Psychopharmacology/Advanced Practice Psychology

[edieb]

They will never admit defeat, will they?

Is there any chance they will be able to block the bill from passing still?

No, they cannot block it. The medical establishment tried the same crap in LA and NM

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Members don't see this ad.

 

[Therapist4Chnge]

No, they cannot block it. The medical establishment tried the same crap in LA and NM

As long as it passed both the house and the senate, then only way to block it is to have the Governor reject it. It can be made a law and then legislation made to change/remove it....but that would take quite a bit of effort.

*edit*

There is a stipulation about forming a board that will make recommendations about the training, so that could complicate things, but as far as the legislation goes....the gov't just needs to sign it.

 

[JD7699]

As long as it passed both the house and the senate, then only way to block it is to have the Governor reject it. It can be made a law and then legislation made to change/remove it....but that would take quite a bit of effort.

*edit*

There is a stipulation about forming a board that will make recommendations about the training, so that could complicate things, but as far as the legislation goes....the gov't just needs to sign it.

The last state that was this close(Hawaii) ended with a governor veto. While she may have been against it from the beginning, the AMA worked hard to encourage the veto. As mentioned before on this thread, this governor is thought to be for the bill as last year a bill was signed(2702 I think) by the governor authorizing the work group.

 

[CGOPsych]

As long as it passed both the house and the senate, then only way to block it is to have the Governor reject it. It can be made a law and then legislation made to change/remove it....but that would take quite a bit of effort.

*edit*

There is a stipulation about forming a board that will make recommendations about the training, so that could complicate things, but as far as the legislation goes....the gov't just needs to sign it.

You are right that the only obstacle now for this bill is the governor's veto, and many insiders believe that he is likely to sign it. However, the process of arriving at the bill has been flawed by controversy over conflicts of interest by the RxP side. Additionally, the bill was passed in a special session that was intended to only address obvious and non-controversial issues. Because this bill was hobbled together in a hurried fashion and it even calls itself an emergency bill, many have urged the governor to veto it for procedural reasons alone. The associate editor for the state's largest newspaper, the Oregonian, has urged him to kill it.

However, that's not the end of the story. The bill only creates a process by which the conditions of RxP are set by the state medical board, not by the psychology board. A committee consisting mostly of psychologists will offer their input to the board, which will decide issues such as the formulary, training and supervision.

 

[CGOPsych]

The last state that was this close(Hawaii) ended with a governor veto. While she may have been against it from the beginning, the AMA worked hard to encourage the veto. As mentioned before on this thread, this governor is thought to be for the bill as last year a bill was signed(2702 I think) by the governor authorizing the work group.

The governor of Hawaii deliberated about that bill extensively, so to simply dismiss her veto as the result of a bias is to sell her short. By the way, the Hawaii legislature ordered an extensive study of RxP that was quite detailed.

The RxPers have been trying to pass bills in Hawaii since 1985 ... I assume you wish to ignore all the times the various legislators have said "no" and then assume that she should agree when they finally say "yes" once. I believe in that year it passed the senate by a single vote.

Many people urged her to veto the bill, including a large number of psychologists. The claim that a majority of psychologists support the APA model of RxP has not been substantiated and may actually be quite wrong, but it is repeated nonetheless.

 

[CGOPsych]

Are you a member of the APA?

For 19 years. And you?

 

[CGOPsych]

They will never admit defeat, will they?

Is there any chance they will be able to block the bill from passing still?

The APA campaign's bills to incorporate medicine into psychology have failed 97 times in 24 states after 15 years. I'd say the will of the people has been expressed many times. Perhaps you should consider taking no for an answer.

Also, the graduates of the PDP program said what you and APA want to do is inappropriate because of inadequate training. Perhaps you should listen to them.

Also, the prescribers in Louisiana say what you are proposing is inappropriate, that psychologists should not prescribe with psychology licenses and under the regulation of psychology boards, but instead should be medical providers. Perhaps you should listen to them.

 

[edieb]

The APA campaign's bills to incorporate medicine into psychology have failed 97 times in 24 states after 15 years. I'd say the will of the people has been expressed many times. Perhaps you should consider taking no for an answer.

Also, the graduates of the PDP program said what you and APA want to do is inappropriate because of inadequate training. Perhaps you should listen to them.

Also, the prescribers in Louisiana say what you are proposing is inappropriate, that psychologists should not prescribe with psychology licenses and under the regulation of psychology boards, but instead should be medical providers. Perhaps you should listen to them.

I am not going to mince words: What you are saying is blatant lie. The graduates of the DoD program are all in favor of RxP passing. In fact, Morgan Sammons, one of the DoD graduates, helped construct the Oregon bill. Other DoD gradjuates teach courses at the RxP training programs and have been flown in to testify for RxP bills in other states. Stop making things up.


In regards to how the length of time it is taking to pass RxP bills: Any movement that is substantial is going to take time. Anybody trained in research methodology would know to look at the trend and not the overall time The first RxP bill was introduced in Hawaii in 1985 or so. The first bill did not pass until the early 2002. As no bills passed for 17 years and 4 bills have passed in the last 10 years (including Hawaii), there is a trend showing RxP is being more and more accepted.

 

[CGOPsych]

I am not going to mince words: What you are saying is blatant lie. The graduates of the DoD program are all in favor of RxP passing. In fact, Morgan Sammons, one of the DoD graduates, helped construct the Oregon bill. Other DoD gradjuates teach courses at the RxP training programs and have been flown in to testify for RxP bills in other states. Stop making things up.


In regards to how the length of time it is taking to pass RxP bills: Any movement that is substantial is going to take time. Anybody trained in research methodology would know to look at the trend and not the overall time The first RxP bill was introduced in Hawaii in 1985 or so. The first bill did not pass until the early 2002. As no bills passed for 17 years and 4 bills have passed in the last 10 years (including Hawaii), there is a trend showing RxP is being more and more accepted.

I resent you calling me a liar when I have already presented proof.
I will present it again and I expect your apology.

I quote the 1998 report of the ACNP, which the RxP proponents have quoted as well:

"4. 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. Most said an intensive full-time year of clinical experience, particularly with inpatients, was indispensable."

I expect your apology.

Then you can go ask Morgan Sammons if he was one of the "virtually all". We can probably check the records to see if he's telling the truth.

