Psychology to Psychiatry

[PublicHealth]

PH: No I'm not aware of any studies that you asked about, my thoughts and ideas are founded in experience alone, but I also think that sometimes experience goes a lot further than some of these bunked out studies do. (my n=1 is also additive of 13+ years in healthcare) The things I've seen aren't controlled and they're backed by observations I've made in healthcare in a multitude of different settings.

And yes I think that managed care would approve of this to cut costs - I think managed care providers would do ANYTHING to cut costs. I'm not too sure what you're asking me here - do I know its probably inevitable? Yes. Do I accept it none-the-less? No. I am fundamentally against prescribing meds without the proper training - the reason here again is patient safety and to reiterate, these are NOT going to be the patients with multiple options or that have the best healthcare to begin with (or even the best capacity to make medical decisions in general). These are going to be the VA patients, or the patients that are so mentally ill that they won't know the difference anyway.

Ask any patient with decent medical insurance or plenty of money in their pocket if they would let a psychologist prescribe drugs and I'd bet a dollar the answer would be an unequivocable no.

Why? because we seem to think its ok for the poor to get crappy health care while the upperclass or wealthier are the only ones to reap the benefits of good health care. AGain, this is from experience and 13 years of it can go head to head with any study you show me.

If you're thinking of psychiatry as a specialty - you need to be able to think about these things objectively and make your own decisions about them which is exactly what you're doing now. You'll definitely develop your own ideas about healthcare as time goes by. Some people think that secondary adn tertiary prescribers are great, I just don't happen to be one of them. I think you taking all this into consideration at this point is a great idea -whether you're an MD or a psychologist in training, these are things one should seriously ponder especially since you'll be running into a whole slew of it when out in practice. (which at that point will be yet another new learning experience for me)

Great point!

By the way, how far along are you in your training?

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[Anasazi23]

Great points made by the prescribing practicum PublicHealth outlined:

1. "These practica will help you synthesize what you have learned and bring you to a new depth of understanding about psychopharmacology. In addition, the supervisors of previous RxP psychologists have indicated that they have learned much from the prescribing psychologists students about our biopsychosocial model of intervention."
--Oh, so the psychologist preceptors are learning a lot from their rxp students? That sounds just great.
Good grief.

2. "You will be expected to record a brief log entry about each visit (with no identifying name) that describes the chief complaint, the major symptoms and history components, the differential diagnosis, the diagnosis, medications prescribed and continuing medications, and any comments of interest about the pathophysiology of the condition."
--How on earth can a non-physician...indeed someone who has no formal medical training from a medical school, develop a reasonable differential diagnosis? How might a person with allergies masquerade as depressed? The danger grows. When all you have is a hammer, everything looks like a nail.

3. "The psychologist/psychopharmacology student is expected to “shadow” the physician, read records, ask appropriate questions, and learn and practice basic physical assessment skills as determined by the supervising primary care physician."
--Are psychologists going to perform ligamentous strain tests on people with knee pain? Do they expect the primary care doc to explain every test and the pathophysiology of everything they do? Does a psychologist need to know how to properly perform a Murphy's test? This is just laughable. If so, do they then need to take a course on the pathology of the hepatic biliary system? This just doesn't make sense.

4. "I. Physical Examination/Laboratory Skills
a. Observes and participates in physical examination as situation dictates
b. Recognizes range of symptoms and manifestations of abnormal findings
c. Demonstrates adequacy in assessing vital signs"
--Until they complete medical school, psychologists will simply be unqualified to recognize the "range of symptoms and manifestations of abnormal findings." Period.

5. "Your plan should demonstrate that you will be working with:
A. A minimum of 100 separate patients
B. A range of disorders listed the most recent DSM.
C. Both acute and chronic conditions
D. The 400-Hours are patient only hours
E. A diversity of patients, including gender, ages throughout the lifecycle, various ethnicities, sociocultural background, various economic backgrounds
F. Documentation that the primary or secondary supervisor was on site
G. A minimum of 2 hours weekly supervision"
--Range of disorders in the DSM? A large portion of the DSM is psychosis/mood disorder/etc secondary to a general medical condition. How is that addressed? What about psychosis? All in a primary care setting? or "more restrictive environment?" Why not with psychiatrists? Seems fishy.

 

[50960]

Ok I will bite!! I am not sure who read what where, but in NM the practicum is part of the program of training, but each person wishing to prescribe must do so UNDER a physician for 2 years minimum before they can even apply for independent prescribing rights. IN LA psychs who want to do RxP must always do so in colloboration with, and be supervised by an MD. Having said that, I TOTALLY agree that the residency makes the doc, and this part is very lacking in any MS or RxP prep program out there. I would love to see a manditory 1-2 year residency program be a requirement, but the main impedement to this has been you all! Yes, psychiatrists.
I was very happy to do a 1 year residency program in medical psych at an inpatient hospital, and I learned more in my (total 5 years) there than I ever did in school. Psychopharm is also an art, above and beyond the science etc, and that cannot be taught in a classroom.
I really feel if psychiatry and psychology agreed to work together on this, it would be a great addition to our dismal mental health system...but so far we cannot

