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wait, you never answered my question. How would the treatment of a patient differ between psychiatrist and prescribing psychologists when medicine clears?
The only reason Heimlich says he is tired of the discussion is because he was caught in multiple bold faced lies. If I recall correctly, he was suspended from this board many moons ago.
LSU does, in fact, allow psychologists to prescribe. LSU is my graduate program and some of the psychologists at the student health center prescribe to students who go to the counseling center. I don't know about LSUHSC, but if a psychologist pushed the issue to prescribe, they would have to let her/him. IT'S THE LAW.
Unlike what Heim said, psychologists are prescribing in all state facilities: the hospitals, prisons, developmental centers. Anybody who lives in LA know this... If they say otherwise, they're lying.
LSU does, in fact, allow psychologists to prescribe. LSU is my graduate program and some of the psychologists at the student health center prescribe to students who go to the counseling center. I don't know about LSUHSC, but if a psychologist pushed the issue to prescribe, they would have to let her/him. IT'S THE LAW.
Unlike what Heim said, psychologists are prescribing in all state facilities: the hospitals, prisons, developmental centers. Anybody who lives in LA know this... If they say otherwise, they're lying.
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Why would it not differ?
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I am not a liar and all people do not know that psychologists are prescribing. So lets go over state mental health facilities.
New Orleans Adolescent Hospital in uptown New orleans they do not allow prescribing psychologists.
Depaul hospital in uptown new orleans they do not allow prescribing psychologists.
University Hospital in Downtown new orleans they do not allow prescribing psychologists.
University Medical Center in Lafayette they do not allow prescribing psychologists.
Every hospital is allowed to have their own criteria regarding scope of practice. For example some hospitals allow Family Practice doctors to perform appendectomies in the operating room but many do not.
And here is a link to a private hospital which has prescribing neuropsychologists (Ph.D., M.P.) on its staff.... Funny enough that the rest of the staff consists of MDs and DOs who must trust medical psychologists wth their patients! One of these psychologists taught a class at my graduate school, and also taught didactics at the internship, and told us that neurologists actually PREFER to refer to medical psychologists over psychiatrists because psychologists take time with their patients. If MDs were not referring to psychologists, then the # of scripts written by psychologists thus far would be much lower. Also, as an aside, at Pinecrest Developmental Center, 90 percent of the patients were on psychoactive meds before the current medical psychologist took reigns from psychiatry. Now only 20 percent or son are on meds...
Because there aren't tons of medical psychologists, not all hospitals have them on staff. I am sure when psychiatrists tried to prohibit psychologists from doing diagnostics and psychotherapy, it took time for hospitals to grant psychologists these legal rights. However, it did happen (thank you, Dr Carl Rogers!). Psychiatry and the medical establishment has always opposed the expansion of clinical psychology. However, now that the data is in, all of medicine's scare tactics have been proven false.
.
http://www.theneuromedicalcenter.com/NMC/physicians_4.php
Because there aren't tons of medical psychologists, not all hospitals have them on staff. I am sure when psychiatrists tried to prohibit psychologists from doing diagnostics and psychotherapy, it took time for hospitals to grant psychologists these legal rights. However, it did happen (thank you, Dr Carl Rogers!). Psychiatry and the medical establishment has always opposed the expansion of clinical psychology. However, now that the data is in, all of medicine's scare tactics have been proven false.
.
http://www.theneuromedicalcenter.com/NMC/physicians_4.php
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That is true, though I think where people are in disagreement was the initial post that started the ball rolling.....
This, as we know, is not correct.
What I'd like is for the discussion to get back on topic, and not become heimlichboy vs. etc. Obviously there are a range of opinions in this thread, which is why it is important to differentiate between opinion and fact. Opinions are fine (as long as it is not for the sole purpose of trolling), though it is important to provide citations or similar for statements that are proposed as fact.
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I will concede I do not know about pinecrest. I have not been to the remote bayous of LA to every small hospital to see if there are prescribing psychologists. But my point is that hospitals have their own criteria for scope of practice in LA, and the major hospitals at least in new orleans do not allow psychologists to prescribe in their given hospitals.
For example psychologists in LA by law are allowed to PEC (Physicians emargency certificates) patients. But most hospitals will not allow them to do so.
If people think I am a liar then they can call
Tulane
Ochsner
University Hospital
Depaul
New Orleans Adolescent Hospital
and talk to the psychologists and see if they are allowed to prescribe medications or PEC patients, you will find out they are not.
I agree with T4C it should not be everyone against me just because people do not agree with what I have to say. But I do work in LA and I have a better understanding of the mental health care system then people who do not and are merely calling me a liar due to some second hand information.
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i think everyone is simply asking you to prove your assertions or they will accept the null hypothesis.
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Thanks!
From the APA listserv
Please support Prescriptive Authority for specially trained Medical Psychologists. A bill will be introduced in 2009 that will enable Medical Psychologists to manage mental health medications. If passed it will help relieve the severe shortage of psychiatric services available in state institutions and to the general public.
Psychologists are already prescribing. Medical Psychologists in the military and in New Mexico and Louisiana have written thousands of prescriptions and have an outstanding record of safety and service. Many clinical Psychologists in State of Illinois facilities are already receiving the additional training necessary to meet the requirements outlined in the legislation. Passage of this legislation will help meet the severe shortage of psychiatric services in those facilities without additional costs to the state. Clinical Psychologists located in a variety of settings including private practices are taking the training at their own expense to expand their expertise.
Under the proposed legislation Medical Psychologists will prescribe or change the patient's mental health medication only after consulting with the patient's primary care physician to verify the safety of the medication. Medical Psychologists will prescribe only FDA approved mental health medications which number only about 100 out of the 2,400 medications approved by the FDA.
Medical Psychologists are already doctoral level clinical psychologists who have earned the equivalent of an additional master's degree in clinical psychopharmacology and extensive additional practicum training in prescribing. That additional education includes the part of medical education necessary to prescribe safely.
Your support of the Medical Psychologist bill will make more safe and cost-effective services available to citizens who are in serious need of mental health services. Please support prescriptive authority for Medical Psychologists!
Thank you.
Please support Prescriptive Authority for specially trained Medical Psychologists. A bill will be introduced in 2009 that will enable Medical Psychologists to manage mental health medications. If passed it will help relieve the severe shortage of psychiatric services available in state institutions and to the general public.
Psychologists are already prescribing. Medical Psychologists in the military and in New Mexico and Louisiana have written thousands of prescriptions and have an outstanding record of safety and service. Many clinical Psychologists in State of Illinois facilities are already receiving the additional training necessary to meet the requirements outlined in the legislation. Passage of this legislation will help meet the severe shortage of psychiatric services in those facilities without additional costs to the state. Clinical Psychologists located in a variety of settings including private practices are taking the training at their own expense to expand their expertise.
Under the proposed legislation Medical Psychologists will prescribe or change the patient's mental health medication only after consulting with the patient's primary care physician to verify the safety of the medication. Medical Psychologists will prescribe only FDA approved mental health medications which number only about 100 out of the 2,400 medications approved by the FDA.
Medical Psychologists are already doctoral level clinical psychologists who have earned the equivalent of an additional master's degree in clinical psychopharmacology and extensive additional practicum training in prescribing. That additional education includes the part of medical education necessary to prescribe safely.
Your support of the Medical Psychologist bill will make more safe and cost-effective services available to citizens who are in serious need of mental health services. Please support prescriptive authority for Medical Psychologists!
Thank you.
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Bella, i think you misread that. there are not any places that train in IL, except that PPR. The people in IL are getting trained.
Hey,
Bellapsyd,
You may want to contact your local state representatives to tell them to support the bill. I have forwarded the APA link so all you have to do is type in your ZIP code and it spits out a pre-composed letter to your represnetative. Then you just hit "send" and it sends the letter. You may also want to forward the link to all your graduate school friends and family in Illinois to e-mail their representatives, too. Representatives vote for bills when they hear from constituents like YOU! Without support from people like you, the bill won't pass
Here you go:
http://capwiz.com/apapractice/state/main/?state=IL&view=myofficials
Bellapsyd,
You may want to contact your local state representatives to tell them to support the bill. I have forwarded the APA link so all you have to do is type in your ZIP code and it spits out a pre-composed letter to your represnetative. Then you just hit "send" and it sends the letter. You may also want to forward the link to all your graduate school friends and family in Illinois to e-mail their representatives, too. Representatives vote for bills when they hear from constituents like YOU! Without support from people like you, the bill won't pass
Here you go:
http://capwiz.com/apapractice/state/main/?state=IL&view=myofficials
It looks like Missouri is really stepping up efforts to gain RxP. Check out this EXCELLENT website -- the links about psychiatry on it are very interesting
http://www.mofact.com/RxP.html
http://www.mofact.com/RxP.html
Were you serious or was that sarcasm?
I found that website absolutely horrifying and think its creators are pretty disgusting human beings.
Posting scientology videos in an attempt to win RxP....seriously, would it be possible to sink any lower?
I'm not very vocal on the RxP issue - though I don't think there's anything wrong with it assuming proper training occurs. I'd sooner it never happen then psychology resort to things like that website though. Absolute embarassment to the profession.
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Psychologists need to stick with the research (in our favor), be consistent (we are iffy on this), and build good local support for the issue (getting there).
Scientology slop has no place a real discussion.
Scientology slop has no place a real discussion.
This actually pissed me off enough I did some research on the matter. And I'm crazy busy this semester so the threshold is pretty high for the amount of anger I need to experience to research something like that
One of the founders of that website is Marci Manna, who was recently given an AWARD by APA Div. 55.
She has apparently stepped away from that organization to focus on her practice. For now, I'm going to give her the benefit of the doubt and assume it was only since she stepped down that this organization became what it currently is.
I have no way to verify what the website said before she left. However, if I find out she is in ANY way responsible for the content or still supportive of the direction that website is going, I am writing to APA and canceling my membership until such time as they revoke her award. IF she is responsible or involved (and I don't automatically assume she is), as far as I'm concerned she should be sanctioned or expelled. If APA is going to give out awards for behavior like that, I want nothing to do with it.
Absolutely horrifying...
One of the founders of that website is Marci Manna, who was recently given an AWARD by APA Div. 55.
She has apparently stepped away from that organization to focus on her practice. For now, I'm going to give her the benefit of the doubt and assume it was only since she stepped down that this organization became what it currently is.
I have no way to verify what the website said before she left. However, if I find out she is in ANY way responsible for the content or still supportive of the direction that website is going, I am writing to APA and canceling my membership until such time as they revoke her award. IF she is responsible or involved (and I don't automatically assume she is), as far as I'm concerned she should be sanctioned or expelled. If APA is going to give out awards for behavior like that, I want nothing to do with it.
Absolutely horrifying...
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So for everyone who feels the need to drag down psychiatrists in order to implement RxP for psychologists, what do you envision as the proper role for psychiatrists and psychologists in the future? The only thing I've really seen people say is that psychiatrists take the "harder cases," but it's only a matter of time before psychologists with RxP want to take those harder cases and be reimbursed equally. That's just pure economics.
The elephant in the room is that psychologists never thought psychiatrists really did anything and that they could do med management just as well, so **** the psychiatrists. Please tell me how I'm completely wrong.
The elephant in the room is that psychologists never thought psychiatrists really did anything and that they could do med management just as well, so **** the psychiatrists. Please tell me how I'm completely wrong.
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was your sole purpose in posting on this thread just to start something?