Dr. Sammons is the dean of the California School of Professional Psychology, a private school that sells RxP programs for $13,000 apiece. He got a temporary 4-month license so he could technically qualify as an Oregon psychologist so he could sit on the task force that helped determine training standards for that bill.

THAT is a blatant conflict of interest. Go ask him about that too.

APA, which has spent millions to lobby for these bills, has a whole division devoted to this political campaign. And who is the president of this division? Morgan Sammons.

THAT seems to be an interesting confluence of industry and APA's political machine. It's all about money, right?

Go ask him about that.

Dr. Sammons also spoke out forcefully for the APA policy which was criticized around the world as allowing psychologists to participate in interrogations that could involve torture. That's because the RxP campaign is intertwined with APA's participation in the Bush Administration's torture of detainees.

The APA has since reversed that policy after a referendum of the membership forced them to.

Go ask Sammons about THAT.

Real integrity there ... about as much as the rest of the RxP campaign has shown.

And I expect your apology.

And of course I expect of you evidence to support your statement that ALL the PDP grads are in favor of the RxP proposals such as the one in Oregon.

You can provide that either before or after your apology to me.

 

[Therapist4Chnge]

Dr. Sammons also spoke out forcefully for the APA policy which was criticized around the world as allowing psychologists to participate in interrogations that could involve torture. That's because the RxP campaign is intertwined with APA's participation in the Bush Administration's torture of detainees.

 

[JD7699]

An important part of this bill as enrolled is the development of a task force to determine educational standards, curriculum,training standards, including precribing drugs to special populations. This task force, different than the 7 member board that is to be part of the Board of Medicine (which includes 4 psychologists, 3 MDs), will be comprised of 6 members(3 psychologists and 3 MDs, one of which a psychiatrist). The training standards have yet to be determined.



SECTION 9. { + (1) There is created the Task Force on
Prescribing Psychologists, consisting of six members as follows:
(a) Three licensed physicians, at least one of whom must be a
psychiatrist, appointed by the Oregon Medical Board; and
(b) Three licensed psychologists, at least one of whom must
have a doctorate in clinical psychology, appointed by the State
Board of Psychologist Examiners.
(2) The task force shall:
(a) Develop recommendations on the educational requirements,
curriculum, clinical training and standards, including standards
for prescribing drugs to special populations, that should be
required to grant clinical psychologists the authority to
prescribe psychotropic drugs within a clinical psychology
practice; and
(b) Report its recommendations to the Seventy-sixth Legislative
Assembly in the manner provided in ORS 192.245 no later than
March 1, 2011.
(3) A majority of the members of the task force constitutes a
quorum for the transaction of business.
(4) Official action by the task force requires the approval of
a majority of the members of the task force.

 

[edieb]

You still did not prove me wrong. There has not been one DoD psychology who has testified against RxP. In fact, every single one of them has testified for it in front of state legislatures and, the majority of them, teach psychopharm classes

I resent you calling me a liar when I have already presented proof.
I will present it again and I expect your apology.

I quote the 1998 report of the ACNP, which the RxP proponents have quoted as well:

"4. 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. Most said an intensive full-time year of clinical experience, particularly with inpatients, was indispensable."

I expect your apology.

Then you can go ask Morgan Sammons if he was one of the "virtually all". We can probably check the records to see if he's telling the truth.

Dr. Sammons is the dean of the California School of Professional Psychology, a private school that sells RxP programs for $13,000 apiece. He got a temporary 4-month license so he could technically qualify as an Oregon psychologist so he could sit on the task force that helped determine training standards for that bill.

THAT is a blatant conflict of interest. Go ask him about that too.

APA, which has spent millions to lobby for these bills, has a whole division devoted to this political campaign. And who is the president of this division? Morgan Sammons.

THAT seems to be an interesting confluence of industry and APA's political machine. It's all about money, right?

Go ask him about that.

Dr. Sammons also spoke out forcefully for the APA policy which was criticized around the world as allowing psychologists to participate in interrogations that could involve torture. That's because the RxP campaign is intertwined with APA's participation in the Bush Administration's torture of detainees.

The APA has since reversed that policy after a referendum of the membership forced them to.

Go ask Sammons about THAT.

Real integrity there ... about as much as the rest of the RxP campaign has shown.

And I expect your apology.

And of course I expect of you evidence to support your statement that ALL the PDP grads are in favor of the RxP proposals such as the one in Oregon.

You can provide that either before or after your apology to me.

 

[CGOPsych]

You still did not prove me wrong. There has not been one DoD psychology who has testified against RxP. In fact, every single one of them has testified for it in front of state legislatures and, the majority of them, teach psychopharm classes

You have been insulting and are playing disinegenous games with your statements.
I have shown evidence from a reliable report that the PDP grads said what you are advocating is ill-advised and inadequate.

I do not consider you to be credible or have integrity.

 

[CGOPsych]

An important part of this bill as enrolled is the development of a task force to determine educational standards, curriculum,training standards, including precribing drugs to special populations. This task force, different than the 7 member board that is to be part of the Board of Medicine (which includes 4 psychologists, 3 MDs), will be comprised of 6 members(3 psychologists and 3 MDs, one of which a psychiatrist). The training standards have yet to be determined.



SECTION 9. { + (1) There is created the Task Force on
Prescribing Psychologists, consisting of six members as follows:
(a) Three licensed physicians, at least one of whom must be a
psychiatrist, appointed by the Oregon Medical Board; and
(b) Three licensed psychologists, at least one of whom must
have a doctorate in clinical psychology, appointed by the State
Board of Psychologist Examiners.
(2) The task force shall:
(a) Develop recommendations on the educational requirements,
curriculum, clinical training and standards, including standards
for prescribing drugs to special populations, that should be
required to grant clinical psychologists the authority to
prescribe psychotropic drugs within a clinical psychology
practice; and
(b) Report its recommendations to the Seventy-sixth Legislative
Assembly in the manner provided in ORS 192.245 no later than
March 1, 2011.
(3) A majority of the members of the task force constitutes a
quorum for the transaction of business.
(4) Official action by the task force requires the approval of
a majority of the members of the task force.

The task force made recommendations for training standards to the legislature.
Dr. Sammons was on the task force.
Dr. Sammons is the dean of a private school in California that would profit directly from the training standards adopted in Oregon.
That is a conflict of interest.
Furthermore, the psychology board which appointed him should be held accountable for participating in this.
Oregon has a law against exactly this kind of behavior.

