Psychopharmacology/Advanced Practice Psychology

[Manicsleep]

The sad thing is that the opening is there and there are many psychiatrists, more PCPs and probably even more patients who would love to have psychologists who can prescribe.

The problem is that almost nobody wants to do the hard work. The couple of hours here stuff wont cut it. Once more people are exposed to this, there will also be more scrutiny.

As a psychiatrist I dont mind writing a prescription for a patient with moderate depression that has been pretty much well controlled for a few years. However, this kind of front line work can be done APRNs or preferably, psychologists with proper training. My problem is that nothing psychologists have done so far resembles proper training.

I think this change is inevitable. The nurses are getting on point, making sure they have adequate training and opening new schools regularly. Psychologists are trying to do it politically only and that is a much slower process, plus its not in the best interest of the patient.
You will always have people trying to protect the turf and say "nobody but me" similar to the psychologist vs LCSW or MFT debates but change is inevitable and psychiatry is moving more towards the bio end so clinical psychology needs to follow even its roots are not science based.

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[CGOPsych]

The sad thing is that the opening is there and there are many psychiatrists, more PCPs and probably even more patients who would love to have psychologists who can prescribe.

The problem is that almost nobody wants to do the hard work. The couple of hours here stuff wont cut it. Once more people are exposed to this, there will also be more scrutiny.

As a psychiatrist I dont mind writing a prescription for a patient with moderate depression that has been pretty much well controlled for a few years. However, this kind of front line work can be done APRNs or preferably, psychologists with proper training. My problem is that nothing psychologists have done so far resembles proper training.

I think this change is inevitable. The nurses are getting on point, making sure they have adequate training and opening new schools regularly. Psychologists are trying to do it politically only and that is a much slower process, plus its not in the best interest of the patient.
You will always have people trying to protect the turf and say "nobody but me" similar to the psychologist vs LCSW or MFT debates but change is inevitable and psychiatry is moving more towards the bio end so clinical psychology needs to follow even its roots are not science based.

I would agree that the training proposed by the APA political campaign is clearly inadequate, though politically expedient for APA and economically attractive for the industry of private psychology training schools that offer the training online, and which have strong ties with APA's governance.

However, I wouldn't assume that physicians would welcome psychologists prescribing if they were given all the information which the APA campaign works hard to hide. How many PCP's would refer a patient to a professional for medication management whose entire medical education (undergrad, premed, pre-requisite and medical school equivalent) consisted of the equivalent of 20 semester hours taken through online courses? I would guess that an objective survey using that question would turn up very few. In fact, I'd suggest that very few psychologists would refer to such a professional either!

As always, the marketeers and spinners of the APA campaign characterize the potential prescribers only as "properly trained psychologists" without including those nettlesome details such as grossly inadequate education obtained through a computer and a phone line.

The question then is not whether psychologists could prescribe under some kind of circumstances. What legislatures and professionals are confronted with is the 15-year-old political campaign by APA which proposes specific models that would require incorporating medicine into psychology and feed the private psychology training school industry which APA has helped foster. There is a very good reason why that campaign has been a flop. It's an expensive flop, but APA will not tell the public or its membership how much of the members' money has been spent on it.

 

[Manicsleep]

I would agree that the training proposed by the APA political campaign is clearly inadequate, though politically expedient for APA and economically attractive for the industry of private psychology training schools that offer the training online, and which have strong ties with APA's governance.

However, I wouldn't assume that physicians would welcome psychologists prescribing if they were given all the information which the APA campaign works hard to hide. How many PCP's would refer a patient to a professional for medication management whose entire medical education (undergrad, premed, pre-requisite and medical school equivalent) consisted of the equivalent of 20 semester hours taken through online courses? I would guess that an objective survey using that question would turn up very few. In fact, I'd suggest that very few psychologists would refer to such a professional either!

As always, the marketeers and spinners of the APA campaign characterize the potential prescribers only as "properly trained psychologists" without including those nettlesome details such as grossly inadequate education obtained through a computer and a phone line.

The question then is not whether psychologists could prescribe under some kind of circumstances. What legislatures and professionals are confronted with is the 15-year-old political campaign by APA which proposes specific models that would require incorporating medicine into psychology and feed the private psychology training school industry which APA has helped foster. There is a very good reason why that campaign has been a flop. It's an expensive flop, but APA will not tell the public or its membership how much of the members' money has been spent on it.

This is partially conjecture (partially based on what I have seen in a couple of health systems) but I think psychologists will face a challenge of having to find a place for themselves in the next decade.
LCSWs and even MFTs will grow stronger and as the trend of private practice wanes, they will be incorporated more and more into health care because of cost. I have seen this first hand 3 times now and there was a great article in the NY Times showing how private practice is dying out.

http://www.nytimes.com/2010/03/26/health/policy/26docs.html

Corner office psychotherapy is nice but not too many "therapists" are retiring and too many new "therapists" of all variations are coming into the mix.
With universal health care (it will become more and more universal and socialized) the large groups are the only ones that will survive unless you cater to the second tier (super rich) because everyone else will get their therapy at Kaiser, University Hospital Health Care or St. Whatever Health System.

 

[stigmata]

What program is only 20 semester hrs??

 

[CGOPsych]

What program is only 20 semester hrs??

Here's how it's figured: Legislation proposed by APA around the country calls for online education amounting to 300 "contact hours". At 15 contact hours per semester hour, that would be 20.

The APA programs do not require any graduate or undergraduate pre-requisites or entrance exam. Therefore the entire medical education of these persons presuming to prescribe medication could amount to the equivalent of 20 semester hours of courses taken online.

I know of two physician assistant programs that list all their coursework online. They require 20 semester hours of biomedically related course work as pre-requisites just to enter the program (in addition to other study). That means the graduates of these so-called "rigorous training programs" would probably not even qualify for entry to a PA program.

Thus, it would be most interesting to ask a random sample of physicians, psychologists, social workers, etc. if they would send their patients or family members to someone with that little education for prescription of psychoactive drugs. What do you think they would say?