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MOD NOTE: We welcome anyone who would like to constructively contribute to this thread, but if your sole intent is to troll, and/or be unprofessional, you will be subject to disciplinary action for violating SDN rules.
As far as the role of psychologists and psychiatrists....there are many more areas of psychology and psychiatry outside of this one possible overlap, so I see the consulting relationship continuing.
Your inference about the beliefs of psychologists in regard to psychiatry are off base. Everyone is entitled to an opinion, but you seem to be making large generalizations and painting with the broadest possible strokes, which makes me question your intent for your post in here.
As far as the role of psychologists and psychiatrists....there are many more areas of psychology and psychiatry outside of this one possible overlap, so I see the consulting relationship continuing.
Your inference about the beliefs of psychologists in regard to psychiatry are off base. Everyone is entitled to an opinion, but you seem to be making large generalizations and painting with the broadest possible strokes, which makes me question your intent for your post in here.
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I am admittedly ill-informed about the daily aspects of both psychologists and psychiatrists; I was not trolling. What are some areas where there is no overlap?
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Here is a listing of some common/different areas.....though it is important to remember that "mentoring" for psychology is very different than psychiatry, just like running research is different, administration is different, etc.
Psychology: Administer psych assessments, conduct therapy, teach, research, publish, mentor (academic & applied), consult outside of psych, witness/expert, management/administration, etc.
Psychiatry: (any psychiatrists please feel free to add to this) Meds management in-patient/out-patient, run sleep/neuro/related labs, research, teach, mentor, witness/expert, etc.
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meister:
i exclusively consult for physicians. amicably.
in my practice it works like this:
1) psychiatrist: suspects dementia due to a wide variety of chief complaints. but has no objective measure of memory. or executive functioning or praxis or whatever.
psychologist: objectively measures cognitive domains to rule in/out dementia.
psychiatrist: based on these findings psychiatrist treats based on these objective findings.
100% no overlap.
OR
2) psychiatrist: refers pt with a question of "is there a psychological component to this individual's behavioral presentation?" there are an almost infiinte supply of these pts.
OR
3) Psychiatrist gets objective measures to avoid malpractice issues via documentation based upon objective psychological measures. They think a pt is likely to sue, they send the pt over to me. I offer my impressions, which usually confirm their dx. if the pt ends up suing, the psychiatrist has a full battery of psych tests that support their decision. makes defending their position a slam dunk in court. of course i am screwed if i get it wrong. I also get other physician specialist wanting this type of service.
OR
4) "determine the pt's likely needed level of care upon discharge" or "determine the pt's level of impairment". both of these types of reports are run over to the court house by psych hospitals to support involuntary certificates, guardianship apps, etc. the psychiatrists i work with love this type of referral.
as for prescription privileges in my examples: psychologists do not treat those that they assess. it's one of our professional things. none of the aforementioned types of pts would be treated by psychologists should prescription priveleges be given. dementia requires too much alterations in the non-psych formulary. psychologist can only admit or discharge in CA (nominal law that is basically not been in use for a few decades), brain injured individuals are again too complex and would require tx with pharmacological agents that are outside the psych formulary which would prevent a prescribing psychologist from tx'ing said pt, etc.
in response to your overall point: psychologists are petitioning for an incredibly restricted formulary. one that is less than what your average nurse practitioner could use. we are doing so because the demand for psychiatrists is greater than the supply of them. the basic plea is: let psychologist ease the social problem by treating the extremely easy patients and send psychiatrist the more complex ones. this way psychiatrists' skills are not mis-utilized by the banal, while there is a 6 month waiting list for his/her practice. there is absolutely no disrespect inherent in this discussion, only a recognition that there is a continuum of complexity that correlates with a continuum of amount of education.
i exclusively consult for physicians. amicably.
in my practice it works like this:
1) psychiatrist: suspects dementia due to a wide variety of chief complaints. but has no objective measure of memory. or executive functioning or praxis or whatever.
psychologist: objectively measures cognitive domains to rule in/out dementia.
psychiatrist: based on these findings psychiatrist treats based on these objective findings.
100% no overlap.
OR
2) psychiatrist: refers pt with a question of "is there a psychological component to this individual's behavioral presentation?" there are an almost infiinte supply of these pts.
OR
3) Psychiatrist gets objective measures to avoid malpractice issues via documentation based upon objective psychological measures. They think a pt is likely to sue, they send the pt over to me. I offer my impressions, which usually confirm their dx. if the pt ends up suing, the psychiatrist has a full battery of psych tests that support their decision. makes defending their position a slam dunk in court. of course i am screwed if i get it wrong. I also get other physician specialist wanting this type of service.
OR
4) "determine the pt's likely needed level of care upon discharge" or "determine the pt's level of impairment". both of these types of reports are run over to the court house by psych hospitals to support involuntary certificates, guardianship apps, etc. the psychiatrists i work with love this type of referral.
as for prescription privileges in my examples: psychologists do not treat those that they assess. it's one of our professional things. none of the aforementioned types of pts would be treated by psychologists should prescription priveleges be given. dementia requires too much alterations in the non-psych formulary. psychologist can only admit or discharge in CA (nominal law that is basically not been in use for a few decades), brain injured individuals are again too complex and would require tx with pharmacological agents that are outside the psych formulary which would prevent a prescribing psychologist from tx'ing said pt, etc.
in response to your overall point: psychologists are petitioning for an incredibly restricted formulary. one that is less than what your average nurse practitioner could use. we are doing so because the demand for psychiatrists is greater than the supply of them. the basic plea is: let psychologist ease the social problem by treating the extremely easy patients and send psychiatrist the more complex ones. this way psychiatrists' skills are not mis-utilized by the banal, while there is a 6 month waiting list for his/her practice. there is absolutely no disrespect inherent in this discussion, only a recognition that there is a continuum of complexity that correlates with a continuum of amount of education.
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Psychiatry: Therapy is starting to become re-emphasized in residency (typically psychodynamic, CBT, IPT, DBT). We also serve an important role in consultation to other specialties in medicine. Psychiatrists are also starting to work in oncology clinics as well as in the areas of palliative care and pain medicine.
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Thanks Chimed!
Interesting. Either the website isn't loading correctly or someone got their act together and took the video down.
Click the Psychiatry 1 link. See the gap between the last 2 red boxes? That used to be a video from CCHR, one of the front groups for scientology. Others here saw it too so I'm obviously not making it up. Not that I can think of any possible motivation I'd have to do that.
That said, I openly stated I didn't know if Dr. Manna was still involved. If she's not that is fine and I don't hold her in any way responsible.
The rest I absolutely will not apologize to. Even without the scientology video, the fact that 1) They put it up to begin with and 2) The overall attitude of the website remains the same, tells me that they are a virus that needs to be stamped out if the RxP movement wants to look legitimate. Never will I support any organization like that. Feel free to think what you will of me for it, its no skin off my back.
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I never saw the Scientology video and I looked at that site several times in-detail.
As far as the write-up about psychiatry being a virus, that may be going too far, but look what the apa and the new mexico psychiatric association wrote about psychlogy:
http://pn.psychiatryonline.org/content/vol37/issue5/images/medium/NewMexico_ad.gif
As far as the write-up about psychiatry being a virus, that may be going too far, but look what the apa and the new mexico psychiatric association wrote about psychlogy:
http://pn.psychiatryonline.org/content/vol37/issue5/images/medium/NewMexico_ad.gif
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*MOD NOTE: Okay all....back on track. Let's keep it about RxP advancement for psychologists, and not about mud slinging (which I am sure both sides have done). -t4c*
One last reply since I think its important to clarify where I'm coming from.
T4C - if you feel this is overstepping or will be inflammatory in any way, delete or edit at will
I hold no illusions that psychiatry is an innocent victim in this, I think there has been plenty of behavior on both sides that is absolutely appalling. I think that's typical for nearly any political issue that enough people care about. It becomes more about the competition and "winning" and less about why you should win.
That said, its not an excuse for poor behavior. I absolutely will call people out if they are acting like that, regardless of what side they stand on. That may ruffle some feathers, but I think its the right thing to do and telling me I'm "irresponsible" because I'll call people out on poor behavior isn't going to stop me. People might fire back at me (like the above), and I've accepted that as a possible consequence - I'm fine with it. I won't be losing sleep over what those people think of me. Despite the oft-discussed need for "professional solidarity" here, I don't think that should mean backing up folks who represent us and do embarassing or awful things.
If psychology truly wants RxP (and truly deserves them), then the way to get it is not by screaming about how psychiatry is evil and unethical, pretending that psychologists are somehow morally superior and will not be motivated by money and patient retention, or influenced by big pharma. Call me divisive if you like, but I'd rather be divisive than unite behind people who behave like that. That website is a perfect example of people doing embarassing and awful things. We have a lot to learn from psychiatry about pharmacology, neurochemistry, etc. We should be asking them "If you don't think we can prescribe safely, what about our training is insufficient? How can we change it?". Not throwing around accusations and pretending that psychologists will be immune to big pharma. The only reason psychologists haven't been affected so far is because there aren't enough prescribers for big pharma to justify the expense of really going after them. I know plenty of folks in both fields and its simply ludicrous to think that one group is intellectually or morally superior.
If the goal is RxP, we need to
1) Demonstrate the need for us to have RxP (not just the "we need more prescribers in underserved areas" - that doesn't give any reason it should be psychologists), and the benefit to patients that may result
2) Demonstrate psychologists are ready and capable of receiving the training, 3) Develop a highly standardized training regimen,
4) Demonstrate that when following that training regimen, psychologists can prescribe safely, and
5) Demonstrate that as a result of 4, the patients benefit in the end.
Now there's already some evidence out there supporting some of those points (though I think some are far stronger than others). Regardless, more work and evidence across the board would definitely help the cause.
RxP needs to be approached just like we were trained to approach everything else in this field - rationally and scientifically. Identify a problem, come up with a possible solution, test that solution, and depending on how it works, either implement the solution more broadly in carefully graded steps, or step back and try another approach. Getting into a shouting match with psychiatrists about how unfair it is, who "really" cares more about patients, etc. is not going to win over anyone who matters. Its just going to make people like me question their motives, morals, and intellect, and push the majority of folks who likely fall somewhere in the middle on this issue away. That's not the way to get RxP.
PS - http://www.youtube.com/watch?v=hy79C0v8elE
I'm not 100% certain since it was now almost a month ago, but I believe this was the video they had on their website that apparently has been removed. The logo for CCHR is in the lower left, but it was very easy to miss on their website because the video was small and it made it hard to read (its even a little tough on Youtube unless you make it full screen). I probably would not have noticed myself if I hadn't recognized the video from when I was looking up some stuff on scientology a few months ago. The fact that it was taken down gives me some glimmer of hope for the folks at mofact, but they still have a long way to go before they are anywhere near having my respect.
T4C - if you feel this is overstepping or will be inflammatory in any way, delete or edit at will
I hold no illusions that psychiatry is an innocent victim in this, I think there has been plenty of behavior on both sides that is absolutely appalling. I think that's typical for nearly any political issue that enough people care about. It becomes more about the competition and "winning" and less about why you should win.
That said, its not an excuse for poor behavior. I absolutely will call people out if they are acting like that, regardless of what side they stand on. That may ruffle some feathers, but I think its the right thing to do and telling me I'm "irresponsible" because I'll call people out on poor behavior isn't going to stop me. People might fire back at me (like the above), and I've accepted that as a possible consequence - I'm fine with it. I won't be losing sleep over what those people think of me. Despite the oft-discussed need for "professional solidarity" here, I don't think that should mean backing up folks who represent us and do embarassing or awful things.
