Psychopharmacology/Advanced Practice Psychology

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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.

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That is not true.
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.
 
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?
 
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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?

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.
 
I think the acronym for Louisiana's is LAMP

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

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.

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.

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.

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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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?

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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It would require change, no doubt. The current PsyD is a quasi-professional degree. It's a hybrid between a PhD and a....JD/MD/DDS, whatever. In other words, it has characteristics of a PhD, but also has characteristics of a professional degree. I work with a woman who received her PsyD from either Pace or Rutgers (I really can't remember) and she told me she had to write a dissertation/doctoral paper, take a ton of stats classes, etc. That made me wonder, does she have a watered down PhD or a some kind of hybrid degree? There is no doctoral project or dissertation for the JD or MD or other professional doctorates.

So, you'd have to scap the current PsyD curriculum and make it more like other professional health care programs.

Year 1 - combination of advanced psychology and basic medical sciences
Year 2 - Same
Year 3- clinical psych, clinical med assessment and pharm
Year 4- more clinical psych, clerkships, simple research, pharm
PsyD + licensure exams, including pharmacology
2-3 year post doc residency in a medical/hospital setting

The PsyD in my world would be structured like the MD, DDS, OD, DPM, PharmD, DVM. First two years are mostly clinical/basic sciences. Third year is clinical. Fourth year is clinical and practical.

The PhD would be reserved for researchers only. IMO, a PhD isn't geared for practice. No offense to any PhD practitioners out there, but your doctorate is a research degree. Just my thoughts! :)
Zack

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.
 
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finishin Rxp program soon
 
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finishin Rxp program soon

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?
 
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.

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

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

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.

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

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

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

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?
 
"A lot of places" isn't a real source.
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:
 
How are you differentiating between medical psychology and health psychology?

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

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.
 
So I've been considering going back to school and getting my PA degree, then joining a practice and doing 1/2 therapy 1/2 med management as a longer term career trajectory. I was wondering if anyone might have feedback on if this is a good path to consider? Would like to get away from the turf war, if possible. Obviously I'd be working, in the case of med stuff, under the supervision of a MD or DO.
 
So I've been considering going back to school and getting my PA degree, then joining a practice and doing 1/2 therapy 1/2 med management as a longer term career trajectory. I was wondering if anyone might have feedback on if this is a good path to consider? Would like to get away from the turf war, if possible. Obviously I'd be working, in the case of med stuff, under the supervision of a MD or DO.

Well, it sounds good in theory, but is this really a thing? Are there good working models of practicing both as a psychologist and a midlevel in the same position? I'm not saying it can't be done, but it would be an unusual situation and a tricky fit with many practices.
 
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So I've been considering going back to school and getting my PA degree, then joining a practice and doing 1/2 therapy 1/2 med management as a longer term career trajectory. I was wondering if anyone might have feedback on if this is a good path to consider? Would like to get away from the turf war, if possible. Obviously I'd be working, in the case of med stuff, under the supervision of a MD or DO.

Being in Louisiana, I've (briefly) considered the 'medical psychologist' route. One of the biggest challenges I see for myself would be inhibiting all of those impulses to do in-depth differential diagnostics, cognitive-behavioral case formulation, and cognitive-behavioral interventions that are challenging enough to fit into a 50-55 minute session (and there's no way I could really do any of that in the context of brief med checks). I feel that--in some very real way--I would have to 'kill the old (psychologist) me' and take a completely different approach to interacting with patients.
 
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Being in Louisiana, I've (briefly) considered the 'medical psychologist' route. One of the biggest challenges I see for myself would be inhibiting all of those impulses to do in-depth differential diagnostics, cognitive-behavioral case formulation, and cognitive-behavioral interventions that are challenging enough to fit into a 50-55 minute session (and there's no way I could really do any of that in the context of brief med checks). I feel that--in some very real way--I would have to 'kill the old (psychologist) me' and take a completely different approach to interacting with patients.

