Psychopharmacology/Advanced Practice Psychology

[busi26]

Your argument is predicated on the wrong foundation: Psychologists argue that PhD prescribing brings a different, biopsychosocial, paradigm to prescribing than psychiatry's medical viewpoint. I have never heard a psychologist say that s/he is inferior in that arena to an M.D. but, because we need prescribers, let us do it anyway. Can you show me where this was said? All I have heard are psychologists remarking how the evidence shows they are safe, effective prescribers. So much so that the U.S. government allows psychologists to currently prescribe.

Well said. It appears that those who are opposed to psychologist prescribing psychotropics AFTER THEY RECEIVE 2 YEARS OF TRAINING SPECIFICALLY FOCUSED ON THE PROPER USE OF PSYCHOTROPICS, are not looking at the data and are relying on mere lymbic reflex.

All the data shows that properly trained psychologists can safely and effectively prescribe psychotropics. It is as simple as that. There is no need to disparage psychologists or psychiatrists. The facts are the facts!

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[busi26]

Your argument is predicated on the wrong foundation: Psychologists argue that PhD prescribing brings a different, biopsychosocial, paradigm to prescribing than psychiatry's medical viewpoint. I have never heard a psychologist say that s/he is inferior in that arena to an M.D. but, because we need prescribers, let us do it anyway. Can you show me where this was said? All I have heard are psychologists remarking how the evidence shows they are safe, effective prescribers. So much so that the U.S. government allows psychologists to currently prescribe.

Well said. It appears that those who are opposed to psychologist prescribing psychotropics AFTER THEY RECEIVE 2 YEARS OF TRAINING SPECIFICALLY FOCUSED ON THE PROPER USE OF PSYCHOTROPICS, are not looking at the data and are relying on mere lymbic reflex.

All the data shows that properly trained psychologists can safely and effectively prescribe psychotropics. It is as simple as that. There is no need to disparage psychologists or psychiatrists. The facts are the facts!

 

[JazzPsych]

Any updates on the Oregon bill?

This seems pretty exciting! A third state getting presciption privileges would be a huge boost.

 

[edieb]

Any updates on the Oregon bill?

This seems pretty exciting! A third state getting presciption privileges would be a huge boost.

You can track it here: http://gov.oregonlive.com/bill/SB1046/

The bill has passed the Oregon House and made it out of committee in the Senate. I believe the next step is one more committee before it makes its way onto the senate floor for a full vote and, finally, the governor must sign it. It sounds like many hoops; however, there was an earlier article written in an Oregon newspaper indicating that it had widespread support.

As an aside, a RxP bill in Missouri is also making progress and has a very good chance of passage this year

 

[JazzPsych]

Thanks for that Edieb, I'll keep an eye on the progress of that bill.

The fight over prescription privileges in Holland, as I mentioned earlier, is about to start. My professor has asked me to write my Bachelor's thesis on it.

I'm not sure yet but I think I'm going to make use of American literature as well.

So my question is: is there any source of quality literature you guys know I can make use of? Not sure if there is much to be found in my university's database.

Any leads would be much appreciated.

- Stijn

 

[CGOPsych]

Any updates on the Oregon bill?

This seems pretty exciting! A third state getting presciption privileges would be a huge boost.

Excuse me but if Oregon does approve RxP it will be the second, not the third state to have prescribing psychologists.

You should look up Act 251 in Louisiana, which the "Medical Psychologists" there secretly had passed, and which took effect 1/1/10. This act makes them medical providers to be licensed and regulated by the La. medical board. They call themselves medical providers. Furthermore, the MP's stated that they did this because they realized that prescribing psychoactive drugs was indeed the practice of medicine and not the practice of psychology.

Therefore, they are no longer practicing as psychologists when they write prescriptions, they no longer say they are practicing psychology, they call themselves medical providers, and they are licensed and regulated by a medical board. (By the way, this secretly passed law also allows the state medical board to license them as clinical psychologists as well, completely separated from any psychology board ... thus the incorporation of medicine into psychology has worked in reverse, and has endangered the separation of psychology from medicine.)

Therefore, only New Mexico has "prescribing psychologists." APA has spent untold millions of dollars over 15 years of turf war to incorporate medicine into psychology and they have one state to show for it. Bills have failed 97 times in 24 states.

This is why MANY psychologists, quite possibly most, oppose the campaign to incorporate medicine into psychology as a stand for the integrity of our profession against the forces of greed and political opportunism.

 

[Therapist4Chnge]

I knew LA had the oversight moved over to the med board, but I didn't realize the other implications.

I think most states will go the way of RxP, though I'm hoping the requirements are a bit more rigorous. I'm currently reading through the additions to the Oregon bill....hoping they raise the bar.

 

[CGOPsych]

I knew LA had the oversight moved over to the med board, but I didn't realize the other implications.

I think most states will go the way of RxP, though I'm hoping the requirements are a bit more rigorous. I'm currently reading through the additions to the Oregon bill....hoping they raise the bar.

So far there is only one state with prescribing psychologists while there are 13 states that make psychologist prescribing illegal. That's not a good box score after 15 years and millions of dollars.

La psychologists didn't just move oversight, they became medical providers. They allowed a medical board to create a new form of psychologist who is not licensed or regulated by any psychology entity. This is exactly the kind of mess that was predicted when APA began its campaign to blur the distinction between the disciplines and incorporate medicine into psychology ... the road goes both ways once you open it up. This is why we see RxP as not just a few psychologists writing some prescriptions, but as a threat to the integrity of psychology.

Good fences make good neighbors.

 

[CGOPsych]

Well said. It appears that those who are opposed to psychologist prescribing psychotropics AFTER THEY RECEIVE 2 YEARS OF TRAINING SPECIFICALLY FOCUSED ON THE PROPER USE OF PSYCHOTROPICS, are not looking at the data and are relying on mere lymbic reflex.

All the data shows that properly trained psychologists can safely and effectively prescribe psychotropics. It is as simple as that. There is no need to disparage psychologists or psychiatrists. The facts are the facts!

First, it is NOT two years of training. The models call for as little as 300 "contact hours" (sounds better than semester hours, doesn't it?) of correspondence school courses as the entire body of medical education. And this is with NO pre-requisites or an entrance exam.

Your statement referring to "properly trained" psychologists is misleading and I challenge it as completely meaningless. After all, my paperboy should be allowed to prescribe, or perform brain surgery, if "properly trained". Fact is, that the states already dictate what "properly trained" means and it means medical training, not correspondence school from a for-profit psychology school taught by psychologists with a test developed by psychologists and a passing grade determined by psychologists overseen by a board of psychologists with no medical training.

Precisely what training are we not looking at? If you mean the so-called "safety data" I would love to see what you mean, as we have investigated it and found it to be totally bogus.

If you mean training data, guess again. My local physician's assistant program requires more biological/medical education as a pre-requisite for entry into the program than what the entire correspondence school training calls for in these so-called RxP programs.

There is a very good reason why RxP bills have failed 97 times in 24 states (this number keeps changing so you'll have to bear with me ... it's so hard to keep up with the number of times RxP is rejected. Mississippi just killed their bill, and others are going nowhere).

So let's start with the safety data ... to what are you referring?

 

[edieb]

First, it is NOT two years of training. The models call for as little as 300 "contact hours" (sounds better than semester hours, doesn't it?) of correspondence school courses as the entire body of medical education. And this is with NO pre-requisites or an entrance exam.

Your statement referring to "properly trained" psychologists is misleading and I challenge it as completely meaningless. After all, my paperboy should be allowed to prescribe, or perform brain surgery, if "properly trained". Fact is, that the states already dictate what "properly trained" means and it means medical training, not correspondence school from a for-profit psychology school taught by psychologists with a test developed by psychologists and a passing grade determined by psychologists overseen by a board of psychologists with no medical training.

Precisely what training are we not looking at? If you mean the so-called "safety data" I would love to see what you mean, as we have investigated it and found it to be totally bogus.

If you mean training data, guess again. My local physician's assistant program requires more biological/medical education as a pre-requisite for entry into the program than what the entire correspondence school training calls for in these so-called RxP programs.

There is a very good reason why RxP bills have failed 97 times in 24 states (this number keeps changing so you'll have to bear with me ... it's so hard to keep up with the number of times RxP is rejected. Mississippi just killed their bill, and others are going nowhere).