 

[mosche]

Ok I will bite!! I am not sure who read what where, but in NM the practicum is part of the program of training, but each person wishing to prescribe must do so UNDER a physician for 2 years minimum before they can even apply for independent prescribing rights. IN LA psychs who want to do RxP must always do so in colloboration with, and be supervised by an MD. Having said that, I TOTALLY agree that the residency makes the doc, and this part is very lacking in any MS or RxP prep program out there. I would love to see a manditory 1-2 year residency program be a requirement, but the main impedement to this has been you all! Yes, psychiatrists.
I was very happy to do a 1 year residency program in medical psych at an inpatient hospital, and I learned more in my (total 5 years) there than I ever did in school. Psychopharm is also an art, above and beyond the science etc, and that cannot be taught in a classroom.
I really feel if psychiatry and psychology agreed to work together on this, it would be a great addition to our dismal mental health system...but so far we cannot

Hey Psisci, what took you so long to weigh in?

I have to say that under the rules that you have set out, I would have no problem with psychologists prescribing medications; from what I saw on the link given, that was not the case -- I will yield to your knowledge however.
As OPD stated earlier, other professionals do prescribe medications and, with a few exceptions, do a decent job. I will also state that our respective points of view may be dependant upon where we are from. For instance, I am in Arkansas, a very underserved area; therefore, I've had lots of exposure to PAs who, out of necessity, have been given the right to prescribe. On the other hand, physicians in areas that are saturated with MDs will fail to see the need for such privilages being granted to anyone other that physicians proper.

Therefore, I have to come down to a states rights position: if a particular state sees it as a necessity, then I say okay -- as long as the individuals have PROPER/ADEQUATE training (the states will have to decide what constitutes "proper/adequate training"). I still think that as long as HMOs are involved, they ought to step up to the plate and assume some of the responsibility.

 

[Poety]

But Mosche, would you agree that you need a medical background in order to even differentiate between a medical cause of a condition as opposed to a DSM diagnosis? Isn't this what we base our whole biopsychosocial model on? If we incorporate a training specific to the psychosocial model, we are negating the importance of treating the entire spectrum of a patient don't ya think?

OTOH, I will agree with you on the aspect re: underserved areas. I am from the Northeast where MD's are RAMPID! The only people I have seen treated by NP's and PA's were the poor souls in the VA, nursing home or on medicaid and that was because the medical director (the overseeing MD) was strictly administrative. It was a sad situation to see - especially frustrating for the nurses too.

I am all for treating the underserved, in fact this is one of the areas of medicine I feel pulled toward - however, I don't think that we should just throw in some unqualified prescriber to fill our shoes since the docs don't want to do it.

All in all this entire situation speaks to the disparity in healthcare delivery today and how absolutely discouraging the outlook is for those that are underserved or poor.

PH: I"m a 4th year now matching (hopefully this year!) into psych. I did a year of research with psyd's between my 3rd/4th year (who btw don't seem to like the psychiatrists very much) - what is this whole iatrists vs. ologists thing about anyway? oy!

Mosche: my hotel bed looks dirty

 

[LM02]

But Mosche, would you agree that you need a medical background in order to even differentiate between a medical cause of a condition as opposed to a DSM diagnosis? Isn't this what we base our whole biopsychosocial model on? If we incorporate a training specific to the psychosocial model, we are negating the importance of treating the entire spectrum of a patient don't ya think?

Although this kind of differential Dx is not our call to make, I feel obligated to clarify that assessment is one of psychology's biggest strengths. We are well trained in the assessment of psychopathology and when to make a referral to a primary care doc or psychiatrist. I do so often.

I do think your point was made in the context of prescribing medications (and understandably so), but I think it's also important that we don't gloss over the extensive training that psychologists receive in assessment.

 

[Poety]

LM02 I completely agree and I apologize if I sounded like I didn't think psychologists have an important role in the mental health field - they absolutely do! And I didn't mean to imply that they don't make assessments re: psychopathology - I meant more on the differential side where you would need to delineate between a medical cause vs. psychological cause.

I think that the whole debate is so difficult to understand as I've seen both sides (iatrists vs. ologists both at eachothers throats) It always seems to be an us vs. them which it shouldn't be. For example- as a psychiatrist we don't adminster all the testing psychologists do, we need them to do all this testing and interpretation, I know I don't understand it. And on the other hand, I think thats the point I was making for the meds.

I'm not saying we couldn't do it, but there is no way we understand the mechanics of those tests since we didn't study them in depth like your profession has (I'm just using these tests as an example). Its the exact flip side of med administration to me.

Again, I hope no one gets the impression that I think psychologists are not fundamentally important to MHC, because I believe that it is, I jsut think we both have our different roles and should perhaps complement eachother as opposed to try to be the other in practice.

Did that post make sense? I hope so - Im tired sorry if its jumbled

 

[50960]

You make sense, and we respect your opinion. More to say tomorrow...I had turkey for dinner. I have NO idea why that makes me tired, so I need to ask anasazi who is in real doctor training....lol

 

[LM02]

No problem, Poety. I agree with you - I find this whole us vs. them situation to be completely counter-productive, and I am a huge proponent of multidisciplinary teamwork (and am against the RxP movement).

