Psychopharmacology/Advanced Practice Psychology

[Therapist4Chnge]

If we start throwing in waves of variably-trained individuals, though, the chances for pharm-associated adverse outcomes would likely rise.

I have those concerns too, though I have seen quite a variance w. NPs (direct entry, minimal experience, fully online training, etc) and there hasn't been a rash of adverse cases (at least that I have seen reported).

---

Members don't see this ad.

 

[DynamicDidactic]

why do you lie so much, dynamic didactic? You know the psychopharmacology courses are not $70,000, rather they are $15,000-$18,000 total. Your posts are always filled with so much disinformation that I have to believe you are either lying or just not very well informed

maybe I was wrong, I could have sworn I read somewhere that New Mexico in particular would cost 70k at the end (maybe that included room and board or something). But you are correct that I can no longer find that information and I apologize.

On the other hand, I always attempt to provide accurate information when I say something that is more than just my opinion. Can you point out other instances when I have said something that was incorrect?

 

[AcronymAllergy]

I have those concerns too, though I have seen quite a variance w. NPs (direct entry, minimal experience, fully online training, etc) and there hasn't been a rash of adverse cases (at least that I have seen reported).

Hmm, good point. Although NPs do also have additional years of more medically-intensive training and experience on which to rely vs. the average (or particularly the average variably-trained) psychologist.

 

[edieb]

I had 20 people in my cohort @ NMSU. All attended class in person except one person who was in Guam. The majority lived in Illinois, Arizona and New Jersey. Most of the cohort was over 55 years of age but I don't know where they received their doctorates.

 

[nitemagi]

maybe I was wrong, I could have sworn I read somewhere that New Mexico in particular would cost 70k at the end (maybe that included room and board or something). But you are correct that I can no longer find that information and I apologize.

On the other hand, I always attempt to provide accurate information when I say something that is more than just my opinion. Can you point out other instances when I have said something that was incorrect?

The DoD program was much higher ($610,000) per prescribing psychologist, in the end (all costs).

http://www.narpa.org/prescribe.htm

 

[Rivi]

I had 20 people in my cohort @ NMSU. All attended class in person except one person who was in Guam. The majority lived in Illinois, Arizona and New Jersey. Most of the cohort was over 55 years of age but I don't know where they received their doctorates.

What did the people who were in non-RxP states end up doing?

 

[edieb]

Many of the people work for the Indian Health Service. Many others were going back to their home states to begin lobbying for RxP. From what I know, there are a few other states that are very close to passing RxP that are flying under the radar. Illinois is one state that I am pretty sure will pass this time (finally) because the bill has a lot of factors in its favor this time including the fact that the person who introduced it is the president of the Senate and his party is a supermajority in the House and Senate. This is the primary reason why it passed out of committee unanimouslly.

 

[edieb]

The DoD program was much higher ($610,000) per prescribing psychologist, in the end (all costs).

http://www.narpa.org/prescribe.htm

That was years ago and they were not trained in a cost efficient manner because it was a government-only program. Speaking of the government, at the local military base I work near, I am giving supervision to 3 other soon to be prescribing psychologists who have passed their licensing tests. In return, they plan on mentoring 5 others at the same base, and so on. We are really trying to increase our numbers in the Department of Defense so we can start getting to critical mass

 

[CriminalPsych]

That was years ago and they were not trained in a cost efficient manner because it was a government-only program. Speaking of the government, at the local military base I work near, I am giving supervision to 3 other soon to be prescribing psychologists who have passed their licensing tests. In return, they plan on mentoring 5 others at the same base, and so on. We are really trying to increase our numbers in the Department of Defense so we can start getting to critical mass

This just popped up a question for me, but for those prescribing psychologists who work for the DoD, are those only enlisted personnel or can civilian employees prescribe for the DoD as well?

 

[edieb]

This just popped up a question for me, but for those prescribing psychologists who work for the DoD, are those only enlisted personnel or can civilian employees prescribe for the DoD as well?

Civilian and enlisted can both prescribe.

 

[psychedout69]

I work alongside Psychiatrists as a PHD myself, and it does seem like I do most of the work, then they walk in with their pad and write the medications I recommend. Their salary is about 600% higher than mine, and a lot of the time -- the American taxpayer gets stuck with the bill. They are in such demand right now, while PHD Psychologists are not in any demand at all. Makes sense to let us help fill that gap.

