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Discussion in 'Psychology [Psy.D. / Ph.D.]' started by 50960, Dec 6, 2005.
The psychologists have plenty of money to spend on this. And they have.
Yes, both sides have spent a considerable amount of money on this issue. I don't think anyone has disputed that notion here.
I honestly haven't looked at/don't know how much they've spent, particularly in the states where legislation as failed, but I can say that as a whole, psychology generally has a pretty crappy track record of funding political efforts on behalf of our profession. It seems to be getting better, though, so maybe I'm wrong re: RxP specifically. And I do know APA has sunk a considerable amount of resources into this over the years, yes.
Really? I am thinking the AMA might have a bit deeper pockets than us. maybe we should make a deal with the devil, I mean pharmaceutical companies, to sponsor our organization and we might get a bit more political traction on this.
2014 Lobbying $'s spent:
That is a 15:1 spending difference in lobbying.
But where's to show the AMA lobbying was specifically against psychology prescribing? There are a lot of battles the AMA is already fighting.
If anything, that is a lot of APA money!
The AMA continuously advocates for issues that they feel is in the public's best interest vs. physician's personal interest. For example, they were wholehearted supporters of Obamacare from the beginning. Likewise, I don't think Big Pharma would mind having lower-trained practicioners be their middle-men! So please- stop with the persecution complex/turf war paranoia. APA is by far the biggest source of money and lobbying effort on the RxP issue.
In fact it seems that RxPers care more about the politics then what your proposals will actually have you doing. It's rare when I actually hear a prospective RxPer discussing, honestly, the possible disastrous implications of practicing medicine without proper training.
We can't predict what can go wrong- that's why proper medical training relies on having enough training time and rigor to see as many possibilties as possible. I mean what can I say? Make sure your online class somehow teaches you to catch the induced thrombocytopenia from your psych drug treatment or teaches you enough medicine to put aside (a very large RxP ego) and suggest a proper physician consult before dismissing someone complaining of seemingly-psych related dizzyness. Because once they go to their "medical psychologist" they will take your word for it and proper diagnosis can be delayed to disastrous effects and nobody will ever hear of it.
Don't fret. There will be a psychiatrist to clean things up.
There are many times as many physicians as psychologists, so the ratio cited is somewhat misleading. I'm looking at figures that there are 168,000 physicians in just the primary care specializations alone. APA benefits heavily from the lobbying of AMA, on topics such as Medicare reimbursement (although if you read the APAPO propaganda, you might think APA did all by themselves).
APA created the APAPO specifically to act as its lobbying arm, with an annual budget of $5 million, so the cited figures are also not accurate. Add the APA lobbying, then you have about $6.2 million, which is likely far greater per capita than what AMA spends.
Edit: OK, Dr. Google says there are about 10 times as many physicians as practicing psychologists in the United states, so actually APA spends about three times as much as AMA per capita.
APAPO's fundraising method of lying to the membership of APA, to make them think that donating to APAPO was required for membership has been unmasked as a scam and APA has agreed to a class-action lawsuit settlement in the matter.
APA has spent more than $3 million just on grants to state associations alone for RxP lobbying. It's spent a lot more in other ways. In Illinois, the RxP campaign spent hundreds of thousands of dollars, and hired a platoon of 8 lobbyists to push their failed RxP bill. You can be sure that the psychiatric or medical societies didn't have those resources. So let's not shed too many tears for those poor underdogs, they have all that APA/APAPO money to play with. But you won't read about that in the American Psychologist.
I'd say this IS a turf war. APA is trying to steal the business of another profession without having to actually do the work it takes to practice it properly. The purpose is to make more money and have more political power, even though it very likely puts people at risks and it helps keep our profession from exploring far better alternatives.
lol I'm sure your RxP cronies, I mean colleagues, have already been doing that. An RxPer that cares about public health over his pocketbook is about as realistic as the tooth fairy.
They were required to create a separate PAC, just like every other non-profit organization who wants to lobby because it is illegal to be a non-profit and directly lobby; the gov't would revoke non-profit status of any organization that doesn't distinctly separate those activities. Yes there are ways to "lobby" without meeting the current definition, and the AMA does an excellent job of toeing that line and maximizing the benefits.