So let's start with the safety data ... to what are you referring?

While Act 251 moves supervision of medical psychologists to the medical board, the prescribing psychologists are also still licensed psychologists, to be supervised by the Board of Psychologists, in Louisiana. Thus, they are not solely supervised by the medical board. Thus, these psychologists are still practicing medical psychology and are practicing as such.

There is an abundance of safety data on psychologist prescribing, much of it from non-partial sources such as the U.S. government (you can google the Department of Defense study). The DoD data corroborates the data from Louisiana and New Mexico: Psychologists can be trained to prescribe safely.

 

[busi26]

First, it is NOT two years of training. The models call for as little as 300 "contact hours" (sounds better than semester hours, doesn't it?) of correspondence school courses as the entire body of medical education. And this is with NO pre-requisites or an entrance exam.

Your statement referring to "properly trained" psychologists is misleading and I challenge it as completely meaningless. After all, my paperboy should be allowed to prescribe, or perform brain surgery, if "properly trained". Fact is, that the states already dictate what "properly trained" means and it means medical training, not correspondence school from a for-profit psychology school taught by psychologists with a test developed by psychologists and a passing grade determined by psychologists overseen by a board of psychologists with no medical training.

Precisely what training are we not looking at? If you mean the so-called "safety data" I would love to see what you mean, as we have investigated it and found it to be totally bogus.

If you mean training data, guess again. My local physician's assistant program requires more biological/medical education as a pre-requisite for entry into the program than what the entire correspondence school training calls for in these so-called RxP programs.

There is a very good reason why RxP bills have failed 97 times in 24 states (this number keeps changing so you'll have to bear with me ... it's so hard to keep up with the number of times RxP is rejected. Mississippi just killed their bill, and others are going nowhere).

So let's start with the safety data ... to what are you referring?

I can only speak to the LA postdoctoral masters degree in psychopharmacology. It DOES take 2 years to complete. Do you know anyone who has completed the postdoctoral masters in psychopharmacology? I would surmise not. I suggest that you delve into what is actually covered in the 2 years of postdoctoral training before you disparage the training as inadequate.

I repeat. Where is the evidence that psychologist cannot prescribe psychotropics safely. My evidence that "PROPERLY TRAINED" Psychologists can prescribe safely comes from the DOD study of prescribing psychogists in the military and reports out of LA and NM that show that there have been "0" adverse events that have resulted from psychologists prescribing.

Facts are facts! If "PROPERLY TRAINED" prescribing Psycholgists are really a significant danger to their patients, as suggested by many MDs, wouldn't there be bodies lining the streets by now. Remember psychologists have been prescribing in LA for over 5 years.

 

[CGOPsych]

You can track it here: http://gov.oregonlive.com/bill/SB1046/

The bill has passed the Oregon House and made it out of committee in the Senate. I believe the next step is one more committee before it makes its way onto the senate floor for a full vote and, finally, the governor must sign it. It sounds like many hoops; however, there was an earlier article written in an Oregon newspaper indicating that it had widespread support.

As an aside, a RxP bill in Missouri is also making progress and has a very good chance of passage this year

May I ask your source of information for a Missouri bill? No one else has a record of Missouri having an active bill at this time.

 

[CGOPsych]

I can only speak to the LA postdoctoral masters degree in psychopharmacology. It DOES take 2 years to complete. Do you know anyone who has completed the postdoctoral masters in psychopharmacology? I would surmise not. I suggest that you delve into what is actually covered in the 2 years of postdoctoral training before you disparage the training as inadequate.

I repeat. Where is the evidence that psychologist cannot prescribe psychotropics safely. My evidence that "PROPERLY TRAINED" Psychologists can prescribe safely comes from the DOD study of prescribing psychogists in the military and reports out of LA and NM that show that there have been "0" adverse events that have resulted from psychologists prescribing.

Facts are facts! If "PROPERLY TRAINED" prescribing Psycholgists are really a significant danger to their patients, as suggested by many MDs, wouldn't there be bodies lining the streets by now. Remember psychologists have been prescribing in LA for over 5 years.

The "Master's Degree" varies. The CSPP model calls for abouit 540 hours. It's still correspondence school. No pre-requisites, no entrance exam.

WHAT? You want to create an entirely new form of medical education and practice based on far less training than any other non-physician prescriber and you argue that opponents must prove in advance that it will NOT be safe????

I think you have this wrong, my friend. It is incumbent upon those who advocate massive change that on its face appears to be highly risky to show that it is safe.

So ... WHERE IS THE SAFETY DATA YOU CLAIMED WAS THERE?????
Where do you find this alleged data of zero events? What is your source? You DO believe this is important don't you?

I ask this because I challenged this before and Glenn Ally himself, one of the prime movers in Louisiana admitted that there IS NO DATA ... they made it up. They guessed. They speculated, They theorized. They huffed and puffed and pulled it out of their sleeves.

So I repeat what is the source of your "Data"?

 

[CGOPsych]

I can only speak to the LA postdoctoral masters degree in psychopharmacology. It DOES take 2 years to complete. Do you know anyone who has completed the postdoctoral masters in psychopharmacology? I would surmise not. I suggest that you delve into what is actually covered in the 2 years of postdoctoral training before you disparage the training as inadequate.

I repeat. Where is the evidence that psychologist cannot prescribe psychotropics safely. My evidence that "PROPERLY TRAINED" Psychologists can prescribe safely comes from the DOD study of prescribing psychogists in the military and reports out of LA and NM that show that there have been "0" adverse events that have resulted from psychologists prescribing.

Facts are facts! If "PROPERLY TRAINED" prescribing Psycholgists are really a significant danger to their patients, as suggested by many MDs, wouldn't there be bodies lining the streets by now. Remember psychologists have been prescribing in LA for over 5 years.

Amazing repetition of the APA propaganda concerning DOD:

1. DOD project was a failure. They could only get 10 people to sign up ... could not fill all the slots. They dropped the training from 2 years to 1 year, and dropped the requirement of being in the military to join, and STILL could not get enough.

2. The program was a political boondoggle forced on the military by Sen. Daniel Inouye, boss of Patrick DeLeon, the psychologists who is the godfather of RxP. The military didn't want or need it. Afterward, they said it was not cost-effective. It was DEAD until the Democrats took over the Senate again, and Inouye forced more onto the military

3. The DOD project had 10 people educated in the Uniformed Services Medical University for 1-2 years. Would you agree to have this requirement for RxPers nowadays?

4. Those in the military did not treat anyone under 18 or over 65. They worked within medical centers surrounded by free medical care for their patients, easy consults, etc. etc. They did not treat anyone with serious medical or mental illness. Would you agree to requiring this for all RxPers?

5. The DOD RxPers worked without any financial pressure on their time or prescriptons and could schedule patients as much as they wanted since the services were free.

The DOD project was a tiny, failed demonstration project that has as much relevance to civilian RxP as a fish does to a bicycle.

 

[CGOPsych]

While Act 251 moves supervision of medical psychologists to the medical board, the prescribing psychologists are also still licensed psychologists, to be supervised by the Board of Psychologists, in Louisiana. Thus, they are not solely supervised by the medical board. Thus, these psychologists are still practicing medical psychology and are practicing as such.

There is an abundance of safety data on psychologist prescribing, much of it from non-partial sources such as the U.S. government (you can google the Department of Defense study). The DoD data corroborates the data from Louisiana and New Mexico: Psychologists can be trained to prescribe safely.

This is not correct.
Act 251 not only licenses the "medical psychologists" to prescribe, it also allows the state medical board to license them to perform all activities of clinical psychologists. Go read the act and you will see that the medical psychologists added their title "medical psychologist" to all references clinical psychologists, and then saw to it that medical psychologists are licensed by the medical board.

Thus, these people have created a new form of clinical psychology in Louisiana that is under the control of medicine and completely out of the control of any psychology board or organization. The organization of medical psycholoigsts, LAMP, is wholly independent of any psychology oversight.

This is why RxP is a serious threat to the integrity of psychology, as it blurs the distinction between the disciplines.

What is the source of your data? I don't think it's appropriate to make such wild claims on such an important topic and then say "go google it."