 

[AnnoyedByFreud]

Does anyone know if prescribing psychologists can work with children? I have a friend who is trying to figure out what she wants to do (she's mid-way through a clin psych program and hates it, wishes she had gone the med school or pa/np route, etc.) Anyway, she is interested in becoming a prescribing psychologist, especially if the IL law passes, however, she wants to be able to see kids. Does anyone know if the prescribing psychology training includes peds or is it adults only?

 

[edieb]

Yes, they can as long as it is in their area of competence

 

[nitemagi]

Yes, they can as long as it is in their area of competence

Well that's a relief. Psychiatrists usually do a 2-year fellowship before they prescribe to children. Glad to know the RxP programs fit in that and all of the rest of psychopharmacology and necessary medical training into their 2-yr program.

 

[PHD12]

Well that's a relief. Psychiatrists usually do a 2-year fellowship before they prescribe to children. Glad to know the RxP programs fit in that and all of the rest of psychopharmacology and necessary medical training into their 2-yr program.

My understanding is that the fellowship is not required to work with children in psychiatry. I know several psychiatrists who work with children immediately out of residency in PP and never completed a fellowship at all. I also know one who just switched to work in a child inpatient unit from an adult program and has no child fellowship.

 

[nitemagi]

My understanding is that the fellowship is not required to work with children in psychiatry. I know several psychiatrists who work with children immediately out of residency in PP and never completed a fellowship at all. I also know one who just switched to work in a child inpatient unit from an adult program and has no child fellowship.

Technically we're licensed to perform surgery, too. So no, it's not required. Out of adult training we get board certified in Adult Psychiatry.

The difference being what the state "Allows" us to do, vs. what we actually have quality training to do.

Psychiatry residency has 2 months of required training in child/adolescent. Does RxP even have that? How about the differences in dosing for children compared to adults (metabolism, volume of distribution, presentation of medical conditions that mimic psychiatric, let alone the differences in actual mental illnesses)?

/offhighhorse

 

[edieb]

Well that's a relief. Psychiatrists usually do a 2-year fellowship before they prescribe to children. Glad to know the RxP programs fit in that and all of the rest of psychopharmacology and necessary medical training into their 2-yr program.

Yes, our training includes training in geriatric and pediatric prescribing

 

[AnnoyedByFreud]

Technically we're licensed to perform surgery, too. So no, it's not required. Out of adult training we get board certified in Adult Psychiatry.

The difference being what the state "Allows" us to do, vs. what we actually have quality training to do.

Psychiatry residency has 2 months of required training in child/adolescent. Does RxP even have that? How about the differences in dosing for children compared to adults (metabolism, volume of distribution, presentation of medical conditions that mimic psychiatric, let alone the differences in actual mental illnesses)?

/offhighhorse

I'm curious, do clinical psychologists who come from adult (as opposed to child) training (and vice versa) have the same scope of practice w/prescribing?

 

[PHD12]

Technically we're licensed to perform surgery, too. So no, it's not required. Out of adult training we get board certified in Adult Psychiatry.

The difference being what the state "Allows" us to do, vs. what we actually have quality training to do.

Psychiatry residency has 2 months of required training in child/adolescent. Does RxP even have that? How about the differences in dosing for children compared to adults (metabolism, volume of distribution, presentation of medical conditions that mimic psychiatric, let alone the differences in actual mental illnesses)?

/offhighhorse

Clinical psychologists who specialize in working with children/adolescents will have several years of training (including extensive coursework and supervision), internship, and postdoc fellowships in child/adolescent disorders, assessment and treatment. I don't even work with children and don't plan on working with children, and my psychopharmacology courses in graduate school covered children/adolescent medication issues pretty extensively. This does not include the two year R x P curriculum, which I am not taking. I think you are ignoring the fact that we have 8 years of training (including training in psychopharmacology, neuroscience, neurology etc) without R x P. During my training years and internship, I was also supervised by psychiatrists as my secondary supervisors as well.

This is akin to saying that psychiatrists are not competent to perform psychotherapy after a 2 year psychotherapy curriculum post-MD, supervision by psychologists, practicum etc.