If psychology truly wants RxP (and truly deserves them), then the way to get it is not by screaming about how psychiatry is evil and unethical, pretending that psychologists are somehow morally superior and will not be motivated by money and patient retention, or influenced by big pharma. Call me divisive if you like, but I'd rather be divisive than unite behind people who behave like that. That website is a perfect example of people doing embarassing and awful things. We have a lot to learn from psychiatry about pharmacology, neurochemistry, etc. We should be asking them "If you don't think we can prescribe safely, what about our training is insufficient? How can we change it?". Not throwing around accusations and pretending that psychologists will be immune to big pharma. The only reason psychologists haven't been affected so far is because there aren't enough prescribers for big pharma to justify the expense of really going after them. I know plenty of folks in both fields and its simply ludicrous to think that one group is intellectually or morally superior.
If the goal is RxP, we need to
1) Demonstrate the need for us to have RxP (not just the "we need more prescribers in underserved areas" - that doesn't give any reason it should be psychologists), and the benefit to patients that may result
2) Demonstrate psychologists are ready and capable of receiving the training, 3) Develop a highly standardized training regimen,
4) Demonstrate that when following that training regimen, psychologists can prescribe safely, and
5) Demonstrate that as a result of 4, the patients benefit in the end.
Now there's already some evidence out there supporting some of those points (though I think some are far stronger than others). Regardless, more work and evidence across the board would definitely help the cause.
RxP needs to be approached just like we were trained to approach everything else in this field - rationally and scientifically. Identify a problem, come up with a possible solution, test that solution, and depending on how it works, either implement the solution more broadly in carefully graded steps, or step back and try another approach. Getting into a shouting match with psychiatrists about how unfair it is, who "really" cares more about patients, etc. is not going to win over anyone who matters. Its just going to make people like me question their motives, morals, and intellect, and push the majority of folks who likely fall somewhere in the middle on this issue away. That's not the way to get RxP.
PS - http://www.youtube.com/watch?v=hy79C0v8elE
I'm not 100% certain since it was now almost a month ago, but I believe this was the video they had on their website that apparently has been removed. The logo for CCHR is in the lower left, but it was very easy to miss on their website because the video was small and it made it hard to read (its even a little tough on Youtube unless you make it full screen). I probably would not have noticed myself if I hadn't recognized the video from when I was looking up some stuff on scientology a few months ago. The fact that it was taken down gives me some glimmer of hope for the folks at mofact, but they still have a long way to go before they are anywhere near having my respect.
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Hey All,
I have a couple of questions...
First off, does anyone know of any push in the state of Colorado for psychopharmacology and who a contact person would be for that? I assume CO Psych Assoc. would be the ones to go to for that and I see little activity of any kind on their website, frankly.
I ask this for a couple of reasons. One being that I would like to pursue psychopharm myself and am from "the healthiest state" (at least physically...mental health, on the medical side at least, is a FREAKING JOKE here!)
Secondly, I ask because of the major shortage of psychiatric care here. It is to the point where MDs (non-psychiatrists, at least) are complaining that they have to handle the residual effects of mental health patients not receiving the care they are due and therefore being mismedicated or going unmedicated resulting in suicide attempts, etc. With this in mind, an MD I know well happens to hold an administrative position at a metro-area hospital, does interhospital work, and supervises the training and work of residents and medical researchers. He is willing to write a letter of complaint to our state senators and representatives as well as to CC it to the Colorado Psychological Association, but I would want to make sure such a letter had maximum effect. Any thoughts?
Btw, in terms of psychopharmacology, his feeling is that based on our field's training for psychologists, they are undoubtedly better prepared than any other profession for the diagnosis of mental disease. In addition, many concerns about lack of knowledge of physiology come up here and elsewhere (legitimate concerns, I would say); however, from both his colleagues' and his own experience, psychiatrists go so long without actually using their knowledge of physiology (beyond their limited knowledge of the brain), that other specialists end up actually seeing most drug complications long before the psychiatrist ever notices them (or anticipates them). For that reason, he is very much for psychopharm for psychologists as we at least would understand our limitations (something many psychiatrists evidently do not) and because we would be required (by law) to consult with the PCP regularly about each patient, there would be both a stronger continuum of care and an ongoing conversation about side effects and things to watch for. His feeling on giving PCPs additional training in psych is that they already have so much to do that it would simply not be possible to load them with that kind of training (nor could they fill the need seeing as their is already a critical shortage of PCPs nationally, not including having to do additional psychiatric care). Basically, he is of the opinion that we need a competent class of mid-level providers who can be trained quickly to fill in this gap. Furthermore, because of programs such as UpToDate that actually do most of the work for doctors in terms of choosing the appropriate medication and looking up potential complications, side effects and drug interactions, it is even more unlikely that the initially limited training of a psychologist would cause improper prescribing. Finally, he has said that such programs as NP and PA programs would be a huge waste of time and be unlikely to train us properly, considering our needs. That is, if you trained as a PA (the shorter of the two for a psychologist, by far), it would take 3 years total (full time -- 2 years for the PA program itself and 1 year for all the pre-req coursework); however, because your courses would be meant for a generalist, you would be ill-suited for actual practice in psychopharm. I'm sure he could go on, but that's the gist of what he told me.
So anyone have any thoughts?
Also... just out of curiosity, anyone know how reimbursement works for medical psychologists? Do they make more than a regular Clinical Psychologist? It would seem that ought to at least make a bit more because of their additional training (and expense). Any salary range guesses? I haven't really seen anything.
P.S.
To clarify, this MD does not think psychiatrists are incompetent. He simply notes that A) their own arguments about why psychologists cannot be trained to effectively prescribe (lack of knowledge of biomed/anatomy/physiology/disease/etc. and unaware of the rest of the body) are largely the same as the complaints that are made by other specialties about psychiatrists (he only brought that up when I brought up the psychiatrists' arguments against Rx for psychologists -- which really just made him laugh) and B) there are far too many people in need of medically-based mental health treatment (as well as psychotherapy) for the number of psychiatrists in most areas of the country (and specifically this state)
I have a couple of questions...
First off, does anyone know of any push in the state of Colorado for psychopharmacology and who a contact person would be for that? I assume CO Psych Assoc. would be the ones to go to for that and I see little activity of any kind on their website, frankly.
I ask this for a couple of reasons. One being that I would like to pursue psychopharm myself and am from "the healthiest state" (at least physically...mental health, on the medical side at least, is a FREAKING JOKE here!)
Secondly, I ask because of the major shortage of psychiatric care here. It is to the point where MDs (non-psychiatrists, at least) are complaining that they have to handle the residual effects of mental health patients not receiving the care they are due and therefore being mismedicated or going unmedicated resulting in suicide attempts, etc. With this in mind, an MD I know well happens to hold an administrative position at a metro-area hospital, does interhospital work, and supervises the training and work of residents and medical researchers. He is willing to write a letter of complaint to our state senators and representatives as well as to CC it to the Colorado Psychological Association, but I would want to make sure such a letter had maximum effect. Any thoughts?
Btw, in terms of psychopharmacology, his feeling is that based on our field's training for psychologists, they are undoubtedly better prepared than any other profession for the diagnosis of mental disease. In addition, many concerns about lack of knowledge of physiology come up here and elsewhere (legitimate concerns, I would say); however, from both his colleagues' and his own experience, psychiatrists go so long without actually using their knowledge of physiology (beyond their limited knowledge of the brain), that other specialists end up actually seeing most drug complications long before the psychiatrist ever notices them (or anticipates them). For that reason, he is very much for psychopharm for psychologists as we at least would understand our limitations (something many psychiatrists evidently do not) and because we would be required (by law) to consult with the PCP regularly about each patient, there would be both a stronger continuum of care and an ongoing conversation about side effects and things to watch for. His feeling on giving PCPs additional training in psych is that they already have so much to do that it would simply not be possible to load them with that kind of training (nor could they fill the need seeing as their is already a critical shortage of PCPs nationally, not including having to do additional psychiatric care). Basically, he is of the opinion that we need a competent class of mid-level providers who can be trained quickly to fill in this gap. Furthermore, because of programs such as UpToDate that actually do most of the work for doctors in terms of choosing the appropriate medication and looking up potential complications, side effects and drug interactions, it is even more unlikely that the initially limited training of a psychologist would cause improper prescribing. Finally, he has said that such programs as NP and PA programs would be a huge waste of time and be unlikely to train us properly, considering our needs. That is, if you trained as a PA (the shorter of the two for a psychologist, by far), it would take 3 years total (full time -- 2 years for the PA program itself and 1 year for all the pre-req coursework); however, because your courses would be meant for a generalist, you would be ill-suited for actual practice in psychopharm. I'm sure he could go on, but that's the gist of what he told me.
So anyone have any thoughts?
Also... just out of curiosity, anyone know how reimbursement works for medical psychologists? Do they make more than a regular Clinical Psychologist? It would seem that ought to at least make a bit more because of their additional training (and expense). Any salary range guesses? I haven't really seen anything.
P.S.
To clarify, this MD does not think psychiatrists are incompetent. He simply notes that A) their own arguments about why psychologists cannot be trained to effectively prescribe (lack of knowledge of biomed/anatomy/physiology/disease/etc. and unaware of the rest of the body) are largely the same as the complaints that are made by other specialties about psychiatrists (he only brought that up when I brought up the psychiatrists' arguments against Rx for psychologists -- which really just made him laugh) and B) there are far too many people in need of medically-based mental health treatment (as well as psychotherapy) for the number of psychiatrists in most areas of the country (and specifically this state)
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Reimbursements are based on insurance codes, so they would receive the same amount as other prescribers. As for salary range....it all depends on the services provided. I'd think it is very job specific, particularly since most psychologists have multiple jobs.
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As a psychiatry resident, I can tell you that using the above arguments based on this psychiatrists opinion is not going to get you very far and will likely hurt your cause. Do you have evidence to support this? Are you sure you're not just going to make the case even stronger that psychologists shouldn't prescribe? From someone who is open minded to psychologists prescribing, I can tell you that this argument is very irritating and actually makes me more skeptical. First, there is no evidence to support that psychiatrists often fail to find side-effects. In fact, I can tell you from my experience and that of many attendings with years of experience how often we get calls from PCP's and psychologists having no idea about the side-effects from the psych meds. It is a common complaint that we on the consult service deal with all the time. Can I add our experience to your letter? But that is just my experience and I don't think making generalizations is helpful. Believe me, I could also tell you some pretty bizarre stories from my experience with some psychologists regarding psychiatric diagnosis, but...I think we can all agree that there are bad people in ANY field and that making generalizations based on anecdotal cases is typically just that--generalizations. I have tremendous respect for psychologists and their training, but some of the arguments that I've heard that use trashing psychiatrists to support their case for prescribing makes me lose interest and respect for their position.
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I agree with Chimed....pursuing prescription privileges should be about meeting a need, and smearing the other side really isn't an honest nor effective approach.
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I agree, but I do not see any reason not to undermine the very arguments psychiatry has used to defeat Rx for psychologists. Have you not read some of the trash they have written? The anecdotal evidence I gave was simply the response of this MD to the arguments I've seen against Rx. His feeling was that most of those same arguments can be used against the very people using them. I'm not saying we ought to smear psychiatrists, but logically, if they are able to prescribe with what other specialists feel is less than current knowledge and/or lack of practice in a specialty requiring knowledge of the whole body, why should someone who is trained for twice the amount of time in psychopathology and has more specific training in terms of psychopharmacology not be prescribing?