 

[JD7699]

The task force made recommendations for training standards to the legislature.
Dr. Sammons was on the task force.
Dr. Sammons is the dean of a private school in California that would profit directly from the training standards adopted in Oregon.
That is a conflict of interest.
Furthermore, the psychology board which appointed him should be held accountable for participating in this.
Oregon has a law against exactly this kind of behavior.

that was a different task force which made their recommendations by Jan of this year. this report is due in 2011. I went back and checked hb 2702. What I posted is from sb 1046.

 

[edieb]

The task force made recommendations for training standards to the legislature.
Dr. Sammons was on the task force.
Dr. Sammons is the dean of a private school in California that would profit directly from the training standards adopted in Oregon.
That is a conflict of interest.
Furthermore, the psychology board which appointed him should be held accountable for participating in this.
Oregon has a law against exactly this kind of behavior.

Nice try to deflect attention from your misinformation, but your dishonesty is transparent
Again, I ask you to tell me where DoD psychologists have testified against any RxP bills. We have already seen where they have suppoted them

 

[CGOPsych]

that was a different task force made which made their recommendations by Jan of this year. this report is due in 2011. I went back and checked hb 2702. What I posted is from sb 1046.

Yes that is exactly the task force to which Sammons was appointed.
That task force deliberated and made recommendations to the legislature.

That task force reported to the Senate Health Committee where Sen. Alan Bates busted Sammons even though the psychology board tried to hide it.

 

[CGOPsych]

Nice try to deflect attention from your misinformation, but your dishonesty is transparent
Again, I ask you to tell me where DoD psychologists have testified against any RxP bills. We have already seen where they have suppoted them

I stated that the PDP grads are on record opposing the kind of program you advocate. I quoted a report.

You on the other hand have made statements you cannot support and then you have changed them.

You have no credibility or integrity in my eyes. Come back when you think you can discuss this with both.

 

[psich]

CGO, you keep accusing people of being dishonest, disingenuous, and lacking integrity. How does any of that contribute to the factual discussion of the topic?

 

[JD7699]

Yes that is exactly the task force to which Sammons was appointed.
That task force deliberated and made recommendations to the legislature.

That task force reported to the Senate Health Committee where Sen. Alan Bates busted Sammons even though the psychology board tried to hide it.

That was a work group composed of 7 members(2 psychiatrists, pharmacist, gp, three psychologists). What I have posted is a Task Force which is part of the new bill, sb 1046. I know that the original work group was designed to iron out education and training and proposed the original sb 1046 before it was amended, but the bill that passed ads a 6 person task force besides the 7 person committee that will serve on the Medical Board.

 

[phillydave]

CGO: As a layman to the entire topic and someone who could be swayed in either direction (although I do admit that at this point I am more pro RxP than not) , I have to say that in the last couple weeks I haven't found any of your posts to be particularly compelling. I understand very clearly that you are against RxP and very much dislike the APA, but your posts come off as more angry than passionate, and more arrogant than enlightening.

My real point here, I guess, is: Why should someone like me, a future psychologist, buy stock in your argument? What is the real problem with RxP, besides all of the studies and letters and "corrupt" PhDs you keep talking about? Because honestly, while these things you cite may add potency to your argument in your mind, they don't make me (the "swing voter") want to join your camp.

And yes, the burden of proof for safety is incumbent upon those who wish to make the change, I get it. But asking someone to prove that safetybelts save lives without letting them install them in a few cars is just being thickheaded.

 

[CGOPsych]

That was a work group composed of 7 members(2 psychiatrists, pharmacist, gp, three psychologists). What I have posted is a Task Force which is part of the new bill, sb 1046. I know that the original work group was designed to iron out education and training and proposed the original sb 1046 before it was amended, but the bill that passed ads a 6 person task force besides the 7 person committee that will serve on the Medical Board.

You are conflating two groups.
The task force to which Sammons was appointed by the psychology board represents a conflict of interest.
The one to which you are referring has not started yet.

Sammons' appointment is a clear conflict of interest. It made recommendations on training that were consistent with the financial position of his employer. That is a moral and probably legal conflict of interest.
qed

 

[CGOPsych]

CGO: As a layman to the entire topic and someone who could be swayed in either direction (although I do admit that at this point I am more pro RxP than not) , I have to say that in the last couple weeks I haven't found any of your posts to be particularly compelling. I understand very clearly that you are against RxP and very much dislike the APA, but your posts come off as more angry than passionate, and more arrogant than enlightening.

My real point here, I guess, is: Why should someone like me, a future psychologist, buy stock in your argument? What is the real problem with RxP, besides all of the studies and letters and "corrupt" PhDs you keep talking about? Because honestly, while these things you cite may add potency to your argument in your mind, they don't make me (the "swing voter") want to join your camp.

And yes, the burden of proof for safety is incumbent upon those who wish to make the change, I get it. But asking someone to prove that safetybelts save lives without letting them install them in a few cars is just being thickheaded.

The RxP forces have had many years to compile data to show the safety and effectiveness of this program and have not. Why do you say that the safety must be proven before the changes are made?

Why don't you ask for the safety data which has been claimed by the RxPers? I doubt that you have been a neutral observer, but thanks for shilling for the RxPers.

There is NO data to show this is safe or effective. Nor is there evidence presented that this is necessary. That's a fact. And if it were not, we would have seen it.

 

[CGOPsych]

CGO, you keep accusing people of being dishonest, disingenuous, and lacking integrity. How does any of that contribute to the factual discussion of the topic?

The dishonesty of some who have pretended to engage in debate is obvious.

I don't waste my time with such garbage.

I have presented evidence. They have not.

Why don't you ask them for the safety data they claim exists?
Why don't you ask them for effectiveness data?
Why don't you ask them about the "secret" bill in Missouri?
Why don't you ask the RxPer above why he changed his argument after I presented evidence to fully support my statement?

It does no good to chase these people in circles. Each time I show them to be charlatans, they change the topic.

I don't see much reason to continue playing games with those who are dishonest.

 

[JD7699]

You are conflating two groups.
The task force to which Sammons was appointed by the psychology board represents a conflict of interest.
The one to which you are referring has not started yet.

