Psychopharmacology/Advanced Practice Psychology

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NeuroObsessed said:
New Mexico also had a pretty big win this past week, expanding their prescriptive scope. I believe it removed most restrictions on what they can prescribe, and just states that they can prescribe meds consistent with the practice of clinical psychopharmacology, allows prescriptions of meds to help protect from or manage side effects that are a result of psychotropic meds, and now allows them to administer injections (previously they could only prescribe them, but I believe administration is allowed only with additional board approved training).
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This likely needed to happen bc side effects with psych meds are so common. The injection thing is interesting. I don't really think it will make much of a difference because psych injectables are still pretty rare (as compared to pill/capsule), and cost-wise most Pharma companies don't give a break on pricing for them, so I've only really seen them used in community MH and patients who struggle with compliance. Some in the VA too.
 
Can anyone who has earned an mscp and gotten supervised clinical experience in a state that doesn’t allow RxP yet speak to how that went for them? I am work in an AMC with a lot of psychiatrists, so probably wouldn’t be hard to find a supervisor, but am in a state that doesn’t yet allow for psychologist prescribers. Anyone know how that works? Am considering FDU’s program.
 
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Harry3990 said:
Can anyone who has earned an mscp and gotten supervised clinical experience in a state that doesn’t allow RxP yet speak to how that went for them? I am work in an AMC with a lot of psychiatrists, so probably wouldn’t be hard to find a supervisor, but am in a state that doesn’t yet allow for psychologist prescribers. Anyone know how that works? Am considering FDU’s program.
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How would they supervise you, if you can't legally prescribe there?
 
FDU’s website says that the “clinical practicum” part of their program does not need to happen within a state that has rxp, so I’m guessing that means that it happens.
 
I believe it’s similar to how prospective students applying to med school get hours, except in a more collaborative capacity. You talk with them about cases, the medical problems, suggest certain medications, and they can agree and take your advice or disagree and ignore your input. The ultimate decision is on them on how to treat the patient and what prescribe or unprescribe.
 
PsyDr said:
Same way a practicum student writes a report without being licensed. Under someone else’s license, under direct supervision.

Weird.
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I'd imagine the state laws would have to allow for it in some capacity. I can't imagine most prescribers jumping at the chance to do this, unless you paid them fairly well.
 
WisNeuro said:
I'd imagine the state laws would have to allow for it in some capacity. I can't imagine most prescribers jumping at the chance to do this, unless you paid them fairly well.
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1) Medical students do it all the time. I can’t imagine a state that doesn’t have this practice worked into their laws and case law.

2) Nurse practitioners have created a robust market for supervising physicians, with websites and such.
 
PsyDr said:
1) Medical students do it all the time. I can’t imagine a state that doesn’t have this practice worked into their laws and case law.

2) Nurse practitioners have created a robust market for supervising physicians, with websites and such.
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For certain trainees, sure, but in some cases they'd have to amend the definitions section of that statute.
 
NeuroObsessed said:
I believe it’s similar to how prospective students applying to med school get hours, except in a more collaborative capacity. You talk with them about cases, the medical problems, suggest certain medications, and they can agree and take your advice or disagree and ignore your input. The ultimate decision is on them on how to treat the patient and what prescribe or unprescribe.
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People applying to med school aren't doing the clinical work and just having the physicians sign off on it like we're discussing here. They're shadowing physicians during their regular patient care.

PsyDr said:
1) Medical students do it all the time. I can’t imagine a state that doesn’t have this practice worked into their laws and case law.

2) Nurse practitioners have created a robust market for supervising physicians, with websites and such.
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The difference is that there are legal pathways and established standards for NPs, med students, and others to do this supervised work while there isn't one for RxP in the vast majority of states.
 
psych.meout said:
People applying to med school aren't doing the clinical work and just having the physicians sign off on it like we're discussing here. They're shadowing physicians during their regular patient care.


The difference is that there are legal pathways and established standards for NPs, med students, and others to do this supervised work while there isn't one for RxP in the vast majority of states.
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1) I don't think that your characterization of the supervised experience is accurate. I believe the expectation is that the psychologist shadows a physician. That is how I did it.

2) The law is generally based upon similarity. That is how common law works. You can't say, "Hiring a supervising physician this way is totally legal for NPs, and we have established that through decades of case law. But we are going to introduce a wild variation for a specific profession that nullifies all previous case law." It simply would not work.
WisNeuro said:
For certain trainees, sure, but in some cases they'd have to amend the definitions section of that statute.
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1) The law is based upon similarity. The prongs of malpractice are the exact same for psychologists, physicians, PAs, NPs, etc. I don't know how that would work. "Hey, we accept supervision as X criteria. That is codified into federal law too. But our state is going to completely alter the definition of supervision for a very small profession, opening the door to different interpretations of established case law." That would create appeals for every case mentioning supervision in any profession. Mostly with medical labs and radiology.
 