As for the rest of it, your math doesn't make sense, someone's "annual budget" does not equal the $ spent lobbying, so please stop distorting the information. The data I cited is non-partisan and references actual $'s spent…not budgets.
Ah, yes, but you cited APA, not APAPO. The APAPO's only function is political advocacy. It was indeed created because APA wanted to spend more than $1 million a year on advocacy, and a big reason for that was RxP. It was started when RxP godfather Pat DeLeon was APA president ... and in his administration the massive deception of APA members began, eventually leading to a major scandal that cost APA about 7 percent of its membership ... you can write Pat and thank him some time. The RxP campaign also was cited in Risen's book as one of the reasons that APA got involved in the torture scandal, bringing more shame and controversy to the organization. RxP is the gift that just keeps on giving, eh?
LOL, it's all about money and power, and then sometimes power and money.
Or does anyone think that millions are being spent just because they want to see people get more medications, but not through any alternatives that are safer, non-controversial, and easily implemented. Nope, they want to do this the worst way, the hardest way, the most controversial way, the least effective way, and the most expensive way because they care so much about getting people more psychoactive medications.
I feel like I should grab some popcorn as this turf war rages down several tangentially related rabbit holes.
You are terrible at data. Reminds me of your earlier claim that a military readiness report and you not personally having heard of adverse effects in NM/LA (not true anyway) = data. How is the % of AMA's spending, of which psychiatry is a small part, going to the issue of RxP the same as the % of the APA's spending? How can you purposefully not include APAPO's spending? Common sense alone dictates that the medical community has many other things to worry about besides RxPers wanting a shortcut to practice medicine.
Apparently the terribleness at data runs abound. APAPO also has many other things to worry about than turf management by MD's (e.g., SGR, mental health access act, PQRS registry issues, etc). These are listed along with financials. Ad hominems are fun though. We should just continue along with those, they will surely decide this issue once and for all.
You keep saying someone is "mis-characterizing", making "straw men" or making "ad hominems" and each and every time I have to explain to you that's not the case. In this case- how is pointing out that comparing AMA spending to APA spending completely ridiculous an "ad hominem"? In your paranoid "turf management" view of the world you're imaging physicians spending globs of time and money to put down RxP Psychologists. They don't consider you (RxPers) any more than they do a myriad of other non-medical practitioners trying to practice medicine through politics- which includes pharmacists, optometrists and even chiropractors.
Name calling is directly an ad hominem, and it's been done countless times, even within the past few days. Especially when you make those claims with no data to support your argument. Do you know exactly how much was spent by each side on that one issue? Also, you can pretend turn management doesn't exist, doesn't make it any less real. We all deal with the issue, some of just have bigger war chests with which to defend that turf. And some choose to protect that turf with politics instead of objective data.
I wasn't the one listing unrelated monetary figures and calling it meaningful data, was I? You have an VERY ironic penchant for accusing anybody who disagrees with RxP of a fallacy of relevance (ad hominem, red herring, straw man, etc. whatever else you can think of).
Someone brought up lobbying money, and meaningful monetary figures were supplied. Seemed fairly simple. As far as logical fallacies go, if the shoe fits... most of your arguments just happen to be putting words into people's mouths and insinuating hidden motivations.
1. I'm going to have to strongly disagree!
2. isn't "turf" your favorite word? No matter how bad RxP is, you can trot out that horse whenever anybody objects.
Disagree away. Turf is a great word, probably not my favorite though. As a favorite, I'm going to go with chamois.
So as a psychologist, presumably very well-trained in research, you believe this:
is meaningful data that physicians out-spend psychologists in regards to RxP?
There you go putting words into someone's mouth again and divining motivations.
Someone made a claim that psychology has plenty of money to spend on this one issue. Data was brought up looking at money spent on lobbying. That's where the data stops. It does not break down where the money went, which specific issue was lobbied for. It merely serves to bring out that the size of the lobbying war chest differs quite significantly. I don't recall T4C ever stating that X spent more than Y on RxP. You provided that particular interpretation.