Sammons' appointment is a clear conflict of interest. It made recommendations on training that were consistent with the financial position of his employer. That is a moral and probably legal conflict of interest.
qed

I know it hasn't started, and my point was that despite the fact that group that already took place (with Sammons) recommending training standards, The standards are still not set. If one of the argument is that the standards are set too low, I am saying that the standards have not been set in the enrolled bill. Even if it is signed, there is much to be done. Thats it. I was hoping to have some thoughtful discussion about what individuals believe would be acceptable. I was not directing this to you alone, but the whole group.

 

[CGOPsych]

I know it hasn't started, and my point was that despite the fact that group that already took place (with Sammons) recommending training standards, The standards are still not set. If one of the argument is that the standards are set too low, I am saying that the standards have not been set in the enrolled bill. Even if it is signed, there is much to be done. Thats it. I was hoping to have some thoughtful discussion about what individuals believe would be acceptable. I was not directing this to you alone, but the whole group.

Fair enough.
A survey published in an APA journal says that 78 percent of licensed clinical psychologists believe psychologists who wish to prescribe should have the same training as other non-physician prescribers. Let's begin with that general principle. Would you agree with that?

 

[Therapist4Chnge]

Fair enough.
A survey published in an APA journal says that 78 percent of licensed clinical psychologists believe psychologists who wish to prescribe should have the same training as other non-physician prescribers. Let's begin with that general principle. Would you agree with that?

I agree with that.

I'm hoping the appointed panel will recommend/push training that is in line with the current NP training, though have it be done only residentially. There are some weaknesses in most of the NP training programs I have reviewed (which I have mentioned previously), but I think a properly designed RxP program for psychologists can address most of those issues.

I think in the end some of the standards will be raised, but not to where most people want them to be.

 

[CGOPsych]

I agree with that.

I'm hoping the appointed panel will recommend/push training that is in line with the current NP training, though have it be done only residentially. There are some weaknesses in most of the NP training programs I have reviewed (which I have mentioned previously), but I think a properly designed RxP program for psychologists can address most of those issues.

I think in the end some of the standards will be raised, but not to where most people want them to be.

Therefore, would it be safe to assume that you oppose the APA models?
For example, the Illinois and the USVI bills call for 300 "contact hours" which could be taken through correspondence school. That is far less than what APN's are required.

Furthermore, as you may know, a nurse doesn't simply take a few classes and do a practicum to become an APN. She (usually a she) has been educated and working within the medical system for years, sometimes rising up from an RN to a BSN, MSN and then the APN credential. In that time they obviously learn a great deal and are part of the medical culture and systems, which is an important part of medical practice.

The APA model bills not only allow psychologists to receive all their education online, but there are no other pre-requisites and psychologists quite possibly will have no exposure to, or experience in, the complexities of medicine as a system and culture. I know only too well that many of my colleagues have no contact with the medical system and would be prescribing in a way that is wholly separate from it, whereas an APN or PA, even if they were allowed to prescribe independently, would by training and experience be an integral part of the system. These circumstances would make it more important that psychologists receive more education and more extensive supervision, however, oftentimes the opposite is true.

Bills vary as to supervision requirements. In Missouri it called only for a psychologists to have at least one person in their practice on medication, and that they receive "weekly supervision" with no requirements as to how long it was, or even if it was on the telephone, or whether the supervisor had any expertise in psychiatric medicine, or even lived in the state!

Therefore while the idea of "properly trained psychologists" prescribing may seem attractive to many, when they learn of these details, many rational people find the APA model bills to be unacceptable.

Also, the APA campaign has actually opposed requiring training for psychologists that equals that of PA's, APN's, etc. That's because if they agree to it, then it invites the argument of why not just have them get PA or APN training?

There is evidence that extensive training would not be feasible because psychologists would not want it. The vaunted PDP program failed to attract enough psychologists to fill the slots authorized for it. Quite possibly one reason is that the training was too hard! As you probably know, the first wave went through two full years of university-based medical school, plus one fulltime year of inpatient practicum. The second wave only did one full year in the university, taking all the classes of the second-year medical students, and the year of inpatient practicum.

Also, I am told there was an executive APN program in New Jersey that could train psychologists on weekends, but it folded for lack of interest.

Thus, those of us who oppose the APA campaign believe that it would not at all be successful if the wishes of the 78 percent of psychologists were fulfilled and equivalent training was required, as virtually no one would want to do it. The fact that psychologists can get all their medical education on their laptops in the kitchen seems to be a major selling point in offering the path to RxP.

I applaud your forthrightness in agreeing that there should be equivalence in training. That is certainly an important part of this whole debate.

 

[Therapist4Chnge]

Therefore, would it be safe to assume that you oppose the APA models?
For example, the Illinois and the USVI bills call for 300 "contact hours" which could be taken through correspondence school. That is far less than what APN's are required.

Furthermore, as you may know, a nurse doesn't simply take a few classes and do a practicum to become an APN. She (usually a she) has been educated and working within the medical system for years, sometimes rising up from an RN to a BSN, MSN and then the APN credential. In that time they obviously learn a great deal and are part of the medical culture and systems, which is an important part of medical practice.

This would be nice, and that may be how the Nursing Associations pitched the training, but many nurses are using 'direct-entry' programs and are skipping almost all of the "Experience" part. There are minimum requirements to meet RN licensure, though after that it is mostly paperwork to get into an NP program. There are many great nurses who bring their 10-20+ years of experience to an NP program, though they are far from the majority of NP students.

www.allnurses.com has whole threads/forums about various program options for the quickliest way to getting prescribing rights. The AACN (American Association of Colleges of Nursing) has a list of all of the direct-entry programs for non nursing majors. So while there is the appearance that many of the freshly minted NPs are very experienced nurses....many have barely spent any time on the floors of a hospital. I have tutored nursing students in a number of core areas, so I have quite a bit of experience with the curriculums, topic areas covered, etc. There is also the issue of many programs doing strictly online NP classes. I don't mean this to be a knock on nurses, as they are the backbone of most medical facilities, but the "same as a midlevel" reasoning is slightly flawed if you dig a bit.

As for PA programs, I think they do a better job of keeping students in the classroom and making sure they do what they need to do. Their training is pretty condensed, so there are definitely pro's/con's to the training. When I looked at PA programs I thought their curriculum was more in line with what I would look for, but I still think there is room for psychologists to take a set of classes that maximize their training. You mentioned the option of going to be a PA, but I think there is a better opportunity to educate psychologists.