Additionally, the thoughts I gave come from a large pool of experience in that doctor's hospital and surrounding hospitals. I understand that to make such an argument requires more than anecdotal evidence and personal experience, but one must start somewhere in order to get some support built up as well as to ask for additional ideas on where to go to push for something to take place here. I think the need is self-evident to the medical community here but to get people going and actually considering Rx for psychologists -- what does that take?
I apologize. I actually had a lot of respect for psychiatrists and considered following that path but meeting with psychiatrists here and hearing their bravado turned me off. Reading their arguments about how psychologists cannot possibly be trained well enough to accept medical responsibilities as well simply reconfirmed that and angers me (and made me complete a pre-med curriculum so I'd have some of what they claim psychologists don't have). I personally want to see psychology training (at all levels -- BA, MA, Ph.D./Psy.D.) take on a more medical model as I don't think our current training really puts us in a good place for psychopharm (among other things) but the attitude of some psychiatrists has made me lose respect for many of them. I agree there are good and bad in every profession.
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Washington, D.C. The American Psychological Associations 2008 State Leadership Conference focused on gaining greater clout for change through lobbying or litigating to protect and expand the purview of psychology.
The big picture in plenary sessions for the roughly 600 in attendance stressed playing a defining role in enacting a national parity law and negotiating with managed care organizations or joining court actions to force them to improve payment rates.
Workshops and breakout groups emphasized the need for strong efforts at the state level, such as lobbying more states to allow psychologists with proper training to prescribe psychotherapeutic drugs and to enhance the image of doctoral psychologists through a revised model licensure act.
Norman Anderson, Ph.D., APAs chief executive officer, drew applause when he pointed out that the U.S. House passed the Paul Wellstone Mental Health Parity Act on March 5, just days before the March 9-12 conference opened.
But it was quickly added that the House version, named for Minnesota Sen. Paul Wellstone who died in a 2002 plane crash, differs considerably from the version passed by the U.S. Senate last September.
The House bill requires health plans to include coverage for substance abuse and all disorders included in the DSM-IV and would preempt state standards that fall short of that. The Senate bill requires only that insurers meet existing state or federal standards of mental health care. A House-Senate conference committee must resolve differences if the bill is to pass this year. The White House supports the scaled-back Senate version.
Both versions call for eliminating many inequities permitted under the Parity Act of 1996, such as requiring higher employee co-pays for mental health treatment or setting lower limits on visits for mental health care than those allowed for medical or surgical procedures.
In the continuing battle with managed care, Randy Phelps, Ph.D., interim executive director of the Practice Directorate, similarly drew applause when he assured that the directorate will continue through all means available to champion a fair wage for those of you who are taking care of the public.
Katherine Nordal, Ph.D., then executive director-designate who now heads the directorate, vowed to continue that battle. I know that practitioners are hurting, Nordal said.
Phelps said bread-and-butter issues, such as payment rates, are the reason psychologists must increase their political presence at both the state and federal level. If you are not part of the decision-making you will always be downstream second-class citizens.
In an RxP workshop, Mario Marquez, Ph.D., president of the American Society for the Advancement of Pharmacotherapy, Division 55, spelled out the long-term goal unequivocally: gaining prescription privileges in all U.S. states and territories. Currently, only two states, Louisiana and Marquez home state of New Mexico, and the territory of Guam grant RxP privileges to psychologists.
Marquez predicted Missouri will approve RxP for psychologists this year and added, Were looking at a couple of other states in 2009. He said Division 55 would send SWAT teams to assist states in their efforts, similar to the January rally in Kansas City that helped Missouri supporters get a majority of Missouri House members to sign on as cosponsors of an RxP bill before it was officially introduced as legislation.
Morgan T. Sammons, Ph.D., dean of the California School of Professional Psychology at Alliant University, who is a prescribing psychologist and a graduate of the Department of Defense Psychophar-macology Demonstration Project, said the medical communitys chief objection to granting prescribing privileges to psychologists that it will jeopardize patient safety is fallacious.
Sammons said the same argument was raised when limited prescription authority was granted in other fields, such as optometry and podiatry, but no problems have ever surfaced. Nobody has ever demonstrated the validity of the patient-safety argument, Sammons said.
Melba J.T. Vasquez, Ph.D., chair of the task force revising the model licensure act, said the task force will probably have one more meeting in the fall and expects to present the final draft to the APA Council in February.
The most controversial element in the proposal is elimination of the exemption that allows non-doctoral school psychologists to use the terms psychologist and psychology.
The exemption was included in the first model act approved in 1955 and was retained in revisions passed in 1967 and 1989, although it was presented as a temporary measure to allow time for masters level school psychologists to upgrade to doctoral status.
The proposed elimination drew fire from the National Association of School Psychologists (NASP) and prompted about 9,000 letters and e-mails in opposition during the task forces period for receiving public comments. Vasquez said about 8,700 of the objections were on a form composed for members by NASP officers.
Tammy L. Hughes, Ph.D., president of the Division of School Psychology, Division 16, said the division opposes the change. Weve asked to retain the exemption, she said.
Hughes said although NASP does not require doctoral degrees the organization has fostered increased standards for school psychologists over the years and most states now require a specialist certification, which involves about two years of training after receiving a masters degree.
Division 16 allows specialist-level school psychologists to join as professional affiliates but NASP has remained the strongest lobbying force for school psychologists.
Hughes said some practicing psychologists feel masters level school psychologists are infringing on their turf because some states, including her home state of Pennsylvania, permit school psychologists to engage in private practice, usually with students or their family members.
Thats a slippery slope, she said.
Ronald Palomares, Ph.D., assistant executive director of the Practice Directorate for policy advocacy in the schools, said eliminating the exemption would at most require a name change for masters level school psychologists, such as licensed specialist in school psychology (LSSP), the designation used in Vasquezs home state of Texas.
Palomares said there are valid pro and con positions on the proposed elimination but even if it is adopted by the APA Council it is up to individual state legislatures to decide whether to follow suit. He said most states that adopt the change likely would grandfather in current school psychologists to let them retain their titles.
It (changing state laws) doesnt happen overnight, Palomares said, pointing out that the 1987 revision of the model act added requirements for continuing education but five states, including New York, still do not require CE credits.
Vasquez said other proposed revisions call for adopting language on RxP privileges, adjusting the recommended education sequence to allow supervised training either before or after receiving a doctoral degree, facilitating mobility among jurisdictions, allowing I/O psychologists to seek licensure to distinguish themselves from non-doctoral workers in the field and including a few tweaks in scope of practice language.
In an aside to the conference, a delegation from New York took the opportunity to hold a closed-door session with top APA officers on concerns that trouble their members.
The agenda for the meeting was hashed out in a one-year study by the New York State Psychological Associations Task Force on the Crisis in Private Practice co-chaired by Frank Goldberg, Ph.D., and Barbara Fontana, Ph.D.
Goldberg said primary concerns center on developing a model approach for a statewide independent practice association to better integrate psychologists with medical care, mounting an effective assault on insurance monopolies that violate antitrust laws to exploit practicing psychologists, pressing for reforms to improve access to health care by eliminating administrative inefficiencies and allying with other organizations with a common interest in health care reform.
Goldberg said the state delegation included NYSPA President Richard Wexler, Ph.D., Past President Dianne Polowczyk, Ph.D., and APA Council Representative Sharon Brennan, Ph.D.
APA officers who met with them included Phelps, Nordal, President Alan Kazdin, President-elect James Bray, Ph.D., Daniel J. Abrahamson, Ph.D., assistant executive director of the Practice Directorate for state advocacy, and Sanford Portnoy, Ph.D., chair of the Committee for the Advancement of Professional Practice (CAPP).
The big picture in plenary sessions for the roughly 600 in attendance stressed playing a defining role in enacting a national parity law and negotiating with managed care organizations or joining court actions to force them to improve payment rates.
Workshops and breakout groups emphasized the need for strong efforts at the state level, such as lobbying more states to allow psychologists with proper training to prescribe psychotherapeutic drugs and to enhance the image of doctoral psychologists through a revised model licensure act.
Norman Anderson, Ph.D., APAs chief executive officer, drew applause when he pointed out that the U.S. House passed the Paul Wellstone Mental Health Parity Act on March 5, just days before the March 9-12 conference opened.
But it was quickly added that the House version, named for Minnesota Sen. Paul Wellstone who died in a 2002 plane crash, differs considerably from the version passed by the U.S. Senate last September.
The House bill requires health plans to include coverage for substance abuse and all disorders included in the DSM-IV and would preempt state standards that fall short of that. The Senate bill requires only that insurers meet existing state or federal standards of mental health care. A House-Senate conference committee must resolve differences if the bill is to pass this year. The White House supports the scaled-back Senate version.
Both versions call for eliminating many inequities permitted under the Parity Act of 1996, such as requiring higher employee co-pays for mental health treatment or setting lower limits on visits for mental health care than those allowed for medical or surgical procedures.
In the continuing battle with managed care, Randy Phelps, Ph.D., interim executive director of the Practice Directorate, similarly drew applause when he assured that the directorate will continue through all means available to champion a fair wage for those of you who are taking care of the public.
Katherine Nordal, Ph.D., then executive director-designate who now heads the directorate, vowed to continue that battle. I know that practitioners are hurting, Nordal said.
Phelps said bread-and-butter issues, such as payment rates, are the reason psychologists must increase their political presence at both the state and federal level. If you are not part of the decision-making you will always be downstream second-class citizens.
In an RxP workshop, Mario Marquez, Ph.D., president of the American Society for the Advancement of Pharmacotherapy, Division 55, spelled out the long-term goal unequivocally: gaining prescription privileges in all U.S. states and territories. Currently, only two states, Louisiana and Marquez home state of New Mexico, and the territory of Guam grant RxP privileges to psychologists.
Marquez predicted Missouri will approve RxP for psychologists this year and added, Were looking at a couple of other states in 2009. He said Division 55 would send SWAT teams to assist states in their efforts, similar to the January rally in Kansas City that helped Missouri supporters get a majority of Missouri House members to sign on as cosponsors of an RxP bill before it was officially introduced as legislation.
Morgan T. Sammons, Ph.D., dean of the California School of Professional Psychology at Alliant University, who is a prescribing psychologist and a graduate of the Department of Defense Psychophar-macology Demonstration Project, said the medical communitys chief objection to granting prescribing privileges to psychologists that it will jeopardize patient safety is fallacious.
Sammons said the same argument was raised when limited prescription authority was granted in other fields, such as optometry and podiatry, but no problems have ever surfaced. Nobody has ever demonstrated the validity of the patient-safety argument, Sammons said.
Melba J.T. Vasquez, Ph.D., chair of the task force revising the model licensure act, said the task force will probably have one more meeting in the fall and expects to present the final draft to the APA Council in February.
The most controversial element in the proposal is elimination of the exemption that allows non-doctoral school psychologists to use the terms psychologist and psychology.
The exemption was included in the first model act approved in 1955 and was retained in revisions passed in 1967 and 1989, although it was presented as a temporary measure to allow time for masters level school psychologists to upgrade to doctoral status.
