Psychopharmacology/Advanced Practice Psychology

[WisNeuro]

Again, we have all reached the point that we won’t convince each other of whether psychologists should pursue RxP as a field. However, now we are taking about changing education. Not sure how we don’t all agree that this is the beginning of a core change in what being a psychologist means.

Whether you support the change is irrelevant. Obviously, most RxP proponents will and I won’t. For those complaining about PCSAS, this is another reason the fielding is splitting. I think we are on a crash course for a (even more) divided field.

The proliferation of dimploma millers has already changed what being a psychologist means from a legal standpoint, at least. I mean, I don't consider them psychologists, but the states do.

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[PsyDr]

The proliferation of dimploma millers has already changed what being a psychologist means from a legal standpoint, at least. I mean, I don't consider them psychologists, but the states do.

It's always changing. In your state, there are still some MA level "psychologists" who were grandfathered in.

 

[WisNeuro]

It's always changing. In your state, there are still some MA level "psychologists" who were grandfathered in.

I am definitely aware, there are issues related to this that I have to address on a weekly basis.

 

[sfgucadoc]

I doubt RxP will pass in Texas this year but we keep plugging away. Our legislature only meets every other year, making it even more difficult to pass. With the pandemic, we've been told there will be a bolus of health-related bills. In the 2019 session, the bill got read into committee but that's as far as it went. We have a sponsor this year even though our two previous sponsors retired after the 2019 session.

 

[DynamicDidactic]

The proliferation of dimploma millers has already changed what being a psychologist means from a legal standpoint, at least. I mean, I don't consider them psychologists, but the states do.

Yes, and that is my greatest concern when it comes to RxP. As I have said numerous times before, we need to fix our field before increasing our scope of practice. I have never made the safety argument (that's for the public when politics come into play). My concern is a fundamental change in what it means to be a psychologist.

 

[WisNeuro]

Yes, and that is my greatest concern when it comes to RxP. As I have said numerous times before, we need to fix our field before increasing our scope of practice. I have never made the safety argument (that's for the public when politics come into play). My concern is a fundamental change in what it means to be a psychologist.

Perhaps, but I personally see this as another specialization. Similar to neuro/rehab/forensic/etc. Psychologists (presumably) have a base set of training and skills, similar to the med school route, and then specialize later on. We tend to do it late in grad school and then moreso on internship and postdoc. I think the era of the true generalist is over. Midlevel creep has hastened that along. This will become just another specialty area in the field, moving in the direction we've already been going.

 

[PsyDr]

1) until we see a single datum of danger, the safety argument is more speculative than my personal risk of being hit with a meteorite. Calculate the danger. Zero evidence times supposition based scenarios equals zero.

2) I don’t believe in the “changing field” argument. I was trained under several psychologists who remember when state hospitals threw the state purchased psychoanalytic couchs away. There are actively practicing psychologists who used punch cards based computing for their dissertation. Sanman remembers sending his dissertation over telegraph. I remember pre internet everything. Things change. That is a good thing.

3) I don’t believe in the “psychiatry lite” argument for the same reason I don’t believe that all psychologists want to be in any other lucrative job. Go ask any cam girl. Just because I can technically do something, doesn’t mean I have any interest in doing it.

 

[Sanman]

1) until we see a single datum of danger, the safety argument is more speculative than my personal risk of being hit with a meteorite. Calculate the danger. Zero evidence times supposition based scenarios equals zero.

2) I don’t believe in the “changing field” argument. I was trained under several psychologists who remember when state hospitals threw the state purchased psychoanalytic couchs away. There are actively practicing psychologists who used punch cards based computing for their dissertation. Sanman remembers sending his dissertation over telegraph. I remember pre internet everything. Things change. That is a good thing.

3) I don’t believe in the “psychiatry lite” argument for the same reason I don’t believe that all psychologists want to be in any other lucrative job. Go ask any cam girl. Just because I can technically do something, doesn’t mean I have any interest in doing it.

I see what you did there...

 

[WisNeuro]

I see what you did there...

Don't you mean

"I see what you did there. Stop"

 

[bcliff]

Illinois law allows psychologists to prescribe

Illinois joins New Mexico and Louisiana as states that allow licensed clinical psychologists with advanced, specialized training to prescribe certain medications for the treatment of mental health disorders.

www.apa.org

Last I checked, Illinois allows at least some RxP training to occur concurrent to pursuing the PhD/PsyD.

