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1) Oh no, it's just you. You're approaching things in a dishonest way, and I find that irritating. Notice how everyone here is approaching you in the same way? Notice how most of the posters are not actually supportive of RxP? That group reaction should tell you something about your approach. I like psychiatrists, and was socializing with three psychiatrists this weekend. If you want to internet stalk me, you can also see that I regularly mention hanging out with ortho friends.
2) Yup. There were. And Kaiser ran a program where psychologists wrote the scripts, and a psychiatrists signed them. The numbers are unknown/not published. One of them wrote a book used by psychiatry residencies.
3) I didn't say that suicide rates increased, I said that suicide went from the #10 cause of death in the USA in 1977 to the #11 cause of death in the USA in the last reported CDC metric. That can be described as an increase in total numbers or a relative decrease, depending on how you report it. But either way, you're gonna say that this metric isn't the right one to use, demonstrate an unfamiliarity with how those stats are reported, but that you won't define the right metric, and that your own opinion is better than anything anyone can provide. Which really doesn't matter, because you have zero power to decide if psychologists get to prescribe or not.
4) Yeah, it's not a lot of people. I don't know why you're throwing in non sequiturs, but you are.
LOL. I mean, apparently...all? 😆 /s
All joking aside, I have experienced exactly zero adverse outcomes or board complaints. I am relatively new in this endeavor though... I've also ended up doing more deprescribing than I thought I would. So many kids put on bad drug combos by PCP's, due to misdiagnosis, or just crazy decisions on what to initiate on. Sigh....
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Well, if you went through a 4-year psychiatry residency, the patient deaths were due to something else entirely. You actually cannot kill a patient after psychiatry residency, because.....reasons.
You know, this is a great question... I actually have never looked into it. I should do some further research on the matter. I work at a hospital, so the end number doesn't matter as much to me as if I was in PP.
Again, I feel like my focus tends to be on getting more universal acceptance of prescribing authority. Once we have more of that, there is more leverage to start pursuing better reimbursement rates. It's a slow progression to be sure!
Sanman
O.G.
If you happen to find out, I would love to know. For psychotherapy, we are generally reimbursed at the same rate as psychiatrists. NPs make 85% of psychiatry and I think RXP folks are the same, but I am genuinely curious how an E&M+psychotherapy is reimbursed. Just at the 85% rate or does the 90833 portion get the same reimbursement as a psychiatrist?
So anyone he killed was purposeful murder?
Sanman
O.G.
There's no study asserting the safety of psychiatry because there's nothing else to compare it to. The risk of harm is indeed great and inevitable, and happens quite often, the evidence that our profession practices medicine safely is several decades (more than two) of hundreds of thousands of psychiatrists. Or else hospitals and society would not put so much trust us with the care of patients, and more importantly, money (i.e. not getting sued).
No need to get defensive. I lurk on this forum occasionally because I respect my psychology colleagues greatly for their expertise. You'll have to forgive me for not knowing everything that has been said on here about Rxp, I am asking you these questions because I do not know and you seem to be the only one who has done the MSCP training.
Well, that's not great, but there are a lot of private medical schools without their own teaching hospitals in the US that also make students find their own preceptors for their fourth year electives, and so do a lot of NP schools. I see the issues you've raised MSCP programs would have in finding preceptors for their students. But you would think that they would figure those out before accepting students.
Me personally, I already work with medical students.
I agree with nearly everything you say here. But practicing medicine is not an extension of psychology training. It is almost entirely something else. And evidence that psychologists are prescribing medications for patients with other health conditions is not 'evidence' that they know what they're doing or that they haven't made preventable errors, and I've been clear that this is my chief concern.
That's fair. I'm not firm in my opinions. I doubt time will show Rxp being any worse than NP encroachment.
The DOD still has prescribing psychologists. As does IHS. Neither was scrapped. Still going strong. I have colleagues who still work for both...
Prescriptive authority for psychologists: The next step - PubMed
[Correction Notice: An Erratum for this article was reported online in <i>Psychological Services</i> on Jul 11 2022 (see record 2022-79840-001). In the original article, changes were needed to clarify the timeline of state legalizations of prescriptive authority for psychologists (RxP) and the...pubmed.ncbi.nlm.nih.gov
It was my understanding that the DOD did a study of some ten prescribing psychologists in the 90's and found that it was cheaper to just train NP's. You seem to know much more about Rxp history than me, I could be wrong on this.
[This article was actually listed as evidence for Rxp safety in that Cato review.]
My general point was that the number of psychologists prescribing through both of these programs is a really, really small sample size.