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Ah, so that's why there's been a number of e-mails on my specialty listserv of people "resigning" from ABPP.
 
WisNeuro said:
Must be niche specific. I haven's seen a single mention of it on the npsych listservs, boarded or not.
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Yeah, it was on the health psych one. I was surprised. I believe two folks gave a more thorough explanation later, but did seem to boil down to disagreeing with ABPP supporting that.
 
I feel like health psychologists should be more supportive of this effort, especially with their role in primary care. One of the RxP arguments includes the overwhelming number of psychiatric prescriptions by primary care and other non psychiatric specialists.

Anecdotally, I’ve noticed most of the people pursuing a MSCP have been neuropsychologists which makes sense due to the content being taught and discussed.
 
NeuroObsessed said:
Anecdotally, I’ve noticed most of the people pursuing a MSCP have been neuropsychologists which makes sense due to the content being taught and discussed.
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That's interesting. How would an assessment-heavy neuropsychologist incorporate prescription privileges into their practice? Seems pretty far removed from the testing they do, at least on the surface.
 
Tom4705 said:
That's interesting. How would an assessment-heavy neuropsychologist incorporate prescription privileges into their practice? Seems pretty far removed from the testing they do, at least on the surface.
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Not something I'd pursue, forensic is a better bang for the buck. But, I assume it's because a lot of neuropsych people have had psychopharm and med school coursework even prior to any RxP stuff, so there's already a foundation for some.
 
Tom4705 said:
That's interesting. How would an assessment-heavy neuropsychologist incorporate prescription privileges into their practice? Seems pretty far removed from the testing they do, at least on the surface.
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Of the folks I know who pursued it, I'd say it's about a 50/50 split between neuropsychologists and non.

If I were able to prescribe, I could see how I'd pretty easily incorporate it into my practice with probably a relatively small number of treatment cases. Probably devote a couple days to treatment and a couple days to assessment, or split the workdays in half.
 
Tom4705 said:
That's interesting. How would an assessment-heavy neuropsychologist incorporate prescription privileges into their practice? Seems pretty far removed from the testing they do, at least on the surface.
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As a person who semi-fits this description ( I am consulting pediatric psychologist in a neuro department of an AMC that does some mixed assessment and intervention), it makes a lot of sense, at least in the pediatric sense. A number of pediatric assessments include evaluation of psychiatric comorbidities and a number of identifiable conditions respond well to medication management (i.e.; ADHD, anxiety, behavioral concerns associated with neurodevelopmental concerns, etc.) alongside EBP psychotherapy interventions. Also, strong agree with WisNeuro that my previous education made this very easy to transition over to, as I had already attended neuroanatomy and neurophysiology coursework with medical students during my doctorate. I also have a strong background in biological and chemistry sciences, which is what drew me a bit towards health and neuro. Having said that, there is a number of students in my program who also hail from all sorts of background, including strong psychoanalytic and Rogerian therapy models. So, you kinda get the whole perspective during class discussions.
 
AcronymAllergy said:
Of the folks I know who pursued it, I'd say it's about a 50/50 split between neuropsychologists and non.

If I were able to prescribe, I could see how I'd pretty easily incorporate it into my practice with probably a relatively small number of treatment cases. Probably devote a couple days to treatment and a couple days to assessment, or split the workdays in half.
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I'm a neuropsychologist who sees adults with severe TBI across the rehabilitation continuum (i.e., inpatient to outpatient). I often evaluate patients first at bedside, then (sometimes serially) post-discharge, then (for some people) I'll follow-up every two-to-three months, or so, for reinforcement of feedback, brain injury education, and problem solving around persistent challenges.

I could definitely see a role for medication management within that model, especially since some of these folks are discharged from their brain injury specialists relatively early on. Medications for management of neurobehavioral dysfunction / emotional distress for many of these patients are currently managed by their PCPs.
 
divergent opinion:

1) IMO, there is some significant self selection at play. It's not unreasonable for psychologists, who self select to focus on biological determinants of behavior, will want to... you know... treat people biologically.

2) I doubt many prescribing neuropsychologists are actually focusing on neurocognitive disorders. The medication interventions for NCDs have very limited effect sizes. Individuals with significant cognitive impairment are unlikely to have private medical insurance and medicare doesn't pay for RxP psychologists. Just doesn't make sense to me.
 
AcronymAllergy said:
Of the folks I know who pursued it, I'd say it's about a 50/50 split between neuropsychologists and non.