 

[Therapist4Chnge]

Don't they have overly complex requirements and/or limitations? I remember hearing about RxP legislation that passed, but it looked like it was going to be a mess. Hopefully they will figure it out.

 

[AcronymAllergy]

Don't they have overly complex requirements and/or limitations? I remember hearing about RxP legislation that passed, but it looked like it was going to be a mess. Hopefully they will figure it out.

My recollection is that it was similar to PA training and that some portion was required to occur in graduate school. But it's been a while since I looked at the actual legislation.

 

[doctorpsych]

What do you all think about the below?

From: Comparing Psychopharmacological Prescriber Training Models
via Examination of Content-Based Knowledge Ryan R. Cooper A Thesis in the Field of Psychology
for the Degree of Master of Liberal Arts in Extension Studies
Harvard University
November 2020

Abstract
The debate over whether psychologists with postdoctoral degrees in psychopharmacology
are adequately trained to prescribe (RxP), has grown increasingly contested over the
years. Five states, the U.S. government, and Guam currently allow psychologists with
advanced training to prescribe limited medications. The literature is wrought with strong
opinions on both sides of the debate. RxP opposers argue that the prescribing
psychologists’ training is truncated and less effective than other available options
(medical and nursing school); while RxP supporters argue that medical school is
essentially overkill for prescribing psychology’s narrow aim, and that nursing schools are
less rigorous than the postdoctoral training uniquely designed for psychologists.
Comparing each prescriber’s basic competence, side-by-side, via examination, had never
been attempted (each has their own licensing examination). This study tested 66
providers: psychiatrists, general physicians, psychiatric nurse practitioners, general nurse
practitioners, prescribing psychologists, and general psychologists.
Psychiatrist performed the best, followed by prescribing psychologists, then
psychiatric nurse practitioners. There was no statistical difference in the performance of
these three groups. Non-psychiatric physicians and non-psychiatric nurses—who
ironically write 80-90% of psychiatric prescriptions—performed worse than the first
three groups, and non-psychiatric nurses performed significantly worse. General
psychologists performed significantly worse than prescribing psychologists, indicating
that the achieved level of competency is due to postdoctoral training. Arguments that
iv
psychologists wishing to prescribe should merely attend nursing school, should be reevaluated
in light of these findings. Prescribing psychologists’ performance is superior to
the performance of those trained as nurse practitioners (both family and psychiatric).

 

[WisNeuro]

Hard to know without seeing the full paper. But, it looks like it was a comparison of a knowledge based exam. Which won't really address some of the baseless criticisms of RxP, namely the "patient harm" claim that is continually thrown around with zero evidence.

 

[medium rare]

...psychologists wishing to prescribe should merely attend nursing school, should be reevaluated
in light of these findings. Prescribing psychologists’ performance is superior to
the performance of those trained as nurse practitioners (both family and psychiatric).

Good to see some of this research finally being done.

These results support my personal experience as a clinical psychologist who went on to train as a PMHNP. My program was one of the ‘top’ PMHNP programs nationally (for whatever those ranking lists are worth) and my training was solid but focused and with limited breadth.

Much of what I learned was significantly reinforced by the clinical psychology training I already possessed (I could have taught several of the courses). I felt the applied pharmacology and psychopharmacology training, while sufficiently foundational, was too abbreviated for a group of future professionals whose main job role would be the prescription of psychotropics.

At the completion of my program, I distinctly remember how much I appreciated the rigor and depth of my psychologist training and how I would feel unprepared to practice independently if my only training had been the NP program. Indeed, several of my colleagues who did not have significant, prior clinical experience stated as much and more than one of them called me requesting guidance on clinical issues they were experiencing at their jobs.

I did my dissertation on prescription privileges for psychologists and continue to stay abreast of RxP developments. The curriculums of the recommended APA-model legislation and the New Mexico State program provide significantly more depth and breadth in pharmacology, psychopharmacology, pharmaco- and psychopharmacotherapy than any PMHNP curriculum I’ve reviewed while being comparable in neuroanatomy, neuropathophysiology, and advanced health assessment.

While a detailed review of the full article is necessary, these results do not surprise me.

 

[doctorpsych]

Yes, I am very glad that this type of research is finally emerging. It is more valuable when taking into account all the other available data out there. I doubt that there will ever be a real head-to-head study between the different bh med prescribers but this is the closest we can get to that at this time. The safety argument is always going to be brought up but with less and less impact as incremental time goes by without any sig data supporting its argument.

