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Psychopharmacology/Advanced Practice Psychology

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by 50960, Dec 6, 2005.

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  1. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    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.
     
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  3. psych844

    psych844 2+ Year Member

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    especially convenient for elderly people.
     
  4. PsychMajorUndergrad18

    PsychMajorUndergrad18 Future School Psychologist 2+ Year Member

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    But isn't that what the NPs do? I heard that CVS hires NPs to handle flu shots and primary care
     
  5. psych844

    psych844 2+ Year Member

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    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.
     
  6. InfoNerd101

    InfoNerd101 Banned Banned 2+ Year Member

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    So you think more medications should be over the counter?
     
  7. PsychMajorUndergrad18

    PsychMajorUndergrad18 Future School Psychologist 2+ Year Member

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    I think what psych844 is trying to say is that medication for common ailments should be over the counter
     
  8. PSYDR

    PSYDR Psychologist 10+ Year Member

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    This is a really uninformed opinion.
     
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  9. smalltownpsych

    smalltownpsych 2+ Year Member

    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?
     
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  10. psych844

    psych844 2+ Year Member

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    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.
     
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  11. image187

    image187 7+ Year Member

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    By definition, drugs that are "relatively safe" can be found on the shelves in your local pharmacy. Those that are not relatively safe generally require a careful clinical examination before they are prescribed to a patient, and they should. There are many drugs that most people would say are safe in general that in fact are not. For example, the COX inhibitor salicyclic acid (aspirin), one of the most widely available and cheap medicines, is responsible for a very large amount of GI bleeds and unintentional overdose deaths today because it so strong, and would require a prescription if it were invented today. Diphenhydramine (Benadryl), a medication commonly used by most of us for cold sx and insomnia (short term), if used in the elderly has a high risk for dilirium and urinary retention. OTC steroids (hydrocortisone 1.0 %) if empirically used to treat a "rash" than turns out to be an infection (fungal, bacterial, etc...) can make it worse. Acetaminophen (Tylenol, Paracetamol, etc..) can destroy a person's liver in daily doses not much past the recommended daily amt, and is a tragic ending to the life of a borderline making a gesture with the intent of just escaping a bunch of emotions (if you're wondering how important your liver is, it's called the "live"er for a reason). Even the flu shot, which is usually benign, has complications of its own. If not placed correctly into the right area of the muscle can cause nerve damage, and rarely can cause Guillan Barre syndrome, and more commonly is associated with either fainting or a generalized dermatological reaction. These are all things that are commonly considered to be "relatively safe", though can have a real and tangible adverse outcome that can end up bad if not monitored or at least predicted by a qualified health professional. Again (referring to my last post), the reason why many decisions are made has to do with politics and how as a society we can save a buck by employing the most minimally qualified satisfactory worker, but the definition of "satisfactory" only exists until something really bad happens. By something bad, I mean the death of a wealthy politician's child.

    To be honest and fair, pharmacists have been indespensible to me. As an example, when I admitted a pt to the unit last week and started them on their home anti-inflammatory pain medication (celecoxib bid prn) and tried to order ibuprofen 400 mg po q6 prn for a headache they complained about, the pharmacist caught that and recommended maybe not doing that or considering something else for pain. This was very important, and is why pharmacists are paid for what they do (among many other things). However, it would be odd if I went into a pharmacy and I encountered a pharmacist who was willing to give me a clinical examination and prescribe me a mecication for a medical condition. For a pharmacist to practice clinical medicine without a background or training in clinical medicine, I would be very skeptical and would seriously consider the political reasons for why this seems to be the case.
     
  12. GroverPsychMD

    GroverPsychMD Gold Donor 7+ Year Member

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    The malpractice climate in the states makes this a whole different ballgame. What meds are pharmacists giving for smoking cessation in the provinces you are referring to? I'll bet its not Chantix.
     
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  13. briarcliff

    briarcliff 5+ Year Member

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    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?
     
  14. smalltownpsych

    smalltownpsych 2+ Year Member

    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.
     
  15. PSYDR

    PSYDR Psychologist 10+ Year Member

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    That is not true.
     