 

[Buzzwordsoldier]

Thus, it would be most interesting to ask a random sample of physicians, psychologists, social workers, etc. if they would send their patients or family members to someone with that little education for prescription of psychoactive drugs. What do you think they would say?

Not trying to be funny here, not trying to suggest the training in question would be appropriate, but, in answer to your question, I'd bet that for the populations I've worked with we'd get a large percentage of responses along the lines of:

"We've tried everything else," "Whatever," "I haven't spoken to [patient] in fifteen years, and if I ever do again it'll be too soon," etc....

 

[stigmata]

I understand that the APA sets the minimum guidelines and they are very lame. However, current recognized programs require much more than this. The PA thing is not a good analogy as these were originally designed for experienced EMTs, military medics etc.. I have knows several people in the past few years who got accepted to a PA program right out of high school.

 

[CGOPsych]

I understand that the APA sets the minimum guidelines and they are very lame. However, current recognized programs require much more than this. The PA thing is not a good analogy as these were originally designed for experienced EMTs, military medics etc.. I have knows several people in the past few years who got accepted to a PA program right out of high school.

APA's legislation says 300 contact hours. Your mileage may vary, but the most I've seen is 450 hours, so that's 30 semester hours, total medical education, and done online. That's still lame.

I don't know about people you know. I do look for PA programs that post their requirements to make comparisons.

 

[Therapist4Chnge]

APA's legislation says 300 contact hours. Your mileage may vary, but the most I've seen is 450 hours, so that's 30 semester hours, total medical education, and done online. That's still lame.

I don't know about people you know. I do look for PA programs that post their requirements to make comparisons.

Between the APA and NAPPP, I am almost afraid to see what they propose next. I've done the training (residential not online), and the training is about 80% there. I think good prescribers can come out, but I'd like to add pre-req hard science classes, ban online learning, and increase supervision req. I think all 3 things are reasonable, but they will be seen as barriers for prospective applicants, so the APA and NAPPP will be against them. I'd also like to see req. consultation once licensed....which I'm hoping the AMA pushes hard for.

 

[CGOPsych]

Between the APA and NAPPP, I am almost afraid to see what they propose next. I've done the training (residential not online), and the training is about 80% there. I think good prescribers can come out, but I'd like to add pre-req hard science classes, ban online learning, and increase supervision req. I think all 3 things are reasonable, but they will be seen as barriers for prospective applicants, so the APA and NAPPP will be against them. I'd also like to see req. consultation once licensed....which I'm hoping the AMA pushes hard for.

WHEW! You would not be welcome at APA, although your ideas are obviously welcome to most others.

One problem is that if the requirements begin to approach that of other non-physician prescribers, who needs special laws for psychologists?

Also, APA and its corporate partners the professional schools like CSPP, have been trying to sell this as being relatively easy with quick access to the Rx pad. To make it harder means fewer people will join the program (which costs $11,000 at CSPP).

You and Stigmata have the right attitude ... this is not about whether psychologists can prescribe medication if given good medical training. So can social workers or mailmen for that matter.

The issue here is the RxP campaign, which is political and not scientific or professional. It aims to incorporate medicine into psychology - under the APA umbrella of course - and to do it with as little training and supervision as possible.

Good professionals who want to improve the quality of care have many options open to them that do not require extra legislation, but those options do not serve the political purpose of the APA Practice Organization. Thus, you will not see them on the APA agenda.

I applaud your aspirations for ethical practice!

 

[Therapist4Chnge]

One of the things I noticed when I went through the training was the specificity of the training. I like that the courses are tailored to leverage -ology knowledge for differentials (one of the areas I've found to be weak in most PA/NP programs), but because there is so much to cover, the foundational courses (orgo, neuroanatomy, etc) were a bit light. Moving them to pre-reqs provides more opportunity for other classes AND weeds out a bit. My cohort was strong (only 1 dropped out of 10), but later cohorts had more ppl and more attrition. I have some wishful thinking I guess.

 

[PsychGraduate]

I've said it a few times in the past, but I'll reiterate it here: I truly believe that with the appropriate training, a doctorally prepared psychologist, with advanced psychopharm and med assessment training, should be more than qualified to prescribe psychotropics.

At first, I was against this, but after doing some research, I don't think it's a bad thing and may actually help some patients who wouldn't otherwise have access to a competent mental health professional (other than an an MSW/MA).

Another point, master's level NPs and bachelor's level PAs, as well as optometrists, prescribe meds all the time and have not been through med school, and research shows that they prescribe meds more safely than many MDs and DOs (especially the IMG/FMGs). Podiatrists, pharmacists, and dentists also have full or partial RxPs and do a safe and effective job, for the most part, in prescribing meds.

With the appropriate training, why wouldn't PhD/PsyDs with additional pharm/med training be effective and safe prescribers? I think the data from NM and LA has shown that so far, so good in terms of prescribing psychologists in those states.

I still maintain that clinical psychology should move from the scientist-practitioner model (Boulder?) to the PsyD (practitioner) or Vail model. A PsyD should be a four year, post BA/BS professional degree, like the JD, MD, PharmD, DDS, DVM, OD, etc. Lose the heavy stats courses, the research courses, and focus on anatomy/physiology, pharmacology, med/psych assessment, counseling/therapeutics, psychometrics, etc.). Incorporate the pharm into the doctoral program rather than mandate a post-doc MS in psychopharm.

If a student wishes to do research, publish, and experimentation, go for a PhD rather than a PsyD.

Just my two cents. I wish you guys the best of luck in fighting for RxPs.

you mentioned losing the heavy stats and the research courses. Also in medical school for example they overemphasize anatomy/physiology at the expense of cell and molecular and they dumb down the biochemistry so the doctors are good enough to practice but not good enough to understand the real risk the meds pose... if a psychologist wants to have prescription rights and their state allows it, then that is great but they need all of the coursework completed: research, advanced stats, anatomy/physiology, and general pharmacology/ psychopharmacology. Really in undergrad if the student has the general academic ability and thinks they may want to be a prescribing psychologist they should complete premed (Biology or Chemistry) and a psych major for the bachelor's and then go straight to a PhD program with a solid education and training program though opting for a master's first does have some advantages.

