PSYCHOLOGISTS to PRESCRIBE PSYCH MEDS

[einey]

Has anyone read the post allowing psychologist to prescribe mediciation in Calif? It is in the PsyD psychology section. I have real concerns about a non medical person prescibing medications, it's more than psych meds, we spend years learning drug interactions with cardiac, thyroid etc meds and I feel very uncomfortable this idea. The union in back of this bill is also stating that this is what is needed to fight against the power of medicine and psychiatry communitee's. I'm not going to psychiatry I'm in emergency medicine and I t hink this bill is plan for all kinds of unwanted problems. What do you think as psychiatry residents and doctors?

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[sunlioness]

I don't have a huge problem with the concept actually. Especially given that there are many areas where there are no psychiatrists and in these areas psychologists being able to prescribe would serve a valuable and needed role. My main concern isn't that psychologists will prescribe medication dangerously (I think a pharmacology course IS required before they are allowed to do so), but that it will change the field of psychology. Psychiatry, I think, has already gone a bit too far in the direction of thinking that everything is biologically/genetically based and can be best treated through meds. I would hate to see psychology go that way too because that would have the effect of reducing people's access to psychotherapy. Especially if insurance companies jump on board and say, "hey, now that psychologists can prescribe meds, we don't need to pay for therapy anymore!"

 

[Pia Getty]

Sunlioness, out of curiosity, as you speak to your colleague psychiatrists, what is the general consensus as you discuss this issue. Do you see your opinion as reflective of most psychiatrist's opinion or do you see yourself as an outlier? Just curious, I'm usually in the psychologist's camp while the issue is discussed and wanted to know more about your personal experience discussing this. Thanks

 

[Solideliquid]

Jeez not another one of these threads.

If you are really serious let me ask you this. Say you are suffering from depression, for example. You are educated about depression and presented with several treatment options, one of which is an anti-depressant (an SSRI to start you off).

Now, would YOU (you are the patient, remember) rather have the medication written to you by a person who spent four years in medical school and four years actually practicing and prescribing these meds in residency giving you the medications? Or would you rather have someone who has virtually no experience beyond what they learned in the limited classroom experience handing you a psychotropic substance?


/end rant

No wait, let me add: For the record, I don't really give a flip if psychologists start prescribing. I don't feel threatened by psychologists prescribing meds. However, let's just get down to the real reason. Money. Don't tell me you want to go to places MDs don't want to live, because we all know you won't be moving to BLANK (insert location, middle of nowhere, USA) when you get your prescribing rights.

 

[positivepsych]

Now, would YOU (you are the patient, remember) rather have the medication written to you by a person who spent four years in medical school and four years actually practicing and prescribing these meds in residency giving you the medications? Or would you rather have someone who has virtually no experience beyond what they learned in the limited classroom experience handing you a psychotropic substance?

While it would always be better to have the most highly-trained person with the greatest expertise doing any prescribing or procedure, this is not how it works in the real world.

Prescribing a standard SSRI for depression nowadays is done in a cookbook fashion. If psychiatric training were so important to prescribing SSRIs, then primary care physicians wouldn't be prescribing something like 25-50% of SSRIs by the handful.

Furthermore, since you bring up money as an issue. I think a patient might slightly prefer a psychiatrist for an SSRI based on their medical training. But where I live, the average intake appointment for a psychiatrist is between $300-$400. If a psychologist would do it for $100-200, then I would bet a lot of people who go to the psychologist for affordability.

While some people might prefer getting the pill from a psychiatrist, I would also imagine that a lot of people who prefer getting medication in conjunction with psychotherapy, as opposed to a 15-minute med check every month or two.

While your point is legitamate, I believe that public preference would probably be offset by cost and availability of adjunctive psychotherapy.