This is the kind of unsubstantiated claim that RxP is based on. There is NO data. Glenn Ally admits this. The head of the Farleigh-Dickinson RxP training program admitted it on an APA list serve.

 

[JazzPsych]

CGO, may I ask what your background is?

You seem really frustrated and it looks like you've only been replying in the RxP threads.

Are you a psychologist? If so, please tell us what you think there is to lose for psychology. Or is it just that you're concerned about the "inadequate" training?

Are you irritated by the "lies" you mentioned?

Are you in private practice? Are you a PsyD, a Phd?

Just curious to where comments like yours are coming from.

 

[CGOPsych]

CGO, may I ask what your background is?

You seem really frustrated and it looks like you've only been replying in the RxP threads.

Are you a psychologist? If so, please tell us what you think there is to lose for psychology. Or is it just that you're concerned about the "inadequate" training?

Are you irritated by the "lies" you mentioned?

Are you in private practice? Are you a PsyD, a Phd?

Just curious to where comments like yours are coming from.

The misinformation by the RxP crowd has been pointed out by me repeatedly. The threats to psychology have also been detailed.

As for your personal interest in me, I'm a practicing clinical psychologist. That is irrelevant. What is important is whether the facts are accurate and the rationale is logical.

If you can help your colleagues in the RxP campaign by providing facts rather than their unsubstantiated claims and misleading marketing phrases I would be most grateful. I and others like me are only interested in the truth, which has become a casualty of the RxP campaign.

 

[maranatha]

The misinformation by the RxP crowd has been pointed out by me repeatedly. The threats to psychology have also been detailed.

As for your personal interest in me, I'm a practicing clinical psychologist. That is irrelevant. What is important is whether the facts are accurate and the rationale is logical.

If you can help your colleagues in the RxP campaign by providing facts rather than their unsubstantiated claims and misleading marketing phrases I would be most grateful. I and others like me are only interested in the truth, which has become a casualty of the RxP campaign.

Thank you, CGOPsych for posting your responses. I think it's important that psychologists on this site understand that there are highly differing opinions within psychology regarding RxP rights and the opposition is not just coming from the "evil" psychiatric community. I work with a lot of psychologists who are very much against this. It's interesting that one of the posters questioned your background assuming that any psychologist who opposes this is a troll.

 

[JazzPsych]

Thank you, CGOPsych for posting your responses. I think it's important that psychologists on this site understand that there are highly differing opinions within psychology regarding RxP rights and the opposition is not just coming from the "evil" psychiatric community. I work with a lot of psychologists who are very much against this. It's interesting that one of the posters questioned your background assuming that any psychologist who opposes this is a troll.

Not at all, he is perfectly entitled to his opinion. I know there are many that oppose this, psychologists too, yes.

 

[busi26]

Amazing repetition of the APA propaganda concerning DOD:

1. DOD project was a failure. They could only get 10 people to sign up ... could not fill all the slots. They dropped the training from 2 years to 1 year, and dropped the requirement of being in the military to join, and STILL could not get enough.

2. The program was a political boondoggle forced on the military by Sen. Daniel Inouye, boss of Patrick DeLeon, the psychologists who is the godfather of RxP. The military didn't want or need it. Afterward, they said it was not cost-effective. It was DEAD until the Democrats took over the Senate again, and Inouye forced more onto the military

3. The DOD project had 10 people educated in the Uniformed Services Medical University for 1-2 years. Would you agree to have this requirement for RxPers nowadays?

4. Those in the military did not treat anyone under 18 or over 65. They worked within medical centers surrounded by free medical care for their patients, easy consults, etc. etc. They did not treat anyone with serious medical or mental illness. Would you agree to requiring this for all RxPers?

5. The DOD RxPers worked without any financial pressure on their time or prescriptons and could schedule patients as much as they wanted since the services were free.

The DOD project was a tiny, failed demonstration project that has as much relevance to civilian RxP as a fish does to a bicycle.

I really doubt that you are a psychologist! Your tone and arguments are more consistent with those of a disgrunteld psychiatrist.

You asked for evidence. I referenced the DOD project. How many people did the DOD psychologists kill or maime? NONE! How many did they help? Quite a few. Your argument that the DOD project was a failure focuses only on the money wasted to get the project going. Not whether or not psychologists were successful in safely treating their patients with and without meds.

By the way, where is the evidence that physicians and psychiatrists can safely prescribe medications? I don't doubt that physicians can safely prescribe psychotropics, but where can I find that information?

 

[edieb]

This is not correct.
Act 251 not only licenses the "medical psychologists" to prescribe, it also allows the state medical board to license them to perform all activities of clinical psychologists. Go read the act and you will see that the medical psychologists added their title "medical psychologist" to all references clinical psychologists, and then saw to it that medical psychologists are licensed by the medical board.

Thus, these people have created a new form of clinical psychology in Louisiana that is under the control of medicine and completely out of the control of any psychology board or organization. The organization of medical psycholoigsts, LAMP, is wholly independent of any psychology oversight.

NO, you are incorrrect. Medical psychologists must maintain their license as psychologists which is, of course, regulated/governed by the Board of Psychologists. The prescribing portion, however, is now governed by the Board of Medicine.




What is the source of your data? I don't think it's appropriate to make such wild claims on such an important topic and then say "go google it."

I am a member of the Louisiana Psychological Association and the idea that medical psychologists are solely governed by the Board of Medicine has been addressed by the LPA President. She has repeatedly stated that medical psychologists MUST be governed by the Board of Psychologists because they are first and foremost psychologists.


This is the kind of unsubstantiated claim that RxP is based on. There is NO data. Glenn Ally admits this. The head of the Farleigh-Dickinson RxP training program admitted it on an APA list serve.

You say there is no data to support the value of RxP. However, what is your data to say RxP is dangerous. You have none. Your are just against prescribing because you don't like the idea of it. You could care less about increased access to care and the growth and survival of the profession

 

[edieb]

May I ask your source of information for a Missouri bill? No one else has a record of Missouri having an active bill at this time.

I have a source for the MO bill, but, because you may speak out against its chances of passage or be a member of some group that will oppose the bill, do not want to disclose the bill number or source to you

 

[CGOPsych]

I have a source for the MO bill, but, because you may speak out against its chances of passage or be a member of some group that will oppose the bill, do not want to disclose the bill number or source to you

Truly amazing. You have a bill number but it's a secret?
Bills are public record. Are you aware of that?
My resources say there is no bill. If you have a bill number, then please produce it.

One grows tired of dealing with amateurs on a topic so serious as this.

Oh, and you can be dead certain, without a doubt, predict with 100 percent accuracy that I will speak out against it.

 

[CGOPsych]

You say there is no data to support the value of RxP. However, what is your data to say RxP is dangerous. You have none. Your are just against prescribing because you don't like the idea of it. You could care less about increased access to care and the growth and survival of the profession

Once again, you make the astounding assertion that it is incumbent upon us to prove that this will be unsafe.

It is the RxP proponents who wish to make a massive change in the way drugs are prescribed. It is incumbent upon you to show evidence that:
1. This is necessary
2. This is safe
3. This is effective.

If you were proposing a new drug, would you simply want to manufacture it and tell the FDA it is their job to prove that it is unsafe?


Once again, the claims and arguments of the RxP crowd are stunning.

I am waiting for your citation of the data that this is safe. You strongly suggest that there is such data, but you do not provide a citation. Do you think this is important?

 

[CGOPsych]

I really doubt that you are a psychologist! Your tone and arguments are more consistent with those of a disgrunteld psychiatrist.

You asked for evidence. I referenced the DOD project. How many people did the DOD psychologists kill or maime? NONE! How many did they help? Quite a few. Your argument that the DOD project was a failure focuses only on the money wasted to get the project going. Not whether or not psychologists were successful in safely treating their patients with and without meds.

By the way, where is the evidence that physicians and psychiatrists can safely prescribe medications? I don't doubt that physicians can safely prescribe psychotropics, but where can I find that information?

OK, this is declining into Amateur Hour.

The DOD project was an expensive failure. The DOD said so. I'm not going to repeat the details.

I don't care if you don't think I'm a psychologist. What matters are the facts and the rationale, and so far all I see is a repetition of propaganda, ridiculous assertions, and pure fantasy.