The proposed elimination drew fire from the National Association of School Psychologists (NASP) and prompted about 9,000 letters and e-mails in opposition during the task forces period for receiving public comments. Vasquez said about 8,700 of the objections were on a form composed for members by NASP officers.
Tammy L. Hughes, Ph.D., president of the Division of School Psychology, Division 16, said the division opposes the change. Weve asked to retain the exemption, she said.
Hughes said although NASP does not require doctoral degrees the organization has fostered increased standards for school psychologists over the years and most states now require a specialist certification, which involves about two years of training after receiving a masters degree.
Division 16 allows specialist-level school psychologists to join as professional affiliates but NASP has remained the strongest lobbying force for school psychologists.
Hughes said some practicing psychologists feel masters level school psychologists are infringing on their turf because some states, including her home state of Pennsylvania, permit school psychologists to engage in private practice, usually with students or their family members.
Thats a slippery slope, she said.
Ronald Palomares, Ph.D., assistant executive director of the Practice Directorate for policy advocacy in the schools, said eliminating the exemption would at most require a name change for masters level school psychologists, such as licensed specialist in school psychology (LSSP), the designation used in Vasquezs home state of Texas.
Palomares said there are valid pro and con positions on the proposed elimination but even if it is adopted by the APA Council it is up to individual state legislatures to decide whether to follow suit. He said most states that adopt the change likely would grandfather in current school psychologists to let them retain their titles.
It (changing state laws) doesnt happen overnight, Palomares said, pointing out that the 1987 revision of the model act added requirements for continuing education but five states, including New York, still do not require CE credits.
Vasquez said other proposed revisions call for adopting language on RxP privileges, adjusting the recommended education sequence to allow supervised training either before or after receiving a doctoral degree, facilitating mobility among jurisdictions, allowing I/O psychologists to seek licensure to distinguish themselves from non-doctoral workers in the field and including a few tweaks in scope of practice language.
In an aside to the conference, a delegation from New York took the opportunity to hold a closed-door session with top APA officers on concerns that trouble their members.
The agenda for the meeting was hashed out in a one-year study by the New York State Psychological Associations Task Force on the Crisis in Private Practice co-chaired by Frank Goldberg, Ph.D., and Barbara Fontana, Ph.D.
Goldberg said primary concerns center on developing a model approach for a statewide independent practice association to better integrate psychologists with medical care, mounting an effective assault on insurance monopolies that violate antitrust laws to exploit practicing psychologists, pressing for reforms to improve access to health care by eliminating administrative inefficiencies and allying with other organizations with a common interest in health care reform.
Goldberg said the state delegation included NYSPA President Richard Wexler, Ph.D., Past President Dianne Polowczyk, Ph.D., and APA Council Representative Sharon Brennan, Ph.D.
APA officers who met with them included Phelps, Nordal, President Alan Kazdin, President-elect James Bray, Ph.D., Daniel J. Abrahamson, Ph.D., assistant executive director of the Practice Directorate for state advocacy, and Sanford Portnoy, Ph.D., chair of the Committee for the Advancement of Professional Practice (CAPP).
Psychologists, in their grandiosity, conflate the title "doctor" with being a real doctor. I believe that the push to gain prescribing priveleges has as much to do with the threats psychologists face, with respect to their monopoly over psychotherapy, from social workers and family therapists.In fact, simply pointing out to psychologists that the curriculum of study in clinical psychology is almost identical to the curriculum of study for Master's level clinicians, is guaranteed to elicit indignation from psychologists and angry denial. Cognitive dissonance is at work: having spent 3 more years (most of it in research) and thousands of dollars more on their educations than Master's level clinicians, its hard for psychologists to accept that they are licensed to do essentially what social workers and family therapists do (with the exception of psychological testing). Add to this the similarities between managed care reimbursement for psychologists and Master's level practitioners, and the push by psychologists to prescribe meds can be seen in a new light. Complications like neuroleptic malignant syndrome and Serotonin syndrome require medical management by a trained physician.
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Wow....quite the classy move.
1. NP/PA would have a similar argument about the years/cost.
2. "medical management" arguments fail at the mid-level argument, and also those are referrals by psychiatry, and not actually handled under their care (with rare exception).
3. "Real doctor"....
. The title of doctor was academic first, and medicine adopted it later on.
1. NP/PA would have a similar argument about the years/cost.
2. "medical management" arguments fail at the mid-level argument, and also those are referrals by psychiatry, and not actually handled under their care (with rare exception).
3. "Real doctor"....
. The title of doctor was academic first, and medicine adopted it later on.- Joined
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I am a child psychiatrist with a very specialized position. I work with great psychologists, counselors, social workers, techs, and MDs everyday in a team format. The work they do is quite good, and we are all friends. I am trained in CBT/ DBT/ Family Therapy, and no one minds if I do therapy as a part of my work since I see the most difficult patients on our census (I'm kind of like a closer in baseball, I love my job!).
I've followed this forum from time to time and I think there are some things that need to be said. I'm just stating my viewpoints here, I'm not upset myself or trying to incite a riot.
Man this is long, but it's off the top of my head. I feel that some of the frustration that the medical community has in the RxP discussion has to do with the issues below. In short, I wish the psychology community would be more transparent about what they want, instead of using the public's lack of understanding to push through legislation with jargon, politics, and sentiment. The following is how I perceive some of the issues in a bare bones straight talk kind of way.
1. Psychologists are underpaid per years of training - enough said but I feel that the economic pressure largely drives the RxP sentiment.
2. There is widespread confusion about the term "Doctor": My history professor was a "doctor" too. I don't mind people calling themselves doctors, but we all know that the public's ignorance about the distinctions are used to the advantage of non MDs. Optometrists and others have played the same angle for gain in the past. The public assumes that since the titles are similar, the training and expertise must be as well. Don't believe me? The term "therapist" has been used in the same way against psychologists by non doctorate level people.
3. Psychologists are more politically active than most - several reasons for this I think. Again, limited compensation on the one hand, threat from non psychologist therapists on the other. In every clinical setting I have worked in, psychologists have been the most sensitive about their "turf." They routinely have political battles with OTs, PTs, speech therapists, substance abuse counselors, family therapists, social workers, etc (just my experience, but I haven't had any issues...whew).
4. There is a lack of standardization in psychology: There is a great deal of variation in any medical specialty. Although MDs get most of the scrutiny for this, no other health related specialty has more stringent standardization criteria (difficulty of getting in to training, training itself, and licensing).
Psychology is at an impasse in someways. Having worked in the private sector and academia, there appears to be a pretty big rift between PsyDs and PhDs. There are fiefdoms and isolated schools of thought, and the variation in quality is more apparent than in nursing or pharmacy, etc. The differences are more akin to a philosophy department in college than a health profession. Some have trained in the Ivy leagues, others have trained ONLINE!
The variation I observe is wider than with MDs (variation is wide enough as it is). I have heard many psychologists from different training backgrounds talk to each other and it's surprising how little overlap there is in their expertise. Don't believe me? Well the evidence is right here in the student doctor psychology forums. Read them for yourself and compare it to some other boards for medical specialties.
There are other issues as well (2/3 of psychology grads are white females, only 5% are minorities). Not exactly the platform for championing public health issues.
5. Training: Though Psychologists and MDs both see mentally ill, the acuity is quite different. I saw more patients in the first two months of my residency (and sicker patients too, ER, psychotic, etc) than many of my psychologists friends did in a year.
All of the difficult cases trickle down (or up) to me in my practice. This has nothing to do with meds. It has to do with the assessment and care of complicated patients. There is a big difference between diagnosing personality disorders or depression and psychosis/ developmental disabilities/ things that don't fit nicely into DSM that I see everyday.
You also can't cherry pick a less acute caseload to give medications to. Those are not the people who are underserved. The underserved in rural and inner city areas are sicker than suburban populations. Look up where most of the psychologists are practicing now. I'll give you a clue, it's not in ERs, or inner cities, or rural areas. Most of the psychologists I know who want prescription privileges have no intention of going anywhere else to meet a mental health need, nor can they even assess (or want to assess) the most complicated patients. Underserved and complicated go hand in hand unfortunately.
I also don't see that psychologists uniformly have any more medical training than MSWs (exception of neuropsychologists who work on stroke units, etc). In fact, some MSW's are more useful to me because they know how to ascertain a person's psychosocial needs and get them resources. It's not like the PhD's I work with have more medical knowledge than the MSW's. They do not. So if Psychologists get RxP, then I don't see why other therapists couldn't.
Finally, some of my psychology friends spend exorbitant amounts of time working on their dissertations, etc. They admit to me, however, that they aren't really becoming better clinicians from it. Actually, many of the therapists I know have already honed their skills in practice and pursue their doctorate mainly to dot "i"s and cross "t"s.
Here's my opinion: I would support making it easier for psychology students to go to medical school and perhaps getting fast tracked in residency somehow since they have therapy training. That would save them a year or so, but maintain quality.
6. Who sets forth the guidelines for training/ practice: Unlike NPs and PAs, who work in close conjunction with physicians, psychologists pretty much want to do govern themselves (write their own boards, set guidelines for their classes). The legislation suggests that psychologist will partner with a primary care physician, but what that means other than the physician being liable for the psychologist's possible mistakes is unclear. That's the difference between the psychologist RxP and NPs/ PAs.
Not the best of analogies, but imagine if a bunch of dentists decide they are going to do what ENT surgeons do. They don't get approval from the medical community but go on creating their own training and boards. Since they both work on the face (and are both doctors), they convince lay people that the shortage of ENT surgeons make it necessary for dentists to broaden their scope of practice. No one on the board of dentists is an ENT. There are so many things that are wrong with this scenario. You can substitute MSW's for dentists and psychologists for ENTs and you'll see what I mean (a governing MSW body that gets to decide who becomes a psychologist... crazy).
The inability of the American Psychological Association to partner with the medical community (like NPs and PAs have done) will continue to be a sore. I think there was a surgeon who was married to a psychologist who spoke at one of the state legislatures giving his approval, but that's like me giving approval for PAs to do surgery.
It's always easier to think that you can do something if you have no or limited experience in it. Many people think this way about therapy (it's actually harder than it looks) and things like abstract art (anyone could do that, right?).
7. Safety is not efficacy: This is a big one. Any person can dabble in low dosages of antidepressants etc. A safe clinician and a good clinician are two different things.
Consider this - hospital A is a top notch academic trauma center and hospital B is a suburban "mom and pop" outfit. Hospital B has a lower mortality rate than hospital A. Does this prove that Hospital B is just as good as Hospital A? Absolutely not. Although safety is important, it is a misleading statistic and we all know it. Since mental health patients don't die in the way that patients in other specialties do, it may be convenient to assume that safety means giving people good service. It doesn't.
8. Underserved argument is deceitful: It's not because there isn't a shortage. It's because psychologists are using a contingency argument to support permanent changes in their guild. If Psychology RxP gains momentum in the name of the underserved , but we suddenly have plenty of psychiatrists, will the psychologist give up their prescriptive privileges? No! So say what you mean. Psychologists are in favor of widening their guild scope of practice, regardless of need.
As an aside, Step brothers is a truly stupid movie. That's what I was watching as I was typing this
My bottomline and advice for students - be great at what you do. Then you won't be so concerned about guild issues in the first place.
I've followed this forum from time to time and I think there are some things that need to be said. I'm just stating my viewpoints here, I'm not upset myself or trying to incite a riot.