 

[doctorpsych]

btw, here's the full thesis: Comparing Psychopharmacological Prescriber Training Models via Examination of Content-Based Knowledge

 

[sarasara123]

Thanks for sharing your experience, Do You have any information about Post Doctoral..

 

[Mason_Ost]

I just wanted to chime in on this thread with my own anecdotal (potentially naïve) opinion. I am a certified pharmacy technician and have worked in the pharmaceutical realm for a couple of years now (hoping to become a clinical psychologist). Obviously that does not qualify my observations, but I think major changes to how medications (specially psychotropics) are prescribed needs to happen.

From my experience speaking with pharmacists and from what I receive from doctors daily; the vast majority of psychotropic medication that we receive on a daily basis comes from GPs/Non-psychiatric physicians and non-psychiatric nurses. Generally, to my understanding, the majority of these patients do not even speak with any form of mental health professional prior to their visit with the doctor. These people are able to receive psychotropic medication prescriptions within their first visits to these doctors, who in my estimation, are not trained enough in respect to these medications to be able to prescribe them responsibly. For example, I receive prescriptions for Adderall often, perhaps 1 out of every 10 prescriptions that comes in. 99% of the diagnosis codes read as "unspecified hyperactivity". Generally the people picking these up obtained the prescription after their first visit with their doctor. It seems to be the case (at least where I am located) that almost zero discretion is used in the prescribing of these medications. Certain doctors in my area are notoriously known within the pharmacy to prescribe endless supplies of psychotropic medications. These same doctors make a plethora of mistakes and often prescribe medications that have negative interactions with other medications the patient might be taking that our pharmacists catch frequently.

The research abstract above was also not surprising to me whatsoever. I see people every day who are taking upwards of five or more psychotropic medications DAILY to treat "unspecified anxiety" related symptoms that they have received from their GP. The people who pick these up seem to be completely unware or unconcerned with the competency of whoever prescribed them their medication.

It seems obvious to me that psychologists with the proper training appear to be distinctly qualified to prescribe these medications, similar to psychiatrists unique qualifications. Perhaps not to the extent of a psychiatrist whose depth of understanding likely exceeds that of the training a prescribing psychologist might receive - but certainly more than your family GP or non-psychiatric physicians and non-psychiatric nurses.

 

[WisNeuro]

It seems obvious to me that psychologists with the proper training appear to be distinctly qualified to prescribe these medications, similar to psychiatrists unique qualifications. Perhaps not to the extent of a psychiatrist whose depth of understanding likely exceeds that of the training a prescribing psychologist might receive - but certainly more than your family GP or non-psychiatric physicians and non-psychiatric nurses.

It all boils down to turf wars essentially. People are going to protect what they see is their practice area. Also comes down to determining what is necessary and sufficient when it comes to training. Similar to how most of us view therapy training in psychiatry as woefully insufficient, they see RxP in the same light for prescribing. But, neither of us have any hard data showing the necessary level of training, it's all just opinion by people who have a vested interest in the field. Aside from that, I don't but the "increased danger to patients" argument as having much water. RxP has been around in some form for decades, so there is more than enough data to actually look at this issue. Either way, RxP is here to stay and will likely slowly progress through most states in the coming decades.

 

[DynamicDidactic]

Recent article:
Peck, K. R., McGrath, R. E., & Holbrook, B. B. (2021). Practices of prescribing psychologists: Replication and extension. Professional Psychology: Research and Practice, 52(3), 195-201. doi:http://dx.doi.org/10.1037/pro0000338

Few studies have examined the practices of prescribing psychologists, and the extant literature suffers from small sample sizes due to the nature of the profession. The current study was based on data from 43 prescribing psychologists, the largest sample of prescribing psychologists examined to date. It was found that prescribing psychology is distinctive from both traditional psychological and psychiatric practice. Prescribing psychologists tend to work in multiple settings. Although respondents espoused a preference for combination therapy, monotherapy—whether medication or psychotherapy—remains the dominant option. Prescribing psychologists reported minimal interaction with pharmaceutical drug representatives. It is also prescribing psychologists’ sense that nonprescribers in their community experience them in positive ways. Future studies should further address patient treatment themes within this practice, as well as looking into changes in interactions with pharmaceutical representatives.