 

[AcronymAllergy]

Technically we're licensed to perform surgery, too. So no, it's not required. Out of adult training we get board certified in Adult Psychiatry.

The difference being what the state "Allows" us to do, vs. what we actually have quality training to do.

Psychiatry residency has 2 months of required training in child/adolescent. Does RxP even have that? How about the differences in dosing for children compared to adults (metabolism, volume of distribution, presentation of medical conditions that mimic psychiatric, let alone the differences in actual mental illnesses)?

/offhighhorse

I will say that psychologists with a child focus will typically have had years' worth of experiences working with children (often the majority of their grad school, internship, and postdoc research and clinical training), leading to a rather astute understanding of mental illness in children/adolescents.

Beyond that, though, I can't speak to what the RxP classes teach regarding medical issues and prescribing in these age groups.

 

[AnnoyedByFreud]

Clinical psychologists who specialize in working with children/adolescents will have several years of training (including extensive coursework and supervision), internship, and postdoc fellowships in child/adolescent disorders, assessment and treatment. I don't even work with children and don't plan on working with children, and my psychopharmacology courses in graduate school covered children/adolescent medication issues pretty extensively. This does not include the two year R x P curriculum, which I am not taking. I think you are ignoring the fact that we have 8 years of training (including training in psychopharmacology, neuroscience, neurology etc) without R x P. During my training years and internship, I was also supervised by psychiatrists as my secondary supervisors as well.

This is akin to saying that psychiatrists are not competent to perform psychotherapy after a 2 year psychotherapy curriculum post-MD, supervision by psychologists, practicum etc.

Is there anything stopping medical clinical psychologists who do not have specialized training working with children from prescribing to kids? Hmm.

 

[PHD12]

Is there anything stopping medical clinical psychologists who do not have specialized training working with children from prescribing to kids? Hmm.

Good point. Edieb probably knows.

At least in my clinical psychology program, even if you ended up specializing in adult work, you are going to do at least 1 year of practicum with child/adolescent population and need experience assessing children/adolescents. I was also required to take several courses on child/adolescent MH issues and children/adolescent issues were addressed in other courses. Plus, most people are working with children/adolescents on internship/postdoc unless you are at a VA etc. I don't know anyone who got through a clinical psychology program without any experience and supervision working with children/adolescents. It would be tough.

I think people need to stick within their area of competence in every field. I'm wondering if there is anything that stops NP's without specialized training in working with children from prescribing to kids? Is this also part of the curriculum? Is there anything stopping primacy care physicians from prescribing psychiatric meds to children?

When you have a license in any field you are supposed to practice ethically and refer outside your area of competence. You can lose your license (as a psychologist) if you practice outside your domain. However, as in every field, the onus is on the provider. There are few strict legal protections (even psychiatrists are licensed to perform surgery).

 

[AnnoyedByFreud]

Good point. Edieb probably knows.
I think people need to stick within their area of competence in every field. I'm wondering if there is anything that stops NP's without specialized training in working with children from prescribing to kids? Is this also part of the curriculum? Is there anything stopping primacy care physicians from prescribing psychiatric meds to children?

When you have a license in any field you are supposed to practice ethically and refer outside your area of competence. You can lose your license (as a psychologist) if you practice outside your domain. However, as in every field, the onus is on the provider. There are few strict legal protections (even psychiatrists are licensed to perform surgery).

The nurse practice act. Scope of practice is a big deal in nursing (pediatric NPs do not see adults, adult NPs do not see kids, CNMs/WHNPs do not see men, etc.), which is what made me curious about how this applies to psychologists. All psych NPs have to have a certain number of hours of clinical (and coursework) with each age group, since they are licensed to see the entire lifespan. I'm all for psychologists getting prescriptive authority, though I am critical of the online programs (I'm critical of pretty much all online education) and graduates from degree mills (Argosy and the like). We need more prescribers who are specialized in psych, desperately. The vast majority of psych is just out of the scope of practice for primary care providers, IMO. I'm not sure why the psychiatrists aren't on board with this.

 

[PHD12]

The nurse practice act. Scope of practice is a big deal in nursing (pediatric NPs do not see adults, adult NPs do not see kids, CNMs/WHNPs do not see men, etc.), which is what made me curious about how this applies to psychologists. All psych NPs have to have a certain number of hours of clinical (and coursework) with each age group, since they are licensed to see the entire lifespan. .