If I were able to prescribe, I could see how I'd pretty easily incorporate it into my practice with probably a relatively small number of treatment cases. Probably devote a couple days to treatment and a couple days to assessment, or split the workdays in half.
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Not sure the increased cost of malpractice insurance would justify a small caseload. I'm not sure what they charge but physician malpractice ranges from thousands to tens of thousands, though I believe psychiatry is on the lower end. We are in the hundreds of dollars.
 
thebalmofhurtminds said:
Yeah, it was on the health psych one. I was surprised. I believe two folks gave a more thorough explanation later, but did seem to boil down to disagreeing with ABPP supporting that.
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That is interesting. Then again, I have struggled to justify bothering with ABPP unless I decide to get into forensics. I already have a VA specialty psych job and have never been denied an opportunity because of lack of ABPP.
 
Sanman said:
That is interesting. Then again, I have struggled to justify bothering with ABPP unless I decide to get into forensics. I already have a VA specialty psych job and have never been denied an opportunity because of lack of ABPP.
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I did mine partially because my AMC required it. But I've since moved to a new setting, and my new colleagues don't even know what this specialty board is. It's been fun explaining that over and over.
 
thebalmofhurtminds said:
I did mine partially because my AMC required it. But I've since moved to a new setting, and my new colleagues don't even know what this specialty board is. It's been fun explaining that over and over.
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I imagine so. I always find the duality of academia placing so many hoops in front of us while most people can not even find a decent general mental health provider interesting.
 
Sanman said:
I imagine so. I always find the duality of academia placing so many hoops in front of us while most people can not even find a decent general mental health provider interesting.
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Along with, “I’m stressed out about work. I only get 2 weeks of PTO, that is dedicated to seeing my family of origin once per year. My work had increased my duties by 400%, and disciplines me if my productivity isn’t 400% of my maximum abilities. They won’t pay for someone whose cognitive abilities are commiserate with that level of productivity. Anyway, I need appointments after 6pm.”

All of mental health, “the increased prevalence of affective disorders is a mystery. why don’t patients want to see us on banking hours? I refuse to tell anyone that their cognitive abilities, and/or personality structure, are not consistent with the environmental demands.“
 
Sanman said:
Not sure the increased cost of malpractice insurance would justify a small caseload. I'm not sure what they charge but physician malpractice ranges from thousands to tens of thousands, though I believe psychiatry is on the lower end. We are in the hundreds of dollars.
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Indeed, and probably depends on what's meant by "small."
 
PsyDr said:
The APA negotiated with the trust for a maximum premium increase of 10% for individuals granted rxp.
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Where could I find information regarding this? I can't seem to find it on the APA website.
 
Tom4705 said:
Where could I find information regarding this? I can't seem to find it on the APA website.
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Unfortunately, this is part of the oral history rather than a part of the scientific literature. I doubt there are official resources for this negotiation, especially since APA and the trust parted ways. The best way to independently verify the cost is to call the Trust and ask.

FYI: Your screen name is concerningly similar to some of the most vocal opponents of RxP. I know you're not the same person(s), but heads up.
 
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PsyDr said:
Unfortunately, this is part of the oral history rather than a part of the scientific literature. I doubt there are official resources for this negotiation, especially since APA and the trust parted ways. The best way to independently verify the cost is to call the Trust and ask.

FYI: Your screen name is concerningly similar to some of the most vocal opponents of RxP. I know you're not the same person(s), but heads up.
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Noted on the lack of resources.

And that's really weird, I've had this username for many years, it's actually from my time gaming lol. I'll try to change it anyway.
 
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PsyDr said:
Unfortunately, this is part of the oral history rather than a part of the scientific literature. I doubt there are official resources for this negotiation, especially since APA and the trust parted ways. The best way to independently verify the cost is to call the Trust and ask.

FYI: Your screen name is concerningly similar to some of the most vocal opponents of RxP. I know you're not the same person(s), but heads up.
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Idaho just updated their RxP laws (Senate Bill 1088) you seemed pretty well versed in breaking down each states rules so I wanted to ask you how this changes things, particularly with regards to collaboration requirements and working with certain populations (geriatric and pediatric). Kinda a big deal imo since Idaho was one of the more laxed states in terms of the rules.
 
Psycho Bunny said:
Idaho just updated their RxP laws (Senate Bill 1088) you seemed pretty well versed in breaking down each states rules so I wanted to ask you how this changes things, particularly with regards to collaboration requirements and working with certain populations (geriatric and pediatric). Kinda a big deal imo since Idaho was one of the more laxed states in terms of the rules.
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Has this passed the House and been signed by the Governor yet?
 
Psycho Bunny said:
I honestly have no idea how the process works. I know that it becomes effective in a few months.
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The SB was referred to the House at the end of February. after that they need to pass it through the House committee, then the House, reconcile any differences and vote on those, it would then have to go to the Governor for signature. If they did that in a month and a half, I would be astounded at the efficiency of teh process there.
 