You must be new here. We talk all the time about the harmful effects of bad psychotherapy. Done wrong, by a poorly trained individual who has poor guidelines like "The ACGME does not require a minimum number of hours," can lead to deterioration and harmful outcomes. It's just not studied extensively like drug trials. But don't take our word for it. How does a couple empirical articles strike you:
Service users' perspective of therapist-related unwanted events in psychotherapy-A systematic review - PubMed
Despite the availability of evidence-based treatments and related studies for depression and anxiety, there is a research gap regarding therapist-related unwanted events in psychotherapy. Conducting a systematic review is essential to address such gap. This review aimed to address (a) How were...
I'm not saying there aren't harmful effects of bad psychotherapy. I believe that it can wholeheartedly. But incorrectly prescribing medication is far more likely to hurt a patient than bad psychotherapy, just by the nature of what medication does, and you know that. It's why a psychiatrist's liability is way more than a therapist's.
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Sanman
O.G.
Is the risk of harm greater or simply easier to prove? It is certainly easier to pin serotonin syndrome as a cause of death on you than proving something I said in session led to someone's suicide. At the end of the day, however, dead is dead.
LOL. If only there was public data. If you had that, then someone could say that between 1990-2025, MDs had 178,656 adverse action events, while NPs had 7,104 adverse action events. If you wanted to get more specific, you could compare psychologists' and physicians' adverse event actions in the RxP states starting on the date of RxP laws. Then you'd find that physicians had 3159 adverse action events, while psychologists had 101, and NPs had 288.
Or if you wanted to read the literature, you could see that 41% of psychiatrists have been sued for malpractice. The leading cause of malpractice suits was suicide (31%).
Alternatively, someone could just make ill informed statements using their own opinions, say that this data doesn't exist, and embarrass one's self. There is literally the same evidence that I courted someone’s mother and your assertions.
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I think this is where I've landed on this. Ironically, if medical schools participated in RxP training (instead of blocking it), they would likely be in a better position to study RxP and control ADEs. I agree that what safety data that does exist could be improved upon, but it's difficult to build a research program in the face of such staunch opposition. Maybe someone said this already, but this thread is getting very circular and difficult to follow.
It's also not true that there is no study that examines ADEs in psychiatry. One minute of casual googling finds studies examining predictors of ADEs in inpatient psychiatric units with medications prescribed by, yes, psychiatrists. There were also calls for studying outpatient ADEs but to my limited knowledge, this has not really been heeded.
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I agree that it's probably difficult to come up with a well-designed and focused study when medical research institutions don't want to give Rxp the time of day. They're already losing a ton of grant money thanks to you know who- why waste time and money on something they don't believe in? I think for this reason these studies have to come from psychology and not psychiatry.
That's not what these people are asking for though. I've said previously on this page that preventable medical errors (not ADE's which can happen for any reason you can think of) happen a lot by physicians who undergo far more rigorous training in medicine.
What I'm saying is to prove why psychiatry is the standard is impossible because there's no other standard to compare it to. And it's generally understood that psychiatrists practice medicine safely.
To clarify, you are saying that it is impossible to prove psychiatry is safe, because there is no standard from which to compare it to, yet you are demanding such a thing from other prescribing providers. But, as there is no metric or standard that satisfies your safety bar, the only thing that will satisfy you is if everyone just go to med school and psychiatry residency? Good faith discussion, indeed.
The studies I'm referencing also examine medical errors made by psychiatrists, which do happen because psychiatrists also suffer from the unfortunate condition of being human. Take a look for yourself.
This is magical thinking and circular reasoning. On the outcome variable of MEs, you could compare psychiatry to other medical specialties that treat psychiatric conditions. Suppose it were found that family medicine doctors or neurologists actually made fewer MEs than psychiatry then would they become the standard? Probably not according to you because psychiatry training is the standard.
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Sanman
O.G.
This is the issue with education in America. We could actually study the shortest and most cost effective route to becoming a prescriber of medication and implement that to help ease the shortage of providers and cost of healthcare in America. We won't because of egos and money, but at least a few people will feel good about themselves and get rich.
Not too mention the tautological problem of claiming something is the standard because it is the standard.
Not defensive. Just recognizing this is not a discussion in good faith anymore. You have stated your position. "This feels unsafe. The number of prescribing psychologist is too small to draw conclusions about safety. It hasn't been long enough. Therefore, I say it's unsafe." It's hard to have a discussion when we cite you evidence and you hand-wave it away.
This is why we are exasperated! I got you tied up. I cited the Muse study in my response. It's actually the Hughes, Niznik study that shows the data I am talking about. A person who had read either study, would have mentioned that I cited the wrong study. You have not read this study or the Muse study. That's now evident. I did read both! Please. Go. Read. You will get your answers. I'll help. Section on Safety, albeit an estimate prediction based on prescribing patterns, but an interesting point the authors make, don't you think?
My school has contracts with teaching hospitals across the country. Again, the barrier is psychiatrists being willing. Not the MSCP programs. I reside in a state that has not yet established a contract, because, we are adding new states and have to adjust...