Please send over the citation for the safety data. That means you will know more than the people in charge of RxP training programs, and I'm sure they'd want to know also.

 

[CGOPsych]

Thank you, CGOPsych for posting your responses. I think it's important that psychologists on this site understand that there are highly differing opinions within psychology regarding RxP rights and the opposition is not just coming from the "evil" psychiatric community. I work with a lot of psychologists who are very much against this. It's interesting that one of the posters questioned your background assuming that any psychologist who opposes this is a troll.

Differing opinions indeed! Here is something we wrote to a senator interested in the topic:

A common claim by those who wish to incorporate medicine into psychology is that the APA model of doing so is supported by a majority of psychologists. However, the data does not support this and there is some evidence that the opposite could be true. Cited surveys include a question of whether psychologists support prescriptive authority for psychologists, but without any reference to any particulars of the APA proposals. Typically about 60-65 percent of those polled agree to such a broad statement. Thus individuals who envision psychologists undergoing as much as a full course of medical school training and psychiatric fellowships and as little as reading a book on pharmacology would be included in these figures. Therefore, this data reveals almost nothing about the real opinions of psychologists except that most can imagine psychologists writing prescriptions under some sort of condition. We urge you to not take at face value any such claims without requiring of the advocate the source of the data, and an accurate interpretation of it.

Furthermore, even under this extremely loose interpretation of support for the prescriptive authority bills pressed by the APA, a number of surveys still found a majority of psychologists opposing any notion of psychologists prescribing. These include a vote within the Society for a Science of Clinical Psychology (SSCP) in which 90 percent of voters opposed RxP, one in which 90 percent of school psychologists opposed it although they believed that extra training in pharmacology is necessary, and a poll of clinical psychologists specializing in health care issues in which 66 percent opposed prescription privileges for licensed psychologists. We do not pretend that these numbers alone show that psychologists are opposed to RxP, but they do show that opinions among licensed psychologists are highly varied, contrary to suggestions of overwhelming support by all. Many psychologists are poorly informed of the deficiencies in the APA training model for prescription privileges.

It is noteworthy that until recently the only organization in the United States that actively sought passage of these bills was the APA. The history of this movement within the organization is outside the scope of this letter, but we feel it is fair to say that it is fraught with controversy and we find it clear that the movement was maintained by political leverage used by a few rather than through the broad support of the membership, which has never been fully surveyed on the topic. In recent years a splinter group of APA, the National Alliance of Professional Psychology Providers, headed by a former president of APA, was formed in great part to pursue these goals as well, while also espousing a philosophy that psychologists should be well versed as entrepreneurs trained as good businesspeople. In contrast, the board of the Association of Behavioral and Cognitive Therapies has called on the APA to stop its political campaign, and this was joined by the aforementioned SSCP. Once again, this shows that psychologists are far from uniform in their opinions.

Finally, recalling the above-mentioned Baird study in Illinois that 78 percent of licensed clinical psychologists say that prescribing psychologists should meet the same training standards as other non-physician prescribers, it would not strain logic to say that they would oppose the APA and CSPP models as inadequate, if they were informed of their contents. Furthermore, this does not mean that the other 22 percent would necessarily endorse the program either, since there are other elements to it that many have found to be objectionable.

In summary, there is no known data that psychologists endorse the prescription privileges model advocated by the APA, and that surveys showing that a majority of psychologists support some variation of psychologists prescribing do not constitute such an endorsement, despite the implication repeated often by proponents. Furthermore, there is evidence that the field is conflicted over the issue and that if psychologists were given details on the flawed training model proposed, they may very well oppose it in great numbers.

 

[Therapist4Chnge]

The "Master's Degree" varies. The CSPP model calls for abouit 540 hours. It's still correspondence school. No pre-requisites, no entrance exam.

I share your concern about correspondence training, though many NPs elect this route, which is probably going to make it harder to enforce a residential requirement. I also believe that the supervision requirements are light and need to be increased, though hopefully this consideration will be accepted before the final bill is signed.

I believe the burden of proof is on the professionals who want to prescribe, and not on the medical community to prove it is not safe. However, the attempts made by the professional in favor of prescription seem to be met by accusations that patients will die and other related and unsubstaintiated mudslinging, which is the exact response mid-levels received when they were lobbying for prescribing rights. Both sides are guilty of throwing mud, so instead I'll refer to a formal evaluation of the DOD study, which you have called "a failure"

As for safety, while the DOD comparison has flaws as a direct comparison, I think it provided some insight into the feasibility of a psychologist being able to seek additional training and then being competent to safely prescribe (and unprescribe) psychotropic medications.

1. DOD project was a failure. They could only get 10 people to sign up ... could not fill all the slots. They dropped the training from 2 years to 1 year, and dropped the requirement of being in the military to join, and STILL could not get enough.

2. The program was a political boondoggle forced on the military by Sen. Daniel Inouye, boss of Patrick DeLeon, the psychologists who is the godfather of RxP. The military didn't want or need it. Afterward, they said it was not cost-effective. It was DEAD until the Democrats took over the Senate again, and Inouye forced more onto the military

The DOD project was not a failure, as it showed that psychologists who were given additional training could safely prescribe psychotropic medications. The cost-effective nature of the DOD project is a separate consideration.

According to the American College of Neuropsychopharmacology ACNP Evaluation Panel Report from May 1998:

In regard to effectiveness: "All 10 graduates of the PDP filled critical needs, and they performed with excellence wherever they were placed. It was striking to the Evaluation Panel how the graduates had filled different niches and brought unique perspectives to their various assignments"

In regard to medical safety and adverse effects, I agree that there is not equivalency to a psychiatrist, which seems to be a popular straw-man argument against RxP, though in a collaborative setting the prescribing psychologists prescribed effectively and without adverse events, per the ACNP report. The other popular stra-man argument is that, "you don't know what you don't know", though the panel found that in fact the prescribing psychologist did have an awareness, and they were able to consult a physician when they needed additional assistance.

As for critiquing the 10 people to sign up, anyone who has done any formalized research understands that recruitment is a complex issue, and simply chalking it up to, "no one wanted to do it" is both ingenuine and inaccurate.

Are there limitations to the DOD…absolutely. Here are the limitations that I see:

1. Small N. Obviously I would have like to see more people, though for a first study it is understandable that they didn't have 100+ people.

2. The training required more direct supervision hours than what is required now under present legislation in NM and LA, so it is not an equitable comparison. I think this is the biggest weakness of the comparison, and an area that has not been sufficiently addressed in the new legislation.

3. Specialized population. Yes the military does not include peds and geriatric patients, however the report said dependants and Veterans were seen by some of the prescribers, with no reported adverse effects (ref. Variety v. Restricted Caseload in the report). I'd like to see more data with these populations, but it is a start.

4. More oversight than a private out-patient provider. I believe that the collaborative piece is very important to not only training, but overall effectiveness. This limitation was clearly noted in the report, and I believe the new legislation is reflective of this limitation by requiring collaborative agreements with a physician. I believe the collaborative requirement will provide an adequate answer to this concern.

As an aside, the report found that while it was a restricted population, "they essentially mirrored what psychiatrists did with the same population, and, in fact, they differed little from the private practices of the psychiatrists on the Evaluation Panel"

This is the kind of unsubstantiated claim that RxP is based on. There is NO data. Glenn Ally admits this. The head of the Farleigh-Dickinson RxP training program admitted it on an APA list serve.

Would you mind asking Dr. Ally if it is okay to share that e-mail here, as I'd like to see exactly what was said.

 

[busi26]

I share your concern about correspondence training, though many NPs elect this route, which is probably going to make it harder to enforce a residential requirement. I also believe that the supervision requirements are light and need to be increased, though hopefully this consideration will be accepted before the final bill is signed.

I believe the burden of proof is on the professionals who want to prescribe, and not on the medical community to prove it is not safe. However, the attempts made by the professional in favor of prescription seem to be met by accusations that patients will die and other related and unsubstaintiated mudslinging, which is the exact response mid-levels received when they were lobbying for prescribing rights. Both sides are guilty of throwing mud, so instead I'll refer to a formal evaluation of the DOD study, which you have called "a failure"

As for safety, while the DOD comparison has flaws as a direct comparison, I think it provided some insight into the feasibility of a psychologist being able to seek additional training and then being competent to safely prescribe (and unprescribe) psychotropic medications.

