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Jon Snow said:I think it is inaccurate to lump clinical psychologists in with nurse practitioners and PAs. We are not midlevels and physicians are not considered the "highest level of care" providers in the field. It is more complicated than that and is driven by area of expertise. Compensation for psychiatrists is directly tied to their ability to prescribe drugs. That's why it is higher than the average clinical psychologist. I believe that is the motivation of psychologists in pushing for prescribing priv. I disagree with prescription rights for psychologists because it places us in a "midlevel" status with respect to pharmacotherapy and blurs the lines relative to areas of expertise. I believe that many clinical psychologists have the requisite physio backgrounds (with some additional pharm training) to be excellent prescribers, but until/if the psychology boards become more powerful I think it is dangerous to pursue prescription rights.
The real enemies are the government (medicaid and medicare) and managed healthcare.
I'm not sure if a psychiatrist's salary is so much larger than a psychologist's simply because they prescribe medications. Indeed, there doesn't seem to be a correlation (thinking off the top of my head) to amount of medications prescribed, or the frequency of medications prescribed and salary within the medical field itself. (Radiology comes to mind) Likewise, (although psychologists may resent the comparison), nurse anesthetists make substantially less than anesthesiologists. Why should they? They perform essentially the same duties most of the time. The truth is that the anesthesiologist can provide a higher level of medical care than a nurse. The same would be true for psychologists and psychiatrists. A higher overall level of medical care is potentially provided by a psychiatrist - post-doc masters/neuropsychology or not. That's just the nature of the training and education.
It's an interesting idea you bring up...the thought that prescribing psychologists will be considered more like mid-levels if they DO prescribe. I think this is accurate and I can understand your trepidation. Psychologists, after all, must confer with a physician, and ultimately defer to their decision when it comes to prescribing. Psychologists, however, will be pleased to find out that most physicians are too busy to welcome the extra unpaid time spent in face-to-face supervision/conferencing and phone calls. I can't say I blame them. This cannot be compared to psychiatry, since the psychiatrist theoretically does not have to confer with a primary care doc, and fully understand the medical complexities of the patient as they are listed. The result of this will be psychologists doing what many PAs do now. Saying hello over the phone for 10 minutes every 6 months, or some such nonsense. This will give them an increased sense of autonomy, but will be bad for the patient. This, incidentally, is a direct violation of the prescribing mandates put forth in LA, and should be prosecuted as such. Given the fact that the disciplinary board, (who refuses to even release a standard passing score for their prescribing test) consists primarily of psychologists. No repercussions will be had. This is in addition to the complete lack of entrance requirements to post-doc psychopharm programs, (and often taught by psychologists, which makes absolutely no sense at all). It reminds me of a sort of pathological inbreeding that results in a genetically mutated offspring.
This again is unfortunate. Peer reviewed physician disciplinary teams appear to be much more objective, and have a reputation for erring on the side of patient care and rights. Given the political clout that psychologists feel that rxp has for them, similar values regarding these scenarios are highly unlikely.