 

[CGOPsych]

you mentioned losing the heavy stats and the research courses. Also in medical school for example they overemphasize anatomy/physiology at the expense of cell and molecular and they dumb down the biochemistry so the doctors are good enough to practice but not good enough to understand the real risk the meds pose... if a psychologist wants to have prescription rights and their state allows it, then that is great but they need all of the coursework completed: research, advanced stats, anatomy/physiology, and general pharmacology/ psychopharmacology. Really in undergrad if the student has the general academic ability and thinks they may want to be a prescribing psychologist they should complete premed (Biology or Chemistry) and a psych major for the bachelor's and then go straight to a PhD program with a solid education and training program though opting for a master's first does have some advantages.

Those are interesting ideas. Let's not forget that we are all debating two very different issues:
1. Is it possible that psychologists could be trained, somehow, to prescribe medication? Of course, although that may entail as much training as full medical school or the same training that other non-physician prescribers do.
2. Is the model for psychologist RxP as dictated and enforced by the American Psychological Association's political campaign appropriate, sufficient, necessary, safe and effective? The answer to this is a resounding no. The training is ridiculously thin and the model is designed to develop more wealth and power for APA and its corporate associates, such as the California School of Professional Psychology.

APA wants everyone to think they are debating No. 1 while it pushes No. 2 without supplying the details of its political campaign. And do NOT think they will compromise so as to try to improve our health care system. That is not their agenda. They have insisted on all the worst conditions for RxP because it gives them the most political power and makes the most money for the corporate associates.

So I welcome a debate about how psychologists could be trained to prescribe, but it's academic. The real issue is this APA campaign, whose bills have failed 100 times in 24 states and which continues to spend its members money with a secret budget and which has operated for 15 years without the consensus of the membership.

 

[edieb]

You keep on perseverating on the idea that bills have failed. I don't think anybody expects them to pass on the first or second try. In addition, many of those bills were introduced with minimal support and funding.

I think as a younger generation of PhDs come into the profession, the push will grow even stronger. I just gave $1000 to one state association to support their RxP campaign and have friends who have also given large sums of money. Whether you like it or not, most psychologists support RxP. There will never be any consensus on any issue within an organization; however, it is the majority that steers policy making.

 

[CGOPsych]

You keep on perseverating on the idea that bills have failed. I don't think anybody expects them to pass on the first or second try. In addition, many of those bills were introduced with minimal support and funding.

I think as a younger generation of PhDs come into the profession, the push will grow even stronger. I just gave $1000 to one state association to support their RxP campaign and have friends who have also given large sums of money. Whether you like it or not, most psychologists support RxP. There will never be any consensus on any issue within an organization; however, it is the majority that steers policy making.

The failure rate over a 15-year campaign shows that state legislatures do not want RxP for psychologists under the conditions that APA dictates.

Your statement is a repeat of APA's misleading propaganda. Surveys find that 60-65 percent of psychologists would favor psychologists prescribing under some condition, in theory. This in itself is remarkable since it indicates that 35-40 percent do not endorse psychologists prescribing under ANY condition.

This does not say how many would favor APA's conditions, which have failed 100 times in 24 states. Here's a hint though: A reliable survey (published in an APA journal favorable to RxP) included a finding that 78 percent of licensed psychologists believe that prescribing psychologists should face the same training standards as other non-physician prescribers. The APA campaign's model doesn't even come close. And that's just one of the conditions. Thus, it appears that the vast majority of psychologists would not favor the APA campaign's model.

Therefore, the vast majority of legislatures as well as quite possibly the vast majority of psychologists find it unacceptable. What we are left with is the politicians at APA still trying to jam RxP down the throats of the membership (no consensus, secret budget) but no one is buying.

I would strongly urge you to reconsider the vague, misleading messages you've been taking as truth from APA. I think if you exert some critical thinking, you'll find that they don't stand up to even the slightest scrutiny or challenge.

 

[stigmata]

I would strongly urge you to reconsider the vague, misleading messages you've been taking as truth from APA. I think if you exert some critical thinking, you'll find that they don't stand up to even the slightest scrutiny or challenge.[/QUOTE]


This statement could be added to nealy every thread on the psychology forum! True indeed.

 

[PsychGraduate]

Those are interesting ideas. Let's not forget that we are all debating two very different issues:
1. Is it possible that psychologists could be trained, somehow, to prescribe medication? Of course, although that may entail as much training as full medical school or the same training that other non-physician prescribers do.
2. Is the model for psychologist RxP as dictated and enforced by the American Psychological Association's political campaign appropriate, sufficient, necessary, safe and effective? The answer to this is a resounding no. The training is ridiculously thin and the model is designed to develop more wealth and power for APA and its corporate associates, such as the California School of Professional Psychology.

APA wants everyone to think they are debating No. 1 while it pushes No. 2 without supplying the details of its political campaign. And do NOT think they will compromise so as to try to improve our health care system. That is not their agenda. They have insisted on all the worst conditions for RxP because it gives them the most political power and makes the most money for the corporate associates.

So I welcome a debate about how psychologists could be trained to prescribe, but it's academic. The real issue is this APA campaign, whose bills have failed 100 times in 24 states and which continues to spend its members money with a secret budget and which has operated for 15 years without the consensus of the membership.

While I do take some issues with the APA it is not required to get a full medical school education to be able to presribe psychotropics. My point on med students and psychiatrists in training is that they do not receive enough specific training related to psychotropics in general.

Neither do psychologists on average if they do not have a solid undergraduate science background first. With the proper undergrad program like a double bachelor's: psychology/biology, or psychology/chemistry with pharmacology coursese, the transition to a PhD program in psychology with emphasis on pharmacology and interpretation of drug related data the post doctoral training for rx rights then becomes more approachable even if rigorous.

4 years of med school is NOT about knowing how to prescribe meds, neither should doctoral training in psych but with mandatory organic chem, biochem inorganic chem and anatomy/phys first with labs and tests, then post doctoral training is pretty much a necessary formality.