The DOD project was not a failure, as it showed that psychologists who were given additional training could safely prescribe psychotropic medications. The cost-effective nature of the DOD project is a separate consideration.

According to the American College of Neuropsychopharmacology ACNP Evaluation Panel Report from May 1998:

In regard to effectiveness: “All 10 graduates of the PDP filled critical needs, and they performed with excellence wherever they were placed. It was striking to the Evaluation Panel how the graduates had filled different niches and brought unique perspectives to their various assignments”

In regard to medical safety and adverse effects, I agree that there is not equivalency to a psychiatrist, which seems to be a popular straw-man argument against RxP, though in a collaborative setting the prescribing psychologists prescribed effectively and without adverse events, per the ACNP report. The other popular stra-man argument is that, “you don’t know what you don’t know”, though the panel found that in fact the prescribing psychologist did have an awareness, and they were able to consult a physician when they needed additional assistance.

As for critiquing the 10 people to sign up, anyone who has done any formalized research understands that recruitment is a complex issue, and simply chalking it up to, "no one wanted to do it" is both ingenuine and inaccurate.

Are there limitations to the DOD…absolutely. Here are the limitations that I see:

1. Small N. Obviously I would have like to see more people, though for a first study it is understandable that they didn’t have 100+ people.

2. The training required more direct supervision hours than what is required now under present legislation in NM and LA, so it is not an equitable comparison. I think this is the biggest weakness of the comparison, and an area that has not been sufficiently addressed in the new legislation.

3. Specialized population. Yes the military does not include peds and geriatric patients, however the report said dependants and Veterans were seen by some of the prescribers, with no reported adverse effects (ref. Variety v. Restricted Caseload in the report). I’d like to see more data with these populations, but it is a start.

4. More oversight than a private out-patient provider. I believe that the collaborative piece is very important to not only training, but overall effectiveness. This limitation was clearly noted in the report, and I believe the new legislation is reflective of this limitation by requiring collaborative agreements with a physician. I believe the collaborative requirement will provide an adequate answer to this concern.

As an aside, the report found that while it was a restricted population, “they essentially mirrored what psychiatrists did with the same population, and, in fact, they differed little from the private practices of the psychiatrists on the Evaluation Panel”

Would you mind asking Dr. Ally if it is okay to share that e-mail here, as I'd like to see exactly what was said.

This is a great rebuttal to the mindless attacks against RxP. Thanks Therapist! I'm going to quote you if you don't mind.

 

[edieb]

CGOPsych's comment about writing Senators makes me believe the poster is from a rogue, fringe organization called Psychologists Opposed to Presciption Privileges (POPP) or something close to that. If this is true, CGOPsych has an agenda and will not be convinced no matter how many facts you throw his/her way.

If you noticed, I asked CGO for data but received none.

 

[CGOPsych]

I share your concern about correspondence training, though many NPs elect this route, which is probably going to make it harder to enforce a residential requirement. I also believe that the supervision requirements are light and need to be increased, though hopefully this consideration will be accepted before the final bill is signed.

I believe the burden of proof is on the professionals who want to prescribe, and not on the medical community to prove it is not safe. However, the attempts made by the professional in favor of prescription seem to be met by accusations that patients will die and other related and unsubstaintiated mudslinging, which is the exact response mid-levels received when they were lobbying for prescribing rights. Both sides are guilty of throwing mud, so instead I'll refer to a formal evaluation of the DOD study, which you have called "a failure"

As for safety, while the DOD comparison has flaws as a direct comparison, I think it provided some insight into the feasibility of a psychologist being able to seek additional training and then being competent to safely prescribe (and unprescribe) psychotropic medications.



The DOD project was not a failure, as it showed that psychologists who were given additional training could safely prescribe psychotropic medications. The cost-effective nature of the DOD project is a separate consideration.

According to the American College of Neuropsychopharmacology ACNP Evaluation Panel Report from May 1998:

In regard to effectiveness: “All 10 graduates of the PDP filled critical needs, and they performed with excellence wherever they were placed. It was striking to the Evaluation Panel how the graduates had filled different niches and brought unique perspectives to their various assignments”

In regard to medical safety and adverse effects, I agree that there is not equivalency to a psychiatrist, which seems to be a popular straw-man argument against RxP, though in a collaborative setting the prescribing psychologists prescribed effectively and without adverse events, per the ACNP report. The other popular stra-man argument is that, “you don’t know what you don’t know”, though the panel found that in fact the prescribing psychologist did have an awareness, and they were able to consult a physician when they needed additional assistance.

As for critiquing the 10 people to sign up, anyone who has done any formalized research understands that recruitment is a complex issue, and simply chalking it up to, "no one wanted to do it" is both ingenuine and inaccurate.

Are there limitations to the DOD…absolutely. Here are the limitations that I see:

1. Small N. Obviously I would have like to see more people, though for a first study it is understandable that they didn’t have 100+ people.

2. The training required more direct supervision hours than what is required now under present legislation in NM and LA, so it is not an equitable comparison. I think this is the biggest weakness of the comparison, and an area that has not been sufficiently addressed in the new legislation.

3. Specialized population. Yes the military does not include peds and geriatric patients, however the report said dependants and Veterans were seen by some of the prescribers, with no reported adverse effects (ref. Variety v. Restricted Caseload in the report). I’d like to see more data with these populations, but it is a start.

4. More oversight than a private out-patient provider. I believe that the collaborative piece is very important to not only training, but overall effectiveness. This limitation was clearly noted in the report, and I believe the new legislation is reflective of this limitation by requiring collaborative agreements with a physician. I believe the collaborative requirement will provide an adequate answer to this concern.

As an aside, the report found that while it was a restricted population, “they essentially mirrored what psychiatrists did with the same population, and, in fact, they differed little from the private practices of the psychiatrists on the Evaluation Panel”



Would you mind asking Dr. Ally if it is okay to share that e-mail here, as I'd like to see exactly what was said.

The DOD project did not fill its quota because they could not convince psychologists to participate. I'm sure they are much more likely to take this training when their entire medical education can be had on a laptop.

The project was undertaken not because the military wanted or needed them but because a powerful senator on the Senate Appropriations Committee had an RxP psychologist on his staff.

If you want to agree to two full years of university training, very close supervision, restricted population, etc etc etc then I think that would be an interesting proposal.

However, since RxP is a political campaign based on increasing the power and wealth of APA and its affiliates, then you will never, ever see such standards invoked.

 

[CGOPsych]

CGOPsych's comment about writing Senators makes me believe the poster is from a rogue, fringe organization called Psychologists Opposed to Presciption Privileges (POPP) or something close to that. If this is true, CGOPsych has an agenda and will not be convinced no matter how many facts you throw his/her way.

If you noticed, I asked CGO for data but received none.

As I have pointed out amply, there are MANY psychologists opposed to APA's 15-year, multi-million dollar failed campaign to incorporate medicine into psychology. Claims of widespread support are propaganda and misleading. If the APA campaign is such a great idea, why is it based on such deceit?

What data are you seeking?

I am still waiting for the citations for all that safety data, and the number or citation of the Missouri bill.

 

[CGOPsych]

I share your concern about correspondence training, though many NPs elect this route, which is probably going to make it harder to enforce a residential requirement. I also believe that the supervision requirements are light and need to be increased, though hopefully this consideration will be accepted before the final bill is signed.

I believe the burden of proof is on the professionals who want to prescribe, and not on the medical community to prove it is not safe. However, the attempts made by the professional in favor of prescription seem to be met by accusations that patients will die and other related and unsubstaintiated mudslinging, which is the exact response mid-levels received when they were lobbying for prescribing rights. Both sides are guilty of throwing mud, so instead I'll refer to a formal evaluation of the DOD study, which you have called "a failure"

As for safety, while the DOD comparison has flaws as a direct comparison, I think it provided some insight into the feasibility of a psychologist being able to seek additional training and then being competent to safely prescribe (and unprescribe) psychotropic medications.



The DOD project was not a failure, as it showed that psychologists who were given additional training could safely prescribe psychotropic medications. The cost-effective nature of the DOD project is a separate consideration.