My main concern, however, is that several of the people who post on this board are just now applying for residency, and may not have had very much interaction with psychologists at this point in their careers. In my experience, I have found that there is often misinformation or clear misunderstanding re: our training, background, and skill set among early career psychiatrists. So I just wanted to jump in and clarify.

 

[Poety]

LM your posts are always beneficial and informative - I think they're a great asset to have especially since like you said, many new psychs have had minimal to no exposure to psychologists. If I hadn't done my year of research, it would have been even more limited for me!

Thank you for any clarifications you can brng about. I just hope I don't run into this a lot in practice - however I did witness a whole lot of it (as well as a lot of perpetuating stereotypes on both ends) while I worked in the behavioral dept.

Most of the research going on was actually conducted by psychologists with the medical aspect supervised by psychiatrists - you'd think they'd have gotten along but instead would bash eachothers profession behind the others back!

Multi disc teams RULE - what would we ever do without the wonderful social workers? Aside of get scutted through 4 years of residency that is

ps PSICI: tryptophan makes you tired

 

[PublicHealth]

Hey Psisci, what took you so long to weigh in?

I have to say that under the rules that you have set out, I would have no problem with psychologists prescribing medications; from what I saw on the link given, that was not the case -- I will yield to your knowledge however.
As OPD stated earlier, other professionals do prescribe medications and, with a few exceptions, do a decent job. I will also state that our respective points of view may be dependant upon where we are from. For instance, I am in Arkansas, a very underserved area; therefore, I've had lots of exposure to PAs who, out of necessity, have been given the right to prescribe. On the other hand, physicians in areas that are saturated with MDs will fail to see the need for such privilages being granted to anyone other that physicians proper.

Therefore, I have to come down to a states rights position: if a particular state sees it as a necessity, then I say okay -- as long as the individuals have PROPER/ADEQUATE training (the states will have to decide what constitutes "proper/adequate training"). I still think that as long as HMOs are involved, they ought to step up to the plate and assume some of the responsibility.

What is the status of psychologist RxP legislation in Arkansas?

 

[mosche]

You make sense, and we respect your opinion. More to say tomorrow...I had turkey for dinner. I have NO idea why that makes me tired, so I need to ask anasazi who is in real doctor training....lol

Besides making you sleepy, turkey will give you an uncontrollable urge to stare at the sky when it's raining -- we lose more turkey farmers that way!

 

[50960]

Um..Ya, I know..it was meant as a joke.

 

[mosche]

What is the status of psychologist RxP legislation in Arkansas?

Not allowed, though there is always "talk" of legalizing it. Most psychologists here tend to work in group practices with psychiatrists; thus, they do not technically perscribe, but the psychiatrist just signs off on the script. Moreover, according to statewide estimates, there are fewer than 150 psychologists (Ph.D.) in the entire state -- over 85% are employed by universities/colleges. I will add, according to the state records, most make over $88,000./year; so most are in a comfortable situation and have little desire to assume the added responsibility.

Poety, I do believe that medical training ought to be a requirement. However, I do not think that medical schools are the only way to attain or disseminate medical knowledge. Since you introduced empirical evidence (your nursing experience) , I will also introduce empirical evidence. Medical training was once obtained "on the job". Now while I do NOT propose that we return to the days of yore, I do contend that psychopharm classes, in conjunction with clinical training, would suffice -- provided that it was comprehensive (I said earlier that the individual states would have to decide what constitutes "adequate").

Finally, I think/hope that we all want what is best for the patient. Unfortunately, the poorer classes will always have poorer healthcare. That having been stated, ANY healthcare is better than NO healthcare and I really believe that in some instances, allowing psychologists to write scripts would equate with increased access.

 

[mosche]

Um..Ya, I know..it was meant as a joke.

I knew you were joking...I just thought that I would add the turkey comment. I do not think that having an M.D or a Ph.D. equates with being able to convey humor on SDN!

 

[mosche]

You make sense, and we respect your opinion. More to say tomorrow...I had turkey for dinner. I have NO idea why that makes me tired, so I need to ask anasazi who is in real doctor training....lol

 

[Anasazi23]

Ok I will bite!! I am not sure who read what where, but in NM the practicum is part of the program of training, but each person wishing to prescribe must do so UNDER a physician for 2 years minimum before they can even apply for independent prescribing rights. IN LA psychs who want to do RxP must always do so in colloboration with, and be supervised by an MD.

Hi Psisci. I know you hate what you perceive to be an arrogant tone in my ranting about psychologists prescribing. Having been on both sides of the fence, and seeing generally piss-poor understanding of psychopharm by midlevels in residency now, I'm sure you understand my position.

That said, I'll ask a few candid questions that the other psychologists in training will again become annoyed with. I'm asking out of genuine curiosity, not as rhetorical statements.

In reference to above, you say that you must prescribe under a physician for two years. But not a psychiatrist? Isn't this the a large part of the argument that psychologists are making (who asked them anyway?)? i.e. Primary care docs don't know enough to prescribe psychotropics? When was the last time psychiatrists butted in and said that we should do testing since master's level psychologists (I know, I know) aren't in underserved areas? See the ironic dichotomy?