All in all, however I do think the APA campaign is safe and effective. After all we are talking about extenisve post-doctoral training first. The psychologist who prescribes would be stupid not to have medical records and some communication about a client's history prior to prescribing drugs. Many doctors of internal medicine prescribe psychotropic drugs that are not safe to the patient and with little knowledge of their mechanism and full side effect profile. Very common across the country. Some psychiatrists also do the same. Other drugs are just too new to be playing around with except when all else fails. Regarding online training; it should be a supplement but not the only source of knoweldge and skill sets.

 

[Therapist4Chnge]

The failure rate over a 15-year campaign shows that state legislatures do not want RxP for psychologists under the conditions that APA dictates.

The legislative process is about horse-trading, leveraging votes, and timing. Making a judgment based strictly on proposal/bill votes is not an accurate measure. Some of the best legislation out there took countless revisions, and some of the worst pork legislation passed through without a problem. I don't agree with the current APA standards, and I am glad the current bills failed, but with revisions they will be passed. The focus should be on finding a workable compromise.

 

[PsychGraduate]

The legislative process is about horse-trading, leveraging votes, and timing. Making a judgment based strictly on proposal/bill votes is not an accurate measure. Some of the best legislation out there took countless revisions, and some of the worst pork legislation passed through without a problem. I don't agree with the current APA standards, and I am glad the current bills failed, but with revisions they will be passed. The focus should be on finding a workable compromise.

very politically motivated on your part. It also seems as if you are playing two sides in terms of the APA regulations and requirements. By your estimation then only a wealthy few would ever get prescription rights.

 

[Therapist4Chnge]

very politically motivated on your part. It also seems as if you are playing two sides in terms of the APA regulations and requirements. By your estimation then only a wealthy few would ever get prescription rights.

The reality of it is that it is politically motivated because it comes down to a turf battle about money. The way things get done in Washington is not pretty nor palatable for most, which is why the PACs make hundreds of millions of dollars in consulting fees to get things done. I've worked with a number of PACs in multiple states, as well as various state and federal politicians, and it is a different world.

If you asked me 5 years ago about the debate, I'd fall a lot farther on APA's side. Though since then I've done a lot more digging into the history and evolution of RxP for psychology, and I'm concerned with the current and future path.

I took the APA recommended training through a residentially-based program (as I 100% disagree with any online training), and frankly I don't think it is enough for everyone. There are some fine prescribing psychologists out there, though I am concerns about the minimal requirements currently proposed. I agree with the general idea that there is an important niche for prescribing psychologists, but I object to the current implementation of that idea.

 

[PsychGraduate]

The reality of it is that it is politically motivated because it comes down to a turf battle about money. The way things get done in Washington is not pretty nor palatable for most, which is why the PACs make hundreds of millions of dollars in consulting fees to get things done. I've worked with a number of PACs in multiple states, as well as various state and federal politicians, and it is a different world.

If you asked me 5 years ago about the debate, I'd fall a lot farther on APA's side. Though since then I've done a lot more digging into the history and evolution of RxP for psychology, and I'm concerned with the current and future path.

I took the APA recommended training through a residentially-based program (as I 100% disagree with any online training), and frankly I don't think it is enough for everyone. There are some fine prescribing psychologists out there, though I am concerns about the minimal requirements currently proposed. I agree with the general idea that there is an important niche for prescribing psychologists, but I object to the current implementation of that idea.

Not enough for everyone, but what training program is?

 

[stigmata]

I think T4C's point is that APA has a significant agenda with their RxP push, that has little to do with quality of training or quality of prescribers.

 

[PsychGraduate]

I think T4C's point is that APA has a significant agenda with their RxP push, that has little to do with quality of training or quality of prescribers.

Whenever there is money and thousands of people or more involved there will be ulterior motives... any agency or powerful group, there will be lobbyists and political maneuvers. Honestly I am not that naive to think the APA has some issues... JAMA and the AMA are not any better... it really is a shame but looking at the post doctoral training prescribed by the APA and additional training suggested by them seems adequate to me if you are serious about the work...

 

[loveoforganic]

What are APA's current prescribed/suggest training guidelines? Just did a brief search, but didn't turn them up.

 

[PsychGraduate]

What are APA's current prescribed/suggest training guidelines? Just did a brief search, but didn't turn them up.

Towards the beginning of this thread there are links given to provide that information.

 

[JazzPsych]

What I wonder is, given the fact that it might take some states many more years to obtain prescriptive authority, how RxP-trained psychologists are using their new diploma/skills in practice in states that don't have these privileges (yet)?

Incorporating Rx-consulting into your practice must be able to improve your professional position as well, right?


So, how do RxP-ers do this?

Or, how could RxP-ers do this?

 

[JazzPsych]

I just came across this very interesting article: 2010

http://onlinelibrary.wiley.com/doi/10.1002/jclp.20623/pdf

Training Comparison Among Three Professions: Prescribing Psychoactive Medications: Psychiatric Nurse Practitioners, Physicians, and
Pharmacologically Trained Psychologists

Results:
- They concluded that psychologists receive four times as much pharmacology coursework as physicians do during medical school, 15 times more training in assessment and diagnosis and 27 times more training in psychosocial interventions.
- However, due to the nature of the curriculi, physicians receive just a little more training in biochemistry/neuroscience (216 vs 161) and clinical practicum (855 vs 680).
- Conclusion: In the majority of content areas pertaining to the prescribing of psychoactive medication to mental health clientele, pharmacologically trained psychologists are better prepared than practitioners in other prescribing professions trained in the programs in this analyses. The results of this study also suggest that psychiatric nurse practitioners are better prepared at the entry level in many of the content areas most relevant to prescribing medication with the mental health population than are physicians prior to specialty training as a resident in psychiatry.

Note: this is RxP compared to physicians without specialty training in psychiatry. Still, these are the physicians that write the majority of all psychotropics.


How about that...

 

[psychmama]

Interesting. However I'd point out that there's a huge difference between someone who just graduated med school and that same person after residency training. And I'm pretty sure that psychiatry residents are under the supervision of their attendings, so it's not like they are flying solo when prescribing meds.