Man this is long, but it's off the top of my head. I feel that some of the frustration that the medical community has in the RxP discussion has to do with the issues below. In short, I wish the psychology community would be more transparent about what they want, instead of using the public's lack of understanding to push through legislation with jargon, politics, and sentiment. The following is how I perceive some of the issues in a bare bones straight talk kind of way.
1. Psychologists are underpaid per years of training - enough said but I feel that the economic pressure largely drives the RxP sentiment.
2. There is widespread confusion about the term "Doctor": My history professor was a "doctor" too. I don't mind people calling themselves doctors, but we all know that the public's ignorance about the distinctions are used to the advantage of non MDs. Optometrists and others have played the same angle for gain in the past. The public assumes that since the titles are similar, the training and expertise must be as well. Don't believe me? The term "therapist" has been used in the same way against psychologists by non doctorate level people.
3. Psychologists are more politically active than most - several reasons for this I think. Again, limited compensation on the one hand, threat from non psychologist therapists on the other. In every clinical setting I have worked in, psychologists have been the most sensitive about their "turf." They routinely have political battles with OTs, PTs, speech therapists, substance abuse counselors, family therapists, social workers, etc (just my experience, but I haven't had any issues...whew).
4. There is a lack of standardization in psychology: There is a great deal of variation in any medical specialty. Although MDs get most of the scrutiny for this, no other health related specialty has more stringent standardization criteria (difficulty of getting in to training, training itself, and licensing).
Psychology is at an impasse in someways. Having worked in the private sector and academia, there appears to be a pretty big rift between PsyDs and PhDs. There are fiefdoms and isolated schools of thought, and the variation in quality is more apparent than in nursing or pharmacy, etc. The differences are more akin to a philosophy department in college than a health profession. Some have trained in the Ivy leagues, others have trained ONLINE!
The variation I observe is wider than with MDs (variation is wide enough as it is). I have heard many psychologists from different training backgrounds talk to each other and it's surprising how little overlap there is in their expertise. Don't believe me? Well the evidence is right here in the student doctor psychology forums. Read them for yourself and compare it to some other boards for medical specialties.
There are other issues as well (2/3 of psychology grads are white females, only 5% are minorities). Not exactly the platform for championing public health issues.
5. Training: Though Psychologists and MDs both see mentally ill, the acuity is quite different. I saw more patients in the first two months of my residency (and sicker patients too, ER, psychotic, etc) than many of my psychologists friends did in a year.
All of the difficult cases trickle down (or up) to me in my practice. This has nothing to do with meds. It has to do with the assessment and care of complicated patients. There is a big difference between diagnosing personality disorders or depression and psychosis/ developmental disabilities/ things that don't fit nicely into DSM that I see everyday.
You also can't cherry pick a less acute caseload to give medications to. Those are not the people who are underserved. The underserved in rural and inner city areas are sicker than suburban populations. Look up where most of the psychologists are practicing now. I'll give you a clue, it's not in ERs, or inner cities, or rural areas. Most of the psychologists I know who want prescription privileges have no intention of going anywhere else to meet a mental health need, nor can they even assess (or want to assess) the most complicated patients. Underserved and complicated go hand in hand unfortunately.
I also don't see that psychologists uniformly have any more medical training than MSWs (exception of neuropsychologists who work on stroke units, etc). In fact, some MSW's are more useful to me because they know how to ascertain a person's psychosocial needs and get them resources. It's not like the PhD's I work with have more medical knowledge than the MSW's. They do not. So if Psychologists get RxP, then I don't see why other therapists couldn't.
Finally, some of my psychology friends spend exorbitant amounts of time working on their dissertations, etc. They admit to me, however, that they aren't really becoming better clinicians from it. Actually, many of the therapists I know have already honed their skills in practice and pursue their doctorate mainly to dot "i"s and cross "t"s.
Here's my opinion: I would support making it easier for psychology students to go to medical school and perhaps getting fast tracked in residency somehow since they have therapy training. That would save them a year or so, but maintain quality.
6. Who sets forth the guidelines for training/ practice: Unlike NPs and PAs, who work in close conjunction with physicians, psychologists pretty much want to do govern themselves (write their own boards, set guidelines for their classes). The legislation suggests that psychologist will partner with a primary care physician, but what that means other than the physician being liable for the psychologist's possible mistakes is unclear. That's the difference between the psychologist RxP and NPs/ PAs.
Not the best of analogies, but imagine if a bunch of dentists decide they are going to do what ENT surgeons do. They don't get approval from the medical community but go on creating their own training and boards. Since they both work on the face (and are both doctors), they convince lay people that the shortage of ENT surgeons make it necessary for dentists to broaden their scope of practice. No one on the board of dentists is an ENT. There are so many things that are wrong with this scenario. You can substitute MSW's for dentists and psychologists for ENTs and you'll see what I mean (a governing MSW body that gets to decide who becomes a psychologist... crazy).
The inability of the American Psychological Association to partner with the medical community (like NPs and PAs have done) will continue to be a sore. I think there was a surgeon who was married to a psychologist who spoke at one of the state legislatures giving his approval, but that's like me giving approval for PAs to do surgery.
It's always easier to think that you can do something if you have no or limited experience in it. Many people think this way about therapy (it's actually harder than it looks) and things like abstract art (anyone could do that, right?).
7. Safety is not efficacy: This is a big one. Any person can dabble in low dosages of antidepressants etc. A safe clinician and a good clinician are two different things.
Consider this - hospital A is a top notch academic trauma center and hospital B is a suburban "mom and pop" outfit. Hospital B has a lower mortality rate than hospital A. Does this prove that Hospital B is just as good as Hospital A? Absolutely not. Although safety is important, it is a misleading statistic and we all know it. Since mental health patients don't die in the way that patients in other specialties do, it may be convenient to assume that safety means giving people good service. It doesn't.
8. Underserved argument is deceitful: It's not because there isn't a shortage. It's because psychologists are using a contingency argument to support permanent changes in their guild. If Psychology RxP gains momentum in the name of the underserved , but we suddenly have plenty of psychiatrists, will the psychologist give up their prescriptive privileges? No! So say what you mean. Psychologists are in favor of widening their guild scope of practice, regardless of need.
As an aside, Step brothers is a truly stupid movie. That's what I was watching as I was typing this
My bottomline and advice for students - be great at what you do. Then you won't be so concerned about guild issues in the first place.
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Since there are so many "schools of thought" in psychology in comparison with medical science, how do you think each one will "merge" their thought with pharmacology?
I actually agree with the majority of what you said Doctor J, but there are a couple of your points I want to address (numbers reflect your points)
2) Obviously, everyone is responsible for clarifying their actual training to patients. Psychologists have used the title doctor in hospitals for a very long time, though it would have added importance of clarifying in a RxP situation as there could be more confusion. To be fair though, we had the title "doctor" first Also - I'm not sure I see terribly much benefit to RxP in those settings in the first place, especially inpatient settings. I'm not a huge proponent, but I can see a case made for managing simple cases in rural areas so someone doesn't have to drive 200 miles to get a refill on their SSRI. That said, as you mentioned below, I too doubt that is REALLY the motivation for many (though not all) of its proponents.
3) Have to completely disagree. I think we're a political disaster, and RxP doesn't have widespread support even among the psychology community.
4) Yup, spot on. People already know my views on this matter so I won't get into it
5) Couple points here. For one, I think comparing number of patients seen is tremendously flawed - given the nature of what people are doing with the patient (therapy versus prescribing), one would need to compare actual patient contact hours. I'll also say if the psychologists you work with don't want to assess complicated cases, that is a function of those individuals. Assessment is a huge part of psychology training, and should be pretty intensive for those who want to work in clinical settings. I think all too often you are correct that psychologists don't get more medical training, but I think this is rapidly changing. Neuroscience, genetics, etc. are definitely part of my training, and its quite rare in social workers. Certainly not as extensive as it should be though.
As for the dissertation - the benefit one gets really depends on the individual. If people are focusing on clinical work, they should be doing a very clinically-oriented dissertation (e.g. treatment study focused on their specialty disorder). A lot of people treat it like a "hurdle" but I actually think that's the problem. If you have to do it anyways, you might as well do something you'll benefit from.
6) I made the point earlier in this thread that if RxP is going to happen, APA and AMA should be working together. Alas, people on both sides have been immature and frankly, idiotic about the whole thing. Such is politics.
Your last line is key, and pretty much what it all boils down to.
2) Obviously, everyone is responsible for clarifying their actual training to patients. Psychologists have used the title doctor in hospitals for a very long time, though it would have added importance of clarifying in a RxP situation as there could be more confusion. To be fair though, we had the title "doctor" first
Also - I'm not sure I see terribly much benefit to RxP in those settings in the first place, especially inpatient settings. I'm not a huge proponent, but I can see a case made for managing simple cases in rural areas so someone doesn't have to drive 200 miles to get a refill on their SSRI. That said, as you mentioned below, I too doubt that is REALLY the motivation for many (though not all) of its proponents.3) Have to completely disagree. I think we're a political disaster, and RxP doesn't have widespread support even among the psychology community.
4) Yup, spot on. People already know my views on this matter so I won't get into it
5) Couple points here. For one, I think comparing number of patients seen is tremendously flawed - given the nature of what people are doing with the patient (therapy versus prescribing), one would need to compare actual patient contact hours. I'll also say if the psychologists you work with don't want to assess complicated cases, that is a function of those individuals. Assessment is a huge part of psychology training, and should be pretty intensive for those who want to work in clinical settings. I think all too often you are correct that psychologists don't get more medical training, but I think this is rapidly changing. Neuroscience, genetics, etc. are definitely part of my training, and its quite rare in social workers. Certainly not as extensive as it should be though.
As for the dissertation - the benefit one gets really depends on the individual. If people are focusing on clinical work, they should be doing a very clinically-oriented dissertation (e.g. treatment study focused on their specialty disorder). A lot of people treat it like a "hurdle" but I actually think that's the problem. If you have to do it anyways, you might as well do something you'll benefit from.
6) I made the point earlier in this thread that if RxP is going to happen, APA and AMA should be working together. Alas, people on both sides have been immature and frankly, idiotic about the whole thing. Such is politics.
Your last line is key, and pretty much what it all boils down to.
I am a child psychiatrist with a very specialized position. I work with great psychologists, counselors, social workers, techs, and MDs everyday in a team format. The work they do is quite good, and we are all friends. I am trained in CBT/ DBT/ Family Therapy, and no one minds if I do therapy as a part of my work since I see the most difficult patients on our census (I'm kind of like a closer in baseball, I love my job!).
so, let's get this straight -- you want to do what a psychologist is expert in (psychotherapy) but you do not want psychologists to do anything that infringes on your scope of practice? furthermore, learning therapy, especially with difficult patients (bordelines in particular) is a full-time job....many phd programs teach one modality of therapy for 4 or more years... i love it when psychiatirists say that they know all these modalities of therapy. i have worked in three separate medical schools and have seen what therapy training entails for residents...a year or so of one-hour didactics and a year or so of cursory supervision by a phd... there are post-doc training opportunities for things like dbt but few psychiatrists take advantage of them. however, they still want to practice therapy without the benefit of this intensive training. but, when a phd wants to prescribe meds with a post-doc master's, they scream, "foul!" seems hypocritical to me...
I've followed this forum from time to time and I think there are some things that need to be said. I'm just stating my viewpoints here, I'm not upset myself or trying to incite a riot.