Some quotes:

This study also found that a third of sessions with prescribing psychologists were 30 min or less, as opposed to the traditional 45–50 min psychotherapy session

Although respondents overwhelmingly considered the combination of medication and therapy to be the best treatment (97.1% agreed), the percentage of patients receiving combined treatment was not so extreme. The psychologists estimated that 54.6% of male patients and 58.1% of female patients were currently being treated with both modalities. When asked about the last two years, and including services from other providers, the rate of combined treatment increased to 73.2%, indicating continued collaboration in the provision of care even while capable of providing both modalities. It is noteworthy that in cases of monotherapy, patients receiving only medication (16.7%) were slightly more frequent than patients receiving only psychotherapy (10.1%). It would behoove researchers in future studies to interview prescribers on decision-making surrounding the choice between combined and monotherapies, considering this discrepancy between the use and popularity of the former.

 

[WisNeuro]

Recent article:
Peck, K. R., McGrath, R. E., & Holbrook, B. B. (2021). Practices of prescribing psychologists: Replication and extension. Professional Psychology: Research and Practice, 52(3), 195-201. doi:http://dx.doi.org/10.1037/pro0000338



Some quotes:

Interesting, any chance you can PM me the article? I no longer have institutional access.

Regarding the attitudes vs. the reality of combo vs. monotherapy, I am curious as to how often it is offered and how often the patients choose to not follow through with a certain recommendation. At least in my experience of recommending both quite often to my patients after an eval, they are much more likely to ask about medication than follow up for therapy.

 

[PsyDr]

Recent article:
Peck, K. R., McGrath, R. E., & Holbrook, B. B. (2021). Practices of prescribing psychologists: Replication and extension. Professional Psychology: Research and Practice, 52(3), 195-201. doi:http://dx.doi.org/10.1037/pro0000338



Some quotes:

PM a brother a copy?

 

[R. Matey]

Recent article:
Peck, K. R., McGrath, R. E., & Holbrook, B. B. (2021). Practices of prescribing psychologists: Replication and extension. Professional Psychology: Research and Practice, 52(3), 195-201. doi:http://dx.doi.org/10.1037/pro0000338



Some quotes:

Chiming in re: the article. I think it's a bit of a shame the authors didn't look at NPs/Psychologists with prescribing psychologists. My understanding is they are far more ubiquitous and probably would offer a clearer picture of what day-to-day practice for a prescribing psychologist would be like in future. FWIW, one of my clinical postdoc supervisors was an NP/Psychologist and that person was functioning mostly as a prescriber with the occasional psych eval here or there. I was completely anti-prescribing when I started postdoc, but now could see the value in it provided that psychologists receive substantially more training in whole body anatomy/physiology, organic chemistry, pharmacokinetics, and the like. Personally, I think that if a psychologist should be able to prescribe, they should be able to do everything you'd expect a psych nurse to do (e.g.: injections) and more. Whether all of that training happens on the front end (more stringent pre-reqs for graduate school) or the back end (postdoc) is really of no consequence to me.

 

[ThatPsyGuy]

Recent article:
Peck, K. R., McGrath, R. E., & Holbrook, B. B. (2021). Practices of prescribing psychologists: Replication and extension. Professional Psychology: Research and Practice, 52(3), 195-201. doi:http://dx.doi.org/10.1037/pro0000338



Some quotes:

I was just a little curious about the whole survey dispersal and response acquisition method in general. I imagine it would have been easy to get in touch with more Prescribing Psychologists throughout the nation instead of just in New Mexico and Louisiana, even if it was just a 2-month study.

Anyways, I think it's surprising to see that a third of the sessions were 30 minutes or less compared to the typical ~45.
With the results saying that well over 50% of their patient population were receiving Both therapy and medications, I would believe session times would be trending upwards more than anything. It just makes sense that you would need more time for both a psychotherapy session and to discuss the medications.

 

[PsyDr]

I was just a little curious about the whole survey dispersal and response acquisition method in general. I imagine it would have been easy to get in touch with more Prescribing Psychologists throughout the nation instead of just in New Mexico and Louisiana, even if it was just a 2-month study.

Usually, it's not easy to get in touch with non-existent people. The study collected data in July and August of 2019. IA, ID, and IL granted their first RxP licenses after that date. And the DoD, IHS, and NHSC people are licensed in LA or NM.