 

[Solideliquid]

Well, I don't agree with the cookbook thing. Also you forgot to mention that while PCP are the majority prescribing SSRIs, they are carefully balancing those meds with the ones they already have the patient on.[/I]

Furthermore, since you bring up money as an issue. I think a patient might slightly prefer a psychiatrist for an SSRI based on their medical training. But where I live, the average intake appointment for a psychiatrist is between $300-$400. If a psychologist would do it for $100-200, then I would bet a lot of people who go to the psychologist for affordability.

Yeah, while that it true, a few points. Most folks don't care/know how much it costs to see their doctor. Their main concern is the co-pay. Most folks pay a monthly insurance premium (or not, medicare/aid). They don't go to the intake appointment thinking about the $200 out of $400 the insurance company is going to pay the physician. Only a small percentage of people pay cash out of pocket. And those folks will want to pay for the best service (ie. MD treatment).
So again, if you are paying a certain amount for Blueshield or whatever, why would you go to a psychologist when you can go to the psychiatrist? Unless the insurance company wants you to go to the cheaper ologist why would it make a difference to the consumer?

 

[sunlioness]

Sunlioness, out of curiosity, as you speak to your colleague psychiatrists, what is the general consensus as you discuss this issue. Do you see your opinion as reflective of most psychiatrist's opinion or do you see yourself as an outlier? Just curious, I'm usually in the psychologist's camp while the issue is discussed and wanted to know more about your personal experience discussing this. Thanks

I don't know. It isn't much talked about. I do know that a prominent psychologist in my department is against it, but I haven't discussed it with him.

I find the antagonism between the two fields as evidenced here in the fora baffling. That isn't how it is in my experience.

And I don't really get the "MDs spend 4 years in medical school" argument either. I don't know about everyone else, but my med school pharm course was not 4 years long. Neither is the pharm course that will be required of psychologists minimal, from what I understand. Also no one is expecting psychologists to move to areas where there are no psych docs. My understanding is that there are already communities WITH psychologists and WITHOUT psychiatrists. It already exists that way. No one has to move anywhere.

How much pharm experience do NPs and PAs get in school and training? This isn't rhetorical, I actually don't know.

 

[zen76]

Fortunately, it's been a long time since this forum has had yet another psychiatry/psychology prescribing flame war. If you're interested, search for it, you won't have any difficulty finding threads. Otherwise, can we please ignore this thread and find some other focus for the pre-match free floating anxiety. No one's mind is going to be changed on either side, and it's too emotional an issue for people to find common ground.

Some other focus for your attention:
http://www.hippocritis.com/

Enjoy, and if you have to debate, why not something important, like whose the craziest celebrity meltdown Anne Heche, Britney Spears, or Courtney Love.

 

[OldPsychDoc]

Enjoy, and if you have to debate, why not something important, like whose the craziest celebrity meltdown Anne Heche, Britney Spears, or Courtney Love.

With Ellen Degeneres hosting the oscars tonight, how many references will be made to Britney's new 'do?

 

[sunlioness]

They need to leave that poor girl alone.

 

[einey]

Better wake up ZEN 76 & Old psych doc, it may be an old idea but it just got some new steam. The is a bill pending in Hawaii, Calif right now to allow psychologists to prescribe meds. They are trying for all 50 states. Their claim about only serving the rural areas is not supported by the evidence according to the Calif state legisture. If that doesn't seem important to you, lets spell it out, sweetheart.

Let's skip the substandard level of care provided by a non-medical person which is the main argument-let's consider the other fall-out from this bill.

It will most likely effect your employment. Why? Psychologists will charge less to provide the same drugs per session that you will charge a higher fee for. Do you really think patients and insurance companies are going to pay for you when they can get the tx for less?

That cuts into your private practice income, why should they see you, when a patient can get it for less.

If case you forgot you have much larger student loans than then average psychology student- your employment may not be so bright in a few years when emerge from residency. They are trying for prescribing rights in all 50 states.

Speaking of residency-why would anyone go through 4 long years of psychiatric residency plus 4 years of med school when a psychologist can do then same thing in 4 years plus the 450hrs of pharm?????
How many people do you think are going to want to go in psychiatry when then can do the same thing as a psychologist for less time and money?