According to the American College of Neuropsychopharmacology ACNP Evaluation Panel Report from May 1998:

In regard to effectiveness: “All 10 graduates of the PDP filled critical needs, and they performed with excellence wherever they were placed. It was striking to the Evaluation Panel how the graduates had filled different niches and brought unique perspectives to their various assignments”

In regard to medical safety and adverse effects, I agree that there is not equivalency to a psychiatrist, which seems to be a popular straw-man argument against RxP, though in a collaborative setting the prescribing psychologists prescribed effectively and without adverse events, per the ACNP report. The other popular stra-man argument is that, “you don’t know what you don’t know”, though the panel found that in fact the prescribing psychologist did have an awareness, and they were able to consult a physician when they needed additional assistance.

As for critiquing the 10 people to sign up, anyone who has done any formalized research understands that recruitment is a complex issue, and simply chalking it up to, "no one wanted to do it" is both ingenuine and inaccurate.

Are there limitations to the DOD…absolutely. Here are the limitations that I see:

1. Small N. Obviously I would have like to see more people, though for a first study it is understandable that they didn’t have 100+ people.

2. The training required more direct supervision hours than what is required now under present legislation in NM and LA, so it is not an equitable comparison. I think this is the biggest weakness of the comparison, and an area that has not been sufficiently addressed in the new legislation.

3. Specialized population. Yes the military does not include peds and geriatric patients, however the report said dependants and Veterans were seen by some of the prescribers, with no reported adverse effects (ref. Variety v. Restricted Caseload in the report). I’d like to see more data with these populations, but it is a start.

4. More oversight than a private out-patient provider. I believe that the collaborative piece is very important to not only training, but overall effectiveness. This limitation was clearly noted in the report, and I believe the new legislation is reflective of this limitation by requiring collaborative agreements with a physician. I believe the collaborative requirement will provide an adequate answer to this concern.

As an aside, the report found that while it was a restricted population, “they essentially mirrored what psychiatrists did with the same population, and, in fact, they differed little from the private practices of the psychiatrists on the Evaluation Panel”



Would you mind asking Dr. Ally if it is okay to share that e-mail here, as I'd like to see exactly what was said.

I see that you did NOT quote the DOD report since it didn't fit your agenda.
And you also did NOT quote the ACNP report concerning whether this program should be emulated in the civilian world. As I stated before, the DOD project was NOT relevant to this discussion of the civilian "quickie" training programs. The training, supervision, facilities etc were far different than what is called for in APA's program.

I quote the same report:

"Should the PDP be emulated? There was discussion at many sites about political pressures in the civilian sector for prescription privileges for psychologists. Virtually all graduates of the PDP considered the "short-cut" programs proposed in various quarters to be ill-advised. Most, in fact, said they favored a 2-year program much like the PDP program conducted
at Walter Reed Army Medical Center, but with somewhat more tailoring of the didactic training courses to the special needs, and skills of clinical psychologists."

Notice it was the PDP graduates themselves who found your APA program proposals to be ill-advised.

Once again, if this RxP campaign is so wonderful, why must its proponents use such tactics?

I continue to wait for the citation of safety data and the number of the Missouri RxP bill.

 

[edieb]

I see that you did NOT quote the DOD report since it didn't fit your agenda.
And you also did NOT quote the ACNP report concerning whether this program should be emulated in the civilian world. As I stated before, the DOD project was NOT relevant to this discussion of the civilian "quickie" training programs. The training, supervision, facilities etc were far different than what is called for in APA's program.

I quote the same report:

"Should the PDP be emulated? There was discussion at many sites about political pressures in the civilian sector for prescription privileges for psychologists. Virtually all graduates of the PDP considered the "short-cut" programs proposed in various quarters to be ill-advised. Most, in fact, said they favored a 2-year program much like the PDP program conducted
at Walter Reed Army Medical Center, but with somewhat more tailoring of the didactic training courses to the special needs, and skills of clinical psychologists."

Notice it was the PDP graduates themselves who found your APA program proposals to be ill-advised.

Once again, if this RxP campaign is so wonderful, why must its proponents use such tactics?

I continue to wait for the citation of safety data and the number of the Missouri RxP bill.

Please share with us any malpractice or licensing board complaints against psychologists prescribing so we can have a rational discussion re: psychologist prescribing

 

[busi26]

Please share with us any malpractice or licensing board complaints against psychologists prescribing so we can have a rational discussion re: psychologist prescribing

I second this statement!

 

[Therapist4Chnge]

The burden of proof should be on the people seeking extended scope, and in this case the DOD project was that proof. The findings in the 1998 report support the SAFETY and TRAINING of prescribing psychologists. There is a question about the amount of training needed, and I agree that a higher standard should be required, though as a famous person* once said, "we have already established [the situation], all we are doing now is negotiating the price". Discussing the particulars about contact hours, supervision hours, and the method of education are all fair areas of discussion.

The focus on the ECONOMIC value within the DOD study is a straw-man argument, and frankly is a poorly built collection of grass and mud. Discussing the economic impact on scope expansion is worth looking at, though I think the medical community is over-estimating the effect on their bottom line. It would be helpful if both sides admitted there is an economic incentive tied to the legislation.

Additionally, complaints about political influence is naive, as ANY successful legislative endeavor is the culmination of enough effective horse trading. A new neighborhood park in a community is as much of a bargaining chip as a tax break to attract new business, and deals are required to get either thing through....RxP legislation is no different. A lot of political capital has been used to get things moving, but no piece of legislation has ever made it through without paying a toll.

One of psychology's greatest strengths (diversity of study) is also a weakness. Attempting to gain concensus amongst a very divergent group is akin to Cat Herding. Also, I'd question the survey construction and sampled population, as many of those "surveys" are sampling from their own, and not the larger psychology population. Admittedly it is not overwhelming supported, but rarely are changes to the system.

*Comedians have used this line in the past, though I believe Churchill was credited with the original idea.

 

[phillydave]

The burden of proof should be on the people seeking extended scope, and in this case the DOD project was that proof. The findings in the 1998 report support the SAFETY and TRAINING of prescribing psychologists. There is a question about the amount of training needed, and I agree that a higher standard should be required, though as a famous person* once said, "we have already established [the situation], all we are doing now is negotiating the price". Discussing the particulars about contact hours, supervision hours, and the method of education are all fair areas of discussion.

The focus on the ECONOMIC value within the DOD study is a straw-man argument, and frankly is a poorly built collection of grass and mud. Discussing the economic impact on scope expansion is worth looking at, though I think the medical community is over-estimating the effect on their bottom line. It would be helpful if both sides admitted there is an economic incentive tied to the legislation.

Additionally, complaints about political influence is naive, as ANY successful legislative endeavor is the culmination of enough effective horse trading. A new neighborhood park in a community is as much of a bargaining chip as a tax break to attract new business, and deals are required to get either thing through....RxP legislation is no different. A lot of political capital has been used to get things moving, but no piece of legislation has ever made it through without paying a toll.

One of psychology's greatest strengths (diversity of study) is also a weakness. Attempting to gain concensus amongst a very divergent group is akin to Cat Herding. Also, I'd question the survey construction and sampled population, as many of those "surveys" are sampling from their own, and not the larger psychology population. Admittedly it is not overwhelming supported, but rarely are changes to the system.

*Comedians have used this line in the past, though I believe Churchill was credited with the original idea.

This is the most worked up I've ever seen you.

Truly insightful posts on the topic, I can't agree more.

 

[Therapist4Chnge]

This is the most worked up I've ever seen you.

Truly insightful posts on the topic, I can't agree more.

Just to clarify, I'm not worked up about it at all, though the conversation has gotten rather cyclical, so I thought it'd be helpful to clarify the actual issues and not get bogged down in the speaking points and rebuttals of the speaking points.

While I differ with the opposition to RxP about the general principle of prescribing psychologists, I am in more agreement about wanting to raise the current standards. Ideally the various organizations (APA-iatry & -ology, AMA, etc) would be able to have a compromise that works for all involved parties.