 

[WisNeuro]

Usually, it's not easy to get in touch with non-existent people. The study collected data in July and August of 2019. IA, ID, and IL granted their first RxP licenses after that date. And the DoD, IHS, and NHSC people are licensed in LA or NM.

Clearly, the authors should have utilized a time machine. Or, at the very least, opened a wormhole to speak with future RxPers in those states.

 

[DynamicDidactic]

HEY HEY HEY! You are all forgetting Guam.


Last check, there were no prescribing psychologists in Guam despite it being the first place with RxP for Psychologists.

 

[PsyDr]

HEY HEY HEY! You are all forgetting Guam.


Last check, there were no prescribing psychologists in Guam despite it being the first place with RxP for Psychologists.

HEY HEY HEY! You are forgetting that Indiana allowed RxP in 1993. Guam was in 1998.

 

[WisNeuro]

HEY HEY HEY! You are forgetting that Indiana allowed RxP in 1993. Guam was in 1998.

Did they later pull back that legislation in Penciana?

 

[PsyDr]

Did they later pull back that legislation in Penciana?

It’s still on the books. When the DoD’s program started, the Indiana legislature freaked out and created an rxp law that allowed rxp in military bases in Indiana.

Why a state government thought they needed to do that… I don’t know.

But counting Indiana still has more validity than the opposing arguments.

 

[WisNeuro]

It’s still on the books. When the DoD’s program started, the Indiana legislature freaked out and created an rxp law that allowed rxp in military bases in Indiana.

Why a state government thought they needed to do that… I don’t know.

But counting Indiana still has more validity than the opposing arguments.

Weird, I am curious about the legality and specifics as military bases/VAs are federal property. I was under the belief that the military base could do that with or without state legislature approval.

 

[PsyDr]

Weird, I am curious about the legality and specifics as military bases/VAs are federal property. I was under the belief that the military base could do that with or without state legislature approval.

Me too. But the IN leg thought otherwise.

 

[WisNeuro]

Me too. But the IN leg thought otherwise.

Having grown up in the Midwest, IN isn't the sharpest tool in the shed round these parts.

 

[Therapist4Chnge]

Having grown up in the Midwest, IN isn't the sharpest tool in the shed round these parts.

They are the dull spoon in the set of flatware that is the Midwest.

 

[Tukenkamen]

Chiming in re: the article. I think it's a bit of a shame the authors didn't look at NPs/Psychologists with prescribing psychologists. My understanding is they are far more ubiquitous and probably would offer a clearer picture of what day-to-day practice for a prescribing psychologist would be like in future. FWIW, one of my clinical postdoc supervisors was an NP/Psychologist and that person was functioning mostly as a prescriber with the occasional psych eval here or there. I was completely anti-prescribing when I started postdoc, but now could see the value in it provided that psychologists receive substantially more training in whole body anatomy/physiology, organic chemistry, pharmacokinetics, and the like. Personally, I think that if a psychologist should be able to prescribe, they should be able to do everything you'd expect a psych nurse to do (e.g.: injections) and more. Whether all of that training happens on the front end (more stringent pre-reqs for graduate school) or the back end (postdoc) is really of no consequence to me.

I agree that the training for RxP needs to be very comprehensive and they need to have level of training that adequately mitigates negative interaction side effects. But how would skills like injecting be necessary? That's something an RxP, not only shouldn't, but would not be allowed to ever do.

 

[R. Matey]

I agree that the training for RxP needs to be very comprehensive and they need to have level of training that adequately mitigates negative interaction side effects. But how would skills like injecting be necessary? That's something an RxP, not only shouldn't, but would not be allowed to ever do.

Some psychiatric medications are administered intravenously. In the fictional world I described above, an RxP would have comparable training to a psychiatric nurse.

 

[medium rare]

I agree that the training for RxP needs to be very comprehensive and they need to have level of training that adequately mitigates negative interaction side effects. But how would skills like injecting be necessary? That's something an RxP, not only shouldn't, but would not be allowed to ever do.

Long-acting injectable (LAI) antipsychotics are becoming much more widely used in clinical practice. I have several patients on a LAI. It is absolutely essential to have training in the administration of injections if you are going to prescribe.

 

[Therapist4Chnge]

I know when I did the RxP training we had a physical assessment course (and labs), which was useful, but we didn't cover injections. This was 10+ years ago, so I'm not sure if any of the training programs have updated this area. I def. can see the usefulness and agree it should be covered. LAIs are def going to be more prevalent going forward.