 

[JazzPsych]

Interesting. However I'd point out that there's a huge difference between someone who just graduated med school and that same person after residency training. And I'm pretty sure that psychiatry residents are under the supervision of their attendings, so it's not like they are flying solo when prescribing meds.

Agreed. However, about 70% of psychotropics are prescribed by physicians with other specialties or no specialty at all. This study does not address psychiatric-residents or psychiatrists.

Here we are talking about entry-level prescribers. Many physicians do not get past this level regarding psychotropics and still prescribe them.

This might shine a new light on the argument that psychologist are ill prepared for Rx. In addition, you should see the differences between the psychologist and PNP's. It's substantial.

 

[DynamicDidactic]

I just came across this very interesting article: 2010

http://onlinelibrary.wiley.com/doi/10.1002/jclp.20623/pdf

Training Comparison Among Three Professions: Prescribing Psychoactive Medications: Psychiatric Nurse Practitioners, Physicians, and
Pharmacologically Trained Psychologists

One of the authors Mark Muse has a lot of letters after his name

I am Mark Muse, MA, EdD, Ldo (PhD), MS, MP, ABPP, ABMP

 

[allopurinol]

Agreed. However, about 70% of psychotropics are prescribed by physicians with other specialties or no specialty at all. This study does not address psychiatric-residents or psychiatrists.

It does not address them for a reason, likely because the authors know that this is where physicians are either training to master their craft, or have mastered their craft. If this article had focused on this population, as it should have because this group's work is more analagous to the outcome the authors are analyzing, it would have weakened their argument.

Here we are talking about entry-level prescribers. Many physicians do not get past this level regarding psychotropics and still prescribe them.

I have to disagree; this is what residency is for (I speak from experience). Also, just because one is not specializing in a given speciality does not mean that one is not exposed to meds commonly used in other specialities (again, I speak from experience). After all, patients tend to have multiple medical conditions. Therefore, by default, one is forced to learn this material to become a competent physician. This article focuses on new med school graduates who do not even have a license to practice yet. Nice.

This might shine a new light on the argument that psychologist are ill prepared for Rx.

I doubt it.

 

[loveoforganic]

Agreed. However, about 70% of psychotropics are prescribed by physicians with other specialties or no specialty at all. This study does not address psychiatric-residents or psychiatrists.

Here we are talking about entry-level prescribers. Many physicians do not get past this level regarding psychotropics and still prescribe them.

This might shine a new light on the argument that psychologist are ill prepared for Rx. In addition, you should see the differences between the psychologist and PNP's. It's substantial.

What are you referring to? If you mean family medicine, there is still a three year postgraduate residency.

 

[JazzPsych]

Quote: It does not address them for a reason, likely because the authors know that this is where physicians are either training to master their craft, or have mastered their craft. If this article had focused on this population, as it should have because this group's work is more analagous to the outcome the authors are analyzing, it would have weakened their argument.

I agree, psychiatric residents/psychiatrists should've been taken into account here. However, still 70% of all psychotropics are prescribed by NON-psychiatric physicians.

Quote: I have to disagree; this is what residency is for (I speak from experience). Also, just because one is not specializing in a given speciality does not mean that one is not exposed to meds commonly used in other specialities (again, I speak from experience). After all, patients tend to have multiple medical conditions. Therefore, by default, one is forced to learn this material to become a competent physician. This article focuses on new med school graduates who do not even have a license to practice yet. Nice.

I disagree. It might be true that all residents do get exposed to psych meds, the same thing holds for Phd of PsyD psychologists. They too, are continually exposed to meds both in school and in practice before they enter the psychopharmacology training.
But for your sake, let's assume psychologists don't get any extra exposure to psych meds and ALL residents do. Would that really be a solid point to prove that physicians are much better prepared to prescribe? I beg to differ.

Quote: I doubt it.

Care to explain? Psychologists have been prescribing for 15 years without any adverse results.
While this argument isn't that specific (they might not fully treat the exact same cases as psychiatrists do, I don't know), it confirms the fact that there is absolutely no reason to doubt the safety of psychologist prescribing. Which is what psysicians continually try to prove.

 

[allopurinol]

Quote: It does not address them for a reason, likely because the authors know that this is where physicians are either training to master their craft, or have mastered their craft. If this article had focused on this population, as it should have because this group's work is more analagous to the outcome the authors are analyzing, it would have weakened their argument.

I agree, psychiatric residents/psychiatrists should've been taken into account here. However, still 70% of all psychotropics are prescribed by NON-psychiatric physicians.

Quote: I have to disagree; this is what residency is for (I speak from experience). Also, just because one is not specializing in a given speciality does not mean that one is not exposed to meds commonly used in other specialities (again, I speak from experience). After all, patients tend to have multiple medical conditions. Therefore, by default, one is forced to learn this material to become a competent physician. This article focuses on new med school graduates who do not even have a license to practice yet. Nice.

I disagree. It might be true that all residents do get exposed to psych meds, the same thing holds for Phd of PsyD psychologists. They too, are continually exposed to meds both in school and in practice before they enter the psychopharmacology training.
But for your sake, let's assume psychologists don't get any extra exposure to psych meds and ALL residents do. Would that really be a solid point to prove that physicians are much better prepared to prescribe? I beg to differ.

Quote: I doubt it.

Care to explain? Psychologists have been prescribing for 15 years without any adverse results.
While this argument isn't that specific (they might not fully treat the exact same cases as psychiatrists do, I don't know), it confirms the fact that there is absolutely no reason to doubt the safety of psychologist prescribing. Which is what psysicians continually try to prove.

1. The "majority of psychotrophics" you are referring to are SSRI's and benzos. I beg to differ about the amount of exposure primary care physicians get to these drugs. They are the "front line" providers; they do the basics, and when this is not effective, they refer. Furthermore, they are dealing with people with multiple medical problems on multiple medications, so they know much more about pharmacoloogy, including about psychopharmacology, than you think. Also, people with serious psychiatric illnesses have medical problems, too and these providers have to always be cognizant of the effects of the medications as well as potential drug interactions.