My post was in response to $'s spent on lobbying. There was mention that the AMA probably has more money at their disposal to use towards lobbying. I provided data that supports the AMA spends more in lobbying. The AMA does not just support one issue, nor does the APA….so the data has to be understood in that context, but it is far better to try and bring some data into the discussion instead of the "opinions masquerading as facts" approach that you seem to prefer.
You called it "meaningful monetary figures." Why would unrelated spending on non-RxP issues be meaningful? I agree it's a very nice figure to put forth, but only if you succeed in blurring the two issues (lobbying funds for various unrelated things vs. RxP lobbying funds). e.g. Does AMA's extensive $$$ spent to keep Obama-care from being repealed count against RxP?
It was meaningful in relation to the claim that psychology has plenty of money to spend on RxP, without implying that the AMA actually has more to spend if they so choose. Is it a tangent, yes. But it was definitely meaningful in the context for which it was presented. You can take it out of context and claim that people said things they didn't, doesn't change the fact.
That's true in my experience. I've seen that APA has spent vast sums of money lobbying for RxP, far more than for any other issue. In my state they have thrown money at this and nothing else. In the last year or two they sent over at least $120,000 for a bill that was worse than a failure. I agree that it would be extremely interesting to know just how much is spent on other issues in comparison. Good luck getting them to face this.
When Illinois psychologists needed help with parity problems with insurance companies, APA's response was to write a letter. Whoop-tee-doo. A letter. As opposed to $120,000 for RxP's platoon of lobbyists.
When trying to help get RxP into Ontario, Canada, (which has failed) a delegation of APA bigwigs found the time and money to fly up there and meet with them. We have never seen any of those people come to Illinois for any reason.
You say it's getting better, and I would welcome that, but I haven't seen APA spend anything close to the amount of money they have poured down the RxP rathole. RxP continues to be a massive failure across the country, and the disproportionate influence that RxPers have over APA politics ensures that they will continue to throw their money away rather than start working on helping psychologists.
It was mostly a general "it's getting better" statement with respect to psychologists finally realizing that 1) lobbying is a fundamentally important component of professional viability and survival, and 2) lobbying takes money. Neuropsych tends to do fairly well on that front, at least relatively speaking, but even then there's still infighting. Then again, I don't think any profession is free from disagreements within its constituents; it just seems as though psychology has a long track record of being particularly adept at picking apart its own support base on most issues.
This thread is in need of a time out. I can no longer even make out what is being contested. Who spends more money? What portion of whose budgets are spent where?
We see there is a strong divide in opinions and no one will have their minds changed. Anyone undecided and sitting on the sideline learning from the content has probably read enough information.
I'm just going to donate to an rxp initiative whenever there is an asinine argument. I'm on a roll financially right now. Should be fun.
*This money coming from forensics, which pays 2-2.57 times better than RxP pursuits.
Sure. Don't spend it all though- diversify your financial portfolio with something more likely to "pay out" than RxP- like lottery tickets.
This might bring it back on topic. I am wondering if RxP would really bring us much money or would we better off from a financial and professional standpoint to increase how much we can get from current practices. My hospital only bills about 110 an hour for therapy and less for testing. They use some national metric for this based on what insurances will pay, I guess. If I could bill as much for therapy as I could for going to court, I would be a fool to want to get mixed up with managing meds.
The monetary side of RxP isn't much different than therapy in that volume is what makes $. There are cash pay private practices for both, but many providers still are reliant on seeing enough patients to make enough money to cover overhead and make a decent income. The hourly rate (or flat fee) a person charges for forensic work is most likely not translatable to strict clinical work unless a person can make a case for why it is worth it to the payor to pay such a higher fee than another provider down the block.
I have spoken to some national billing people, and the overall consensus seems to be that psychologists' hourly rates are not consistent with the market valuation. But third party payors are happy to accept $110/hr when their valuation puts it higher.
Think of it like selling a car. You want 5k for a POS. Guy comes to look at it and offers 9k.
Hmmm. So are you saying that psychologists are billing less than what we could? If so, then all the more reason to not get RxP as that would lend credence to the argument that we aren't smart enough to learn how to prescribe safely.
It all depends on the clinician/practice. Many clinicians don't even know what the $'s are for each panel. While there may be some variance within particular plans, they really need to know what is what….or how else do you negotiate with other payors?