  16. AcronymAllergy

    AcronymAllergy Neuropsychologist SDN Moderator 7+ Year Member

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    There are specific CPT codes for prescribing psychologists to use. There are add-on med management codes, and stand-alone E/M codes with add-on psychotherapy codes.

    That's my understanding, anyway. I'd imagine reimbursement is higher for the add-on med management code than add-on psychotherapy, and for stand-alone E/M than stand-alone therapy.
     
  17. smalltownpsych

    smalltownpsych 2+ Year Member

    So a prescribing psychologist can use the e/m codes? I was just repeating what I had been told and am always open to correct information. I know that who can bill what and how is confusing and depends also on what the payers will pay. You must not have seen the thread I was referring to, but if I recall correctly you have prescription authority so you would know better than any.
     
  18. briarcliff

    briarcliff 5+ Year Member

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    Does anyone have any info on completing the MSCP during a neuro- post-doc? I've received mixed messages on the rigor and time commitment required by most MSCP programs (a la LA & NM). Also, which programs currently offer MSCP training?

    This thread is great, but it requires a lot of digging to find practical information about MP. I've been unable to find good, credible sources about MP training, income, job description, and demand for MPs - Does anyone have any suggestions for places I should look?
     
  19. AcronymAllergy

    AcronymAllergy Neuropsychologist SDN Moderator 7+ Year Member

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    You could try the prescribing psychologist associations in NM and LA as a start. I think the acronym for Louisiana's is LAMP; not sure about New Mexico. I know a couple folks who prescribe, and with respect to income, they've said it's increased. Demand is also high.

    I don't know that it'd be easy to do on postdoc, but I think T4C might've actually gone that route, so it's potentially possible. My understanding is that the class portion occurs something like every other weekend or once-monthly for maybe 1.5 years. Rough figures, as I'm trying to wrack my poor, aging memory for specifics I've heard.

    Another poster on here mentioned at one point that a NM university has developed a fellowship specifically for this, which includes in-person classes and a good bit of structured supervision from physicians.
     
  20. PSYDR

    PSYDR Psychologist 10+ Year Member

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    MPs can and do use e/m codes for many carriers. Cms is a holdout.
     
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  21. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus 10+ Year Member

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    Yes, that'd be a good place to start.

    I completed the residential program at NSU, which is currently dormant (Last I checked was '12). I was told NSU had difficulty getting enough qualified students to commit to the residential training, as it wasn't designed to be taken online, so students opted for other programs. I thought the training was excellent, though I've been impressed by what NM State is doing now.

    The majority of my cohort (6 of the 10) were already in practice and flew/drove in for classes (3 days per mon for two yrs), while the rest of us (4 of 10) had advanced standing at NSU and took classes while we did practica, wrote our dissertations, etc. I had a gap/5th yr so i finished my classes while I TA'd/researched. Looking back it was *a lot* of work, but I preferred classroom learning to online learning.

    I would strongly advise against doing it during post-doc if you don't have a cushy position. I know ppl now in training who are doing it while they work, and it is doable but they have zero free time.

    Indeed. I spoke w Dr. Levine awhile back and she mentioned this option. It sounds like a great setup, though I don't know the nitty gritty of it.

    I had to find practica training and supervision on my own, which was tough away from S.FL (where there previously were training placements). I negotiated my supervision hours as a part of my hiring package for my job. I was able to train w. a brilliant physician as a result, though it took quite a bit of legwork on my part. This is where a place like NM would be vastly preferred bc they have buy-in and existing relationships.
     
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  22. edieb

    edieb Senior Member 10+ Year Member

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    I finished my clinical PhD in 2011 and NMSU program in 2014 and attended the program while studying for the EPPP and working as a staff psychologist at the El Paso V.A. I passed the Psychopharmacology Examination for Psychologists in 2014 and left the V.A. shortly thereafter. My first year full time (32 hours/week), I have made around $260k and have colleagues in the same ballpark. If you have any other questions, pm me
     
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  23. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus 10+ Year Member

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    edieb....you keep tempting me to leave academia. :p
     
  24. DynamicDidactic

    DynamicDidactic Ass of Prof 7+ Year Member

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  25. InfoNerd101

    InfoNerd101 Banned Banned 2+ Year Member

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    I like this idea a great deal... But what about for those psychologists that wants to go into psychology primarily for doing therapy and testing and are not interested in prescribing?