Bills vary as to supervision requirements. In Missouri it called only for a psychologists to have at least one person in their practice on medication, and that they receive "weekly supervision" with no requirements as to how long it was, or even if it was on the telephone, or whether the supervisor had any expertise in psychiatric medicine, or even lived in the state!

Again, I'm with you on the consultation piece. I would like to see in-state requirements, as well as face to face requirements (at least monthly, with more regular contact by phone...as a minimum).

I'm going to leave the rest of your comments alone, as I've addressed most/all of them previously.

 

[JD7699]

Fair enough.
A survey published in an APA journal says that 78 percent of licensed clinical psychologists believe psychologists who wish to prescribe should have the same training as other non-physician prescribers. Let's begin with that general principle. Would you agree with that?

I believe as you that the APA model is not enough. Now, I know that most psychologists do not have the prerequisites that nurses complete. Obviously, psychologists need to know more that just medications, doses, side effects, etc. We would need a similar background in anatomy, bio-chemistry, etc. Now I am not sure that I think prescribing psychologists need all the training that a nurse practitioner needs since the services that they provide are different. Thoughts?

 

[JD7699]

"Furthermore, as you may know, a nurse doesn't simply take a few classes and do a practicum to become an APN. She (usually a she) has been educated and working within the medical system for years, sometimes rising up from an RN to a BSN, MSN and then the APN credential. In that time they obviously learn a great deal and are part of the medical culture and systems, which is an important part of medical practice."

Is it not true that a common path for a nurse to obtain advanced education is to complete the RN and then attend RN to BSN or MSN programs that are readily available online with some residence requirement?

I am aware that the initial AA in Nursing is very practical with tons of hands on work. Sorry, didn't get the quote right.

 

[IndianaOD]

Interesting the nurse topic came up. My wife is an MSW and gets CE brochures all the time. The most recent one was "psychopharmacology" and it was being presented by a nurse. As I said before I don't believe primary care docs should be Rxing psychotropics let alone nurses. I had no idea nurses even had that much Rx autonomy. In this lady's bio it talks about experience prescribing medication for depression, bipolar, schizophrenia, anxiety, and ADHD since 1997. Children and adults.

I think it is disingenuous to say a doctoral level professional should not be allowed Rx privileges in their trained specialty when an MSN can do it all.

In a few states, doctors of optometry (with loads of pharmacology coursework) still can't prescribe orals for ocular conditions. Fortunately I can but I would be quite unhappy if I couldn't and an MSN could. I have 4 years of undergrad, 4 years of OD school and a year of residency training for crying out loud.

Honestly the medical establishment needs to give up the god complex and realize others have great training as well.

 

[JD7699]

Therefore, would it be safe to assume that you oppose the APA models?


"Furthermore, as you may know, a nurse doesn't simply take a few classes and do a practicum to become an APN. She (usually a she) has been educated and working within the medical system for years, sometimes rising up from an RN to a BSN, MSN and then the APN credential. In that time they obviously learn a great deal and are part of the medical culture and systems, which is an important part of medical practice."

what about those of us who have worked for years(8 years personally) in a mental health clinic with psychiatrists, working with them treating our patients and sharing the same chart. Is this less valuable than the time nurse's spend with MDs?

 

[CGOPsych]

"Furthermore, as you may know, a nurse doesn't simply take a few classes and do a practicum to become an APN. She (usually a she) has been educated and working within the medical system for years, sometimes rising up from an RN to a BSN, MSN and then the APN credential. In that time they obviously learn a great deal and are part of the medical culture and systems, which is an important part of medical practice."

Is it not true that a common path for a nurse to obtain advanced education is to complete the RN and then attend RN to BSN or MSN programs that are readily available online with some residence requirement?

I am aware that the initial AA in Nursing is very practical with tons of hands on work. Sorry, didn't get the quote right.

I said sometimes. You say it's not a common path. How do you know this?

I've worked with APN's and PA's and we often discussed each others' fields.

I think the point is made. APN's don't just take some courses online as their only medical education. And they have a lot of background in the medical system before they finish their certification. Psychologists very frequently don't. Therefore, the issue is not just online training with no other medical education, it's about all the learning afforded by being within the system, sometimes for years.

 

[CGOPsych]

Therefore, would it be safe to assume that you oppose the APA models?


"Furthermore, as you may know, a nurse doesn't simply take a few classes and do a practicum to become an APN. She (usually a she) has been educated and working within the medical system for years, sometimes rising up from an RN to a BSN, MSN and then the APN credential. In that time they obviously learn a great deal and are part of the medical culture and systems, which is an important part of medical practice."

what about those of us who have worked for years(8 years personally) in a mental health clinic with psychiatrists, working with them treating our patients and sharing the same chart. Is this less valuable than the time nurse's spend with MDs?

I would say that is valuable experience. And I know many psychologists who have not done so. Prescribing medication independently requires much more than taking some correspondence school courses. In my experience, those who have less contact with medicine underestimate it, just as those who don't know much about psychologists underestimate what we do.

 

[CGOPsych]

I believe as you that the APA model is not enough. Now, I know that most psychologists do not have the prerequisites that nurses complete. Obviously, psychologists need to know more that just medications, doses, side effects, etc. We would need a similar background in anatomy, bio-chemistry, etc. Now I am not sure that I think prescribing psychologists need all the training that a nurse practitioner needs since the services that they provide are different. Thoughts?

All the training of an APN? I don't think so and your point is well taken. But the disparity is so large as to be clearly inadequate.

There is an issue that if a professional is to practice independently, then one must have a broad base of knowledge, not just know a few parts of the discipline, wouldn't you agree? Paraprofessionals and poseurs can always do some of the work of a professional ... lots of people can draw up a will from the Office Max forms. But to practice independently requires much more knowledge to cover the less common and the more severe cases.

I'm sure there are many non-psychologists who would think they can do the therapy and assessments I do, if they just had about three months of good training. And I'm sure they could appear to do my work, and probably perform many of the actions I do. But I don't think they could be competent overall, and they would be outright dangerous in some situations.

I have respect for what it takes to practice medicine, even if one thinks he is doing just a little bit of it, just as I have respect for what it takes to practice clinical psychology.

 

[JD7699]

I said sometimes. You say it's not a common path. How do you know this?

I've worked with APN's and PA's and we often discussed each others' fields.