Still not enough-several medical students at my school already pulled their applications for psychiatry before the ERAS deadline this year because of poor employment outlook and huge loans. I too had considered psychiatry because I used to be a psychologist and wanted a deeper level of knowledge provided by school, so I went to med school. I too dumped the idea of psychiatry a few months ago because of this legislation, I choose ER.

 

[50960]

I hate to chime in here on this old and tired subject, but psychologists really have about the exact same years of training as most medical specialties, and then they need 2.5 years of extra training that includes 1 year of clinical medicine, A&P, biochem, neuro-chem, neuroanatomy, neurophysicology, 1 year of pharmacology (much more that most MD's get), and a host of other specialized courses. I understand you have an opinion, but please educate yourself before you start blowing your horn.............

 

[heimlichboy]

don't worry about psychologists prescribing meds. I was just in louisiana which is one of the states that lets psychologists prescribe meds. But this has not had much of an impact because guess what the psychologists cannot find any insurance company that will cover their malpractice if they prescribe meds. It is a bit of a liability. So just because you have the right to prescribe does not mean that you will.

 

[sunlioness]

That cuts into your private practice income, why should they see you, when a patient can get it for less.

And there you have why most if not all vehement opponents to this oppose it. It isn't about danger to the patients, it's all about the bottom line. It isn't an admirable viewpoint IMHO. (Or an accurate one.) But at least you have the guts to say it.

Just because there are nurse practioners and PAs doesn't mean that family practitioners and general internists are now standing in the unemployment line.

 

[Milo]

your employment may not be so bright in a few years when emerge from residency.

Combine this with the massive declines in mental illness we've seen in recent years (no offense to the 'social construct' thread), and I better be heading for the unemployment line now..

 

[OldPsychDoc]

Combine this with the massive declines in mental illness we've seen in recent years (no offense to the 'social construct' thread), and I better be heading for the unemployment line now..

Yep--every time we send a patient out AMA because they're too "thirsty" to wait for a treatment center opening, everytime we hear that ex-patient A has "hooked-up" with ex-patient B, everytime we catch patients having sex in the bathroom on the unit--the nurses and I just look at each other and say two words:
job security.

 

[Solideliquid]

Combine this with the massive declines in mental illness we've seen in recent years (no offense to the 'social construct' thread), and I better be heading for the unemployment line now..

Dude, WHAT. Oh yeah, ever since they started putting Risperdal in the drinking water. Riiiight.

 

[mille125]

I went to the psychology forum and made a dissenting opinion. Funny they wouldnt post it even though I did not insult or demean anyone. They gave me a lecture about how I was getting off the subject. They seem to care about only their own agendas and do not want to hear any dissenting views. And I thought this was America..............

 

[OldPsychDoc]

I went to the psychology forum and made a dissenting opinion. Funny they wouldnt post it even though I did not insult or demean anyone. They gave me a lecture about how I was getting off the subject. They seem to care about only their own agendas and do not want to hear any dissenting views. And I thought this was America..............

Nope--this is the Internet.

 

[50960]

Mille, first off I have to say "get a life" for trying once again to cause strife between the 2 forums dealing with mental health here, as this is an old and tired argument. As the MOD for the psych forum I have not even red a post by you let alone censured one, so try again. We have enough issues without newbies trying to stir it up, just to do it..................

 

[Therapist4Chnge]

I was the one who flagged the posts.

I went to the psychology forum and made a dissenting opinion. Funny they wouldnt post it even though I did not insult or demean anyone. They gave me a lecture about how I was getting off the subject. They seem to care about only their own agendas and do not want to hear any dissenting views. And I thought this was America..............

As a point of reference, here are the very informative and helpful comments that millie25 posted. They were repeated after I asked politely to stay on topic and to contribute to the thread, and not just post to provoke.

get more privileges through education....not legislation!!!!!!


if you want to write prescriptions go to medical school

Obviously....they weren't posted to cause a problem.

Just wanted to clear that up.

-t

 

[Anasazi23]

Closing.