 

[Spydra]

This is all very interesting and if it becomes a rigorous postdoc opportunity in states that allow it ok fine. One of the arguments I hear pushing for prescribing privileges is supposedly to reduce medical professionals without much mental health training from writing an rx after one visit for symptoms that can effectively be managed with therapy or overprescribing mental health meds. I just don't get how adding psychologists to the prescription table reduces either of these. Disciplines that have always had prescription privileges seem likely to just keep doing what they've always done and patients who prefer seeing a medical doctor will continue to do so.

 

[futureapppsy2]

I know when I did the RxP training we had a physical assessment course (and labs), which was useful, but we didn't cover injections. This was 10+ years ago, so I'm not sure if any of the training programs have updated this area. I def. can see the usefulness and agree it should be covered. LAIs are def going to be more prevalent going forward.

Did you ever pursue/using prescribing privileges, @Therapist4Chnge ?

 

[Therapist4Chnge]

Did you ever pursue/using prescribing privileges, @Therapist4Chnge ?

Nah. I completed the training and didactics, but I never sat for the PPP. I realized that the vast majority of jobs out there were looking for *any* prescriber, and I didn't want to just write scripts all day. In a perfect world I'd get licensed and use it for my patients, but honestly it's easier to have the meds managed elsewhere and I can focus on the neuropsych stuff. I did have a couple of jobs (via recruiters) pop up that were very open to me providing both services (i.e. med management and neuropsych clinic), but I had already decided that I didn't want to work for anyone else but myself. I also didn't want to set aside a few months to study bc I had graduated awhile ago, and I'd have to do some pretty serious review to feel fully ready for the exam.

 

[msc545]

This may be changing, but many Psychiatrists are poorly trained in psychodiagnostics and therapy, and tend to "shotgun" patients with additional meds when one or two don't work. Many cannot do therapy at all because they were never trained in it and believe that meds can (or should) solve all problems. Psychologists have broader training, and with appropriate additional training can do a better job of overall care including the use of meds.

 

[DynamicDidactic]

Psychologists have broader training,

I think you mean to say that psychologists have broader (and I would add more detailed) training in psychotherapy and assessment.

and with appropriate additional training

again, I assume you mean in the sciences/skills relevant to prescribing

can do a better job of overall care including the use of meds.

I think it would be hard to argue that a practitioner that has the extensive training of a psychologist and the extensive training of a psychiatrist (or some other prescriber) would not provide overall better care.

One of the issues at stake includes what it means to get adequate training for RxP. However, that is a small issue for me.

The bigger issue, which I have brought up over the years in this thread, is:

As I have said numerous times before, we need to fix our field before increasing our scope of practice... My concern is a fundamental change in what it means to be a psychologist.

The field still:

• produces psychologists that use outdated, ineffective, and sometimes harmful treatments
• produces psychologists that have a hard time understanding the difference between science-based treatments and pseudoscience-based treatments (e.g., energy therapies, EMDR, apparently tapping is all the rage)
• relies on low-quality continuing education (Non-scientific, pseudoscientific, nonsensical, or seemingly cashing-in-on-a-popular-treatment CE examples)
• continues to have a significant portion of training programs that are predatory (Argosy closing down just happened a few years ago)

Let's clean up our field before we decide to expand our scope of practice. Then let's have a conversation about avoiding the pitfalls and trappings of Big Pharma.

 

[AcronymAllergy]

I think you mean to say that psychologists have broader (and I would add more detailed) training in psychotherapy and assessment.


again, I assume you mean in the sciences/skills relevant to prescribing


I think it would be hard to argue that a practitioner that has the extensive training of a psychologist and the extensive training of a psychiatrist (or some other prescriber) would not provide overall better care.

One of the issues at stake includes what it means to get adequate training for RxP. However, that is a small issue for me.

The bigger issue, which I have brought up over the years in this thread, is:


The field still:

• produces psychologists that use outdated, ineffective, and sometimes harmful treatments
• produces psychologists that have a hard time understanding the difference between science-based treatments and pseudoscience-based treatments (e.g., energy therapies, EMDR, apparently tapping is all the rage)
• relies on low-quality continuing education (Non-scientific, pseudoscientific, nonsensical, or seemingly cashing-in-on-a-popular-treatment CE examples)
• continues to have a significant portion of training programs that are predatory (Argosy closing down just happened a few years ago)

Let's clean up our field before we decide to expand our scope of practice. Then let's have a conversation about avoiding the pitfalls and trappings of Big Pharma.