Awesome

 

[CriminalPsych]

This is a follow up to my last question about civilian prescribing psychologists working for the DoD. How competitive are these positions for civilian employees? And, in comparison to the salary bumps we have seen for those in NM and LA, what kind of expected salary bump could you expect to see by prescribing in the DoD? Is this something that you could realistically plan on doing full time or even part time to supplement your income?

 

[edieb]

http://www.apapracticecentral.org/update/2013/05-16/prescriptive-authority.aspx


Article about NJ and IL

 

[bcliff]

Are there PhD programs that incorporate the psychopharmacological training into their programs, or will all prescribing psychologists (NM/LA/DoD) need to attend a postdoctoral program?

 

[Therapist4Chnge]

It requires an additional MS, so I do not see how that would be possible.

 

[DynamicDidactic]

Here is a blog I never saw before that seems to keep track of RxP movement
http://prescribingpsychologist.wordpress.com/

Also, heard that Ohio is trying to pass a trial program that would allow 6 psychologists to prescribe in the prison system.

 

[futureapppsy2]

Any updates on the Illinois or New Jeresy bills?

 

[nitemagi]

Any updates on the Illinois or New Jeresy bills?

Illinois- dead

http://alert.psychiatricnews.org/2013/05/psychologist-prescribing-bill-dies-in.html

 

[SmoothJams]

An earlier article outlining details of the opposition to the bill.
http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1668022

 

[DynamicDidactic]

Read today that AZ is going to give this another try next year. Iowa has also been trying but with little progress.

 

[DrMarx]

So, taking this whole thread into account, I have a question. Do you guys think the MD/Psychiatry route is even worth it anymore? I'm really not factoring in pay, as I don't care how much I get paid, but it seems that if Psychologists get prescribing rights the job almost seems identical to that of a Psychiatrist. Do you think this trend will continue to the point where all 50 states allow Psychologists to prescribe? Thanks for any answer!

 

[erg923]

I'm really not factoring in pay, as I don't care how much I get paid,

You should. And not just for your (and your family's) sake.

 

[edieb]

So, taking this whole thread into account, I have a question. Do you guys think the MD/Psychiatry route is even worth it anymore? I'm really not factoring in pay, as I don't care how much I get paid, but it seems that if Psychologists get prescribing rights the job almost seems identical to that of a Psychiatrist. Do you think this trend will continue to the point where all 50 states allow Psychologists to prescribe? Thanks for any answer!

This may be the dumbest thing ever said on SDN

 

[erg923]

Commie, hippie, or under 25. Any gueses?

 

[DrMarx]

Commie, hippie, or under 25. Any gueses?

Literally all three, thanks for the help.

 

[erg923]

Literally all three, thanks for the help.

When you are married, you have to support your wife's shoe habit. Kids also appreciate it when you have some spare change...just FYI.

 

[edieb]

yes, just what we want in the profession -- someone who can't use read the hundreds (literally) of posts regarding psychology and prescribing, who has an icon of a dr holding a gun and who is willing to work for free after 12 years of school! Briliiant

 

[PHD12]

Anyone knows what % of APA's budget is spent on advocating for prescription privileges? Doesn't seem like an effective 30 year campaign when only 2 states (where psychiatrists don't care to live anyhow) have produced any results.

Maybe we should spend more time and money advocating for certain evidence-based psychotherapies (the ones that have same efficacy rates as meds) to be the first line of treatment in hospitals and clinics?

 

[Therapist4Chnge]

Maybe we should spend more time and money advocating for certain evidence-based psychotherapies (the ones that have same efficacy rates as meds) to be the first line of treatment in hospitals and clinics?

That would definitely help out our patients.

In general, I have not been impressed by the APAPO (the political action arm of APA), as there is a general lack of understanding about our profession when it comes to the people who matter in gov't. As a result, whenever I speak with an elected official, I usually have to start with some general education about what we actually do, as most cannot differentiate us from social workers, counselors, life coaches, etc. Once they understand what we do, then I get into how we do it....by using EBTS, etc. I wish the APAPO could establish a more effective educational campaign, as having to orient each elected official wastes valuable time for all involved.