I think the point is made. APN's don't just take some courses online as their only medical education. And they have a lot of background in the medical system before they finish their certification. Psychologists very frequently don't. Therefore, the issue is not just online training with no other medical education, it's about all the learning afforded by being within the system, sometimes for years.

I only know several who have done such programs. I know that they have on campus stuff as well. I believe that the reason for this is to allow them to continue their work in their field full time. I am not saying that I think distance education is solid as the classroom, only to say that it is possible for serious professionals to gain a lot from a distance program provided they utilize means of connection with faculty and staff. there also should be a practical component which assesses skill level in person. We are not that far off as far training beliefs. How about the supervised experience? I am think 2 years of supervised experience(and the need for supervised training for different populations like children) and am not opposed to continued supervised practice much like Nurse Practitioners.

 

[CGOPsych]

Interesting the nurse topic came up. My wife is an MSW and gets CE brochures all the time. The most recent one was "psychopharmacology" and it was being presented by a nurse. As I said before I don't believe primary care docs should be Rxing psychotropics let alone nurses. I had no idea nurses even had that much Rx autonomy. In this lady's bio it talks about experience prescribing medication for depression, bipolar, schizophrenia, anxiety, and ADHD since 1997. Children and adults.

I think it is disingenuous to say a doctoral level professional should not be allowed Rx privileges in their trained specialty when an MSN can do it all.

In a few states, doctors of optometry (with loads of pharmacology coursework) still can't prescribe orals for ocular conditions. Fortunately I can but I would be quite unhappy if I couldn't and an MSN could. I have 4 years of undergrad, 4 years of OD school and a year of residency training for crying out loud.

Honestly the medical establishment needs to give up the god complex and realize others have great training as well.

It depends on what the MSN's training is, and what the doctoral level professional's is, wouldn't you say?

Remember that it takes no biomedical pre-reqs to get into psychology grad school (with a few exceptions).
It takes exactly one biologically related course to get that doctoral degree in psychology ... a kind of survey course.
Then the APA training can be taken all online, with no pre-requisite courses or entrance exam.

So would 300 "contact hours" online as the total sum of medical education be sufficient? I don't think so. As for the MSN, I don't know what education she had.

I've looked up some PA programs, and they require more biomedical courses than that just to apply for them.

So I would be careful about comparing them just because one is "doctoral" and the other is not. I'm a "doctor" and I'm not qualified to clean your teeth.

 

[JD7699]

All the training of an APN? I don't think so and your point is well taken. But the disparity is so large as to be clearly inadequate.

There is an issue that if a professional is to practice independently, then one must have a broad base of knowledge, not just know a few parts of the discipline, wouldn't you agree? Paraprofessionals and poseurs can always do some of the work of a professional ... lots of people can draw up a will from the Office Max forms. But to practice independently requires much more knowledge to cover the less common and the more severe cases.

I'm sure there are many non-psychologists who would think they can do the therapy and assessments I do, if they just had about three months of good training. And I'm sure they could appear to do my work, and probably perform many of the actions I do. But I don't think they could be competent overall, and they would be outright dangerous in some situations.

I have respect for what it takes to practice medicine, even if one thinks he is doing just a little bit of it, just as I have respect for what it takes to practice clinical psychology.

It would be nice if individuals considered scope of competence as well as scope of practice. The severe cases I think are a problem which needs to be addressed. It would be nice to see some guidelines for referral to psychiatrists. It is one thing to treat someone with 40mg of Prozac who is 25 years old with a recent physical showing now major physical ailments or problems. Many patients do not take care of their physical health. Psychologists in county or state clinics may have the resources to refer, those in private often do not have the option. So I also see the need for a stronger medical foundation.

 

[CGOPsych]

I only know several who have done such programs. I know that they have on campus stuff as well. I believe that the reason for this is to allow them to continue their work in their field full time. I am not saying that I think distance education is solid as the classroom, only to say that it is possible for serious professionals to gain a lot from a distance program provided they utilize means of connection with faculty and staff. there also should be a practical component which assesses skill level in person. We are not that far off as far training beliefs. How about the supervised experience? I am think 2 years of supervised experience(and the need for supervised training for different populations like children) and am not opposed to continued supervised practice much like Nurse Practitioners.

In the PDP program they had a solid year of inpatient psychiatric experience. And I gather you in particular have an idea of how much experience that would be ... tons. According to the ACNP report, most of them said that was really necessary.

BTW, the training of the PDPers was hands-on. They had to learn how to do a physical examination for example, not just memorize dosages and side effects. I had a conversation with one of the ACNP examiners who told me "it really is learning to be a doctor".

A local PA program requires a full-time year of various practica. Are you suggesting two full years of full-time supervised experience?

I agree that serious professionals can profit from distance learning. If you or I wanted to learn how to use a new assessment instrument I think that would be fine. But I don't think we should have learned everything we know about clinical psychology from an online class.

 

[CGOPsych]

It would be nice if individuals considered scope of competence as well as scope of practice. The severe cases I think are a problem which needs to be addressed. It would be nice to see some guidelines for referral to psychiatrists. It is one thing to treat someone with 40mg of Prozac who is 25 years old with a recent physical showing now major physical ailments or problems. Many patients do not take care of their physical health. Psychologists in county or state clinics may have the resources to refer, those in private often do not have the option. So I also see the need for a stronger medical foundation.

Yes but this is the rub: For the less severe cases, the patient's PCP or other non-psychiatrist physician is fine. The psychiatrist is the specialist who should handle cases too complex for the PCP, or the modestly educated psychologist. Just like PCP's will prescribe pain meds to a degree, then send the patient to a pain clinic.

So if that's the case, it makes less clear why we would want to create a new branch of medicine/practice/education. The collaborative model involving the psychologist (with a good pharm education) working with non-psychiatric physicians, turning the severe cases over to the specialist, appears to be an excellent system.

You may be aware that RxP training is actually the third level. The second level (not so much publicized) is actually to train psychologists to be good collaborators.

I assume you've had the same experience ... I have always had access to my patient's physicians. They take or return calls promptly and listen to my thoughts. In fact, my physician friends say their beef with psychologists is that we don't communicate with them enough.