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Psycho Bunny said:
Idaho just updated their RxP laws (Senate Bill 1088) you seemed pretty well versed in breaking down each states rules so I wanted to ask you how this changes things, particularly with regards to collaboration requirements and working with certain populations (geriatric and pediatric). Kinda a big deal imo since Idaho was one of the more laxed states in terms of the rules.
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It hasn't passed, so nothing has changed. In 2019, Idaho had the worst physician shortage in the nation. Then the state decided to outlaw abortion, threaten OBGYN's with arrest if they do anything that could be considered an abortion, and has repeatedly tried to ban different vaccines.

So, I'm guessing a lot of this bill is meant to work around the physician shortage. And possibly make us prescribe potatoes.
 
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PsyDr said:
It hasn't passed, so nothing has changed. In 2019, Idaho had the worst physician shortage in the nation. Then the state decided to outlaw abortion, threaten OBGYN's with arrest if they do anything that could be considered an abortion, and has repeatedly tried to ban different vaccines.
So, I'm guessing a lot of this bill is meant to work around the physician shortage.
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Hey now, the Idaho legislature is doing very important and serious work! Like trying to figure out a way to prosecute Dr. Fauci for state crimes, for.....reasons! You can't expect them to have time to try and seriously solve their physician shortage problem.

HOUSE CONCURRENT RESOLUTION 5 – Idaho State Legislature

legislature.idaho.gov legislature.idaho.gov
 
WisNeuro said:
Hey now, the Idaho legislature is doing very important and serious work! Like trying to figure out a way to prosecute Dr. Fauci for state crimes, for.....reasons! You can't expect them to have time to try and seriously solve their physician shortage problem.

HOUSE CONCURRENT RESOLUTION 5 – Idaho State Legislature

legislature.idaho.gov legislature.idaho.gov
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Idaho- "We are bad, but at least our state constitution didn't ban black people like Oregon!"
 
Wow, I thought TX would be the worst place to do RxP (on a military base, they were recruiting a few years ago), but Idaho may take that crown if this passes. Both state hate healthcare professionals and women, so they have that going for them too.
 
Heavily invested in all of the RxP movements across the US, so I did a quick scan of the document. It looks like it is still in the Senate, and from what I can quickly glean, it appears to be mostly housekeeping pieces to change the phrasing from "supervising physician" to a "collaborative agreement" setup and also specifying that the degree conferring programs meet APA standards, as opposed to the very specific requirements Idaho had previously spelled out. Let me know what I am missing though...

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://legislature.idaho.gov/wp-content/uploads/sessioninfo/2025/legislation/S1088.pdf
 
Sanman said:
Not sure the increased cost of malpractice insurance would justify a small caseload. I'm not sure what they charge but physician malpractice ranges from thousands to tens of thousands, though I believe psychiatry is on the lower end. We are in the hundreds of dollars.
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I am a prescribing psychologist and just wanted to comment on this: Malpractice for prescribing psychologists is only around 100$ more than for standard psychologists, so you could have a small caseload of patients who need medication management, and it would still be worth it.

Also, the pay rate for prescribing psychologists in my state is way more than I would earn doing therapy or even assessment. For a standard 99214 + 90833 (moderate complexity medication mgmnt plus 30 mins psychotherapy,), I earn $250 from Medicaid Private insurances typically pay much higher than that.

So overall, even with a small caseload, prescribing is definitely a high return on investment skill set to develop.

Even more exciting, it looks like Vermont will be the next state to grant us RxP!
 
psych250 said:
I am a prescribing psychologist and just wanted to comment on this: Malpractice for prescribing psychologists is only around 100$ more than for standard psychologists, so you could have a small caseload of patients who need medication management, and it would still be worth it.

Also, the pay rate for prescribing psychologists in my state is way more than I would earn doing therapy or even assessment. For a standard 99214 + 90833 (moderate complexity medication mgmnt plus 30 mins psychotherapy,), I earn $250 from Medicaid Private insurances typically pay much higher than that.

So overall, even with a small caseload, prescribing is definitely a high return on investment skill set to develop.

Even more exciting, it looks like Vermont will be the next state to grant us RxP!
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Given my current trajectory and direct interest, is it possible to directly message you related to this topic to "pick your brain some more?"
 
psych250 said:
I am a prescribing psychologist and just wanted to comment on this: Malpractice for prescribing psychologists is only around 100$ more than for standard psychologists, so you could have a small caseload of patients who need medication management, and it would still be worth it.

Also, the pay rate for prescribing psychologists in my state is way more than I would earn doing therapy or even assessment. For a standard 99214 + 90833 (moderate complexity medication mgmnt plus 30 mins psychotherapy,), I earn $250 from Medicaid Private insurances typically pay much higher than that.

So overall, even with a small caseload, prescribing is definitely a high return on investment skill set to develop.

Even more exciting, it looks like Vermont will be the next state to grant us RxP!
Click to expand...
Good to know. Sent you a DM.
 
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