- Joined
- Aug 19, 2014
- Messages
- 508
- Reaction score
- 290
then make practical sense.Viva La Overly Literal Interpretations!
then make practical sense.Viva La Overly Literal Interpretations!
This is getting embarrassing for RxPers. The saddest part is RxPers from the 90s who pursued this instead of legitimately educating and training themselves via medical school and residency. And they are still trying to substitute education/training/expertise with politics in the year 2015.
I sincerely hope future grad students reading this thread realize what a Psy/PhD in Psych allows them to master and what it does not. We all have our scopes of practices and areas of expertise. Utilizing politics to change that is never ideal.
"Your requests for data have involved expecting other people to do the work to answer your speculative questions."
Cogpsych demands evidence of safety. Then derides others asking anything of him.
$200 to my favorite rxp concern in honor of cogpsych.
What is your opinion on Psychologists being able to prescribe? Do you think they should or shouldn't?
If yes, do you think a specific specialty of psych should be restricted to do it such a Neuropsych?
I know some of the arguments for theses rights are more comprehensive care for psychologists as they usually need to work along side a psychiatrist due to their lack of prescribing rights. Also is the argument that PA's and APRN's have prescriptive authority and they often have less pharmacology training than psychologists.
On reason that I think would be good, and this might seem counterintuitive, is it's impact on society. There's such an issue with addiction in this country in part by doctors over prescribing. I think Psychologists modest approach and view on pharmacology due to their greater focus on psychotherapy would benefit society in that when a patient came to see them for comprehensive care and treatment, the psychologist would be restrictive and modest with medications and would reserve it for situations where it was really necessary and would try other approaches first.
Also, people see it as infringing on psychologists approach. I don't see this as an issue because they would get psychotherapy training AFTER their phd, so they would still have the primary research, psychotherapeutic and testing training that is essential t psychology. Also, psychiatrists over the years have been allowed to get training and provide psychotherapy so why can't a psychologist get pharmacology training.
Yes, and no. It's a deeply complicated issue. Everyone uses the rural argument for a lot of things, but the truth of the matter is, almost every medical specialty faces a shortage of providers in rural areas. If anything, I'd just like to see it used to simplify some patient's pharma load and get them appropriate treatment. E.g., my elderly patients really do not need hydroxyzine to treat mild anxiety and sleep issues. Especially when you consider it's potent anticholinergic properties. Conversely though, that's likely not what insurers or medical centers will pay these provides to do. My worry is that they would just be used like psychiatrist's and APRN's to just push meds.Isn't the reason as to why RxP is being given to psychologists is because of the rural areas not having enough psychiatrists to provide medication?
How could a great profession like psychiatry become a profession that pill pushes? What happened to the old psychiatry? Gosh our mental health care system is pretty screwed up
Yes, and no. It's a deeply complicated issue. Everyone uses the rural argument for a lot of things, but the truth of the matter is, almost every medical specialty faces a shortage of providers in rural areas. If anything, I'd just like to see it used to simplify some patient's pharma load and get them appropriate treatment. E.g., my elderly patients really do not need hydroxyzine to treat mild anxiety and sleep issues. Especially when you consider it's potent anticholinergic properties. Conversely though, that's likely not what insurers or medical centers will pay these provides to do. My worry is that they would just be used like psychiatrist's and APRN's to just push meds.
But I feel as though they use APRN's just for that purpose largely in part because APRN's don't have a lot of training in psychotherapy so they can't really be utilized for that. Whereas a psychologist with pharmacology training would be training well in both, prescribing and psychotherapy.
No, they use APRN's in that purpose largely because you can bill a lot more for med management than you can for psychotherapy. Our healthcare system is all about billable hours and how much those hours are worth, regardless of what the outcome is.
Exactly. If I had RxP, this hospital would not want me to do psychotherapy, they would want me to crank out the med management visits to maximize the RVUs. Our APRN wants to do psychotherapy (even without training in it, of course) and the hospital won't let them only because of the financial reason.No, they use APRN's in that purpose largely because you can bill a lot more for med management than you can for psychotherapy. Our healthcare system is all about billable hours and how much those hours are worth, regardless of what the outcome is.
OK so let's say we lived in a nation or society where Healthcare isn't all about billable hours and money. How would you then feel about psychologist prescribing right?
OK so let's say we lived in a nation or society where Healthcare isn't all about billable hours and money. How would you then feel about psychologist prescribing right?
Let me guess, succhinylcholine is a paralytic agent that is administered to help prevent injury from the induced seizure? I am serious when I said guess because I don't do ECT and it is well outside my scope of practice so I don't devote too much time to studying it. I concur with your assessment of NPs and my biggest concern is their lack of awareness of what they don't know. I am comfortable enough with my own medical knowledge to know that I am little better than a well-educated amateur which prevents me from giving medical advice to patients.InfoNerd101, what level of training are you?