Last APA cited estimate out there is approximately 30 prescribing psychologists in the DOD. That's more than the 10 from the initial pilot... Do dead programs typically triple in size? I also would strongly recommend you read the literature on the cost portion comparison to training NP's of the actual pilot study. Authors cite a number of reasons why it is still the most logical conclusion to continue to the program...which is why it still exists today.
Rest assured, it did not go unnoticed that you conveniently did not comment back to the statement I made about your suggested study regarding MSCP graduates sitting for your APBN boards. Why is that the only thing you did not respond to?
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Your position is in diametrically opposition to the ICD codes for mortality. Can you reconcile your position with the ICD codes for inappropriate dosage, inappropriate medications, etc? Because your position is the exact opposite of the ICD, which you have claimed to know despite 5-10 posts showing you haven’t read even the titles of those codes.
It’s like listening to a book report from someone who hasn’t read the book and is making guesses. It’s “Scott’s Tots” level of embarrassing for you.
I did some digging, and the answer appears to be "it depends." So for some of the private insurances (Anthem, others, and yes, shockingly, UHC), they classify me the same as a psychiatrist, and I receive 100% the same reimbursement rate as a psychiatrist. Other insurances though, follow the CMS rules and classify me as a non-physician and reimburse me at the 85% rate. And again, some insurances will not allow me to solely bill the E/M codes, at all. This is why there exists the unique add-on bill codes in the CPT coding. From a quick glance, this again does differ amongst states, with some states showing closer to 100% reimbursement rates.
Just another reason why getting more states to pass legislation helps move the needle. My hope is that rising tides raise all ships. Better reimbursement rates on these codes may result in better reimbursement rates for our non-prescribing CPT codes... I hope 🤞
Another State, Hawai'i, has an interesting bill set to get enacted (currently sitting on governors desk, awaiting signature, it looks like).
While I appreciate the inherent frustration that it's a 3-year "pilot program" I have to wonder if this can serve as some additional data points for demonstrating safety and efficacy, for the naysayers out there. Either way, I know Hawai'i has been working for years to get something, so I am super happy for them!
While I appreciate the inherent frustration that it's a 3-year "pilot program" I have to wonder if this can serve as some additional data points for demonstrating safety and efficacy, for the naysayers out there. Either way, I know Hawai'i has been working for years to get something, so I am super happy for them!
Good to see something is finally happening in Hawai’i. They’ve been pursuing RxP for 30+ years. These varied state RxP regulations are frustrating and don’t help promote a unified system for psychologist prescribing although that’s how most of the bills get approved (if they do at all).
I recognized this early on when I was deciding between RxP and psych NP training and I’m very happy I chose the NP route. It’s worked out very well for my career; I’d still be waiting (almost 20 years and counting) in my state. But I still support RxP and have been active in promoting legislation even though my state has failed to make much progress.
I recognized this early on when I was deciding between RxP and psych NP training and I’m very happy I chose the NP route. It’s worked out very well for my career; I’d still be waiting (almost 20 years and counting) in my state. But I still support RxP and have been active in promoting legislation even though my state has failed to make much progress.
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Hawaii has become the 9th RxP state (i.e., 18% of the USA allows RxP).
Dominoes continue to fall.
I am licensed in CA and I’m researching reimbursement rates for prescribing Psychologist in Colorado. I am potentially thinking of getting licensed there. Here’s what I found so far from AI.
Attachments
What state are you in?
Cannot recall if this was already mentioned, but Vermont has also passed a recent bill allowing prescribing psychologists:
Eh, kinda, sorta....
"The Hawaii law, which goes into effect July 15, creates a limited, three-year pilot program at federally qualified health centers on the islands of Hawaii and Kauai to treat adults ages 18 to 65, under supervision by a psychiatrist or physician. Following the pilot program, the state health planning and development agency will make a recommendation to the Hawaii legislature to determine whether the program should be expanded, made permanent statewide or terminated."
It's notable that this isn't even for all neighbor islands, much less Oahu.
Nuance doesn't work when one side acts in bad faith.
Not sure what you mean by that...?
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You might want to see my discussion with MattGM above. He/she asked a question. I stated I would interact, although I believed he would argue in bad faith. He did, which is a repeating pattern for RxP discourse. They accuse, we provide nuanced evidence, they say the evidence isn’t enough without identifying the needed evidence, change the goalpost/arguements, etc. The argument style limits a nuanced discussion.
I'm not sure what that has to do with my post, though--I was just pointing out that counting Hawaii as a state with RxP comes with a really sizable asterik when it's a three-year pilot exclusive to patients ages 18-65 at FQHCs in limited catchment area that makes up about 20% of the state's population. That's better than nothing, but it's not the same as a state with broad and permanent RxP.