On a more "real world" note. The prescribing that occurs "under a physician..." As I'm sure you've seen, physicians don't have the time to pour over in detail, charts and whatnot all day as psychologists try to prescribe the proper medications. The amount of actual quality supervision will likely be bad and of not much use. And by PCPs no less, who psychology has made the original argument is unqualified de facto.

Having said that, I TOTALLY agree that the residency makes the doc, and this part is very lacking in any MS or RxP prep program out there. I would love to see a manditory 1-2 year residency program be a requirement, but the main impedement to this has been you all! Yes, psychiatrists.

Not entirely true. While psychiatrists oppose this push for very understandable reasons, the psychologists do themselves no favors by posting and releasing those incredibly smug, insolent, and childish "rxp updates" whereby they make the classic 3rd year medical student "Only I.....was able to catch that incredibly-hard-to-diagnose condition that my preceptors missed. Ha HA!" Virtually all other statements made by these Hawaii and other psychologists are, from a physician's perspective (i.e. my own) to reek of inexperience and one who is gluttonous from a perceived newfound power. All this while they manage to disseminate even more misinformation and start the intellectual boll rolling for increased privilages with less comprehensive training (i.e. predoctoral psychopharm classes that should waive post-doctoral classes).

I haven't seen a psychologist yet in one of these asinine "updates," which reads more like axis propaganda, stating that psychiatrists or psychopharm has been more complicated than they thought. This is likely because from a medical standpoint, they don't know what they don't know.

I was very happy to do a 1 year residency program in medical psych at an inpatient hospital, and I learned more in my (total 5 years) there than I ever did in school. Psychopharm is also an art, above and beyond the science etc, and that cannot be taught in a classroom.
I really feel if psychiatry and psychology agreed to work together on this, it would be a great addition to our dismal mental health system...but so far we cannot

On a completely separate note, I take exception to the calling of psychology internships or post-doc whatevers being called "residency." Not a big deal to you, I know...nonetheless, a completely inaccurate and incomparable term.

Why did you do five years of medical psych training? What did your typical day entail? I remember you posting long ago about rounding with the psychiatrist and asking about liver function enzymes, ammonia levels, and stuff like that. Is that what it was about?

I 100% agree with you that psychopharmacology is an art as much as a science. This is another concept that psychologists, eager to quantify everything in discrete easily digestible EQS diagrams, will not apparently understand. I'll shock the world when I say this, and remember that I am a scientist in some ways too, and understand statistics better than the average physician and probably many psychologists but - you can't research everything and quantify everything in medicine. EBM is great, and has taken the field of medicine a long way, but its limitations are sweeping as well at this stage. It's unfortunate that psychologists refuse to accept that there is the art form to medicine, not just psychopharm, and that medicine is a thinking field. Not a cookbook field. Ideas must be tried and tinkered with, which often greatly wind up helping the patient. We can't just create a huge flow diagram that has a list of all patient's diagnoses with concomitant medical conditions then slide down the decision tree until their ass hits the bottom box which says, "Effexor XR at 75mg PO QD!"

The real world is much more complex than that. I'm glad it is, or our field would be much less interesting.

 

[PsychEval]

I suspect the reason the law states a physician must provide the supervision instead of a psychiatrist is because most psychiatrists would not be willing to help train psychologists to prescribe. Anasazi, would you be willing to provide psychopharm supervision for a psychologist? Perhaps some type of bartering could be arranged where you could receive supervision on how to conduct psychotherapy or on differential diagnosis. Just a thought.

 

[50960]

FYI, psychologists can and do complete residencies. You are right that most of the time they are called post-docs. This is the case because psychology is still heavily tied with science academia (PhD's do post-docs etc.), and because psychologists are generally not in training at a medical facility. When I have more time I will try to address some more of your questions...

 

[Miklos]

FYI, psychologists can and do complete residencies. You are right that most of the time they are called post-docs. This is the case because psychology is still heavily tied with science academia (PhD's do post-docs etc.), and because psychologists are generally not in training at a medical facility. When I have more time I will try to address some more of your questions...

Sure, they do.

That statement helps illustrate precisely why MDs laugh at psychologists. Residencies, huh?

Gimme a break.

 

[PublicHealth]

I suspect the reason the law states a physician must provide the supervision instead of a psychiatrist is because most psychiatrists would not be willing to help train psychologists to prescribe. Anasazi, would you be willing to provide psychopharm supervision for a psychologist? Perhaps some type of bartering could be arranged where you could receive supervision on how to conduct psychotherapy or on differential diagnosis. Just a thought.

Possibly. But it's also because psychologists in NM want INDEPENDENT prescriptive authority. They want to be able to assess and treat not only psychiatric disorders but also side effects of psychotropics, as well as assist in assessing and managing medical conditions! Specifically,

"Regulations permitting qualified psychologists to prescribe psychotropic medications in New Mexico went into effect on January 7. Since then, advocates have introduced bills to expand the list of drugs that psychologists can prescribe, allowing them to prescribe off-label and possibly to prescribe nonpsychotropic drugs as well, said Paula Johnson, deputy director for state affairs in APA's Department of Government Relations.