My take is that we probably need to do both simultaneously, in terms of expanding/protecting scope of practice and addressing the issues in our field. Some issues I don't think will ever go away (e.g., there are plenty of physicians, nurses, and other healthcare professionals who adhere to pseudoscientific treatments and methods). Some issues are more prevalent in psychology than medicine (e.g., predatory training programs), but I think if we focus on addressing those problems at the expense of expanding/protecting scope of practice (even if not to RxP, to at least focus on improved reimbursement for psychological services, ability to use E&M codes, inclusion in the Medicare definition of physician, etc.), we run a very real risk of becoming non-viable as a profession.

 

[DynamicDidactic]

Some issues I don't think will ever go away (e.g., there are plenty of physicians, nurses, and other healthcare professionals who adhere to pseudoscientific treatments and methods).

It is an empirical question which fields are worse or better. I would guess nursing is worse and medicine is better. But, two (or three, or four) wrongs don't make a right. Additionally, I am not looking at it categorically, obviously some of these issues will be very unlikely to completely go away but many can be (simply) reduced. My anecdotal experience is that we are doing poorly on those metrics.

My take is that we probably need to do both simultaneously, in terms of expanding/protecting scope of practice and addressing the issues in our field.

I think this approach is more fraught with problems.

to at least focus on improved reimbursement for psychological services, ability to use H&M codes, inclusion in the Medicare definition of physician, etc.), we run a very real risk of becoming non-viable as a profession.

I think these issues (as opposed to RxP) have much more agreement across the field. If only APA had used the money they funeled into RxP on these issues.

 

[WisNeuro]

It is an empirical question which fields are worse or better. I would guess nursing is worse and medicine is better. But, two (or three, or four) wrongs don't make a right. Additionally, I am not looking at it categorically, obviously some of these issues will be very unlikely to completely go away but many can be (simply) reduced. My anecdotal experience is that we are doing poorly on those metrics.

I think this approach is more fraught with problems.

I think these issues (as opposed to RxP) have much more agreement across the field. If only APA had used the money they funeled into RxP on these issues.

At least from my friends in other state associations and within APA, RxP is definitely more of a back burner thing when it comes to money and resources. It's more of a pittance in the grand scheme of the overall budget. Vast majority of time spent and campaigns to get out comments come in to things like the CMS comment periods regarding reimbursement and similar issues. I doubt shifting the RxP resources over would do much, if anything at all.

In the beating of a dead horse, the real problem is a large proportion of psychologists not funding advocacy in any way whatsoever. In a good year, APA gets a 60% membership rate, a state association may get 40-50% if they are lucky. And, those memberships are relatively cheap. Everyone wants things to change, but too few people want to put either the time or the money in the pot to help effect that change.

 

[Therapist4Chnge]

At least from my friends in other state associations and within APA, RxP is definitely more of a back burner thing when it comes to money and resources. It's more of a pittance in the grand scheme of the overall budget. Vast majority of time spent and campaigns to get out comments come in to things like the CMS comment periods regarding reimbursement and similar issues. I doubt shifting the RxP resources over would do much, if anything at all.

In the bearing of a dead horse, the real problem is a large proportion of psychologists not funding advocacy in any way whatsoever. In a good year, APA gets a 60% membership rate, a state association may get 40-50% if they are lucky. And, those memberships are relatively cheap. Everyone wants things to change, but too few people want to put either the time or the money in the pot to help effect that change.

This continues to be the biggest problem in the field....and it has been like this for decades.

 

[AcronymAllergy]

This continues to be the biggest problem in the field....and it has been like this for decades.

Compounded by the fact that psychologists are fewer in number to begin with than pretty much all other mental health and healthcare professions, as best I can recall.

 

[Sanman]

This continues to be the biggest problem in the field....and it has been like this for decades.

I disagree slightly. I think the biggest issue is simply an identity crisis and not apathy writ large. A large chunk view what we do as a luxury cash service for those that can afford it. Modern psychoanalysis and some psychodynamic folks continue to perpetuate this philosophy rather than adapting. Then there are those that are all in on being part of the medical establishment. I, myself, am more on the fence then I was as a young clinician. Certainly, the prospect of a cash telehealth practice is alluring at this stage of my life.