 

[Shallot]

A bill just passed the Oregon house and senate giving prescription privileges to psychologists, and now goes to the governor's desk for his signature or veto. If it succeeds, Oregon psychologists will gain RxP in the middle of 2011. More information here: http://www.thelundreport.org/resource/psychologists_win_prescribing_rights

 

[JD7699]

In the PDP program they had a solid year of inpatient psychiatric experience. And I gather you in particular have an idea of how much experience that would be ... tons. According to the ACNP report, most of them said that was really necessary.

BTW, the training of the PDPers was hands-on. They had to learn how to do a physical examination for example, not just memorize dosages and side effects. I had a conversation with one of the ACNP examiners who told me "it really is learning to be a doctor".

A local PA program requires a full-time year of various practica. Are you suggesting two full years of full-time supervised experience?

I agree that serious professionals can profit from distance learning. If you or I wanted to learn how to use a new assessment instrument I think that would be fine. But I don't think we should have learned everything we know about clinical psychology from an online class.

I specifically went back to part time work to complete a doctoral program that was APA accredited and that was classroom based(unfortunately one can become licensed here following an online degree that lacks regional accreditation).

I think there needs to be a strong practical component to the ms degree in psychopharm Since RxP is not law in nearly every state, how can they include a practical piece to the education and provide sites to obtain the skills.

One article I read online (Psychiatric Times Aug 6, 2004) reported that the first group of PDP psychologists received approx the same amount of training as a PA. they completed 2 years didactic plus a 12 month clinical rotation. The following 2 classes of PDP psychologists received 1 year of didactic training plus 12 months clinical rotations. These rotations were probably all psychopharmacology.

I like the idea of supervision spanning 2 years, maybe 2500 to 3000 hours for psychologists in outpatient settings. I do not think that the expectation would be to see 15 people per day for med follow ups(as psychologists we would be using medication for those who need it and also providing therapy). It would take 2 years to really gain enough experience. Also, I am not really opposed to limited practice(requiring ongoing supervision that could be via distance to really meet the desire to treat those in rural communities).

 

[CGOPsych]

I specifically went back to part time work to complete a doctoral program that was APA accredited and that was classroom based(unfortunately one can become licensed here following an online degree that lacks regional accreditation).

I think there needs to be a strong practical component to the ms degree in psychopharm Since RxP is not law in nearly every state, how can they include a practical piece to the education and provide sites to obtain the skills.

One article I read online (Psychiatric Times Aug 6, 2004) reported that the first group of PDP psychologists received approx the same amount of training as a PA. they completed 2 years didactic plus a 12 month clinical rotation. The following 2 classes of PDP psychologists received 1 year of didactic training plus 12 months clinical rotations. These rotations were probably all psychopharmacology.

I like the idea of supervision spanning 2 years, maybe 2500 to 3000 hours for psychologists in outpatient settings. I do not think that the expectation would be to see 15 people per day for med follow ups(as psychologists we would be using medication for those who need it and also providing therapy). It would take 2 years to really gain enough experience. Also, I am not really opposed to limited practice(requiring ongoing supervision that could be via distance to really meet the desire to treat those in rural communities).

True, the PDP training was far more extensive than what is proposed in the APA models. That and other reasons are why it is inappropriate to use the PDP as a reason for supporting the APA model. And as noted before, the PDP grads themselves agreed that less training would not be advisable.

Your thoughts of more training are certainly in line with others who are more reasoned. But now we come back to the political reality: APA and its minions would never agree to that because:
1. It would nullify the training of so many who have been suckered into buying RxP certification in hopes they'll prescribe someday
2. It would devalue the programs by private schools which are major corporate allies of APA (the president of D55 is also the dean of CSPP, etc)
3. Fewer psychologists would seek RxP. PDP couldn't even fill its slots even though it offered what amoutned to free training within the military
4. It would lead to the question: If you are going to get the training of a PA, why create a new medical profession? Why not just trot on over to a PA school and be trained as a PA?

The trend with APA has been to keep whittling down the education, not build it up.

 

[heimlichboy]

I have stated this before. Psychologists have had prescribing rights in louisiana for some time now and it hasn't really changed anything because the medical field is controlled by MD's.

The psychiatrists actually refer to psychologists for psychological testing and therapy. The psychologist would not dare start prescribing because then they would just simply stop getting referrals.

The primary care doctors refer to psychiatrists and the psychiatrists refer to psychologists if the patient needs testing or therapy. That is what psychologists are really used for. If psychiatrists stopped referring to psychologists they would probably starve.

Secondly I have discussed hospital privileges before. Legally any doctor can practice any type of medicine they choose. For example certain hospitals allow family practitioners to perform c sections and appendectomies, most do not.

So just because someone gains the legal right to do something does not mean they will be allowed in the hospital, to do so. Each hospital has there own professional practice standards. For example a lot of hospitals will only allow board certified physicians to work in their hospitals.

So psychologists in louisiana who have prescribing rights might be able to do so in private practice settings but once again who is going to refer them patients?

All the psychologists who have dreams of prescribing have it in their heads that they will be on par with psychiatrists and they will start making all this extra money. This has hardly been the case in louisiana. Medical Doctors will always control access to patients and care.

And please dont respond to this text telling me i dont know what i am talking about unless u have lived and worked in louisiana.

 

[edieb]

As someone who attended Louisiana State University for her PhD, I can say your statements are inaccurate at best..

1 - Act 251 gave psychologists autonomy in regards to prescribing. Therefore, they no longer worry about referrals drying up

2 - Most M.D.s are VERY happy psychologists are prescribing and most also supported RxP passing. In fact, two kep LA Representatives, Sen Hines and Rep Salter, both M.D.s, led the charge to pass RxP in LA

3 - Many prestigious hospitals have prescribing psychologists on board: http://www.chnola.org/content/psychology.htm
Acoording to this link, at least 3 medical psychlogists are on staff and prescribin to children.

4 - Medical psychologists are prescribing in all state facilities, including developmental centers and state hospitals.. I know for a fact that the head of Psychiatry at Pincrest Supports and Services/Central State Hospital is a medical psychologist

5 - At my school, LSU, the student counseling center is now dominated by medical psychologists, not psychiatrists

6 - I don't think psychologists, including non-prescribing ones, dream of making as much as a psychiatrist. Some of us are not motivated by money. Others, like my former grad school advisor, who makes over $500K/year, make more than the average psychiatrist

I have stated this before. Psychologists have had prescribing rights in louisiana for some time now and it hasn't really changed anything because the medical field is controlled by MD's.