2. "Psychologists have been prescribing for 15 years without any adverse results." Prescribing is easy; the potentially adverse outcomes is what one has to be concerned with. Please show me psychologists that have been prescribing in non-relatively-good-health adult populations, geriatrics, children. If you want to truly compare adverse effects, analyze the true populations that your different types of providers are treating instead of making broad generalizations.

I wrote a posed several questions (that were never addressed) about this issue in an earlier post; please feel free to take a look at it and reply.

 

[CGOPsych]

Care to explain? Psychologists have been prescribing for 15 years without any adverse results.
While this argument isn't that specific (they might not fully treat the exact same cases as psychiatrists do, I don't know), it confirms the fact that there is absolutely no reason to doubt the safety of psychologist prescribing. Which is what psysicians continually try to prove.

I respectfully challenge that. Please cite the source of your data, as this is an important aspect of the argument. There are NO data to support safety of psychologists prescribing. Some of the more responsible people, such as the head of the RxP program at Farleigh Dickinson, admit there is NO data.

The less responsible make these claims and then avoid offering any support. A few have been so ridiculous as to offer the following justification: None of the prescribing psychologists (an extraordinary partisan group) has publicly reported harming anyone.

Please tell us where you got this information which you cite as fact.

There are NO data that psychologists prescribing according to the APA model would be necessary, safe or effective. I challenge anyone to offer any such actual data. Taking the word of a group of partisan prescribers making general estimates does not constitute data.

And to make it clear up front, while there are no doubt deficits in psychiatric care in many areas and populations, there are also such deficits in psychological services and other health care services. By necessity I mean, is it necessary to change the medical education and practice standards in order to meet the deficiency or can it be done in far more effective ways which are already available. I believe that the latter is clearly true.

 

[stigmata]

The data is the same as it would be for any other prescriber, so I don't get your argument??

 

[CGOPsych]

The data is the same as it would be for any other prescriber, so I don't get your argument??

Hold on.
The APA campaign to obtain RxP through back-door minimal training is seeking to make a major change in the medical system. There are obvious risks involved, considering that they want to get RxP for psychologists based on 20 semester hours' worth of online education, among other evident short-cuts.

It is not coincidental that this pathway would immensely enhance the political and financial prospects of APA and its corporate partners, while other pathways which are safer and immediately available are ignored, and would not offer these benefits. Strange behavior for an organization which purports to tell psychologists what is ethical, and to sit in judgment of them, wouldn't you say?

Anyway, it is thus incumbent upon those who seek to make this change to show that it is necessary, safe and effective. So far, there are no data to show this. There is plenty of hype, spin, misinformation, mythologizing and plain old propaganda thrown at psychologists and others. Strange behavior for an organization which purports to enforce ethics that psychologists are truthful and base their activities on science.

Now JazzPsych states with apparent certainty of a known fact that psychologists have been prescribing safely for 15 years. I ask for the data to support this. This seems not only reasonable, but vital.

However, I do not expect to see any reference to real data because there is none. And the RxPers who make these claims simply change the subject or disappear for a while.

The political campaign conducted by APA is unbecoming of professionals.

 

[JazzPsych]

1. The "majority of psychotrophics" you are referring to are SSRI's and benzos. I beg to differ about the amount of exposure primary care physicians get to these drugs. They are the "front line" providers; they do the basics, and when this is not effective, they refer. Furthermore, they are dealing with people with multiple medical problems on multiple medications, so they know much more about pharmacoloogy, including about psychopharmacology, than you think. Also, people with serious psychiatric illnesses have medical problems, too and these providers have to always be cognizant of the effects of the medications as well as potential drug interactions.

2. "Psychologists have been prescribing for 15 years without any adverse results." Prescribing is easy; the potentially adverse outcomes is what one has to be concerned with. Please show me psychologists that have been prescribing in non-relatively-good-health adult populations, geriatrics, children. If you want to truly compare adverse effects, analyze the true populations that your different types of providers are treating instead of making broad generalizations.

I wrote a posed several questions (that were never addressed) about this issue in an earlier post; please feel free to take a look at it and reply.

1. You keep on making the case that Primary care physicians are adequately trained to prescribe. This is not the case. Research consistently demonstrates they underdiagnose the frequency of mental and behavioral disorders (Richardson, Keller, Selby-Harrington, & Parrish, 1996; Williams-Russo, 1996).
Isn't a proper diagnosis a premise of modern medicine? Furthermore, they overmedicate.

You state that they refer when necessary. Obviously, they do not, since they overmedicate. The cases that do get refered, are bound to end up on a waiting list due to the shortages of psychiatrists.

2. Psychologists have been prescribing for children, adolescents, adults, and geriatric patients; in children's hospitals, general hospitals, rehabilitation facilities, psychiatric hospitals, private practices, and outpatient clinics, acting in the capacity of provider, department head, clinical supervisors, and preceptors to family medicine residents; within state, federal, and private service; and overseas in Iraq, Afghanistan, Kuwait, and Germany, as well as at sea; for 15 years within the department of defense, 4 years in the state of Louisiana, and 5 years in New Mexico.

 

[JazzPsych]

I respectfully challenge that. Please cite the source of your data, as this is an important aspect of the argument. There are NO data to support safety of psychologists prescribing. Some of the more responsible people, such as the head of the RxP program at Farleigh Dickinson, admit there is NO data.

The less responsible make these claims and then avoid offering any support. A few have been so ridiculous as to offer the following justification: None of the prescribing psychologists (an extraordinary partisan group) has publicly reported harming anyone.

Please tell us where you got this information which you cite as fact.

There are NO data that psychologists prescribing according to the APA model would be necessary, safe or effective. I challenge anyone to offer any such actual data. Taking the word of a group of partisan prescribers making general estimates does not constitute data.

And to make it clear up front, while there are no doubt deficits in psychiatric care in many areas and populations, there are also such deficits in psychological services and other health care services. By necessity I mean, is it necessary to change the medical education and practice standards in order to meet the deficiency or can it be done in far more effective ways which are already available. I believe that the latter is clearly true.