    Maybe then they should offer to clinical psych tracts... One geared towards prescribimg and the other geared towards therapy and more traditional psychological interventions.
     
    PsychMajorUndergrad18 likes this.
  26. PSYDR

    PSYDR Psychologist 10+ Year Member

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    Iowa just passed rxp.
     
  27. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    Let the turf war whining begin anew.
     
  28. DrMikeP

    DrMikeP 2+ Year Member

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    5 other states that I know of are actively in the process so I'm guessing next year you will see one or maybe 2 more.

    Sent from my Nexus 4 using Tapatalk
     
  29. Shooter

    Shooter Modern Psychologist Banned 5+ Year Member

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    finishin Rxp program soon
     
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  30. InfoNerd101

    InfoNerd101 Banned Banned 2+ Year Member

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    As someone who has gone through the program, why are so many people including psychologists against it?

    I keep hearing/ reading that psychologists don't have enough medical training but this program teaches you to draw labs and everything!

    One good point that people have brought up though and I'd like to know your opinion on it, is if they really are giving that hard of a time granting prescribing rights in certain states, why don't those psychologists who want to prescribe just do a PA or Nurse practitioner program?
     
  31. Shooter

    Shooter Modern Psychologist Banned 5+ Year Member

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  32. InfoNerd101

    InfoNerd101 Banned Banned 2+ Year Member

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    So basically other Healthcare providers feel jealous... Going off of your video? Lol
     
  33. Pharmohaulic

    Pharmohaulic Banned Banned

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    Are there enough people that would pursue this training for these programs to continue to function and stay open?
     
  34. Pharmohaulic

    Pharmohaulic Banned Banned

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    Anyone?
     
  35. DrMikeP

    DrMikeP 2+ Year Member

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    Apparently so, as there are now a few successful programs with sufficient numbers of students when currently only a handful of states have approval.

    Many psychologists I know are also obtaining such training to provide better medication understanding as well, since quite a few physicians and even patients discuss psychotropic (and herbal) recommendations with their psychologists. I've more than once collaborated with a physician on psychotropics and even cautioned patients on certain herbals mixed with such. As more states approve then it's likely there will be more seeking training/privileges. I doubt there will ever be enough to warrant many major public universities to offer such courses.

    I've read estimates of 50-1000 prescribing psychologists will likely be practicing in approved states within the next 5-10yrs, but imo it's too early to know how it will really go in the more populous states.
     
  36. Pharmohaulic

    Pharmohaulic Banned Banned

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    Well I've heard that Yale might offer this program soon.

    And yes, I think the training is great especially for health psychologists that work in the medical environment.

    I woder if medical/ psychopharm psychology will become a specialty.

    I know they have the American Academy of medical psychology, but that is completely separate from the APA
     
  37. MamaPhD

    MamaPhD Psychologist, Academic Medical Center 7+ Year Member

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    In my experience, physician-psychologist collaboration in medical settings does not usually overcome concerns about prescribing meds that are relatively unfamiliar to the [non-psychiatrist] physician. This is entirely reasonable on the physician's part. If the tables were turned, I doubt I would readily hang my license on the opinion of a non-physician, no matter how much I trust their judgment, when I could refer to a psychiatrist instead.

    "Medical psychology" has been more or less superseded by clinical health psychology, which (as a field) does not emphasize psychopharm and prescribing privileges.
     
  38. Pharmohaulic

    Pharmohaulic Banned Banned

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    I read that medical psychology is a new emerging field with superior training to a health psychologist
     
  39. Pharmohaulic

    Pharmohaulic Banned Banned

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    When you stated that you doubt you would readily hang your lisence in collaborating with a non physician... what about nurse practitioner? do you feel the same way?
     
  40. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    Where?
     