Right now APA has another scandal on its hands. As noted in this Washington Post article:
APA has agreed to pay up to $9 million to settle the class-action lawsuit which alleged that APA deceived its entire membership for 10 years into thinking that donating money to its lobbying arm, the APA Practice Organization, was required for APA membership, when in fact it was not.
This is a remarkable example of institutional corruption, deceit and fraud in a presumably non-profit organization. Imagine that multiple generations of staff members or elected officials were either co-conspirators in this or they were so incompetent that they were not aware that it was being inflicted on the membership for a decade.
There is a connection between this fraud and the RxP campaign, which is not surprising since RxP is about acquiring power and money at any cost. The scandal began when RxP head Pat DeLeon was president of APA in 2000. The political money collected through the fraud was used to pay for RxP campaigns, such as $526,000 for Louisiana alone. APAPO sent mroe than $120,000 to Illinois.
Dude, we get it, you hate the APA. I think you'd have more sympathetic to your points if you didn't come off like a Fox News blast about Sharia law with hyperbolic language. Also, where are you getting these numbers? I'm not saying they aren't accurate, but you offer them up all the time and I'm curious as to the source.
That's a bit simplistic and certainly not true, dude.
I do hate what some people have done to a once-great organization. By the way, I get the facts by paying attention and doing my homework, for a long time.
When I was an undergraduate, one of my teachers was a former APA president - back when APA leaders were people who loved psychology and humanity more than money and power. He affirmed for me that psychology is one of the most fascinating and rewarding things to learn in this world, and being able to help people while practicing it was the best of all possibilities.
Then in the mid 1980s something very good and very bad happened to psychology. We were successful in getting approval to qualify for Medicare payments and more insurance companies followed suit, which opened up a great many more opportunities for psychology to be a business. The people who valued money and power over science and service took over. This change in emphasis caused those with the latter priorities to leave in droves, and they started the Association for Psychological Science. APS continues to be a beacon of principle and ethics.
However, APA was increasingly led by people who were out to make a buck and be more powerful above all other considerations. A group who called themselves the "dirty dozen" helped turn APA into something that looks more like a shady labor union. As you can imagine, RxP was a crown jewel in the movement to prostitute psychology and, frankly, turn APA and its leaders into a bunch of unprincipled liars ... and I mean that literally.
I've pointed out many ways in which the RxP campaign and its advocates have deceived and misled people. The practice assessment scandal is another perfect example. Imagine that repeated generations of APA officers and staff systematically lied to the entire membership, tens of thousands of people who trusted them, just to get them to pay money into the new lobbying organization. It is mind-boggling, possibly the greatest instance of fraud in a not-for-profit organization. Imagine that not a single person had the morality or the moral courage to stand up and say that this was wrong. That is the power that APA's dishonesty had on people who are otherwise intelligent, ethical and sensible.
The torture scandal is yet another example. APA's leaders were not seduced or dragged into this, they flung themselves into helping the CIA keep the torture going. The interrogation program was actually being suspended after questions were raised about it and they needed some sort of medical professional coverage of interrogations. The psychiatrists in particular and physicians in general wouldn't touch it, but APA eagerly collaborated with Bush-era CIA employees to give the interrogation system the appearance of being overseen by a health care profession.
And so we now read more revelations of how APA's leaders sold the soul of the organization and the profession by helping the CIA do, as one psychologist gleefully put it, "special things to special people in special places."
Some people are holding out hope that the resolution of the torture scandal, and the practice assessment scandal, could force APA's leadership to accept reform. However, it has shown itself to be impervious to any such efforts. Even when APA's membership voted in a referendum to change the torture policy, they found a sleazy way to ignore the will of the members and do whatever they wanted.
Holy long-form Batman! You don't need to sell me on the APA's past shortcomings. If you've read some of my past comments, in other threads than this, you'd know that I gave up my membership some time ago for various reasons. I do think there have been improvements as of late, but I'm still not ready to jump back in until things get resolved. I would still say that some of the language is quite hyperbolic though. And, as we know as psychologists, has the opposite of intended effect, only makes those with the opposing viewpoint hold that viewpoint more strongly.
True, my language can be harsh at times. However, I don't think it exceeds the magnitude of what has been done, and continues to be done.