In order to answer many of your questions you need to realize that the real world is not an ideal situation and healthcare will, unfortunately, never not be "all about billable hours and money". This is sad but true, any many important decisions are made, frankly, by politicians wearing nice suits that are lobbied with money. They are not made based solely on reason or a thorough calculation of risks/benefits to society or our mentally ill. Case in point: NPs practicing independently. If you look at PAs and NPs, NPs are able to practice independently solely because of the huge nursing lobby, while the actual medical training of a PA is of better quality.
I think everyone here would agree that a clinical psychologist with adequate psychopharmacology training and physician supervision would be much more desirable and in general much more likely to be competent and safe than an NP plus adequate psychotherapy training. The problem is that there are many debatable points here. The vague terms "adequate", "safe", "supervision", etc... need to be defined. What is "adequate" psychopharmacology training? In medical school I spent 4 years studying anatomy, physiology, biochemistry, microbiology, pathophysiology and pharmacology, each of which were separate classes followed by full-time clinical rotations in core medical specialties, after which I realized I had only learned the basics of medicine which were to be further refined through 4 more years of intense residency training. There is no substitute for suffering through all of these things in order to safely and competently practice (and understand) medicine. To me, online medical education for NPs is an absolute joke, and I can't even repeat some of the questions some NPs have asked me. Okay, okay, I'll repeat 2 things off the top of my head. Recently an NP asked me what oxycodone ER was... and recently during an ECT session, when asked why succinylcholine is given to the patient, one NP responded "so you get a good seizure?" These are not the people you want treating your family members. Back to the poorly definable terms: what is "adequate" psychotherapy training for NPs? Have you seen an NP skilled in practicing psychotherapy? Me neither. In my very opinionated and narrow point of view, these clinicians are solely used for "pushing meds" and making money for the system. They are good for boosting the income of hospitals, boosting the income of physicians/psychologists in a practice they work for, and basically nothing else. To have them practice independently is beyond me. By the way, "filling a rural gap", "provider shortage", yada yada, are all political buzz words and mean nothing, watch out for them.
As for RxP, this is an interesting prospect, but first we need that definition of "adequate" psychopharm training. Recently, I think there were a bunch of politicians who shot themselves in the feet fighting for RxP legislation by getting a law passed basically requiring PA-level education, and setting precedent for future similar laws. I think this PA level education, while an inconvenient amount of further education for a group of professionals who just finished suffering through graduate school, externships, internships, post-docs, etc... may in the end be the only way to get an adequate level of actual clinical experience and generalized medical education needed to be able to do this thing safely and appropriately. I'm going to stop myself short before going on about the definitions of "safe" or "supervision" because this post may already be too long, but there are many many debatable things to be debated here.
Also, we must point out that most of psychologists don't even want or support this.
Sorry for the long post, my reading-to-posting ratio is usually a lot higher
Let me guess, succhinylcholine is a paralytic agent that is administered to help prevent injury from the induced seizure? I am serious when I said guess because I don't do ECT and it is well outside my scope of practice so I don't devote too much time to studying it. I concur with your assessment of NPs and my biggest concern is their lack of awareness of what they don't know. I am comfortable enough with my own medical knowledge to know that I am little better than a well-educated amateur which prevents me from giving medical advice to patients.
In contrast, our NP was giving child rearing advice to one of my patients today based on.....? Coincidentally, this is one of the few patients that the NP is treating for Bipolar Disorder that actually has it. Diagnostic reliability is clearly one area that psychologists seem superior to NPs based on my limited sample. It does make sense that this would be the case given our focus on assessment and knowledge of research and methods for improving diagnostic reliability.
I really liked the way you framed the question about needing to determine the level of medical knowledge that is sufficient as I would not want to go from being a top-notch provider of psychological services to being a second-rate prescriber of psychotropic medications.
Oh, and I am pretty sure that infonerd is in undergrad and is just trying to get a grasp of the field of mental health and all the different roles that the various people have. As more and more midlevels get their online alphabet soup degrees, it is getting more and more confusing for the public and many have a vested interest in making it so and it's not for the public's benefit, that's for sure.
Yes, that is correct. I am an undergrad and currently work in the mental health field, love it, and want to advance. However, when I research on what avenue I should advance in within the mental health field, since there are so many different types of mental health providers (msw, Aprn, etc), I get so many different and conflicting responses, answers and just overall get confused and lost on what route to take or what would be best for me.
For example, one person will say go the MSW route because clinical social workers are in demand, flexible, broad scope of practice, can get extensive psychotherapy training in many modalities and are utilized in so many different settings.. Others will say don't do that route because the pay is so horrible and I should go the psych APRN route because they can do therapy and diagnose, and can do whatever a social worker or psychologist can do and more.