Language in the original legislation limits psychologists to prescribing drugs only for FDA-approved indications. The new bills would permit psychologists to prescribe drugs "recognized and customarily used...for the treatment of mental, emotional, behavioral, or cognitive disorders...." Drugs listed as used "sometimes" for mental or emotional disorders in Drug Facts and Comparisons or in the American Hospital Formulary Service would be acceptable.

In addition, the new proposal would permit psychologists to prescribe drugs to manage the side effects of psychotropic drugs. These could cover drugs to treat any condition from high blood pressure and seizures to Parkinson's disease and impotence, according to a report prepared by the Psychiatric Medical Association of New Mexico and the New Mexico Medical Society in opposing the proposed legislation" (http://pn.psychiatryonline.org/cgi/content/full/40/5/7)

That said, Louisiana "medical psychologists" are required to consult with a patient's primary care physician prior to writing a prescription. This seems to me to be a safer model, given that many primary care physicians already consult with psychologists for their psychopharmacological expertise.

 

[PsychEval]

Possibly. But it's also because psychologists in NM want INDEPENDENT prescriptive authority. They want to be able to assess and treat not only psychiatric disorders but also side effects of psychotropics, as well as assist in assessing and managing medical conditions! Specifically,

"Regulations permitting qualified psychologists to prescribe psychotropic medications in New Mexico went into effect on January 7. Since then, advocates have introduced bills to expand the list of drugs that psychologists can prescribe, allowing them to prescribe off-label and possibly to prescribe nonpsychotropic drugs as well, said Paula Johnson, deputy director for state affairs in APA's Department of Government Relations.

Language in the original legislation limits psychologists to prescribing drugs only for FDA-approved indications. The new bills would permit psychologists to prescribe drugs "recognized and customarily used...for the treatment of mental, emotional, behavioral, or cognitive disorders...." Drugs listed as used "sometimes" for mental or emotional disorders in Drug Facts and Comparisons or in the American Hospital Formulary Service would be acceptable.

In addition, the new proposal would permit psychologists to prescribe drugs to manage the side effects of psychotropic drugs. These could cover drugs to treat any condition from high blood pressure and seizures to Parkinson's disease and impotence, according to a report prepared by the Psychiatric Medical Association of New Mexico and the New Mexico Medical Society in opposing the proposed legislation" (http://pn.psychiatryonline.org/cgi/content/full/40/5/7)

That said, Louisiana "medical psychologists" are required to consult with a patient's primary care physician prior to writing a prescription. This seems to me to be a safer model, given that many primary care physicians already consult with psychologists for their psychopharmacological expertise.

From the New Mexico Psychological Associations Website:

Section 7. A new section of the Professional Psychologist Act is enacted to read:
"[NEW MATERIAL] PRESCRIBING PRACTICES.—

A. A prescribing psychologist or a psychologist with a conditional prescription certificate may administer and prescribe psychotropic medication within the recognized scope of the profession, including the ordering and review of laboratory tests in conjunction with the prescription, for the treatment of mental disorders.

B. When prescribing psychotropic medication for a patient, the prescribing psychologist or the psychologist with a conditional prescription certificate shall maintain an ongoing collaborative relationship with the health care practitioner who oversees the patient's general medical care to ensure that necessary medical examinations are conducted, the psychotropic medication is appropriate for the patient's medical condition and significant changes in the patient's medical or psychological condition are discussed. The ongoing collaborative relationship shall be maintained pursuant to guidelines developed by the board and the New Mexico board of medical examiners which shall optimize patient care. The guidelines shall ensure that the prescribing psychologist or the psychologist with a conditional prescription certificate and the treating physician coordinate and collaborate the care of the patient to provide optimal care. A committee composed of members of both boards shall be established and, pursuant to the guidelines, shall evaluate complaints. The committee shall report its findings and recommendations to each board for each board’s appropriate actions.

The psychologists in New Mexico are also required to consult with the patient’s primary care physician. For most psychologists, integrated and collaborative care is not new, and is in fact something we do on a daily basis without being ordered to do so. My impression is that it is far more difficult to become a prescribing psychologist in New Mexico compared to Louisiana, look at the differences in the numbers of prescribing psychologists: NM – approximately 4. Louisiana – approximately 25.

 

[Anasazi23]

I think Miklos probably is referring to reaction he (she?) had when seeing the term 'residency' as completed by psychologists. It's a loaded term within the medical community...one often associated with drudgery, pain, suffering, scut, and other descriptive terms. One where you work at times 80+ hours/week, with loss of holidays, family events, milestone celebrations, and other things. It comes standard with sleep deprivation, and is for some residents, completely soul-crushing. I've seen more than one resident simply break into tears at the stress of residency.

Rectals, pimping, screaming family members, non-stop pages, exposure to others' bodily fluids, and countless other unpleasantries are associated with residency...yes including psychiatry residency. All this after a previous four years of hellish studying and unending competition, rotations, and even worse pimping, scut, etc.

