will now be replaced with trainwrecks that require her to spend extra time with and probably require her to work more hours (for less pay!). In addition she now gets to "collaborate" with you which really means you get to ask her endless questions and take up even more of her time because of your inadequate training and she gets to share or take on your liability entirely. So she gets the added bonus of burning out far more quickly while getting increased liability.

Lastly, being unsaid, but I'm sure is implied, is that you'd want to work in an urban/suburban area and avoid the rural areas where access is actually needed most.

Your business proposal sounds fantastic for her! Please let us know how we can help you get this moving forward!

 

[Pharmohaulic]

My stance is that if a psychologist wants to prescribe medications then they should attend the appropriate training program for their needs (MD, PA, NP). I think it's important to develop practice and ethical models for clinicians who maintain more than one type of professional license, but I'm not necessarily opposed to the practice.

But this is my point rather than going through somebody else's training why not incorporate and equivalent level of training into their own professional body?

 

[Shikima]

Why not just have one only and be done with it. We're all DO's now.

 

[Pharmohaulic]

Why not just have one only and be done with it. We're all DO's now.

A DO doesn't have to go to MD school to practice and prescribe lol

 

[wesleysmith]

But this is my point rather than going through somebody else's training why not incorporate and equivalent level of training into their own professional body?

That idiom about reinventing the wheel comes to mind.

 

[Pharmohaulic]

That idiom about reinventing the wheel comes to mind.

Again, psychiatrist and nurse practitioners aren't considered to be "reinventing the wheel when they get psychotherapy and psychosocial intervention training within their respective schools vs going and getting a PsyD or msw.

 

[splik]

because psychotherapy is s part of that training. psychiatrists were doing therapy here long before psychologists were. there is no reason why one needs to have any professional background to do therapy it is only in the US that it is like this.

 

[smalltownpsych]

because psychotherapy is s part of that training. psychiatrists were doing therapy here long before psychologists were. there is no reason why one needs to have any professional background to do therapy it is only in the US that it is like this.

To protect the public from harm which is the same reason that we have other professions that are regulated.

also I don't know of many nurse practitioners who do therapy

Some think they are.

 

[Shikima]

A DO doesn't have to go to MD school to practice and prescribe lol

You really don't know what you're talking about... just admit it troll.

 

[PsyDr]

You guys know this person isn't a psychologist, let alone a prescribing psychologist, right?

 

[st2205]

You guys know this person isn't a psychologist, let alone a prescribing psychologist, right?

Yes. Though I doubt the OP would consider themselves as a troll but legitimately believe they have the answers and are baffled why people in both fields can't see it.

 

[Pharmohaulic]

You really don't know what you're talking about... just admit it troll.

It was a counter argument to what you were saying.

 

[Pharmohaulic]

You guys know this person isn't a psychologist, let alone a prescribing psychologist, right?

Correct not one but work closely with those that are psychologists and interested in this and after working in the field (not as a psychologist) and working closely with them, I think this would be a great step. Heck, the folks that I know who have the pdoc but don't prescribe because they aren't in a state that allows it, they have so much knowledge even the PCP's ate advocatong for it.

 

[PsyDr]

Correct not one but work closely with those that are psychologists and interested in this and after working in the field (not as a psychologist) and working closely with them, I think this would be a great step. Heck, the folks that I know who have the pdoc but don't prescribe because they aren't in a state that allows it, they have so much knowledge even the PCP's ate advocatong for it.

You are trying to take on a highly political issue against people who have substantially more education and information than you do. Not knowing about things like osteopathic medical school is rei ipsa to not listen to you. If you are for RxP, then you would be well served to defer the debate to people who have sufficient education, education, and experience. If you really want to inoculate the opposing side against rxp then continue to use a weak argument.

 

[cookymonster]

Correct not one but work closely with those that are psychologists and interested in this and after working in the field (not as a psychologist) and working closely with them, I think this would be a great step. Heck, the folks that I know who have the pdoc but don't prescribe because they aren't in a state that allows it, they have so much knowledge even the PCP's ate advocatong for it.

This has far more to do with how much PCPs detest working with mental health clients (in the context of 15 minute visits, in which they have to address all of their other problems and have minimal training and zero time for therapy) than how proficient the psychologists are with pharmacology. When those psychologists aren't even allowed to prescribe in those states, how are those PCPs even supposed to tell how knowledgeable they are? Do you really think they're just shooting the breeze about P450 interactions and mood stabilizers in pregnancy over the water cooler? Face it, they just want to dump those clients on somebody. They'd refer them to social workers, naturopaths, or life coaches if they could (kidding... a little).