Others will say go the clinical psychologist route because they are the only ones that can perform psychological tests and evaluations and you can specialize in Neuro and potentially have prescription rights (which I happen to find Neuro interesting)
Then others will say that psych APRN's don't have the greatest diagnostic and therapeutic skills compared to other professionals so I shouldn't go that route.
And still others will say don't go the psychologist route as they are a dying profession, make no money in comparison to their education level and are slowly being replaced with master level clinicians (ie. MSW's and LPC's) who can do just about everything a psychologist can do.
So you see, it's a very confusing situation especially when your recieve conflicting advice. After working with each type of professional and observing them I can honestly say I can see myself doing any one of those careers. I even find the mental health Occupational Therapist I work with fascinating and like their approach to mental health and can see myself doing that as well.
Any feedback would be great. Thanks in advance!
None of this should be a surprise to you. Psychology 101: biases.
You are not receiving conflicting "advice." You are receiving biases perceptions. Can I ARNP do psychotherapy? Sure. No one has a copyright on therapy right? Are they gonna be any good at it. Likely not, if you play the odds (the odds being they were never trained in therapy). Are psychologist being forced out in some setting? Probably. It doesnt happen where I am though. Is SW a flexible field? I suppose. It not like any of this information is wrong, or even conflicting really.
And people don't want to make a mistake obviously. Nobody wants to invest x amount of years into something and then be out of a job. The idea that psychology is dying out though..not sure where that comes from. If psychology didn't die when psychology = psychoanalysis, not sure why it would now.
And people don't want to make a mistake obviously. Nobody wants to invest x amount of years into something and then be out of a job.
Infonerd,
Being a undergrad myself, I know what it feels like to go through all of the conflicting biases that a lot of the mental health providers give here. I have gone through so many end-career changes (i.e. LCSW, LPC, Clinical Psychologist, Neuropsych, etc.) that I have not focused on what I am doing now. I think the best thing that you could do right now is shadow the many different providers, get research experience (if you are a undergrad psych major start contacting lab professors) and focus mostly on what you are accomplishing now while slowly thinking about the future. From my experience, if you worry about the future too much you are gonna lose track of what you are doing now and will become confused and depressed because you do not for sure what you will do
PsychUndergrad18
I think the general consensus from the forum has been that if you specialize, you will have job security (ie neuropsych, forensic, health psychology, rehab psych, etc) if you stay a generalist, then yes, you may face some issues in the future. (but again, not guaranteed that you will)
But why a pharmacists? I understand that they have training in all things drug related but wouldn't it not be beneficial to them.
Because places like Walgreens and Rite-Aid offer flu shots. Pick up your prescription, get a flu shot real quick. It's convenient and it takes like 10 seconds.
There is also no reason people should have to go to the doc to get really common prescriptions for stuff that are relatively safe. So i'd like to see that change in my province as well.Because places like Walgreens and Rite-Aid offer flu shots. Pick up your prescription, get a flu shot real quick. It's convenient and it takes like 10 seconds.
There is also no reason people should have to go to the doc to get really common prescriptions for stuff that are relatively safe. So i'd like to see that change in my province as well.
There is also no reason people should have to go to the doc to get really common prescriptions for stuff that are relatively safe. So i'd like to see that change in my province as well.
There is already a mechanism in place for that, they are called over the counter medications. Are you really advocating that medications that directly affect the most complex organ system in the body shoulld be that accessible? Also what would be the benefit to patients or society? Also, think about the fact that it is not just the safety of the medication itself but also the risk of the illness it is treating that has to be considered. I want my patients who need psychotropics to be getting them from a doctor, preferably a psychiatrist who understands the complexity of the bio-psycho-social mechanisms of mental illness and how to assess severity and tailor treatment recommendations. How many people know how to self treat and self diagnose PTSD vs severe depression vs adjustment disorder vs OCD vs Bipolar, etc?There is also no reason people should have to go to the doc to get really common prescriptions for stuff that are relatively safe. So i'd like to see that change in my province as well.
There is also no reason people should have to go to the doc to get really common prescriptions for stuff that are relatively safe. So i'd like to see that change in my province as well.
Yeah, I'll be honest..I didn't exactly have an idea of what I meant with the statement I made. Just in a general sense thought maybe there was some drugs that could be prescribed by the pharmacists, that would not pose any risks. Like in my province pharmacists can prescribe medications related to smoking cessation.
My understanding from psychiatrist's response on this very question a few days ago is that we could only use a psychotherapy code with the med management add-on code. EM codes are reserved for physicians only.I'm still confused what MP looks like from a billing perspective. What CPT codes do MPs use. For example, would it be more appropriate to use a psychotherapy + med mgmt add-on code, or an E/M code, or would it depend on the case? How does MP affect actual earnings, and specifically, how does it affect income in a PP environment and a staff psychology position?