I assume residents or medical students (or medical attendings) wouldn't want the term 'cheapened' when hearing psychologists or other non-medical folks using the term to describe their post-doc training.

 

[50960]

Well said, and saves me the time in writing it out..... My job as medical psych. Myself, and non-psych MD were co-attendings for a unit of 30-40 pts. All had psych and/or behavioral problems, most had a plethora of medical problems, and 90% were on psychotropics. 1st year I trained under another psychologist and psychiatrist to do this, the next four I did so independently. This was a large facility with many specialists on staff (psychiatry, podiatry, dental, neuro etc..), and we regularly consulted with them. This was a collaborative model, in which I worked side by side with the MD to manage all aspects of patient care. MD's did all the Rxing, with consults from the psychiatrist and I, but I wrote most of the behavioral orders (restraints etc.). 80% of my role was psych med management, and I learned ALOT in 5 years...stuff I never did or would learn in school. Did I catch things the MD did not, yes, and vice versa. I do not gloat about it. I truly have learned that psychopharmacology is ALOT more complex than the RxP courses teach, infinitely more complex than any mid-level's knowledge, and sufficiently difficult for most non-psych MDs.

 

[PublicHealth]

I do believe that medical training ought to be a requirement. However, I do not think that medical schools are the only way to attain or disseminate medical knowledge.

What, in your estimation, would be sufficient?

 

[LM02]

I think Miklos probably is referring to reaction he (she?) had when seeing the term 'residency' as completed by psychologists. It's a loaded term within the medical community...one often associated with drudgery, pain, suffering, scut, and other descriptive terms. One where you work at times 80+ hours/week, with loss of holidays, family events, milestone celebrations, and other things. It comes standard with sleep deprivation, and is for some residents, completely soul-crushing. I've seen more than one resident simply break into tears at the stress of residency.

Rectals, pimping, screaming family members, non-stop pages, exposure to others' bodily fluids, and countless other unpleasantries are associated with residency...yes including psychiatry residency. All this after a previous four years of hellish studying and unending competition, rotations, and even worse pimping, scut, etc.

I assume residents or medical students (or medical attendings) wouldn't want the term 'cheapened' when hearing psychologists or other non-medical folks using the term to describe their post-doc training.

Although I completely appreciate what you're saying, it's important to understand that most of the internships that are referred to as "residencies" are actually in departments of psychiatry at academic medical centers. And, as such, the "name" of the training program is not a decision made by psychology faculty alone. If the psychiatry faculty were not on board, I'm sure that the interns would not be referred to as such.

And, as it stands, internships are referred to as residencies at only a very small percentage of sites.

LM your posts are always beneficial and informative - I think they're a great asset to have especially since like you said, many new psychs have had minimal to no exposure to psychologists. If I hadn't done my year of research, it would have been even more limited for me!

Thank you for any clarifications you can brng about. I just hope I don't run into this a lot in practice - however I did witness a whole lot of it (as well as a lot of perpetuating stereotypes on both ends) while I worked in the behavioral dept.

Most of the research going on was actually conducted by psychologists with the medical aspect supervised by psychiatrists - you'd think they'd have gotten along but instead would bash eachothers profession behind the others back!

Multi disc teams RULE - what would we ever do without the wonderful social workers? Aside of get scutted through 4 years of residency that is

Just getting caught up now, but wanted to say - Thank You.

You seem to have an interesting background that can allow you to view the multidisciplinary approach from a unique perspective. On a related note, I noticed in your IOL review (on another thread) that one perceived benefit of residency there was the opportunity to do anxiety research with David Tolin - a clinical psychologist, I might point out.

 

[LM02]

p.s. I just love the fact that the "phychology to phychiatry" thread has grown to 4 pages. Who knew such a question could generate so much discussion?

 

[Poety]

Dr. Tolin is very well known for his work with anxiety disorders - rememember I mentioned all my reserach was conducted under clinical psychologists with psychs overseeing the medical aspect - I learned quickly who does a lot if not most of the research And, the ones that do do research as MD's seem to often times be: MDPhD :0 We all have so much to offer the MHC - I hope it all works out soon.

And yes, what the heck would we do without multidisc teams! There is no way I'm doing all that work when I know there are other specialist that can do it faster and more efficiently with more background in it than I have!

 

[PublicHealth]

The DoD PDP graduates: http://www.apa.org/monitor/feb03/prescribers.html

I wonder why Drs. Seda and Duke went to medical school? Did they want to prescribe outside the military, get better training?

 

[50960]

My guess is they learned enough medicine to really want to go to med school. The DOD folks did 2 years med school, and then a different psych-focused training. They are sound

 

[mosche]

p.s. I just love the fact that the "phychology to phychiatry" thread has grown to 4 pages. Who knew such a question could generate so much discussion?

 

[PublicHealth]

My guess is they learned enough medicine to really want to go to med school. The DOD folks did 2 years med school, and then a different psych-focused training. They are sound

Any idea why the VA does not endorse prescribing psychologists?

 

[mosche]

What, in your estimation, would be sufficient?