Regarding the proof of safely prescribing, you actually make a valid point. The argument of "no adverse effects" is not that solid. People not filing complaints does not necessarily mean that the services provided are of quality. However, it's a very clear hint that it is indeed safe.
This issue needs to be addressed by controlled research. We are actually planning this in Holland at the moment.

I do question your view on the RxP-curriculum though. The study I quoted a few posts back, shows prescribing psychologists are equally and often better prepared than are (non-psychiatric)physicians and psychiatric nurse practitioners. Among these professions, psychologists are best equipped at the entry level. While these physicians and PNPs might seek further education, so can the psychologists.

This must mean that you even more strongly oppose PNPs and non-psychiatric physicians prescribing?

 

[CGOPsych]

Regarding the proof of safely prescribing, you actually make a valid point. The argument of "no adverse effects" is not that solid. People not filing complaints does not necessarily mean that the services provided are of quality. However, it's a very clear hint that it is indeed safe.
This issue needs to be addressed by controlled research. We are actually planning this in Holland at the moment.

I do question your view on the RxP-curriculum though. The study I quoted a few posts back, shows prescribing psychologists are equally and often better prepared than are (non-psychiatric)physicians and psychiatric nurse practitioners. Among these professions, psychologists are best equipped at the entry level. While these physicians and PNPs might seek further education, so can the psychologists.

Correct: There are no data to show that this back-door minimalist approach to obtaining RxP by the APA is necessary, safe or effective. Once again, you have NO data to show that there have been no complaints filed. These claims issued by the APA RxP campaign border on the unethical since they are repeated often and have no backing.

The study you cite is highly partisan serving the interests of the authors. One of them is the director of an RxP training program in a private school that benfits from selling the RxP program online. The article laughably claims that the training offered is equivalent if you in effect ignore most of the training that real medical professionals receive.

You didn't post the rejoinder by Elaine Heiby effectively taking that article apart.

I put to you the following: Would you send a family member to a health care professional for medication if that person's ENTIRE medical education consisted of 20 semester hours of education taken online. No pre-requisites, no entrance exam.

Your claims of 15 years of prescribing in the military are not accurate. You are referring to the PDP pilot program of 10 psychologists whose training was far above that which is being proposed by the APA campaign. That pilot project was forced on the military by a powerful senator who was the mentor of an RxP psychologist. There was NO data that this was necessary, safe or effective. Furthermore, virtually all those psychologists said that what you are endorsing would be inadequate.

Furthermore, I ask you for data on any other psychologists prescribing in the military. These claims are grossly exaggerated and suggest that any military programs were necessary, safe or effective. There is NO such data.

However, the same powerful US Senator who forced the DoD to run the pilot program, which was a failure, now has even more power over the military's budget. A far more parsimonious hypothesis is that he is forcing the DoD to accept these individual even though they are not needed. This is pure politics, not health care or science.

 

[stigmata]

FYI, the APA is a completely worthless organization, full of leftist academics who wouldn't know how to treat a single patient collectively; they are bureaucracy for the sake of bureaucracy. I know what the APA guidelines say and they suck as would be expected. However, I know many graduates of good programs, myself included and the curriculum far exceeds APA. RxP is a grassroots movement, and APA jumped on the bandwagon. I do not support APA, am not a member, am RxP trained and have been managing medications for a number of years safely.
The rest of the arguments are semantic nit-picking and mental masturbation.

 

[allopurinol]

1. You keep on making the case that Primary care physicians are adequately trained to prescribe. This is not the case. Research consistently demonstrates they underdiagnose the frequency of mental and behavioral disorders (Richardson, Keller, Selby-Harrington, & Parrish, 1996; Williams-Russo, 1996).
Isn't a proper diagnosis a premise of modern medicine? Furthermore, they overmedicate.

You state that they refer when necessary. Obviously, they do not, since they overmedicate. The cases that do get refered, are bound to end up on a waiting list due to the shortages of psychiatrists.

2. Psychologists have been prescribing for children, adolescents, adults, and geriatric patients; in children's hospitals, general hospitals, rehabilitation facilities, psychiatric hospitals, private practices, and outpatient clinics, acting in the capacity of provider, department head, clinical supervisors, and preceptors to family medicine residents; within state, federal, and private service; and overseas in Iraq, Afghanistan, Kuwait, and Germany, as well as at sea; for 15 years within the department of defense, 4 years in the state of Louisiana, and 5 years in New Mexico.

Yes, I will continue to make the case that they can adequately prescribe psychotrophics because they do, especially in reference to THE BASICS. I have yet to come across any PCP that has Rx any more potent psychotrophics other than in emergency/continuity of care situations.
PCP's do refer when THEY deem necessary. Yes, there is a shortage of psychiatrists, but this does not automatically translate into providing Rx authority to non-physician providers w/ subpar training. Also, you're neglecting the managed care issue (or did you not know about this) for the basics, because they typically want to see that the PCP has attempted to treat the illness before they will pay for higher level of care; this is a null issue if it is a more serious illness.
Overmedicate? Maybe, however, this is not limited to psychiatry. The vast majority patients, regardless of illness, tend to think that there is a pill that can cure everything.
Underdiagnose? Maybe, maybe not, but again, they know when to refer. If it is not obvious, and there are other areas to cover in a 30 minute appointment, then underlying mental illness can be overlooked. Again this is not limited to psychiatry, and it happens in all areas of medicine. Patients have the option to call their PCP's for a follow-up visit if they are not feeling well, and a more detailed, focused examination can be done. It is a huge leap to use suspected underdiagnosis of mental illness to conclude that psychologists should receive Rx authority.
You're citing data from 1996; anything more recent?
As far as your 2nd point, where is all of the data that prove this? How many of these providers are really going to self-report any adverse events? I am very familiar w/ the DoD demo project, and the military population that was the basis of this study was a very healthy population. The DoD project, which is where the majority of your 15 year-time line comes from, did not include the geri, peds, or the seriously medically ill. So, again, I ask you for all of your data.
When you go to medical school, you learn pretty quickly to accept your limitations as a provider. My concern w/ the Rx push by psychologists is that the most vocal ones have yet to learn how much they really don't know.