I still cannot get my head around what an extraordinary thing it was for so many people in APA, over a decade, to lie to the entire membership in a clear-cut instance of fraud and to adopt the Code of Silence so completely. I have seen how RxP advocates do things that were extraordinarily unethical and dishonest, people who have high positions in this profession. These people knew what they were doing in the torture scandal was unacceptable to members and the public. The PENS report that gave ethical cover to the CIA was published without the names of the task force members on it. During the meetings they told members they could not take notes of the proceedings.
The scandals continue. The APA leadership has done everything it can to block any information about the torture issue, and the organization has attacked, stonewalled and dismissed any thoughtful questions about what they have done. Only when the Senate Intelligence Committee started to release some information it had, did APA realize that they could no longer stonewall the psychologists who questioned this, and the investigative reporters uncovering evidence of their deeds. Now they've fallen back on hiring an investigator, who will report back to APA's leadership - who have not committed themselves to releasing that report. The investigator may be honest, but even then the information he reveals will be held and used by APA's leadership as it sees fit.
The APA has never admitted that it lied to the membership in the practice assessment scandal, even though the evidence is overwhelming. There are recovered APA website web pages from multiple years showing that APA said all licensed psychologists "must" pay the fee or that the fee is "applied" in the cases of licensed mental health professionals. And yet they play a cynical game of denying it rather than do the right thing, admit that this happened in the past, and move on.
And as I have noted many times, APA continues to run the RxP campaign without the consensus and oftentimes without the knowledge of the members, including those paying the very high bill for this massive failure. APA continues to issue what is quite literally propaganda - the management of information for political purposes - about RxP, among other topics.
This is an organization that was once great, the organization of William James, for example. And it has been dragged into the gutter and kept there. Strong language may be off-putting to some, but I think it is accurate.
I still think it detracts from your message, I feel like I'm reading about Jade Helm 15 at times. Also, needing to separate some of this animosity on tangential issues. I don't think an organization handling on one issue, makes every issue they take a stance on somehow bad. For example, they also campaigned on the SGR and related issues, should we pan those efforts because of the torture debacle? Just got to keep things consistent. Also, still curious as to where some of the numbers come from.
Plenty of good things happen within APA. It's a large organization.
However, the grossly objectionable and unethical actions are undertaken with the knowledge and direction of the organization's highest leadership. And they have been enacted and covered up over the course of years, so that this is not just a slipup by someone acting on his own. I think this says a lot about the inherent nature of the organization as it has been formed by those who control it.
For example, the PENS task force closely involved the executive director of the Practice Directorate, and several psychologists who were very much insiders, such as a former president, and the person who was the director of the ethics office. The torture scandal, the practice assessment scandal, and the scandalous way APA has run the RxP campaign are just the most prominent and egregious issues.
Furthermore, open and appropriate attempts to address these issues have been thwarted by those in control; the APA leadership ignored the results of a referendum in which a majority of the members voting wished to change the torture policy.
Therefore, I think it is appropriate to call into question the ethical nature of the organization as it is being led and controlled. This degrades the reputation of the organization and our profession, and it also overshadows the good that comes from APA.
I am not a big fan of the APA and am on the fence about RxP, but I think that conflating the two issues weakens your arguments. In other words, I could hate APA for the reasons that you listed and for many others, but still be a strong supporter of RxP for many other reasons or vice versa. Actually, I think that how the APA handles RxP is support of the argument "APA bad" but it doesn't work so well the other way. RxP is bad because APA supports it and APA is bad.
The main reason I am against RxP is that I believe that psychotherapy is more effective in a wide variety of cases and I think that psychologists are well positioned to maintain their status as the experts in psychotherapy and pursuing RxP would detract from that. The main reasons I would be for RxP is that I think I might be able to do a better job helping my patients if I had access to that tool and I might make more money.
Yeah, I gathered your opinions on those issues already, that is not in question. Where did those numbers come from, though? I enjoy numbers, and wanted to take a gander myself.
Or, RxP is a bad idea because of the details of the proposal and the effect of incorporating the practice of medicine into psychology. The campaign is a bad idea because it required to employ questionable tactics to support a proposition so inherently flawed. APA is mismanaged and RxP is an example of that. There are other examples.