I think a more traditional classroom based training with structured supervision experiences will help address some of the training questions brought up by the opposition. The reason why an existing PA or NP route is less appealing is that those types of programs don't fit nearly as well with a psychologist. I considered an NP program awhile back, and after reviewing the coursework, I was not very impressed. A friend of mine went through her NP training at the same time I did my RxP training, and I found the breadth and depth of the material I studied was not only more significant for my training, but it allowed me to leverage more of my psych. training. Differentiating psych. diagnoses and understanding presentation differences were two major areas of weakness I've seen in NP training. Conversely, it would have been helpful if we had more classes about specialized populations. We covered quite a bit, but if some of those 1st year classes could be moved to pre-reqs, I think it would allow for more time to be spent on specific pharma areas, and also appease some of the opposition's issue with the class work.

 

[Psychology 76]

Just to clarify, I'm not worked up about it at all, though the conversation has gotten rather cyclical, so I thought it'd be helpful to clarify the actual issues and not get bogged down in the speaking points and rebuttals of the speaking points.

While I differ with the opposition to RxP about the general principle of prescribing psychologists, I am in more agreement about wanting to raise the current standards. Ideally the various organizations (APA-iatry & -ology, AMA, etc) would be able to have a compromise that works for all involved parties.

I think a more traditional classroom based training with structured supervision experiences will help address some of the training questions brought up by the opposition. The reason why an existing PA or NP route is less appealing is that those types of programs don't fit nearly as well with a psychologist. I considered an NP program awhile back, and after reviewing the coursework, I was not very impressed. A friend of mine went through her NP training at the same time I did my RxP training, and I found the breadth and depth of the material I studied was not only more significant for my training, but it allowed me to leverage more of my psych. training. Differentiating psych. diagnoses and understanding presentation differences were two major areas of weakness I've seen in NP training. Conversely, it would have been helpful if we had more classes about specialized populations. We covered quite a bit, but if some of those 1st year classes could be moved to pre-reqs, I think it would allow for more time to be spent on specific pharma areas, and also appease some of the opposition's issue with the class work.

I was just wondering what kinds of specific classes are in a psychologists RxP program? Do you mean like having pre-reqs in clinical psych PhD that apply to RxP program for psychologists?

Thanks!

 

[Therapist4Chnge]

I was just wondering what kinds of specific classes are in a psychologists RxP program? Do you mean like having pre-reqs in clinical psych PhD that apply to RxP program for psychologists?

Thanks!

In regard to what is included in an RxP curriculum, it seems that most of the programs are setup to hit certain areas recommended by the APA, though there can be some various with how the pie is sliced. My pre-req. comment was about having a class like neuroanatomy completed before starting. The major issue with this is the idea of "double dipping", which I believe appears in the LA requirements.

 

[CGOPsych]

The burden of proof should be on the people seeking extended scope, and in this case the DOD project was that proof. The findings in the 1998 report support the SAFETY and TRAINING of prescribing psychologists. There is a question about the amount of training needed, and I agree that a higher standard should be required, though as a famous person* once said, "we have already established [the situation], all we are doing now is negotiating the price". Discussing the particulars about contact hours, supervision hours, and the method of education are all fair areas of discussion.

The focus on the ECONOMIC value within the DOD study is a straw-man argument, and frankly is a poorly built collection of grass and mud. Discussing the economic impact on scope expansion is worth looking at, though I think the medical community is over-estimating the effect on their bottom line. It would be helpful if both sides admitted there is an economic incentive tied to the legislation.

Additionally, complaints about political influence is naive, as ANY successful legislative endeavor is the culmination of enough effective horse trading. A new neighborhood park in a community is as much of a bargaining chip as a tax break to attract new business, and deals are required to get either thing through....RxP legislation is no different. A lot of political capital has been used to get things moving, but no piece of legislation has ever made it through without paying a toll.

One of psychology's greatest strengths (diversity of study) is also a weakness. Attempting to gain concensus amongst a very divergent group is akin to Cat Herding. Also, I'd question the survey construction and sampled population, as many of those "surveys" are sampling from their own, and not the larger psychology population. Admittedly it is not overwhelming supported, but rarely are changes to the system.

*Comedians have used this line in the past, though I believe Churchill was credited with the original idea.

I will say again, the PDP program as a project was a failure. And it is NOT relevant to the discussion of the civilian RxP programs. The PDP grads themselves said it. The burden of proof remains on the shoulders of those who propose this massive change and they have not offered the proof. Just a load of baloney.

The PDP project was the result of pure power politics. No one in the military wanted it. It was pushed on them by a powerful senator from Hawaii. It happens all the time in Washtington.

I agree that the legislative process is more complex. This is why RxP bills have failed 97 times in 24 states. What part of NO do you not understand?

Still waiting for that citation of the safety data and that Missouri bill ... the "secret" one.

 

[busi26]

I will say again, the PDP program as a project was a failure. And it is NOT relevant to the discussion of the civilian RxP programs. The PDP grads themselves said it. The burden of proof remains on the shoulders of those who propose this massive change and they have not offered the proof. Just a load of baloney.

The PDP project was the result of pure power politics. No one in the military wanted it. It was pushed on them by a powerful senator from Hawaii. It happens all the time in Washtington.

I agree that the legislative process is more complex. This is why RxP bills have failed 97 times in 24 states. What part of NO do you not understand?

Still waiting for that citation of the safety data and that Missouri bill ... the "secret" one.

Tell me, CGO, how many times did podiatrists, NPs, and optometrists prescribing bills fail before they were given the right to prescribe in each state? The fearmongerers were out in full force suggesting that patients would be harmed if prescribing rights were given to nonphysicians. Look were we are today.

 

[CGOPsych]

Please share with us any malpractice or licensing board complaints against psychologists prescribing so we can have a rational discussion re: psychologist prescribing

Oh please ... this is becoming sophomoric.

OK ...

Please share with me the full body of data of malpractice and licensing board complaints filed against psychiatrist in New Mexico and Louisiana in the relevant periods in their role solely as prescribing medication. Then we can have a standard against which to compare those against any psychologists in their prescribing role.

 

[CGOPsych]

Tell me, CGO, how many times did podiatrists, NPs, and optometrists prescribing bills fail before they were given the right to prescribe in each state? The fearmongerers were out in full force suggesting that patients would be harmed if prescribing rights were given to nonphysicians. Look were we are today.

I don't know. You tell me how long.

How many millions of dollars has APA spent to get exactly one (1) state with prescribing psychologists after 15 years? Answer: It's a secret. None of your business. Just keep paying them.

According to my calculations America will be all RxP in 750 years.

Oh, 13 states explicitly make it illegal for psychologists to prescribe.
So the score is even more lopsided.

 

[busi26]

I don't know. You tell me how long.

How many millions of dollars has APA spent to get exactly one (1) state with prescribing psychologists after 15 years? Answer: It's a secret. None of your business. Just keep paying them.

According to my calculations America will be all RxP in 750 years.

Oh, 13 states explicitly make it illegal for psychologists to prescribe.
So the score is even more lopsided.

Would you support properly trained psychologists (you can define what properly trained means) prescribing meds to patients in any situation? How many years of training and experience do you think it would take to train a psychologist to prescribe only antidepressants?

 

[Therapist4Chnge]

Oh, 13 states explicitly make it illegal for psychologists to prescribe.

So the score is even more lopsided.

There are many laws on the books that make little to no sense. Feel free to check out: http://www.dumblaws.com/.

In regard to "The Score" for RxP, I'd like to reference the beginning steps for the various mid-levels when they first pursued prescribing rights. There were similar tactics utilized by the AMA and also lesser known fringe groups. Comments like "Patients are going to die!" and "Only physicians have enough training to prescribe!" were commonly used to encourage outrage, but eventually they were proven to be untrue. Scare tactics can be effective in some circumstances, but they prove much less effective when they are shown to be unsubstantiated opinions that parade as "facts".

I agree that there need to be some improvements, but your comments are starting to sound like the unsubstantiated opinions that echoed through the various halls of congress back when mid-levels were seeking prescribing rights. The results of those bills are well known, and I believe prescribing psychologists will eventual follow that path, even with some initial unsuccessful attempts.

 

[CGOPsych]

Would you support properly trained psychologists (you can define what properly trained means) prescribing meds to patients in any situation? How many years of training and experience do you think it would take to train a psychologist to prescribe only antidepressants?