I will say that "I don't know, nor do I pretend to know". As I alluded to earlier, I believe that it ought to be left to the individual states to set their respective standards. I know that that will be problematic to some; however, I really belive that that paradigm is the inevitable end of this discussion. If there are states that cannot attract adequate numbers of physicians, the standards in those states will be lowered. That may be unfortunate, but I believe that it is the real-world inevitability.

 

[PublicHealth]

I will say that "I don't know, nor do I pretend to know". As I alluded to earlier, I believe that it ought to be left to the individual states to set their respective standards. I know that that will be problematic to some; however, I really belive that that paradigm is the inevitable end of this discussion. If there are states that cannot attract adequate numbers of physicians, the standards in those states will be lowered. That may be unfortunate, but I believe that it is the real-world inevitability.

But let's just say, hypothetically, that YOU could decide what is considered adequate training for prescribing psychologists. How many years of basic sciences and how many years of practical training/residency would you recommend? This discussion is missing in the debate on psychologist RxP. Psychiatrists are quick to point out that the existing training model for psychologist RxP programs is inadequate but fail to recommend alternative training options apart from medical school. Is medical school really the only way to train competent and safe prescribing psychologists?

 

[mosche]

But let's just say, hypothetically, that YOU could decide what is considered adequate training for prescribing psychologists. How many years of basic sciences and how many years of practical training/residency would you recommend? This discussion is missing in the debate on psychologist RxP. Psychiatrists are quick to point out that the existing training model for psychologist RxP programs is inadequate but fail to recommend alternative training options apart from medical school. Is medical school really the only way to train competent and safe prescribing psychologists?

No. I granted that point earlier. But I really can't make a blanket statement that would be all-inclusive for psychologists. For example, some psychology programs don't even require the GRE to be taken prior to admission. Now, I don't think that the GRE ought to be a requirement for prescribing, I just use the test to illustrate how varied psychology programs are. Thus, the additional requirements in some states would be less taxing than in other states. Further, since I have no issue with psychologists prescribing, I refuse to allow myself to stress over the issue. You, on the other hand, seem to have an opinion; so you tell me. I'll take your opinion into consideration, and will not get bent if I disagree with you.

 

[Anasazi23]

But let's just say, hypothetically, that YOU could decide what is considered adequate training for prescribing psychologists. How many years of basic sciences and how many years of practical training/residency would you recommend? This discussion is missing in the debate on psychologist RxP. Psychiatrists are quick to point out that the existing training model for psychologist RxP programs is inadequate but fail to recommend alternative training options apart from medical school. Is medical school really the only way to train competent and safe prescribing psychologists?

If I may point out, you seem to be very, very concerned with this issue. I have to say, in the "real world" (whatever that is) as I've seen it, nobody cares about this issue. I've never heard a psychiatrist bring it up. They're all too busy to apparently care. On the few occasions that I have brought it up, either to residents or attendings, the response is universal.

 

[50960]

Ask where your APA dues are going anasazi.....

 

[mosche]

"real world" (whatever that is)

Don't you watch MTV? "Seven strangers picked to live in a house, to discover what happens when people stop being nice and start being real...."

The real world is ONLY occupied be pretty people -- except for the one who is from the midwest and is really smart (um, ur "smart" might be a streeeeetch), and s/he always has a good personality (um, ur "good" might be a lie).

 

[Anasazi23]

Ask where your APA dues are going anasazi.....

I've been asked only once to donate to this cause by the APA. Given that, the amount of public press on this issue by the APA is relatively small. Surprisingly small, in fact. It doesn't consume the field, and the future of its existence doesn't depend on it. My APA dues are likely supporting this issue in part, and I'm glad it does. Thankfully, it's been effective the vast majority of the time. Psychologists prescribing has been voted down dozens of times in many states. There is "first instinct" 'this isn't a good idea' reaction by most politicians and policymakers.

Unlike the American Psychological Association, our APA has its hands in many political pots which help keep the field secure, including reimbursement issues, formularly coverage, access to mental health care, mental health parity laws, and lots of others.

By "real world" which is admittedly a stupid term, I mean practicing psychiatrists that I commonly come in contact with. As I'm sure you agree, our home base political representative organization, (the APAs) should have time and dues dedicated to their respective agendas.

 

[Anasazi23]

p.s. I just love the fact that the "phychology to phychiatry" thread has grown to 4 pages. Who knew such a question could generate so much discussion?

At the risk of appearing "big-brotherish" or manipulating free artistic speech, I broke down and corrected the spelling on the thread title. I just couldn't take it anymore and felt like it made us all look a little silly.

Hope noboby minds.

 

[Poety]

At the risk of appearing "big-brotherish" or manipulating free artistic speech, I broke down and corrected the spelling on the thread title. I just couldn't take it anymore and felt like it made us all look a little silly.

Hope noboby minds.

Sazi you ARE big brotherish thats why your psych mod!

 

[PublicHealth]

Hope noboby minds.

Freudian slip?