  41. Pharmohaulic

    Pharmohaulic Banned Banned

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    A lot of places are hiring them as psychopharm consulting and to counsel patients with comorbid medical concerns
     
  42. WisNeuro

    WisNeuro Board Certified Neuropsychologist 7+ Year Member

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    No, where did you read that? I read research articles and policy stuff all the time and have yet to come across that.
     
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  43. nitemagi

    nitemagi Senior Member 10+ Year Member

    "A lot of places" isn't a real source.
     
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  44. MamaPhD

    MamaPhD Psychologist, Academic Medical Center 7+ Year Member

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    "New"? 20 years ago, maybe.

    Anyway, don't believe everything you read.
     
  45. MamaPhD

    MamaPhD Psychologist, Academic Medical Center 7+ Year Member

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    Yes.
     
  46. smalltownpsych

    smalltownpsych 2+ Year Member

    Is it any better than I read this somewhere? :rolleyes:
    I have always been partial to the "I have a friend who..." being touted as solid scientific evidence. Ever get the dubious opportunity to teach undergrad psych and you'll get to hear that one only about a million times.
    :smack:
     
  47. psych.meout

    psych.meout

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    How are you differentiating between medical psychology and health psychology?
     
  48. MamaPhD

    MamaPhD Psychologist, Academic Medical Center 7+ Year Member

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    Medical psychologists try to practice medicine, whereas health psychologists do not.

    From the web site of the American Board of Medical Psychology (not affiliated with ABPP), my emphasis added:

    "Medical psychologists are trained to act as primary care coordinating and attending doctors in healthcare facilities. They have provided independent practice, diagnosis, and coordination of medical and psychological services in facilities for the last twenty years. The Medical Psychologist's training is informed by science, but is more focused on mastery of clinical diagnosis and techniques and placements, rotations, residencies, and internships in healthcare facilities and settings. Medical psychologists arrange for medical, dental, podiatric, nursing, educational, nutritional, speech and audiological, and other healthcare services as indicated by their diagnostic screening and assessment, and like other doctors operating in the healthcare arena are equipped to screen patients for the need for referral to other specialists and diagnostic and laboratory procedures that they may need. They provide case management and active communication with members of multidisciplinary intervention teams, and coordination of the medical psychology and psychopharmacology aspects of the patient's treatment plan."

    :eyebrow:

    I've never met a psychologist who claims to do all these things, but if I did, I would never send them a patient.
     
  49. psych.meout

    psych.meout

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    Wow, that's a new one for me. It sounds like a position trying to backdoor into being a primary care physician. I'm always wary of the limits of scope of practice and when people seem to be expanding theirs beyond their qualifications.
     
  50. DrMikeP

    DrMikeP 2+ Year Member

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    Medical psychologists have extra training beyond that of a typical health psychologists, often an additional masters (~2yrs) beyond the doctorate along with ~ a year practicing under a physician/psychiatrist. The don't seek to replace primary care services. Many medical psychologists started off in health psych and found the medical side more interesting. The training varies, but medical psychologists are in general trained in performing/interpreting basic physical examinations (similar to those learned by medical providers), ordering/interpreting certain labs, when to write orders for other providers when things are beyond their scope, and psychopharmacology for prescriptive purposes. Medical Psychologists work closely in collaboration with other medical providers to provide care, especially to rule out or treat co-morbid medical issues. In some institutions they function as attendings in that they can admit/discharge psychiatric patients and coordinate care, but that is limited to psychiatric patients admitted for psych issues with medical issues treated by other providers.

    In comparison to many of my friends/colleagues who are NP's (sadly many not even psyc NPs) and PA's the level of psych training is very very limited (1-2 courses and they may not even have a psyc rotation). These individuals along with gp's with also a limited amount of real psych training are providing the majority of psychiatric care. The 2 yrs of education/training for Medical Psychologists is not as general as that of a PA or NP, but parts are similar. Medical Psychologists are progressively filling the psychiatric care shortage as increasingly states are considering/approving them to practice within their scope and to date have had no significant malpractice/negligence issues.
     
  51. Saltwater

    Saltwater

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    Zero? Really? All of 'em? No Phd/Psyd psychologist anywhere has any "medical knowledge" at all?

    Kind of a global statement there, doncha think?

    Well, okay then!
     
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