I have this fantasy of the old school psychoanalyst who occasionally prescribes something. Don't think it works like that unless you have an established private practice.
 
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Yep, the only folks I know who are actually able to practice that way are in PP. I also wonder about the issues related to practicing at the doctoral/LIP professional in one sense, and in what's technically been considered a mid-level role under the supervision of a physician in another sense.
 
Thanks for the feedback. Yeah, I'd want to be in private practice doing this route. I am really drawn to the flexibility of private practice, but I don't want to be doing therapy all day. I like therapy, but I can't fathom 8 hours of it each day. A half day of therapy, half day of meds, some teaching, some research - that sounds far more ideal to me. I also love physical medicine.

What I'm less certain about is whether it would be financially worth it.
 
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Thanks for the feedback. Yeah, I'd want to be in private practice doing this route. I am really drawn to the flexibility of private practice, but I don't want to be doing therapy all day. I like therapy, but I can't fathom 8 hours of it each day. A half day of therapy, half day of meds, some teaching, some research - that sounds far more ideal to me. I also love physical medicine.

What I'm less certain about is whether it would be financially worth it.

I actually think an MBA would create more financial ROI (its the only degree I would remotely entertain doing 5 years post phd) , but only if you are interested/willing to get out of doing primarily clinical service work.
 
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Thanks for the feedback. Yeah, I'd want to be in private practice doing this route. I am really drawn to the flexibility of private practice, but I don't want to be doing therapy all day. I like therapy, but I can't fathom 8 hours of it each day. A half day of therapy, half day of meds, some teaching, some research - that sounds far more ideal to me. I also love physical medicine.

What I'm less certain about is whether it would be financially worth it.
The only thing worse than doing therapy 8 hours a day which is what I do now would be to deal with the patients that the NP who writes the scripts down the hall has to deal with each day. I cringe whenever I get a referral from her because the vast majority of those patients do not really want to or believe that they can get better except through some miracle of medication combinations that is actually making them worse.
I have this fantasy of the old school psychoanalyst who occasionally prescribes something. Don't think it works like that unless you have an established private practice.
If I was ever to prescribe medications, this would be the only way that I could do it. My fear would be that market pressure, social pressure, and patient pressure would override this fantasy and I would end up being another mid level med manager.
 
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The only thing worse than doing therapy 8 hours a day which is what I do now would be to deal with the patients that the NP who writes the scripts down the hall has to deal with each day. I cringe whenever I get a referral from her because the vast majority of those patients do not really want to or believe that they can get better except through some miracle of medication combinations that is actually making them worse.

If I was ever to prescribe medications, this would be the only way that I could do it. My fear would be that market pressure, social pressure, and patient pressure would override this fantasy and I would end up being another mid level med manager.
Hmm, so you're telling me my options are to work hard at making cognitive, behavioral, social, and emotional changes OR just take some pills and not have to change anything about my lifestyle?
 
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So I've been considering going back to school and getting my PA degree, then joining a practice and doing 1/2 therapy 1/2 med management as a longer term career trajectory. I was wondering if anyone might have feedback on if this is a good path to consider? Would like to get away from the turf war, if possible. Obviously I'd be working, in the case of med stuff, under the supervision of a MD or DO.
I practice this way every day (as a clinical psychologist and PMHNP) and it works very well for me. I am in full-time private practice and it would be hard to practice in an integrated way working in a CMHC or VA - they would only want me to prescribe. But in private practice, I am able to integrate psychotherapy and medication management seamlessly and it works very well. I see most of my patients for 50 minutes combining therapy and meds and most of my patients seek me out specifically for this reason. I am able to run a very busy and thriving self-pay practice completely free of insurance (and I can't say enough about how enjoyable that part is).

I would encourage you to check into NP training vs PA training as you have considerably more ability to practice autonomously as a NP vs PA, but both models can work - you would just need to have a physician "supervisor" to practice as a PA.
 
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