Man this is long, but it's off the top of my head. I feel that some of the frustration that the medical community has in the RxP discussion has to do with the issues below. In short, I wish the psychology community would be more transparent about what they want, instead of using the public's lack of understanding to push through legislation with jargon, politics, and sentiment. The following is how I perceive some of the issues in a bare bones straight talk kind of way.
1. Psychologists are underpaid per years of training - enough said but I feel that the economic pressure largely drives the RxP sentiment.
2. There is widespread confusion about the term "Doctor": My history professor was a "doctor" too. I don't mind people calling themselves doctors, but we all know that the public's ignorance about the distinctions are used to the advantage of non MDs. Optometrists and others have played the same angle for gain in the past. The public assumes that since the titles are similar, the training and expertise must be as well. Don't believe me? The term "therapist" has been used in the same way against psychologists by non doctorate level people.
you are assuming that psychologists try to mislead people into thinking that they are psychiatrists....why would we want to impersonate a profession that is actually much easier to enter into than our own? it is common knowledge that psychiatry can't fill its own residency slots and has to recruit many, many (if not most) of its residents from third world countries. in fact, i have worked at 3 medical schools, 2 of which are upper tier, and all but one of the psychiatry residents and fellows @ these schools went to med schools in the third world. one of the psychiatrists told us that there is less and less demand for psychiatry residencies and that he regretted the decline of the profession.... on the other hand, psychology internships are very competitive -- 600 people this year alone will be unmatched. to top it off, it is much harder to gain entranse into a good psychology phd or psyd program than to gain entrance into a medical school. you can look at the stats if you want proof i think psychiatrists should be wanting to impersonateus.
3. Psychologists are more politically active than most - several reasons for this I think. Again, limited compensation on the one hand, threat from non psychologist therapists on the other. In every clinical setting I have worked in, psychologists have been the most sensitive about their "turf." They routinely have political battles with OTs, PTs, speech therapists, substance abuse counselors, family therapists, social workers, etc (just my experience, but I haven't had any issues...whew).
wrong -- psychologists are among the least active health professionals politically. do research before you make such outlandish arguments
4. There is a lack of standardization in psychology: There is a great deal of variation in any medical specialty. Although MDs get most of the scrutiny for this, no other health related specialty has more stringent standardization criteria (difficulty of getting in to training, training itself, and licensing).
Psychology is at an impasse in someways. Having worked in the private sector and academia, there appears to be a pretty big rift between PsyDs and PhDs. There are fiefdoms and isolated schools of thought, and the variation in quality is more apparent than in nursing or pharmacy, etc. The differences are more akin to a philosophy department in college than a health profession. Some have trained in the Ivy leagues, others have trained ONLINE!
there is only one on-line accredited school in clinical psychology, and i seriously doubt that anybody from it is teaching in the ivy leagues. i looked at all the ivy's before posting, and did not see anybody from fielding institute, the on-line school to which you are referring, teaching at any of them. can you give me a name of this person? you are either misinformed or prevaricating...
on top of all this, what is so bad about on-line training?? why don't you look at your profession and look at all the people who attend medical schools located in the third world? i can tell you that many, if not most, people in psychiatry went to schools in india, pakistan, the philippines. most medical specialties shun people who go to caribbean medical schools, but psychiatry openly welcomes people from schools which have far worse reputations... why? because nobody wants to go into psychiatry.
The variation I observe is wider than with MDs (variation is wide enough as it is). I have heard many psychologists from different training backgrounds talk to each other and it's surprising how little overlap there is in their expertise. Don't believe me? Well the evidence is right here in the student doctor psychology forums. Read them for yourself and compare it to some other boards for medical specialties.
you're right in ackowledging that psychiatrists also have schisms.. some are psychodynamic, others biological, etc.... so what? the bottom line is that psychologists may have different points of view, but most of these views are empirically supported...'many roads lead to rome" In other words, there are many different etiologies and efficacious treatments for a single disorder
There are other issues as well (2/3 of psychology grads are white females, only 5% are minorities). Not exactly the platform for championing public health issues.
so what??? many psychiatrists are from india and pakistan? are they seeing only indians and pakistanis??? your arguments are outrageous!
5.
Training: Though Psychologists and MDs both see mentally ill, the acuity is quite different. I saw more patients in the first two months of my residency (and sicker patients too, ER, psychotic, etc) than many of my psychologists friends did in a year.
All of the difficult cases trickle down (or up) to me in my practice. This has nothing to do with meds. It has to do with the assessment and care of complicated patients. There is a big difference between diagnosing personality disorders or depression and psychosis/ developmental disabilities/ things that don't fit nicely into DSM that I see everyday.
psychologists have more training in the diagnosis and assessment of mental illness than any other health profession.and that include psychiatrists... so why would someone from a profession with less training in assessment be seeing the more difficult patients? from the many med schools i have worked at, psychologists are the go-to people on difficult cases... this is because other health professions know that we have the most training centered on mental illness
so, let's get this straight -- you want to do what a psychologist is expert in (psychotherapy) but you do not want psychologists to do anything that infringes on your scope of practice? furthermore, learning therapy, especially with difficult patients (bordelines in particular) is a full-time job....many phd programs teach one modality of therapy for 4 or more years... i love it when psychiatirists say that they know all these modalities of therapy. i have worked in three separate medical schools and have seen what therapy training entails for residents...a year or so of one-hour didactics and a year or so of cursory supervision by a phd... there are post-doc training opportunities for things like dbt but few psychiatrists take advantage of them. however, they still want to practice therapy without the benefit of this intensive training. but, when a phd wants to prescribe meds with a post-doc master's, they scream, "foul!" seems hypocritical to me...
I've followed this forum from time to time and I think there are some things that need to be said. I'm just stating my viewpoints here, I'm not upset myself or trying to incite a riot.
Man this is long, but it's off the top of my head. I feel that some of the frustration that the medical community has in the RxP discussion has to do with the issues below. In short, I wish the psychology community would be more transparent about what they want, instead of using the public's lack of understanding to push through legislation with jargon, politics, and sentiment. The following is how I perceive some of the issues in a bare bones straight talk kind of way.
1. Psychologists are underpaid per years of training - enough said but I feel that the economic pressure largely drives the RxP sentiment.
2. There is widespread confusion about the term "Doctor": My history professor was a "doctor" too. I don't mind people calling themselves doctors, but we all know that the public's ignorance about the distinctions are used to the advantage of non MDs. Optometrists and others have played the same angle for gain in the past. The public assumes that since the titles are similar, the training and expertise must be as well. Don't believe me? The term "therapist" has been used in the same way against psychologists by non doctorate level people.
you are assuming that psychologists try to mislead people into thinking that they are psychiatrists....why would we want to impersonate a profession that is actually much easier to enter into than our own? it is common knowledge that psychiatry can't fill its own residency slots and has to recruit many, many (if not most) of its residents from third world countries. in fact, i have worked at 3 medical schools, 2 of which are upper tier, and all but one of the psychiatry residents and fellows @ these schools went to med schools in the third world. one of the psychiatrists told us that there is less and less demand for psychiatry residencies and that he regretted the decline of the profession.... on the other hand, psychology internships are very competitive -- 600 people this year alone will be unmatched. to top it off, it is much harder to gain entranse into a good psychology phd or psyd program than to gain entrance into a medical school. you can look at the stats if you want proof i think psychiatrists should be wanting to impersonateus.
3. Psychologists are more politically active than most - several reasons for this I think. Again, limited compensation on the one hand, threat from non psychologist therapists on the other. In every clinical setting I have worked in, psychologists have been the most sensitive about their "turf." They routinely have political battles with OTs, PTs, speech therapists, substance abuse counselors, family therapists, social workers, etc (just my experience, but I haven't had any issues...whew).
wrong -- psychologists are among the least active health professionals politically. do research before you make such outlandish arguments
4. There is a lack of standardization in psychology: There is a great deal of variation in any medical specialty. Although MDs get most of the scrutiny for this, no other health related specialty has more stringent standardization criteria (difficulty of getting in to training, training itself, and licensing).
Psychology is at an impasse in someways. Having worked in the private sector and academia, there appears to be a pretty big rift between PsyDs and PhDs. There are fiefdoms and isolated schools of thought, and the variation in quality is more apparent than in nursing or pharmacy, etc. The differences are more akin to a philosophy department in college than a health profession. Some have trained in the Ivy leagues, others have trained ONLINE!
there is only one on-line accredited school in clinical psychology, and i seriously doubt that anybody from it is teaching in the ivy leagues. i looked at all the ivy's before posting, and did not see anybody from fielding institute, the on-line school to which you are referring, teaching at any of them. can you give me a name of this person? you are either misinformed or prevaricating...
on top of all this, what is so bad about on-line training?? why don't you look at your profession and look at all the people who attend medical schools located in the third world? i can tell you that many, if not most, people in psychiatry went to schools in india, pakistan, the philippines. most medical specialties shun people who go to caribbean medical schools, but psychiatry openly welcomes people from schools which have far worse reputations... why? because nobody wants to go into psychiatry.
The variation I observe is wider than with MDs (variation is wide enough as it is). I have heard many psychologists from different training backgrounds talk to each other and it's surprising how little overlap there is in their expertise. Don't believe me? Well the evidence is right here in the student doctor psychology forums. Read them for yourself and compare it to some other boards for medical specialties.
you're right in ackowledging that psychiatrists also have schisms.. some are psychodynamic, others biological, etc.... so what? the bottom line is that psychologists may have different points of view, but most of these views are empirically supported...'many roads lead to rome" In other words, there are many different etiologies and efficacious treatments for a single disorder
There are other issues as well (2/3 of psychology grads are white females, only 5% are minorities). Not exactly the platform for championing public health issues.
so what??? many psychiatrists are from india and pakistan? are they seeing only indians and pakistanis??? your arguments are outrageous!
5.
Training: Though Psychologists and MDs both see mentally ill, the acuity is quite different. I saw more patients in the first two months of my residency (and sicker patients too, ER, psychotic, etc) than many of my psychologists friends did in a year.
All of the difficult cases trickle down (or up) to me in my practice. This has nothing to do with meds. It has to do with the assessment and care of complicated patients. There is a big difference between diagnosing personality disorders or depression and psychosis/ developmental disabilities/ things that don't fit nicely into DSM that I see everyday.
psychologists have more training in the diagnosis and assessment of mental illness than any other health profession.and that include psychiatrists... so why would someone from a profession with less training in assessment be seeing the more difficult patients? from the many med schools i have worked at, psychologists are the go-to people on difficult cases... this is because other health professions know that we have the most training centered on mental illness
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oh, and one more thing, you said that most rxp psychologists are not in rural areas. below is a list of all rxp psychologists in new mexico.. all but one or two are located in rural areas...
Lic # License Type Location
William Bernstein, Ph.D 0012C RxP Conditional Prescription Santa Fe, NM
Steven M. Cobb, Ph.D. 0005C RxP Conditional Prescription Roswell, NM
Rosalie S. Davis, Ph.D. 0008C RxP Conditional Prescription Albuquerque, NM
Marlin C. Hoover, Ph.D. 0007C RxP Conditional Prescription Flossmoor, IL
C. Alan Hopewell, Ph.D. 0009C RxP Conditional Prescription Fort Worth, TX
Stuart S. Kelter, Psy.D. 0004C RxP Conditional Prescription Las Cruces, NM
Elaine Levine, Ph.D. 0001 RxP Prescription Certificate Las Cruces, NM
James M. Mash, Ph.D. 0013C RxP Conditional Prescription Taos, NM
Robert C. Mayfield, Ph.D. 0010C RxP Conditional Prescription Las Cruces, NM
E. Mario Marquez, Ph.D. 0002 RxP Prescription Certificate Albuquerque, NM
Robert E. Sherrill, Jr., Ph.D. 0011C RxP Conditional Prescription Farmington, NM
Soterios J. Soter, Ph.D. 0006C RxP Conditional Prescription Evanston, IL
Thomas C. Thompson, Ph.D. 0003 RxP Prescription Certificate Las Cruces, NM
Marianne G. Westbrook 0014C RxP Conditional Prescription Hobbs, NM c..