The psychiatrists actually refer to psychologists for psychological testing and therapy. The psychologist would not dare start prescribing because then they would just simply stop getting referrals.

The primary care doctors refer to psychiatrists and the psychiatrists refer to psychologists if the patient needs testing or therapy. That is what psychologists are really used for. If psychiatrists stopped referring to psychologists they would probably starve.

Secondly I have discussed hospital privileges before. Legally any doctor can practice any type of medicine they choose. For example certain hospitals allow family practitioners to perform c sections and appendectomies, most do not.

So just because someone gains the legal right to do something does not mean they will be allowed in the hospital, to do so. Each hospital has there own professional practice standards. For example a lot of hospitals will only allow board certified physicians to work in their hospitals.

So psychologists in louisiana who have prescribing rights might be able to do so in private practice settings but once again who is going to refer them patients?

All the psychologists who have dreams of prescribing have it in their heads that they will be on par with psychiatrists and they will start making all this extra money. This has hardly been the case in louisiana. Medical Doctors will always control access to patients and care.

And please dont respond to this text telling me i dont know what i am talking about unless u have lived and worked in louisiana.

 

[Therapist4Chnge]

I am quite familiar with things down in Louisiana (specifically Baton Rouge and New Orleans), and I second everything edieb wrote. The "broken record" myths about medicine restricting psychologists from working is patently false. Many GPs and FPs now have trusted colleagues with which to work, and they are better off for it.

 

[CGOPsych]

The Louisiana prescribers got their bill because they hired the most powerful lobbying firm in the state. I have a letter from Glen Ally to an APA official - which was posted on the LPA list-serve - which says that. In fact, Ally says they needed to be able to continue to pay this firm's fees or they could not be successful in Act 251. He even brags that this lobbyist got LAMP members placed into a bill that would have named them deputy coroners ... and how did he do that? Because the lobbyist from this firm made a single phone call to a single legislator. Money talks. In Louisiana it can scream (to paraphrase Bob Dylan).

APA sent $547,000 of practice assessment fees to Louisiana to help them buy that bill. That's how RxP has succeeded ... pure back-room politics and a ton of money from APA psychologists doled out in secret slush funds.

Same thing happened with the PDP program. You think the military was begging for second rate psychiatrists who, according to the ACNP report, were operating at the level of second-year medical students? It was because Pat DeLeon's boss, the powerful Daniel Inouye, wanted it.

I for one recognize the reality of power politics, although I don't condone using APA members' money in secret funding and without allowing them the chance to vote on it. But I don't let pass the ridiculous insinuations that these bills were the result of a desperate need for more Prozac prescriptions, or that the peoples' representatives were crying out for it. Hogwash.

I ask that you provide evidence that most physicians in Louisiana support RxP for psychologists. You present that as a fact and therefore evidence is called for.

And no, I'm not holding my breath, any more than I expect the safety data, the secret Missouri bill, the data on rural prescribing, etc etc etc.

 

[JD7699]

Back to educational requirements, here is a listing of coursework in one ms program in psychopharmacology for discussion:

Total 450 hrs of instruction

Clinical Biochemistry (24 contact hours, 1.6 units)
Neurosciences (84 total contact hours, 5.6 units including:
Neurochemistry (24 contact hours, 1.6 units)
Neurophysiology (24 contact hours, 1.6 units)
Neuroanatomy/Neuropathology (36 contact hours, 2.4 units)
Clinical Medicine/Pathophysiology (60 contact hours, 4 units)
Physical Assessment (36 contact hours, 2.4 units)
Pharmacology and Clinical Pharmacology (60 contact hours, 4 units)
Psychopharmacology (48 total contact hours, 3.2 units - includes Antidepressants, Anxiolytics, Antipsychotics, Mood Stabilizers/Drug-Drug Interactions)
Introduction to Molecular Nutrition and its Place in Psychopharmacology (12 contact hours, .8 units)
Special Populations in Psychopharmacology (60 total contact hours, 4.0 units – includes Child/Adolescent Psychopharmacology, Gender Issues, Geriatric Psychopharmacology/Chronic Pain, PTSD/Borderline Personality/Chronic Medical Conditions, and Ethnopsychopharmacolog)
Chemical Dependence (12 contact hours, .8 units)
Pharmacotherapeutics (36 total contact hours, 2.4 units - includes Research Issues in Psychopharmacology, Professional, Ethical and Legal Issues, and Integrating Psychotherapy and Pharmacotherapy)
Case Seminar (12 contact hours, .8 units)
Review Course for the Psychopharmacology Examination for Psychologists (PEP)

Most are similar, some are real time but video conference, others just online, and some have in person classes. Thoughts?

 

[edieb]

The Louisiana prescribers got their bill because they hired the most powerful lobbying firm in the state. I have a letter from Glen Ally to an APA official - which was posted on the LPA list-serve - which says that. In fact, Ally says they needed to be able to continue to pay this firm's fees or they could not be successful in Act 251. He even brags that this lobbyist got LAMP members placed into a bill that would have named them deputy coroners ... and how did he do that? Because the lobbyist from this firm made a single phone call to a single legislator. Money talks. In Louisiana it can scream (to paraphrase Bob Dylan).

APA sent $547,000 of practice assessment fees to Louisiana to help them buy that bill. That's how RxP has succeeded ... pure back-room politics and a ton of money from APA psychologists doled out in secret slush funds.

Same thing happened with the PDP program. You think the military was begging for second rate psychiatrists who, according to the ACNP report, were operating at the level of second-year medical students? It was because Pat DeLeon's boss, the powerful Daniel Inouye, wanted it.

I for one recognize the reality of power politics, although I don't condone using APA members' money in secret funding and without allowing them the chance to vote on it. But I don't let pass the ridiculous insinuations that these bills were the result of a desperate need for more Prozac prescriptions, or that the peoples' representatives were crying out for it. Hogwash.

I ask that you provide evidence that most physicians in Louisiana support RxP for psychologists. You present that as a fact and therefore evidence is called for.

And no, I'm not holding my breath, any more than I expect the safety data, the secret Missouri bill, the data on rural prescribing, etc etc etc.

In Louisiana, Missouri and Hawaii, many rural medical centers and rural M.D.s/D.O.s testified FOR the prescribing bills to be passed because of a shortage of psychiatrists. Is that proof enough for you?