It is worth nothing that the APAPO were effective in staving off the most recent ridiculous Medicare cuts. They also have assisted multiple states with some insurance complaints, I just think they could do more if they focused their resources in places that impact the majority of its constituents. Just my 2 cents.

 

[PHD12]

That would definitely help out our patients.

In general, I have not been impressed by the APAPO (the political action arm of APA), as there is a general lack of understanding about our profession when it comes to the people who matter in gov't. As a result, whenever I speak with an elected official, I usually have to start with some general education about what we actually do, as most cannot differentiate us from social workers, counselors, life coaches, etc. Once they understand what we do, then I get into how we do it....by using EBTS, etc. I wish the APAPO could establish a more effective educational campaign, as having to orient each elected official wastes valuable time for all involved.

It is worth nothing that the APAPO were effective in staving off the most recent ridiculous Medicare cuts. They also have assisted multiple states with some insurance complaints, I just think they could do more if they focused their resources in places that impact the majority of its constituents. Just my 2 cents.

We need some good psychologists in political positions. Those congressional fellowships sound like a great deal if you enjoy public speaking, advocacy, and writing. Many psychologists would actually be great at this role.

 

[Therapist4Chnge]

We need some good psychologists in political positions. Those congressional fellowships sound like a great deal if you enjoy public speaking, advocacy, and writing. Many psychologists would actually be great at this role.

I was tempted towards the end of my clinical fellowship to apply for a similar position, but relocating to DC and living on $50k-$75k/yr were both deal breakers.

 

[DynamicDidactic]

Quote from Pat DeLeon

During our recent Hawaii convention, we were very pleased to receive an update from Illinois RxP proponent Beth Rom-Rymer that in Ohio: "While, originally the Ohio RxP bill had been introduced as a small-scale demonstration project focusing upon the needs of the criminal justice system, legislative sponsors have urged us to introduce a full-scale RxP bill. This bill will be introduced in the 2014 legislative session, with a promise of doing well (Michael Ranney)." Those familiar with nursing's successful RxP quest over the years will appreciate the pivotal role that a small demonstration project in Ohio (when then-Dean Ron Fox was at Wright State University.

 

[doctorpsych]

wanted to share success story that I'm particularly proud of. About a year ago, pt bib police, pt's had obvious thought disorder, paranoid and actively hallucinating, was engaging in disorganized behaviors, holding a knife, slashing the air. Got pt admitted into our local psych hospital, pt was subsequently discharged on haloperidol, switched to sga, and then eventually to another sga due to sig SE's. Work with pt through CBT along with regular med management. Now pt is in full remission, working on readmission into an Ivy league school. I'm particularly happy about this one because pt is the first one from pt's family to go to college and couldn't finish because of the mental illness. Putting all the political bs aside, you can't argue that a psychologist with psychopharm training was able to make a real difference!

 

[edieb]

http://www.papsyblog.org/2014/02/episode-2-prescriptive-authority-for.html

APA Link re: RxP

 

[DynamicDidactic]

http://www.papsyblog.org/2014/02/episode-2-prescriptive-authority-for.html

APA Link re: RxP

Only about 25 prescribing psychologists in New Mexico, which is attributed to the required 3-years of supervision

 

[edieb]

Only about 25 prescribing psychologists in New Mexico, which is attributed to the required 3-years of supervision

There are around 45 prescribing psychologists licensed in New Mexico (I am number 40). However, around 20 of those are prescribing in the Indian Health Service in other states and some others are prescribing in the military. Also, the supervision period is 2 years, not 3. The supervision is not on-site. I have a psychiatrist supervisor whom I meet with for 1 hour a week and we review my prescribing practices.

 

[DynamicDidactic]

There are around 45 prescribing psychologists licensed in New Mexico (I am number 40). However, around 20 of those are prescribing in the Indian Health Service in other states and some others are prescribing in the military. Also, the supervision period is 2 years, not 3. The supervision is not on-site. I have a psychiatrist supervisor whom I meet with for 1 hour a week and we review my prescribing practices.

maybe you could provide us a better understanding of what Bob McGrath was alluding to when comparing the difficulty of supervision in New Mexico vs. Louisiana.