 

[PsychEval]

I've been asked only once to donate to this cause by the APA. Given that, the amount of public press on this issue by the APA is relatively small. Surprisingly small, in fact. It doesn't consume the field, and the future of its existence doesn't depend on it. My APA dues are likely supporting this issue in part, and I'm glad it does. Thankfully, it's been effective the vast majority of the time. Psychologists prescribing has been voted down dozens of times in many states. There is "first instinct" 'this isn't a good idea' reaction by most politicians and policymakers.

Unlike the American Psychological Association, our APA has its hands in many political pots which help keep the field secure, including reimbursement issues, formularly coverage, access to mental health care, mental health parity laws, and lots of others.

By "real world" which is admittedly a stupid term, I mean practicing psychiatrists that I commonly come in contact with. As I'm sure you agree, our home base political representative organization, (the APAs) should have time and dues dedicated to their respective agendas.

??????????

http://pn.psychiatryonline.org/cgi/...X=20&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...X=30&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...X=40&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...X=20&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...EX=0&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...EX=0&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...EX=0&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...EX=0&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...EX=0&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...X=10&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...X=10&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...X=10&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...X=10&sortspec=relevance&journalcode=psychnews

and 5,000 more.

 

[PublicHealth]

??????????

http://pn.psychiatryonline.org/cgi/...X=20&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...X=30&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...X=40&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...X=20&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...EX=0&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...EX=0&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...EX=0&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...EX=0&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...EX=0&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...X=10&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...X=10&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...X=10&sortspec=relevance&journalcode=psychnews

http://pn.psychiatryonline.org/cgi/...X=10&sortspec=relevance&journalcode=psychnews

and 5,000 more.

Thank you for hunting these down. I was going to do it, but really need to get back to studying!

As I see it, RxP press from both APA and ApA (or however these acronyms sort themselves out these days) picks up when the legislative cycle comes around.

In optometry, once one state (NY) passed RxP legislation, it took ten years for the rest of the states to do the same. Will the same happen for psychologist RxP?

 

[Poety]

Ok PH- I'm biting - why are you so obsessed with the whole psychologist RxP thing? come on, we gotta know!!!

 

[PublicHealth]

Ok PH- I'm biting - why are you so obsessed with the whole psychologist RxP thing? come on, we gotta know!!!

First, I have to pay off my loans somehow!

Second, I considered pursuing a fully-funded PhD in clinical neuropsychology, but chose instead to pursue a $200K medical education. I just want to make sure that as a psychiatrist I will have skills that are unique and marketable. Sazi assures me that this will be the case!

Nevertheless, I think psychologist RxP is an issue that psychiatrists and psychologists alike -- in the "real world" and elsewhere -- will have to grapple with in the course of our careers.

Third, I like distracting myself from my studies. What better way to do that than debate psychologist RxP on SDN!

 

[Poety]

First, I have to pay off my loans somehow!

Second, I considered pursuing a fully-funded PhD in clinical neuropsychology, but chose instead to pursue a $200K medical education. I just want to make sure that as a psychiatrist I will have skills that are unique and marketable. Sazi assures me that this will be the case!

Nevertheless, I think psychologist RxP is an issue that psychiatrists and psychologists alike -- in the "real world" and elsewhere -- will have to grapple with in the course of our careers.

Third, I like distracting myself from my studies. What better way to do that than debate psychologist RxP on SDN!

ok, touche

 

[mosche]

First, I have to pay off my loans somehow!

Second, I considered pursuing a fully-funded PhD in clinical neuropsychology, but chose instead to pursue a $200K medical education. I just want to make sure that as a psychiatrist I will have skills that are unique and marketable. Sazi assures me that this will be the case!

Nevertheless, I think psychologist RxP is an issue that psychiatrists and psychologists alike -- in the "real world" and elsewhere -- will have to grapple with in the course of our careers.

Third, I like distracting myself from my studies. What better way to do that than debate psychologist RxP on SDN!

Damn medical students, that's all they do is cause a rukus .

 

[Anasazi23]

??????????
.....
http://pn.psychiatryonline.org/cgi/...X=10&sortspec=relevance&journalcode=psychnews

and 5,000 more.

I didn't say there were none. I said there were relatively few. Know what I mean? Further, I said, relatively small compared to the amount of press provided by organized psychology. Notice also that I said public press.

Updates on psychiatry and medical association victories, which are much more numerous, are expected in public press. Psychiatry's propagandized messages are much fewer than psychology's, as I'm sure you'll admit.

PublicHealth is concerned that psychologists will undercut psychiatry's market. This is a reasonable concern. Considering they have failed to curb or curtail their own numbers in any way shows an incompetent governing body. Physicians are considered to provide the highest (and thus are the highest compensated) level of care in this field. The same is true of anesthesiology, OB, and family practice. NPs and PAs have not undercut our salaries, but they have governing bodies to check their growth and placement. Psychology has none of this. What is psychology produces 300k new prescribers in the next 20 years? The field may then collapse on itself and be destroyed. By that time, psychiatrists will have garnered other niches in the field of medicine and mental health that psychologists are unable to practice.

 

[Poety]

Sazi is a brainiac and I'm afraid of him Are you sure you don't hold multiple degrees? Why do you know so much, and where can I learn it?