 

[CGOPsych]

FYI, the APA is a completely worthless organization, full of leftist academics who wouldn't know how to treat a single patient collectively; they are bureaucracy for the sake of bureaucracy. I know what the APA guidelines say and they suck as would be expected. However, I know many graduates of good programs, myself included and the curriculum far exceeds APA. RxP is a grassroots movement, and APA jumped on the bandwagon. I do not support APA, am not a member, am RxP trained and have been managing medications for a number of years safely.
The rest of the arguments are semantic nit-picking and mental masturbation.

Grassroots movement? Hardly. The RxP campaign is funded by the APA's practice organization. The budget has been secret for the full 15 years of the campaign. APAPO sent $527,000 to Louisiana to help buy the RxP law down there. They send hundreds of thousands of dollars a year to state organizations to fund their "grass roots movement".

Virtually every "initiative" for RxP is conducted by APA. And if a proposed bill goes off the APA reservation, it is shut down. In Missouri a couple of legislators wanted to add to the required training to make a compromise, but that was unacceptable to APA because it would hurt the business of the professional schools allied with APA, so the local "grass roots" advocates, who were all from the state practice association that has received tens of thousands of dollars from APA to be their surrogates, didn't even show up for the committee hearing.

The "grass roots movement" began with a single phone-in vote by the APA board in 1995. The council was later conned into agreeing after they were told that it was a done deal and that many states would be approving RxP just any day now. It was all part of the back-room politicking and spin. The DoD inroads were pure back-room politics. They turned to the DoD, with no open hearings or rational discussion, when the "grass roots initiative" costing millions of dollars from APA failed in the legislatures. Bills have been rejected 100 times in 24 states.

Sorry, but if you really think this is grass roots, that is only evidence of how the campaign has bamboozled you, as it has many. The spin, propaganda, mythologizing ... it's been going on for years and it's been swallowed by way too many.

 

[stigmata]

I admit you are the only person here who REALLY knows what is going on...enjoy. I actually have work to do.

 

[Ollie123]

FYI, the APA is a completely worthless organization, full of leftist academics who wouldn't know how to treat a single patient collectively; they are bureaucracy for the sake of bureaucracy. I know what the APA guidelines say and they suck as would be expected. However, I know many graduates of good programs, myself included and the curriculum far exceeds APA. RxP is a grassroots movement, and APA jumped on the bandwagon. I do not support APA, am not a member, am RxP trained and have been managing medications for a number of years safely.
The rest of the arguments are semantic nit-picking and mental masturbation.

Though I'm in total agreement about the APA being worthless, I'm going to have to disagree with them being an academic organization.

Last I heard, the vast majority of their membership was practitioners - even more surprising when you consider that this is an organization that is supposed to represent all areas of psychology, not just clinical and counseling. Just my opinion, but I also suspect that if you conducted a poll you would find stronger support for APA and feelings that they are looking out for their best interest among practitioners than among academics. Even many of the academic leaders within APA seem generally unhappy with the direction it is moving in recent years. The APA essentially sanctioned the APAPO's scamming members out of money to fund the campaign, without so much as an "whoopsie" even when they finally got caught.

 

[stigmata]

You are wrong on every point. They lose practitioner membership points every year, but have always been academically overloaded. You as a student probably think they are great, that will change.

 

[Ollie123]

Trying to track down their membership numbers now but APA doesn't make them easy to find...maybe I'm remembering wrong, but I remember seeing that at some point and I thought it was an actual source and not just hearsay. A decrease in membership does not preclude practitioners still being the majority...I do know their membership has dropped like a stone across the board and that attendance at the convention is nowhere near what it used to be.

As for thinking they are great...isn't the very first thing I say that I think they are worthless


Edit: Bingo. 2009 numbers and I have no idea how they got them (it can't be complete data unless membership has dwindled even more than I thought) but at least a decent portion. Not quite as extreme as I remember but still points towards practitioners being the best represented of the various employment settings.

http://www.apa.org/workforce/publications/09-member/index.aspx

People in "applied" subfields make up the vast majority of the membership, though that would count clinical/counseling folks regardless of their focus. Mental health services is the dominant activity listed, far surpassing research and education even in combination. Though interestingly, fellows (maybe a better indicator of who the leadership is likely to be?) are far more research-heavy. Though there are probably a number of factors at work there.

 

[clc8503]

Does anyone have some numbers they can throw at me? For as long as I can remember I have wanted to go to medical school and become a Psychiatrist; I actually just completed my applications for medical school. Lately however, I have been giving a lot of thought to pursuing a PhD or PsyD with advanced training in Psychopharmacology instead. That said, The economy isn't the greatest right now so I have to consider the financial aspects of the profession before I fully commit myself to it, and leave my current job of $56,000/year.

Its not too late for me to go to medical school. I would just prefer to not accumulate the heavy debt of a medical education if I can do something very similar to psychiatry for a fraction of the tuition. On the same note, it would be impractical for me to become a Psychologist (RxP) if it means going to school for 5-6 more years, only to earn a smaller salary than I do at present. Is there any chance of that happening?

 

[loveoforganic]

I can't answer your question, but I'd look into how medical psychologists can bill medcare/aid/insurance for prescription maintenance relative to psychiatrists. Would probably give a good idea of your income potential. Why so concerned about the debt though? Unless you go somewhere like Tufts (and lsu is not tufts - tuition in lowest quartile), you'll be able to pay med school debt off in pretty much any specialty assuming you can manage money at all, and the job security is unparallelled. Basically, if you know you want to do a lot of rx work from the get go, med school route seems to make more sense.

 

[Therapist4Chnge]

MOD NOTE: All prescribing psychology topics belong in here, so I moved your thread. -t4c

My typical advice about medical school vs. psych RxP is to go to medical school. Becoming a physician will open the most doors, provide the best training, and allow for the most stability for employment.