Here's what I tell young psychologists:
If you want to practice medicine get a medical education. Medical school is not necessary, but it sure helps. If you are trained as a PA or APN, you will be worth your weight in gold practice-wise and you will be well qualified to augment your psychology training.

I would never "certify" someone to just prescribe antidepressants, any more than I would certify someone with no psychology training to just perform prolonged exposure therapy for persons suffering from traumatic stress. You don't practice just a little medicine, and you don't practice just a little psychology ... not independently anyway.

When you get a medical education, you aren't just reading a book or going to correspondence school. You will be in hospitals, dealing with physicians, techs, nurses, administrators, many different kinds of patients. You will learn the culture of medicine, which is the vehicle for medical health care.

Among the many things wrong with the APA model is that psychologists who often practice in near isolation, even from each other, will become medical practitioners. An APN with RxP will have been trained and enculturated within the medical system for years before prescribing, independently or through consultation contracts.

So your question is looking at the wrong end.
For example, how many law courses do I need to take to JUST be able to file personal-injury torts? The answer would make no sense ... practicing law is more than just knowing how to do one thing. Medicine and psychology are the same way.

Therefore, I have supreme respect for psychology and for medicine, and I don't think anyone should pretend to be able to practice them independently based on a few narrowly defined courses, especially those taken in correspondence school. I think it's not only an insult to medicine, but it's an insult to the whole notion of practicing complex disciplines such as ours.

 

[CGOPsych]

There are many laws on the books that make little to no sense. Feel free to check out: http://www.dumblaws.com/.

In regard to "The Score" for RxP, I'd like to reference the beginning steps for the various mid-levels when they first pursued prescribing rights. There were similar tactics utilized by the AMA and also lesser known fringe groups. Comments like "Patients are going to die!" and "Only physicians have enough training to prescribe!" were commonly used to encourage outrage, but eventually they were proven to be untrue. Scare tactics can be effective in some circumstances, but they prove much less effective when they are shown to be unsubstantiated opinions that parade as "facts".

I agree that there need to be some improvements, but your comments are starting to sound like the unsubstantiated opinions that echoed through the various halls of congress back when mid-levels were seeking prescribing rights. The results of those bills are well known, and I believe prescribing psychologists will eventual follow that path, even with some initial unsuccessful attempts.

I want to be clear that this campaign has serious problems on many levels.

One of them is purely selfish. I think it is a terrible idea for psychology. The Louisiana mess is just a perfect example (and one that was predicted by an RxP opponent long ago.) Blurring the distinction between us and medicine is not a good idea. It will harm our profession in many ways.

I also have very grave concerns about the quality of care as well. Remember that I said that it has not yet been proven that is necessary, that it will be safe, and that it will be effective. There are many risks involved and it is indeed incumbent upon those who would make such a massive change in the system to show that the benefits are greater than the risks, and that alternatives are not viable.

And I think we should be very honest here: The primary motivation for this is money and power. The APA NEVER investigates any alternative that would not lead to more wealth and power. This was started in an era when APA was taken over by people like Nick Cummings who to this day unabashedly says psychologists should be good entrepreneurs and we should make as much money as possible. He made a fortune running a managed care outfit, and he wants to turn psychology into a cash box.

One reason why the RxP campaign has been so full of baloney is that it cannot admit its real mission - to make money and get power. Yes, this IS a turf war ... APA has been running a turf war to steal the business and power from psychiatry.

I fully support bringing better mental health care to those who are underserved. There are many ways to do so that do not bring these risks. I encourage all psychologists to learn about medications and become fantastic consultants to physicians, just as many psychologists have learned a lot about the law, and testify in court, but they do not practice law without a law degree, etc.

 

[CGOPsych]

Let me pose to you all a hypothetical and question which I think is relevant and fair:

Assume that the National Association of Social Workers has spent millions of dollars over 15 years to pass legislation in all 50 states that will allow social workers to perform all types of psychological testing and evaluations – forensic, neuropsychological, school, cognitive, clinical of all types – through bills that allow:
1. These "Psychological Social Workers" may practice with social work licenses
2. They are licensed and regulated by a board of social workers, who themselves may have no knowledge of psychological evaluations or testing
3. The Psychological Social Workers' training in this area is substantially less than what psychologists receive, less than half.
4. Training for the Psychological Social Workers is done in private, mostly for-profit social worker training schools with very close ties to the national organization
5. The curriculum requirements are written by NASW
6. This education is acquired through online courses and on the telephone
7. There are no pre-requisites for this online course, such as in statistics or test theory and there is no entrance exam
8. The training is done by other social workers
9. They are "certified" with a Master's Degree in Psychological Testing when they pass a test designed by NASW, with a passing grade determined by NASW

And hey, after all, you can just give someone an MMPI and you get this nice long printout of what it means! Any fool can just give a test, right?

Tell me, would you support or oppose this national effort by NASW to pass such a bill throughout this country and to pass a bill in your home state?

If not, why not? And if not, why is it not hypocrisy to oppose this and support this RxP campaign?

If you cannot stomach being treated the way you treat others, then there may be a problem with the nature of your behavior. I for one would and do oppose both. What about you?

 

[phillydave]

Yes, this IS a turf war ... APA has been running a turf war to steal the business and power from psychiatry.

They were also seen on the beaches of France shooting at American soldiers in the 40's. Be very careful of the APA everyone, they seek world domination.

 

[JazzPsych]

Let me pose to you all a hypothetical and question which I think is relevant and fair:

Assume that the National Association of Social Workers has spent millions of dollars over 15 years to pass legislation in all 50 states that will allow social workers to perform all types of psychological testing and evaluations – forensic, neuropsychological, school, cognitive, clinical of all types – through bills that allow:
1. These "Psychological Social Workers" may practice with social work licenses
2. They are licensed and regulated by a board of social workers, who themselves may have no knowledge of psychological evaluations or testing
3. The Psychological Social Workers' training in this area is substantially less than what psychologists receive, less than half.
4. Training for the Psychological Social Workers is done in private, mostly for-profit social worker training schools with very close ties to the national organization
5. The curriculum requirements are written by NASW
6. This education is acquired through online courses and on the telephone
7. There are no pre-requisites for this online course, such as in statistics or test theory and there is no entrance exam
8. The training is done by other social workers
9. They are "certified" with a Master's Degree in Psychological Testing when they pass a test designed by NASW, with a passing grade determined by NASW

And hey, after all, you can just give someone an MMPI and you get this nice long printout of what it means! Any fool can just give a test, right?

Tell me, would you support or oppose this national effort by NASW to pass such a bill throughout this country and to pass a bill in your home state?

If not, why not? And if not, why is it not hypocrisy to oppose this and support this RxP campaign?

If you cannot stomach being treated the way you treat others, then there may be a problem with the nature of your behavior. I for one would and do oppose both. What about you?

Again, I feel like you sound like a threatened psychiatrist by making this comparison to social workers. That's beside the point though.

I'm not sure about the situation in America but in Holland, my country, I reckon that someday social workers might actually try this. There are 2 things that need to be considered first in a case like that:

1. Is the current situation "broken" and does it really need drastic changes?
- In the case of Rxp (especially in Holland) this is the case - namely, 80% of all psychotropics is being prescribed by GP's that really, really shouldn't be doing that.
- Furthermore it seems to have resulted in an unreasonable price/quality; psychiatrists having a monopoly on psychotropics. They spend very little time with their patients and still cost alot.
- Then there is the notion that psychologists are the therapists that spend most time with the patients, which puts them in a very good position to prescribe and monitor the medication (only if they are properly trained! See point 2)

2. (This second reason should only be considered if the first can be answered positively.) Is the education sufficient?
- I want to make clear here that, like therapist4change, I reject the idea of being trained online. Just like MDs you will need hands on experience with both physicians and patients and let's not forget professors.
- If the education seems to be sufficient, then objective studies should be carried out, measuring whether or not the students can actually safely do what they were trained for.

Of course I could think of more points here but the aforementioned to me seems like a prerequisite for any process of change regarding scope of practice.

It could be that social workers will one day try something like this. If so, we should seriously consider it and not let our first reaction be led by fear.

It is natural that professions seek to expand their scope of practice and if this serves the patient then it should always be considered. Rationally!