 

[Pharmohaulic]

This has far more to do with how much PCPs detest working with mental health clients (in the context of 15 minute visits, in which they have to address all of their other problems and have minimal training and zero time for therapy) than how proficient the psychologists are with pharmacology. When those psychologists aren't even allowed to prescribe in those states, how are those PCPs even supposed to tell how knowledgeable they are? Do you really think they're just shooting the breeze about P450 interactions and mood stabilizers in pregnancy over the water cooler? Face it, they just want to dump those clients on somebody. They'd refer them to social workers, naturopaths, or life coaches if they could (kidding... a little).

I wasn't trying to step on toes, I've just gone by things I've heard and seen myself. They collaborate with the pcp and pick up on side effects from medications and possible alternative diagnoses that the pcp possibly looked over. I'm advocating because again, not that I'm being difficult, but I've seen how wonderful it is with these psychologists who have a strong biological understanding but since they're training is first as a clinical psychologist they maintain a strong biological approach and don't look at the person as a disease... They recommended the docs taking more folks off meds than putting them on them. And the ones I've spoke with are quite humble and don't think they should have independent rights just yet, they are fine collaborating with a pcp or psychiatrist.

 

[smalltownpsych]

I wasn't trying to step on toes, I've just gone by things I've heard and seen myself. They collaborate with the pcp and pick up on side effects from medications and possible alternative diagnoses that the pcp possibly looked over. I'm advocating because again, not that I'm being difficult, but I've seen how wonderful it is with these psychologists who have a strong biological understanding but since they're training is first as a clinical psychologist they maintain a strong biological approach and don't look at the person as a disease... They recommended the docs taking more folks off meds than putting them on them. And the ones I've spoke with are quite humble and don't think they should have independent rights just yet, they are fine collaborating with a pcp or psychiatrist.

I already do this work without having prescription authority. In addition, I typically encourage my patients to educate and advocate for themselves with whoever is prescribing the medications.

 

[Shikima]

I already do this work without having prescription authority. In addition, I typically encourage my patients to educate and advocate for themselves with whoever is prescribing the medications.

Please don't encourage internet doctoring. There are enough whackadoodles with sufficient amount of opinions to choke a horse because of something that happened to a friend, who had a brother, who had a friend, that read it on a forum.

 

[deleted343839]

In addition, I typically encourage my patients to educate and advocate for themselves with whoever is prescribing the medications.

Please don't encourage internet doctoring.

Perhaps smalltownpsych was referring to reputable sources of information.

Anyway, sometimes the misinformation comes from licensed professionals. For example, I have no problem printing out the Endocrine Society's position statement for my patients who think that bioidentical hormones are going to solve their life's problems.

 

[deleted343839]

I wasn't trying to step on toes, I've just gone by things I've heard and seen myself. They collaborate with the pcp and pick up on side effects from medications and possible alternative diagnoses that the pcp possibly looked over. I'm advocating because again, not that I'm being difficult, but I've seen how wonderful it is with these psychologists who have a strong biological understanding but since they're training is first as a clinical psychologist they maintain a strong biological approach and don't look at the person as a disease... They recommended the docs taking more folks off meds than putting them on them. And the ones I've spoke with are quite humble and don't think they should have independent rights just yet, they are fine collaborating with a pcp or psychiatrist.

Collaborative practice is a good alternative to independent prescribing for psychologists. Discussing a treatment plan with a physician is very different from taking on responsibility for the patient's medical management.

 

[smalltownpsych]

Please don't encourage internet doctoring. There are enough whackadoodles with sufficient amount of opinions to choke a horse because of something that happened to a friend, who had a brother, who had a friend, that read it on a forum.

I have the time to go over some of the info with them and encourage them to discuss in a reasonable way with their doc. Sometimes even do a bit of roleplaying as they do struggle with communicating to them. Also, keep in mind that we have no psychiatrists in our community so both the patients and myself by necessity have to take a more active role. No need to worry, I don't encourage the whackadoodles as they are already annoying me with their anti-gluten, anti-vaccine, anti-whatever-of-the month.

 

[SeniorWrangler]

I'm advocating because again, not that I'm being difficult, but I've seen how wonderful it is with these psychologists who have a strong biological understanding but since they're training is first as a clinical psychologist they maintain a strong biological approach and don't look at the person as a disease...

The force is strong in this one.

 

[TexasPhysician]

I have a hard enough time getting psychologists to coordinate care with me without them prescribing.