Lic # License Type Location
William Bernstein, Ph.D 0012C RxP Conditional Prescription Santa Fe, NM
Steven M. Cobb, Ph.D. 0005C RxP Conditional Prescription Roswell, NM
Rosalie S. Davis, Ph.D. 0008C RxP Conditional Prescription Albuquerque, NM
Marlin C. Hoover, Ph.D. 0007C RxP Conditional Prescription Flossmoor, IL
C. Alan Hopewell, Ph.D. 0009C RxP Conditional Prescription Fort Worth, TX
Stuart S. Kelter, Psy.D. 0004C RxP Conditional Prescription Las Cruces, NM
Elaine Levine, Ph.D. 0001 RxP Prescription Certificate Las Cruces, NM
James M. Mash, Ph.D. 0013C RxP Conditional Prescription Taos, NM
Robert C. Mayfield, Ph.D. 0010C RxP Conditional Prescription Las Cruces, NM
E. Mario Marquez, Ph.D. 0002 RxP Prescription Certificate Albuquerque, NM
Robert E. Sherrill, Jr., Ph.D. 0011C RxP Conditional Prescription Farmington, NM
Soterios J. Soter, Ph.D. 0006C RxP Conditional Prescription Evanston, IL
Thomas C. Thompson, Ph.D. 0003 RxP Prescription Certificate Las Cruces, NM
Marianne G. Westbrook 0014C RxP Conditional Prescription Hobbs, NM c..
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- Reaction score
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Wow, I just want everyone to know that I didn't want this to get ugly. Your arguments are all pretty much "I'm better than you, psychology > psychiatry who are all accented foreigners." You don't have to have complex about this. Childish but I'll egg you on for fun. Most of my comments are directed to Edeib alone, thanks. Ollie, thanks for your reply. I am less concerned about who was a "doctor" first. I'm happy to go by physician or my first name. I am merely implying that if you went to a layperson and said doctor, they think MD, that's all. Not debating whether that is right, wrong, or fair.
You know Edieb, some of your statements border on racist. Would you be comfortable if I used some your statements elsewhere to see how it is received? I knew someone would be baited to throwing in the foreign medical grad argument. Looks like I struck a nerve with you. We live in a global community and it is psychology that is still stuck in a Western hemisphere dogma. 2/3 white female graduates and 95% white are psychology statistics. Those are the statistics out of line in today's society my friend.
Internal medicine and Neurology actually have more foreign medical graduates than psychiatry. And there are many specialties that don't match. It is a mistake to assume that people from India and Pakistan are inferior to you because they have an accent, which anyone reading your post will assume you are doing.
How do you come off saying that psychology is more difficult to get into? What are you smoking? I'm not going to disclose personal info, but I'd gladly put my credentials/ training against yours (or any med student vs psychology grad student). You know, PT applicants get into PT school at a lower rate than medical students. That doesn't mean PT is a more difficult specialty either. You should know better. Even the foreign medical graduates have to pass the same boards as every other MD.
What kind of med schools have you worked at exactly? I didn't have 1 hour courses as you suggest in therapy, but psychologists were NOT THE GO TO PERSON. More like armchair quarterback for less acute cases, hand off to me when they can't handle it...easy now. If the psychologists were the go to person, they wouldn't have recruited me for my job (and it has everything to do with assessment and treatment, not meds thank you, they had other MDs on board for that). On the other hand, during my 6 years of training post med school, I didn't see a single psychologist in the ER, not once. I worked mostly with social workers on acute units, the psychologists surface in research trials and outpatient clinics. I also didn't suggest that the online persons (maybe it was long distance, whatever the case) taught at Ivy league schools. Where did you get that? And what's wrong with online? Let me ask you this. Would you trust an MD who got their doctorate online?
I don't oppose psychologists prescribing. I oppose their tactics and means. So does NAMI and AMA. There are already avenues available for psychologists to be mid level prescribers if they want. The pharm companies support you though, if that's consolation. Again, the American Psychological Association's inability to partner with the medical community will be more detrimental than you think to the mental health field in general. The negative tone of your reply only validates everyone's concerns about RxP and its proponents. I was merely asking people to be more transparent (more money, not about underserved, etc etc).
You know Edieb, some of your statements border on racist. Would you be comfortable if I used some your statements elsewhere to see how it is received? I knew someone would be baited to throwing in the foreign medical grad argument. Looks like I struck a nerve with you. We live in a global community and it is psychology that is still stuck in a Western hemisphere dogma. 2/3 white female graduates and 95% white are psychology statistics. Those are the statistics out of line in today's society my friend.
Internal medicine and Neurology actually have more foreign medical graduates than psychiatry. And there are many specialties that don't match. It is a mistake to assume that people from India and Pakistan are inferior to you because they have an accent, which anyone reading your post will assume you are doing.
How do you come off saying that psychology is more difficult to get into? What are you smoking? I'm not going to disclose personal info, but I'd gladly put my credentials/ training against yours (or any med student vs psychology grad student). You know, PT applicants get into PT school at a lower rate than medical students. That doesn't mean PT is a more difficult specialty either. You should know better. Even the foreign medical graduates have to pass the same boards as every other MD.
What kind of med schools have you worked at exactly? I didn't have 1 hour courses as you suggest in therapy, but psychologists were NOT THE GO TO PERSON. More like armchair quarterback for less acute cases, hand off to me when they can't handle it...easy now. If the psychologists were the go to person, they wouldn't have recruited me for my job (and it has everything to do with assessment and treatment, not meds thank you, they had other MDs on board for that). On the other hand, during my 6 years of training post med school, I didn't see a single psychologist in the ER, not once. I worked mostly with social workers on acute units, the psychologists surface in research trials and outpatient clinics. I also didn't suggest that the online persons (maybe it was long distance, whatever the case) taught at Ivy league schools. Where did you get that? And what's wrong with online? Let me ask you this. Would you trust an MD who got their doctorate online?
I don't oppose psychologists prescribing. I oppose their tactics and means. So does NAMI and AMA. There are already avenues available for psychologists to be mid level prescribers if they want. The pharm companies support you though, if that's consolation. Again, the American Psychological Association's inability to partner with the medical community will be more detrimental than you think to the mental health field in general. The negative tone of your reply only validates everyone's concerns about RxP and its proponents. I was merely asking people to be more transparent (more money, not about underserved, etc etc).
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don't throw the race card in here; i am a pakistani, so i don't think i would be racist against persons from my own country of origin. however, it is an undisputed fact that the AMA attempts to fill the vast majority of its residency slots with american medical graduates. specialties that are less competitive are filled with foreign medical students. is that racist, too? you are trying to throw the race card in to divert attention from your disinformation. i notice you didnt comment on how all or most rxp psychologists would be located in rural areas after i showed the list of where the actual medical psychologists are.
i also caught you again. nami is not against prescribing psychologists. here is nami's policy statement (from their website):
Based on the information and evidence obtained at the Task Force meeting and in preparing this report, staff believe that it would not be appropriate at this time for NAMI to adopt a position in support of state legislation allowing prescribing privileges for psychologists.
i also asked you what the name of the psychologist who graduated from an on-line program who was who is teaching at an ivy league school, but i notice you didn't supply it. please back up what you write or don't write it at all...
i also caught you again. nami is not against prescribing psychologists. here is nami's policy statement (from their website):
Based on the information and evidence obtained at the Task Force meeting and in preparing this report, staff believe that it would not be appropriate at this time for NAMI to adopt a position in support of state legislation allowing prescribing privileges for psychologists.
i also asked you what the name of the psychologist who graduated from an on-line program who was who is teaching at an ivy league school, but i notice you didn't supply it. please back up what you write or don't write it at all...
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"name of the psychologist who graduated from an on-line program who was who is teaching at an ivy league school..."
I never said that. Please read my post accurately before losing your cool. Your therapist would disapprove. You know, I've read some of your other posts and you are indeed an angry angry person. What gives?
Just because you are Pakistani doesn't mean you can't be racist or better yet classist. I don't know how anyone else would interpret your "third world" remarks. Why don't you say that at your work or in public tomorrow and see what happens.
Some of my colleagues in training talked about the stigma of going into a mental health specialty (american grads, smart, good grades) that was intensified by their south asian culture. This is not talked about widely but it's there. Since you are Pakistani, perhaps your fixation with the foreign medical issue has more to do with your cultural context than anything else ("not a real doctor...why didn't you become a cardiologist like your brother/ sister/ cousin...those are some of the quotes I've heard).
Look, NM is a rural area. Half of those people work in decently populated cities for that state. Another in fort worth and Evanston? Not underserved. Are you suggesting that the only reason psychologists aren't in underserved areas is because they can't prescribe?
You really got me good with the NAMI thing. Next time, I will differentiate between not supporting and against. Well played sir or madam, well played.
Don't be angry Edieb, it doesn't help the cause. I'm not here to get into an argument. I have a good life and I'm very busy. I hardly ever post anything. Wife was away for the weekend, and I was posting between football games and movies. Not a big deal. I do stand by what I said though. What makes you angry perhaps, is that many of your colleagues would agree with what I did post. Have a nice life, try to smile.
I never said that. Please read my post accurately before losing your cool. Your therapist would disapprove. You know, I've read some of your other posts and you are indeed an angry angry person. What gives?
Just because you are Pakistani doesn't mean you can't be racist or better yet classist. I don't know how anyone else would interpret your "third world" remarks. Why don't you say that at your work or in public tomorrow and see what happens.
Some of my colleagues in training talked about the stigma of going into a mental health specialty (american grads, smart, good grades) that was intensified by their south asian culture. This is not talked about widely but it's there. Since you are Pakistani, perhaps your fixation with the foreign medical issue has more to do with your cultural context than anything else ("not a real doctor...why didn't you become a cardiologist like your brother/ sister/ cousin...those are some of the quotes I've heard).
Look, NM is a rural area. Half of those people work in decently populated cities for that state. Another in fort worth and Evanston? Not underserved. Are you suggesting that the only reason psychologists aren't in underserved areas is because they can't prescribe?
You really got me good with the NAMI thing. Next time, I will differentiate between not supporting and against. Well played sir or madam, well played.
Don't be angry Edieb, it doesn't help the cause. I'm not here to get into an argument. I have a good life and I'm very busy. I hardly ever post anything. Wife was away for the weekend, and I was posting between football games and movies. Not a big deal. I do stand by what I said though. What makes you angry perhaps, is that many of your colleagues would agree with what I did post. Have a nice life, try to smile.
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I disagree with most of what you wrote. I am in the middle of finishing up some interviews, but I'll come back and respond when I have more time.
Everyone needs to remember to keep it professional....so please refrain from going back and forth on personal matters.
Everyone needs to remember to keep it professional....so please refrain from going back and forth on personal matters.
